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Item Spatiotemporal gait variability in children aged 2 to 10 decreases throughout pre-adolescence(2023-12-03) Applequist, Bryon C.; Motz, Zachary L.; Kyvelidou, AnastasiaBackground: Children’s gait is traditionally understood to mature as young as three years old through pre-adolescence. Studies looking at gait biomechanics suggest that gait matures around three years old, while studies investigating gait variability propose a much later maturation. The studies that have examined children’s gait variability did so while the children walked around a track or down hallways that created a discontinuous gait, potentially affecting the measures of variability and the efficacy of the results. Purpose: Therefore, the purpose of our study was to investigate the development of gait dynamics and gait variability in children in a more continuous fashion, in this case, by walking on a treadmill. Methods: To accomplish this, we included four age groups of children, ranging 2–10 years old, walking on a treadmill for at least three minutes while stride time and stride length were collected. Stride time and stride length’s variability was then analyzed using linear (mean, standard deviation, coefficient of variation) and nonlinear (sample entropy, detrended fluctuation analysis) measures across the varying ages of our participants. Results: Interestingly, both the linear and nonlinear variabilities of the stride time and stride length measures decreased as the groups of children got older. Specifically, CV ST (2–3 (9.3 ± 4%), 8–10 (3.6 ± 0.7%), p < 0.05) and CV SL (2–3 (11.4 ± 3%), 8–10 (4.6 ± 1%), p < 0.05) were our strongest linear measures, and DFA α ST (2–3 (0.97 ± 0.12), 8–10 (0.82 ± 0.10), p < 0.05) and DFA α SL (2–3 (0.91 ± 0.04), 8–10 (0.81 ± 0.03), p < 0.05) were our strongest nonlinear measures, particularly between the youngest and oldest groups. This trend of variability decreasing with age suggests that as children’s gait matures, their gait becomes more stable and reliable. Significance: Our study rejects the notion that children’s gait is mature by the age of three, as some would suggest. By analyzing the variability of stride time and stride length, we can see that even later into childhood, children’s gait continues to change and evolve.Item Breast health and preventative screening(2023-09-06) Walker-Smith, TammyBreast health and its importance in every stage of a woman’s life is discussed from adolescence, across the life span, and addressing the aging process. The importance of self-breast exams, clinical breast exam, and screening mammograms play an integral part of ensuring early detection of breast cancer. The risk factors, genetic mutations, and how breast cancer is triggered is discussed. The advancements in screening recommendations, genetic testing, and treatments is explored and what innovative approaches are being taken to prevent, treat, and cure breast cancer.Item Cellular and molecular activities of IP6 in disease prevention and therapy(2023-06-10) Dilworth, Lowell; Stennett, Dewayne; Omoruyi, FelixIP6 (phytic acid) is a naturally occurring compound in plant seeds and grains. It is a poly-phosphorylated inositol derivative that has been shown to exhibit many biological activities that accrue benefits in health and diseases (cancer, diabetes, renal lithiasis, cardiovascular diseases, etc.). IP6 has been shown to have several cellular and molecular activities associated with its potential role in disease prevention. These activities include anti-oxidant properties, chelation of metal ions, inhibition of inflammation, modulation of cell signaling pathways, and modulation of the activities of enzymes and hormones that are involved in carbohydrate and lipid metabolism. Studies have shown that IP6 has anti-oxidant properties and can scavenge free radicals known to cause cellular damage and contribute to the development of chronic diseases such as cancers and cardiovascular diseases, as well as diabetes mellitus. It has also been shown to possess anti-inflammatory properties that may modulate immune responses geared towards the prevention of inflammatory conditions. Moreover, IP6 exhibits anti-cancer properties through the induction of cell cycle arrest, promoting apoptosis and