Background In 2006, to increase opportunities for patients to become aware of their HIV status, the Centers for Disease Control and Prevention released updated guidelines for routine, opt-out HIV screening of adults, adolescents, and pregnant women in healthcare settings. To date, there are few documented applications of these recommendations. Objective To measure the impact of application of the guidelines for routine screening in health centers serving communities disproportionately affected by HIV in the southeastern US. Design A multi-site program implementation study, describing patients tested and not tested and assessing changes in testing frequency before and after new guidelines were implemented. Participants All patients aged 13 to 64 seen in participating health centers. Interventions Routine rapid HIV screening in accord with CDC guidelines. Measurements The frequency of testing before and after routine screening was in place and demographic differences in offering and receipt of testing. Main Results Compared to approximately 3,000 patients in the year prior to implementation, 16,148 patients were offered testing with 10,769 tested. Of 39 rapid tests resulting in preliminary positives, 17 were newly detected infections. Among these patients, 12 of 14 receiving referrals were linked to HIV care. Nineteen were false positives. Younger patients, African Americans and Latinos were more likely to receive testing. Conclusions By integrating CDC-recommended guidelines and applying rapid test technology, health centers were able to provide new access to HIV testing. Variation across centers in offering and receiving tests may indicate that clinical training could enhance universal access.
Two counseled groups—one using anger reduction for cognitive‐relaxation coping skills and the other using time‐limited, anger‐focused, process‐oriented group counseling—were compared to an uncounseled control group. Both forms of counseling led to significant reductions on a number of trait, state, and person‐specific measures of anger as well as nontargeted general anxiety. Effects were maintained at 5‐week and 15‐month follow‐ups. At no point did counseling conditions differ significantly from one another, suggesting process groups are effective for general anger reduction and as effective as one of the best researched options in the field. Limitations of this conclusion are outlined along with needed research.
BackgroundmRNA for biomarkers of kidney injury extracted from urinary exosomes may reflect or predict levels of the corresponding protein after transplantation and clinical outcomes.MethodsUrinary exosomes were isolated from patients following renal transplantation, from healthy controls, and patients with CKD. Expression of exosomal mRNA for the injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C was compared with the concentrations of corresponding urinary proteins, 18S RNA and serum creatinine.ResultsAll biomarker protein concentrations increased after transplantation, and urinary NGAL and IL-18 at 24 and 168 h correlated with the day 7 creatinine reduction ratio (CRR). Exosomal18S RNA increased after transplantation, but exosomal mRNA for NGAL, IL-18 and cystatin C did not correlate with the day 7 CRR, or urinary biomarker concentrations at any time after transplantation. Exosomal NGAL mRNA was lower 4 h after transplantation than in control exosomes. In contrast, exosomal mRNA for cystatin C was unchanged after transplantation and in CKD, although urinary cystatin C temporarily increased following transplantation. Urinary KIM-1 increased after transplantation, but exosomal mRNA for KIM-1 remained undetectable. In CKD 18S RNA was raised, and exosomal mRNA for NGAL, IL-18 and cystatin C was detected in all patients. While urinary NGAL was greater in CKD than control subjects, exosomal NGAL mRNA was unchanged. Exosomal IL-18 mRNA was increased in CKD, but not IL-18 protein.ConclusionsAfter renal transplantation, urinary NGAL and IL-18 levels reflect the day 7 CRR. However, while mRNA for these biomarkers is present in exosomes, their levels do not reflect or predict urinary biomarker levels or the CRR. This likely reflects the fact that packaging of mRNA in exosomes is selective, and is not necessarily representative of mRNA in the parent cells responsible for biomarker production.
The authors would like to gratefully acknowledge the Counseling and Psychological Services Center at the University of Texas at Austin for its support during the treatment phase of this study.Copies of the treatment and/or assessment materials are available from the authors for the costs of reproduction and postage; please specify the information requested.
This article discusses the implications of the Downing and Roush (1985) model of feminist identity development for feminist therapy with women. Following a summary of the model, the potential pitfalls of feminist therapy with the passive-acceptant client are described, as well as potential issues at subsequent stages of the client's identity development. Suggestions are made regarding how to facilitate clients' movement to higher levels of development. Finally, a research agenda is proposed that suggests hypotheses to be tested that arise from applying this model to conducting therapy with women.
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