This part of BS 7346 gives recommendations and guidance on functional and calculation methods for smoke and heat exhaust ventilation systems for steady-state design fires. It is intended for a variety of building types and applications, including single-storey buildings, mezzanine floors, warehouses with palletized or racked storage, shopping malls, atria and complex buildings, car parks, places of entertainment and public assembly and uncompartmented space within multi-storey buildings.
This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline.
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We are using active and passive recruitment strategies. Active approaches involve conducting eligibility screening via electronic tablet at bars/clubs, support groups, and community events (e.g., groups at the NYC LGBT Center, LGBTQ pride events in NYC and Miami). Passive approaches involve advertising on young gay and bisexual men-oriented mobile apps and websites (e.g., Grindr, Scruff, BGCLive, Growlr), clinic waiting rooms, social media (e.g., Craigslist, Facebook, Reddit, party listservs), and referrals from previous or current study participants. As part of passive recruitment, we also contact participants from previous research studies who consented to be contacted for future studies. Our advertisements engage help-seeking young gay and bisexual men by emphasizing the study as a safe venue for discussing mental health and sexuality.
Intervention participants are excluded for any of the following: 1) current active suicidality or homicidality (defined as active intent or concrete plan, as opposed to passive suicidal ideation); 2) evidence of active untreated mania, psychosis, or gross cognitive impairment; 3) current enrollment in an intervention study; 4) current enrollment in intensive mental health treatment (receiving treatment more than once per month or 8 or more sessions of cognitive-behavioral therapy (CBT) within the past year); or 5) HIV-positive status.
The current standard of care for LGBTQ individuals who seek mental, behavioral, or sexual health care is LGBTQ-affirmative therapy [58]. The practice of LGBTQ-affirmative therapy is outlined across 21 guidelines published by the American Psychological Association. However, the efficacy of LGBTQ-affirmative psychotherapy has never been tested [59], despite several promising case studies [60,61,62]. We refer young gay and bisexual men to community clinicians who provide this standard of care. These community clinicians are located in community clinics providing LGBTQ-affirmative psychotherapy, one in New York City, one in Miami. Similar to participants randomized to ESTEEM, CMHT participants will complete 10 sessions of therapy, with one session per week. If participants miss sessions or need to reschedule, we make every effort to reschedule sessions such that participants stay as close to a one session per week schedule. If participants miss a week, they may be rescheduled to do two sessions in 1 week, but they are told the goal is once per week. All sessions must be completed within 4 months.
Our primary outcome is condomless anal sex in the absence of either PrEP or known undetectable viral load of HIV+ primary partners, measured with the Time-Line Follow-Back (TLFB), a semi-structured interview [67]. The TLFB will yield past-90-day incidence of HIV risk behavior: condomless anal sex, sex while using drugs or alcohol, number of sexual partners, and preceding-week PrEP use (i.e., coverage defined as 4+ doses per week). TLFB interviewers will be masked to study arm.
Participants complete the Brief Symptom Inventory (BSI) [70], the Center for Epidemiology Studies Depression Scale (CES-D) [71], the Beck Anxiety Inventory [72, 73], the Overall Anxiety and Depression Severity and Impairment Scales [74], the Social Interaction Anxiety Scale [57, 75], and the Sexual Compulsivity Scale [76]. In addition to the MINI substance use module, participants complete the self-report Short Inventory of Problems-Alcohol and Drugs (SIP-AD), capturing negative consequences of substance use across life domains [77].
ESTEEM and CMHT sessions are video- or audio-taped in the settings where they are delivered to monitor intervention fidelity for the ESTEEM sessions and potential contamination with ESTEEM elements in the CMHT condition. Also, both therapists and participants complete short surveys after each therapy session at the appointment site regarding perceptions of treatment; ESTEEM participants complete a short comprehension quiz to assess engagement.
It is possible that participants may experience emotional discomfort in responding to assessments or receiving HIV/STI test results. While every possible step will be taken to minimize such risk, consent documentation will make it clear that if participants have any concerns about any aspect of the study they may refuse to continue with the study at any time, without penalty. In addition, we will remind participants during the course of their assessments that they can refuse to answer any questions and may discontinue participation at any time. Staff members at our Yale and Miami sites will be thoroughly trained in appropriate responses to participant distress through ongoing trainings by a licensed clinical psychologist. This training will address the appropriate handling of imminent threats and provision of referrals to free counseling services in less imminent clinical situations. We have developed a protocol for immediately referring participants who learn, as a result of our study, that they are HIV-positive or infected with chlamydia or gonorrhea to a local LGBTQ-affirmative HIV care clinic.
Given the public health importance addressed by this study and the potential benefit of the information to be gained, we believe that the risk to subjects is reasonable. Sexual-risk behavior among young gay and bisexual men is a clear public health concern. As all participants in the present study will be exposed to information about HIV-transmission risks, we anticipate that participants will acquire knowledge and skills and will receive support needed to improve their capacity for managing HIV risk. Benefits to society in general are anticipated through the dissemination of intervention findings and community trainings in the ESTEEM treatment approach, if it is found to be efficacious. Results will better inform local and national public health agencies about potentially effective outreach and prevention strategies that can be delivered to young gay and bisexual men who experience lifetime stress-sensitive mental health disorders, such as depression and anxiety, and HIV-risk behavior. In sum, the potential benefits outweigh the potential risks to subjects.
The documentation set for this product strives to use bias-free language. For the purposes of this documentation set, bias-free is defined as language that does not imply discrimination based on age, disability, gender, racial identity, ethnic identity, sexual orientation, socioeconomic status, and intersectionality. Exceptions may be present in the documentation due to language that is hardcoded in the user interfaces of the product software, language used based on RFP documentation, or language that is used by a referenced third-party product. Learn more about how Cisco is using Inclusive Language.
Testing the fire resistance of a building element involves determining its behaviour when exposed to a particular heating condition and pressure, normally those representing a fire in an enclosed space, e.g. a room. Fire resistance is one of several properties of a structure or system, and thus is not simply a property of the specific materials used in the structure or system.
This part identifies a specific heating scenario where standard conditions given in EN 1363: Part 1 are inappropriate due to other additional factors that need to be considered, such as the nature of the products or systems, intention of use and regulatory requirements. Alternative conditions include the hydrocarbon curve, slow heating and external fire exposure curves.
This standard specifies the method for determining the fire resistance of parts of curtain walling incorporating non-fire resistant infill product to internal or external fire exposure. The test method includes assessment regarding falling parts that are liable to cause personal injury. It can also be used to determine any increase in the field of application for fire resistance of parts of curtain walling tested to EN 1364: Part 3.
This part specifies the method for determining the fire resistance of floor construction without cavities or with unventilated cavities, roof construction with or without cavities (ventilated or unventilated) and floor or roof construction incorporating glazed elements. Fire exposure is from the underside.
This part specifies the method for determining the fire resistance of beams with or without applied fire protection systems, and with or without cavities. The fire resistance of beams is assessed against load bearing capacity criteria.
This part specifies the method for determining the fire resistance of columns when fully exposed to fire on all sides. The fire resistance of the column is assessed against load bearing capacity criteria.
This part specifies the method for determining the fire resistance of vertical and horizontal ventilation ducts under standardised fire conditions. The test examines fire resistance for ducts exposed to fire from outside (Duct A) and fire inside the duct (Duct B). The performance of the ducts is assessed against integrity, insulation and smoke leakage criteria. 2ff7e9595c
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