inhibiting cancer cell growth. Additionally, it has been shown to have anti-mutagenic properties, which reduce the risk of malignancies by preventing DNA damage and mutations. IP6 has also been reported to have a potential role in bone health. It inhibits bone resorption and promotes bone formation, which may help in the prevention of bone diseases such as osteoporosis. Overall, IP6’s cellular and molecular activities make it a promising candidate for disease prevention. As reported in many studies, its anti-inflammatory, anti-oxidant, and anti-cancer properties support its inclusion as a dietary supplement that may protect against the development of chronic diseases. However, further studies are needed to understand the mechanisms of action of this dynamic molecule and its derivatives and determine the optimal doses and appropriate delivery methods for effective therapeutic use.Item Nursing graduates’ preparedness for practice: Substantiating the call for competency-evaluated nursing education(2023-07-04) McGarity, Tammy; Monahan, Laura; Acker, Katelijne; Pollock, WendiPractice readiness continues to be a challenge in healthcare. This was especially evident during the COVID-19 pandemic. This focused descriptive–correlational study examined nurses’ perceived preparedness for practice during the pandemic. One hundred and eighty-four registered nurses (RN) responded to Qualtrics survey questions addressing the competencies they perceived they had and the competencies they felt they needed that would have better prepared them to care for patients during the COVID-19 pandemic. The results demonstrated that although these nurses felt competent in certain areas, they perceived that they needed more education in those same areas to feel better prepared. Bivariate correlations and linear regression analysis indicated that institutional competency development, education, and work experience influenced perceived competency.Item The experience of working nurses attending graduate school during COVID-19: A hermeneutic phenomenology study(2023-07-05) DeGrande, PhD, Heather; Seifert, Madison; Painter, ElizabethIntroduction: There has been unprecedented uncertainty involved in the COVID-19 pandemic, especially for working nurses. Nurses working while attending graduate school faced additional unique challenges including working extended hours while also home-schooling young children, managing a family life while also navigating pandemic-related changes affecting students’ educational paths. Objectives: The purpose of this study was to explore the lived experiences of working nurses attending graduate school during the COVID-19 pandemic. The central research question was: What is the lived experience of working nurses attending graduate school during COVID-19? Methods: The exploration of the lived experience of working nurses attending graduate school during a pandemic required a research methodology delving into the meaning of lived experience as it has been lived, temporally, and contextually (during a pandemic). Qualitative hermeneutic phenomenology was used to explore the meaning of lived experience from an interpretational stance. Results: The overall meaning of the experience was a paradigm shift of existence across the three realms of work, home, and school. The themes associated with the shift were rapid change, uncertainty, fear, and support persons. Stress was a resulting overarching theme. Conclusions: To support working nurses further their education during times of crisis, nurse leaders and educators should put processes in place to mitigate change and stress through strategic communication and supportive work environments.Item Bioactive ingredients in K. pinnata extract and the effects of combined K. pinnata and metformin preparations on antioxidant activities in diabetic and non-diabetic skeletal muscle cells(2023-03-25) Ramon, Pedro; Bergmann, Daniela; Abdulla, Hussain; Sparks, Jean; Omoruyi, FelixWith healthcare costs rising, many affected by ailments are turning to alternative medicine for treatment. More people are choosing to complement their pharmacological regimen with dietary supplements from natural products. In this study, the compound composition of Kalanchoe Pinnata (K. pinnata) and the effects of combined preparations of K. pinnata