Background: Young men of color who have sex with men face a continual increase in rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an important prevention method for these young men. Setting: The Connecting Resources for Urban Sexual Health (CRUSH) demonstration project provided sexual health services, including PrEP, to young men who have sex with men aged 18–29 years. We report on adherence and factors influencing it. Methods: Participants were offered HIV and sexually transmitted infection testing, prevention counseling, PrEP, and when appropriate, sexually transmitted infection treatment and postexposure prophylaxis. Participants taking PrEP had erythrocyte tenofovir diphosphate and emtricitabine levels measured through dried blood spot testing at 4, 12, and 24 weeks to estimate medication adherence. Participants also completed surveys to assess demographic and psychosocial measures. Results: From February 2014 to November 2015, CRUSH enrolled 257 participants. Ninety-three percent started PrEP, 81% of whom initiated it at their first visit. Twelve percent required postexposure prophylaxis before starting PrEP. Adherence at protective levels was initially high with 87% demonstrating levels consistent with at least 4 doses per week at week 4, compared with 77% at the 48-week follow-up. African American race, exposure to violence, and having survival needs were associated with significantly lower levels of adherence [odds ratio (OR): 0.33; confidence interval (CI): 0.11 to 0.97, P < 0.04; OR: 0.79; CI: 0.59 to 1.04, P < 0.10; OR: 0.51; CI: 0.24 to 1.05, P < 0.07]. Conclusions: Most young men who initiate PrEP adhere at levels that confer protection against HIV infection. Interventions should account for differences in life experiences, particularly addressing the structural challenges facing young African American men.
Species colonizations (both natural and anthropogenic) can be associated with genetic founder effects, where founding populations demonstrate significant genetic bottlenecks compared to native populations. Yet, many successfully established free‐living species exhibit little reduction in genetic diversity—possibly due to multiple founding events and/or high propagule pressure during introductions. Less clear, however, is whether parasites may show differential signatures to their free‐living hosts. Parasites with indirect life cycles may particularly be more prone to founder effects (i.e., more genetically depauperate) because of inherently smaller founding populations and complex life cycles. We investigated this question in native (east coast) and introduced (west coast) North American populations of a host snail Tritia obsoleta (formerly Ilyanassa obsoleta, the eastern mudsnail) and four trematode parasite species that obligately infect it. We examined genetic diversity, gene flow, and population structure using two molecular markers (mitochondrial and nuclear) for the host and the parasites. In the host snail, we found little to no evidence of genetic founder effects, while the trematode parasites showed significantly lower genetic diversity in the introduced versus native ranges. Moreover, the parasite's final host influenced infection prevalence and genetic diversity: Trematode species that utilized fish as final hosts demonstrated lower parasite diversity and heightened founder effects in the introduced range than those trematodes using birds as final hosts. In addition, inter‐regional gene flow was strongest for comparisons that included the putative historical source region (mid‐Atlantic populations of the US east coast). Overall, our results broaden understanding of the role that colonization events (including recent anthropogenic introductions) have on genetic diversity in non‐native organisms by also evaluating less studied groups like parasites.
This paper recounts an experiment by a mathematics professor who primarily teaches mathematics majors. The main question explored is whether the ordering of the questions makes a difference as to how students perform in a test. More specifically we focus here on the following research questions: (1) Does arranging a math test with easy-to-hard items versus hard-to-easy items impact student performance? and (2) If so, does item order impact male and female mathematics majors and non-majors in unique ways? We examine data collected over multiple semesters with several different classes. We find that for most of the mathematics students who were examined, the ordering of the questions on a test did not impact performance. However, female majors performed better on classroom exams when the test was arranged with the more difficult questions presented first. Readers who are interested in teaching mathematics, educational psychology, or gender issues in the classroom may find our results intriguing.Evolution of a research project. A mathematics professor, I (Kristin Kennedy) often give two versions of the same exam to reduce the possibility of students copying from one another. Recently, I began to wonder if the order of the questions could affect a student's grade. I approached Allison Butler, professor of psychology, for her expertise. I of course wanted to ensure that both tests were fair, and Professor Butler was interested to see if there was any difference from a psychological point of view. This paper describes our joint inquiry into this matter.
PurposeSmaller companies must continually review the pay‐per‐click (PPC) option or an organic listing on search engines. The purpose of this paper is to present a case study of a small manufacturing firm that is beginning to evaluate which search engine, Yahoo or Google, is more cost effective. Ultimately, management would like to identify if PPC advertising is worth the cost to a small company.Design/methodology/approachA one month's section of data from Yahoo and Google was examined. Patterns or indications as to which key word landed a better bid position was determined. Seven consecutive campaigns for click‐through rates (CTRs), average cost per click (CPC) and average position of keywords between the search engines Yahoo and Google were observed.FindingsThe average CPC was higher with Google. Kennedy Incorporated set a budget with Google and Yahoo to stay below a certain dollar limit, thus the total costs were the same. That would make the difference in the average CPC rather significant. Management also noticed a higher CTR on Yahoo than on Google. Thus it appears that Yahoo outperformed Google most of the time in the monthly samples.Research limitations/implicationsLonger historical data need to be studied, to see if these patterns continue. Other statistics that would be interesting to examine are data that would reveal how CTR in Yahoo and Google are affecting conversions to sales.Originality/valueIt appears from this data that Yahoo is outperforming Google for Kennedy Incorporated with a better CTR and a lower variance in average position when listed on the screen by a return from a search. The company has the impression that Yahoo is a better company for PPC advertising when the marketing budget is small.
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