and metformin on antioxidant activity in human skeletal muscle myoblasts (HSMMs) and human diabetic skeletal muscle myoblasts (DHSMMs) were investigated. Ultraperformance liquid chromatography fusion orbitrap mass spectrometry (UPLC-OT-FTMS) identified biologically active flavanols in K. pinnata. The main compounds identified in locally grown K. pinnata were quercetin, kaempferol, apigenin, epigallocatechin gallate (EGCG), and avicularin. Antioxidant results indicated that a combinatorial preparation of K. pinnata with metformin may modulate antioxidant responses by increasing the enzymatic activity of superoxide dismutase and increasing levels of reduced glutathione. A combination of 50 µM and 150 µg/mL of metformin and K. pinnata, respectively, resulted in a significant increase in reduced glutathione levels in non-diabetic and diabetic human skeletal muscle myoblasts and H2O2-stress-induced human skeletal muscle myoblasts. Additionally, a K. pinnata treatment (400 µg/mL) alone significantly increased catalase (CAT) activity for non-diabetic and diabetic human skeletal muscle myoblasts and a H2O2-stress-induced human skeletal muscle myoblast cell line, while significantly lowering malondialdehyde (MDA) levels. However, the treatment options were more effective at promoting cell viability after 24 h versus 72 h and did not promote cell viability after 72 h in H2O2 -stress induced HSMM cells. These treatment options show promise for treating oxidative-stress-mediated pathophysiological complications associated with type II diabetes.Item Paging the clinical informatics community: Respond STAT to Dobbs v. Jackson's Women's Health Organization(2023-03-01) Arvisais-Anhalt, Simone; Ravi, Akshay; Weia, Benjamin; Aarts, Jos; Ahmad, Hasan B.; Araj, Ellen; Bauml, Julie A.; Benham-Hutchins, Marge; Boyd, Andrew D.; Brecht-Doscher, Aimee; Butler-Henderson, Kerryn; Butte, Atul J.; Cardilo, Anthony B.; Chilukuri, Nymisha; Cho, Mildred K.; Cohen, Jenny K.; Craven, Catherine K.; Crusco, Salvatore; Dadabhoy, Farah; Dash, Dev; DeBolt, Claire; Elkin, Peter L.; Fayanju, Oluseyi A.; Fochtmann, Laura J.; Graham, Justin V.; Hanna, John J.; Hersh, William; Hofford, Mackenzie R.; Hron, Jonathan D.; Huang, Sean S.; Jackson, Brian R.; Kaplan, Bonnie; Kelly, William; Ko, Kyungmin; Koppel, Ross; Kurapati, Nikhil; Labbad, Gabriel; Lee, Julie J.; Lehmann, Christoph U.; Leitner, Stefano; Liao, Zachary C.; Medford, Richard J.; Melnick, Edward R.; Muniyappa, Anoop N.; Murray, Sara G.; Neinstein, Aaron Barak; Nichols-Johnson, Victoria; Novak, Laurie Lovett; Ogan, William Scott; Ozeran, Larry; Pageler, Natalie M.; Pandita, Deepti; Perumbeti, Ajay; Petersen, Carolyn; Pierce, Logan; Puttagunta, Raghuveer; Ramaswamy, Priya; Rogers, Kendall M.; Rosebloom, S Trent; Ryan, Angela; Saleh, Sameh; Sarabu, Chethan; Schreiber, Richard; Shaw, Kate A.; Sim, Ida; Sirintrapun, S Joseph; Solomonides, Anthony; Spector, Jacob D.; Starren, Justin B.; Stoffel, Michelle; Subbian, Vignesh; Swanson, Karl; Tomes, Adrian; Trang, Karen; Unertl, Kim M.; Weon, Jenny L.; Whooley, Mary A.; Wiley, Kevin; Williamson, Drew F. K.; Winkelstein, Peter; Wong, Jenson; Xie, James; Yarahuan, Julia K. W.; Yung, Nathan; Zera, Chloe; Ratanawongsa, Neda; Sadasivaiah, ShobhaIf the coronavirus disease 2019 (COVID-19) pandemic was a wake-up call that clinical informatics and digital health play vital roles in our future, the 2022 U.S. Supreme Court ruling in Dobbs v. Jackson Women's Health Organization (Dobbs)[1] is a blaring alarm. Dobbs, which overturned Roe v Wade and Planned Parenthood v. Casey, allows states to individually regulate access to abortion. This ruling has triggered the enforcement of existing state laws that ban or restrict abortion and efforts to pass similar new laws.Item Waterpipe tobacco smoking impact on public health: Implications for policy(2015-08-27) Martinasek, Mary; Gibson-Young, Linda; Davis, Janiece; McDermott, RobertGiven the increasing evidence of its negative health effects, including contributions to both infectious and chronic diseases, waterpipe tobacco smoking raises public health concerns beyond even those presented by traditional smoking. Identification of Clean Indoor Air Acts (CIAAs) from each of the 50 United States and District of Columbia were retrieved and examined for inclusion of regulatory measures where waterpipe tobacco smoking is concerned. Several instances of exemption to current CIAAs policies were identified. The cumulative policy lens is presented in this study. States vary in their inclusion of explicit wording regarding CIAAs to the point where waterpipe tobacco smoking, unlike traditional smoking products, is excluded from some legislation, thereby limiting authorities’ ability to carry out enforcement. Consistent, comprehensive, and unambiguous legislative language is necessary to prevent establishments where waterpipe tobacco smoking occurs from skirting legislation and other forms of regulatory control. Stricter laws are needed due to the increasing negative health impact on both the smoker and the bystander. Actions at both the federal and state levels may be needed to control health risks, particularly among youth and young adult populations.Item BDPS: An efficient spark-based big data processing scheme for cloud Fog-IoT orchestration(MDPI, 2021-12-10) Hossen, Rakib; Whaiduzzaman, Md; Uddin, Mohammed Nasir; Islam, Md. Jahidul; Faruqui, Nuruzzaman; Barros, Alistair; Sookhak, Mehdi; Mahi, Md. Julkar NayeenThe Internet of Things (IoT) has seen a surge in mobile devices with the market and technical expansion. IoT networks provide end-to-end connectivity while keeping minimal latency. To reduce delays, efficient data delivery schemes are required for dispersed fog-IoT network orchestrations. We use a Spark-based big data processing scheme (BDPS) to accelerate the distributed database (RDD) delay efficient technique in the fogs for a decentralized heterogeneous network architecture to reinforce suitable data allocations via IoTs. We propose BDPS based on Spark-RDD in fog-IoT overlay architecture to address the performance issues across the network orchestration. We evaluate data processing delays from fog-IoT integrated parts using a depth-first-search-based shortest path node finding configuration, which outperforms the existing shortest path algorithms in terms of algorithmic (i.e., depth-first search) efficiency, including the Bellman–Ford (BF) algorithm, Floyd–Warshall (FW) algorithm, Dijkstra algorithm (DA), and Apache Hadoop (AH) algorithm. The BDPS exhibits low latency in packet deliveries as well as low network overhead uplink activity through a map-reduced resilient data distribution mechanism, better than in BF, DA, FW, and AH. The overall BDPS scheme supports efficient data delivery across the fog-IoT orchestration, outperforming faster node execution while proving effective results, compared to DA, BF, FW and AH, respectively.Item Engagement with care, substance use, and adherence to therapy in HIV/AIDS(Hindawi, 2014-04-03) Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, Shahnaz; Nicholas, Patrice; Willard, Suzanne; Thompson, Clinton J.; Dawson Rose, Carol; Corless, Inge; Wantland, Dean; Sefcik, Elizabeth; Nokes, Kathleen; Kirksey, Kenn; Hamilton, Mary Jane; Holzemer, William; Portillo, Carmen; Rivero-Mendez, Marta; Robinson, Linda M.; Rosa, Maria; Human, Sarie P.; Cuca, Yvette; Huang, Emily; Maryland, Mary; Arudo, John; Sanzero Eller, Lucille; Stanton, Mark A.; Driscoll, MaryKate; Voss, Joachim; Moezzi, ShahnazEngagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial () that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.Item Self-care behaviors and activities for managing HIV-related anxiety(Lippincott, Williams & Wilkins, 2011-08-11) Kemppainen, Jeanne; Wantland, Dean; Voss, Joachim; Nicholas, Patrice; Kirksey, Kenn; Corless, Inge; willard, suzanne; Holzemer, William; Robinson, Linda; Hamilton, Mary Jane; Sefcik, Elizabeth; Sanzero Eller, Lucille; Huang, Emily; Arudo, John; Moezzi, Shahnaz; Rivero-Mendez, Marta; Rosa, Maria; Human, Sarie; Cuca, Yvette; Lindgren, Terri; Portillo, Carmen J; Maryland, MaryThe goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.Item A cross-sectional relationship between social capital, self-compassion, and perceived HIV symptoms(Elsevier, 2015-02-04) Webel, Allison; wantland, dean; Dawson Rose, Carol; Kemppainen, Jeanne; Holzemer, William; Chen, Wei-ti; Johnson, Mallory O.; Nicholas, Patrice; Sanzero Eller, Lucille; chaiphibalsarisdi, puangtip; Sefcik, Elizabeth; Nokes, Kathleen; Corless, Inge; Tyer-Viola, Lynda; Kirksey, Kenn; Voss, Joachim; Sullivan, Kathy; Rivero-Mendez, Marta; Brion, John; Iipinge, Scholastika Ndatinda; Phillips, J. Craig; Portillo, CarmenContext Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience. Objectives The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship. Methods We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience. Results Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms. Conclusion Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.Item A qualitative description of service providers' experiences of ethical issues in HIV care(Sage Journals, 2019-08-26) Sabone, Motshedisi; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther; Corless, Inge; Cuca, Yvette; Holzemer, William; Dawson Rose, Carol; Solis-Baez, Solymar; Rivero-Mendez, Marta; Webel, Allison; Sanzero Eller, Lucille; Reid, Paula; Johnson, Mallory O.; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen; Sabone, Motshedisi; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther; Corless, Inge; Cuca, Yvette; Holzemer, William; Dawson Rose, Carol; Solis-Baez, Solymar; Rivero-Mendez, Marta; Webel, Allison; Sanzero Eller, Lucille; Reid, Paula; Johnson, Mallory O.; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, EllenBackground: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.Item A multinational study of self-compassion and human immunodeficiency virus-related anxiety(wILEY, 2013-12) Kemppainen, Jeanne; Johnson, M.O.; Phillips, J. Craig; Sullivan, Kathleen M; Corless, Inge; Reid, Paula; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Sefcik, Elizabeth; Chen, Wei-ti; Kirksey, Kenn; Voss, Joachim; Rivero-Mendez, Marta; Tyer-Viola, Lynda; Dawson Rose, Carol; Webel, Allison; Nokes, Kathleen; Portillo, Carmen; Holzemer, William; Sanzero Eller, Lucille; Nicholas, Patrice; Wantland, Dean; Brion, John; Beamon, E. R.; Kemppainen, Jeanne; Johnson, M.O.; Phillips, J. Craig; Sullivan, Kathleen M; Corless, Inge; Reid, Paula; Iipinge, Scholastika Ndatinda; Chaiphibalsarisdi, Puangtip; Sefcik, Elizabeth; Chen, Wei-ti; Kirksey, Kenn; Voss, Joachim; Rivero-Mendez, Marta; Tyer-Viola, Lynda; Dawson Rose, Carol; Webel, Allison; Nokes, Kathleen; Portillo, Carmen; Holzemer, William; Sanzero Eller, Lucille; Nicholas, Patrice; Wantland, Dean; Brion, John; Beamon, E. R.Aim This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease. Background Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. Methods Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. Findings Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries. Conclusions Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.Item Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America(BMC, 2013-08-08) Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, William; Phillips, J. Craig; Webel, Allison; Dawson Rose, Carol; Corless, Inge; Sullivan, Kathleen M; Voss, Joachim; wantland, dean; Nokes, Kathleen; Brion, John; Chen, Wei-ti; Iipinge, Scholastika; Sanzero Eller, Lucille; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Johnson, Mallory O.; Maryland, Mary; Kemppainen, Jeanne; Portillo, Carmen; chaiphibalsarisdi, puangtip; Kirksey, Kenn; Sefcik, Elizabeth; Reid, Paula; Cuca, Yvette; Huang, Emily; Holzemer, WilliamBackground Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations.Item A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)(BMC, 2012-03-13) Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, Robert; Webel, Allison; Phillips, J. Craig; Dawson Rose, Carol; Holzemer, William; Chen, Wei-Ti; Tyer-Viola, Lynda; Rivero-Mendez, Marta; Nicholas, Patrice; Nokes, Kathleen; Kemppainen, Jeanne; Sefcik, Elizabeth; Brion, John; Eller, Lucille; Iipinge, Scholastika; Kirksey, Kenn; Wantland, Dean; Chaiphibalsarisdi, Puangtip; Johnson, Mallory O.; Portillo, Carmen; Corless, Inge; Voss, Joachim; Salata, RobertBackground Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS. Methods We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis. Results Participant's mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected. Conclusions This is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population.Item Mediators of antiretroviral adherence: A multisite international study(Taylor and Franics Online, 2013-03) Corless, Inge; Guarino, Alessio; Nicholas, Patrice; Tyer-Viola, Lynda; Kirksey, Kenn; Brion, John; Dawson Rose, Carol; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Kemppainen, Jeanne; Nokes, Kathleen; Sefcik, Elizabeth; Voss, Joachim; Wantland, dean; Johnson, Mallory O.; Phillips, J. Craig; Webel, A.; Iipinge, Scholastika Ndatinda; Portillo, Carmen; Chen, Wei-ti; Maryland, M.; Hamilton, M.J.; Reid, P.; Hickey, D.; Holzemer, William; Sullivan, K.; Corless, Inge; Guarino, Alessio; Nicholas, Patrice; Tyer-Viola, Lynda; Kirksey, Kenn; Brion, John; Dawson Rose, Carol; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Kemppainen, Jeanne; Nokes, Kathleen; Sefcik, Elizabeth; Voss, Joachim; Wantland, dean; Johnson, Mallory O.; Phillips, J. Craig; Webel, A.; Iipinge, Scholastika Ndatinda; Portillo, Carmen; Chen, Wei-ti; Maryland, M.; Hamilton, M.J.; Reid, P.; Hickey, D.; Holzemer, William; Sullivan, K.The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.Item Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV(Taylor and Francis Online, 2013-10-04) Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.; Sanzero Eller, Lucille; Rivero-Mendez, Marta; Voss, Joachim; Chen, Wei-ti; chaiphibalsarisdi, puangtip; Iipinge, S.; Johnson, Mallory O.; Portillo, Carmen; Sullivan, K.; Tyer-Viola, Lynda; Kemppainen, Jeanne; Dawson Rose, Carol; Sefcik, Elizabeth; Nokes, Kathleen; Phillips, J. Craig; Nicholas, P.K.; Holzemer, William; Webel, A.R.; Brion, J.M.The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = −0.154), education (r = −0.106), work status (r = −0.132), income adequacy (r = −0.204, self-esteem (r = −0.617), HIV symptom self-efficacy (r = − 0.408), and self-kindness (r = − 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.Item Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS(Taylor and Francis Online, 2013-03-25) Kemppainen, Jeanne; Brion, John; Leary, Mark; wantland, dean; Sullivan, K; Nokes, Kathleen; Bain, Catherine A; chaiphibalsarisdi, puangtip; Chen, Wei-ti; Holzemer, William; Sanzero Eller, Lucille; Iipinge, Scholastika; Johnson, Mallory O; Portillo, Carmen; Voss, Joachim; Tyer-Viola, Lynda; Corless, Inge; Nicholas, Patrice; Dawson Rose, Carol; Phillips, J Craig; Sefcik, Elizabeth; Rivero-Mendez, Marta; Kirksey, Kenn; Kemppainen, Jeanne; Brion, John; Leary, Mark; wantland, dean; Sullivan, K; Nokes, Kathleen; Bain, Catherine A; chaiphibalsarisdi, puangtip; Chen, Wei-ti; Holzemer, William; Sanzero Eller, Lucille; Iipinge, Scholastika; Johnson, Mallory O; Portillo, Carmen; Voss, Joachim; Tyer-Viola, Lynda; Corless, Inge; Nicholas, Patrice; Dawson Rose, Carol; Phillips, J Craig; Sefcik, Elizabeth; Rivero-Mendez, Marta; Kirksey, KennThe objective of this study was to extend the psychometric evaluation of a brief version of the Self-Compassion Scale (SCS). A secondary analysis of data from an international sample of 1967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self-Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with 0.714 for the total scale and 0.822 for Factor I and 0.774 for Factor II. Factor I (lower self-compassion) demonstrated strongly positive correlations with measures of anxiety and depression, while Factor II (high self-compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.Item Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory(Wiley, 2016-09-21) Sullivan, Kathleen M; Dawson Rose, Carol; Phillips, J Craig; Holzemer, William; Webel, Allison; Nicholas, Patrice; Corless, Inge; Kirksey, Kenn; Eller, Lucille Sanzero; Voss, Joachim; Tyer-Viola, Lynda; Portillo, Carmen; Johnson, Mallory O; Brion, John; Sefcik, Elizabeth; Nokes, Kathleen; Reid, Paula; Rivero-Mendez, Marta; Chen, Wei-Ti; Sullivan, Kathleen M; Dawson Rose, Carol; Phillips, J Craig; Holzemer, William; Webel, Allison; Nicholas, Patrice; Corless, Inge; Kirksey, Kenn; Eller, Lucille Sanzero; Voss, Joachim; Tyer-Viola, Lynda; Portillo, Carmen; Johnson, Mallory O; Brion, John; Sefcik, Elizabeth; Nokes, Kathleen; Reid, Paula; Rivero-Mendez, Marta; Chen, Wei-TiAim: Sexual risk behaviour was explored and described using Social Action Theory. Background: The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. Design: Cross-sectional survey. Methods: Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. Findings: Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. Conclusion: Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.