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How to Repair Scratched Stainless Steel
Stainless steel is an excellent choice for cookware, kitchen appliances, and more. It is durable and attractive, and it has a well-deserved reputation for resisting stains and other damage. However, over a long period of time, your stainless steel will inevitably sustain a few scratches. Depending on the severity of the scratch, repairing it can be a quick fix or an expensive, professional endeavor. Read on after the jump to learn how to repair scratched stainless steel.
1Work some vegetable oil into the scratch. Applying vegetable oil can help eliminate the appearance of very small scratches. Simply rub the oil in with a paper towel, and then wipe the area dry. This process can be repeated regularly to minimize the appearance of small scratches.
2Refinish the steel with a non-metallic abrasive pad. Most stainless steel will have a polished finish with short, directional polish lines. To inexpensively repair small to medium scratches, you can refinish the stainless steel. Use an abrasive pad to stroke the steel's surface in long, smooth strokes following the grain of the polish lines. This will result in a new finish that looks slightly different, with longer polish lines.
3Refinish the steel with sandpaper. In addition to an abrasive pad, you can also use sandpaper to refinish the steel. Use 80 to 120 grit sandpaper and rub the surface in long, smooth strokes. Always stroke along the grain. Although this method will help remove scratches, it can dull the finish of your stainless steel slightly.
4Replace the scratched stainless steel panel. If the scratches are on a refrigerator or dishwasher that has a removable door panel, you can opt to replace the panel if it is scratched. This will be much less expensive than either getting the appliance professionally refinished or buying a new appliance. Consider buying a panel with a distressed or swirl finish, as these hide scratches better than a straight-grained polished finish.
5Remove the scratches with a commercial scratch repair product. There are several products designed to repair scratches in stainless steel; 2 of the most popular cleaners are Bar Keepers Friend and Scratch-B-Gone. These products should be applied with a non-abrasive cloth along the grain of the finish. These products can be quite expensive, but work well for all but the deepest gouges.
6Soak the stainless steel in vinegar. This method works well for damaged stainless steel sinks, as scratches can be caused by heavy mineral content in the tap water. Soak several dish towels in distilled vinegar, and line the sink with the towels. Allow them to sit for several hours, and then rinse the sink clean.
7Have the stainless steel professionally refinished. If the above options don't work, you can get a contractor that specializes in fabricating and finishing stainless steel to repair the finish on your appliance. This process will be expensive, but can usually restore your appliance's finish to its factory appearance.
Community Q&A
How can I tell if my steel is coated?wikiHow ContributorUsing a very fine grit white sand paper (the finest you can get), test a small area by lightly rubbing. If it turns black, your stainless is not coated.
I used a scratch pad on my stainless steel fridge to take a mark off. It ended up marking a spot on my fridge. How can I get it off or is it wrecked now?
How do I remove a small dent on the buckle of my leather belt?
How can I get rid of a small scratch on a leather belt buckle?
Things You'll Need
- Vegetable oil
- Paper towels
- Abrasive pad
- Sandpaper
- Commercial scratch repairer
- Distilled vinegar
- Dish towels
Sources and Citations
Article Info
Categories: Care and Use of Cooking Equipment
In other languages:
Español: reparar acero inoxidable rallado, Italiano: Riparare i Graffi su Acciaio Inox, Русский: отремонтировать поцарапанную нержавеющую сталь, Deutsch: Kratzer in Edelstahl reparieren, Português: Remover Arranhões em Aço Inoxidável
Thanks to all authors for creating a page that has been read 382,010 times.

subset: commoncrawl


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Weigh the pros and cons of technologies, products and projects you are considering.
Two Factor and Multifactor Authentication Strategies
FIDO authentication standard could signal the passing of passwords
The FIDO authentication standard could eventually bypass passwords, or at least augment them, as government and industry turns to more effective authentication technologies. Continue Reading
What new NIST password recommendations should enterprises adopt?
NIST is coming up with new password recommendations for the U.S. government. Expert Michael Cobb covers the most important changes that enterprises should note. Continue Reading
How identity management systems strengthen cybersecurity readiness
Identity management is a core component of cybersecurity readiness, but there are many layers and complexities behind it. Expert Peter Sullivan explains the basics of IAM. Continue Reading
Is a no-SMS 2FA policy a good idea for enterprises?
Now that NIST has deprecated the use of SMS 2FA, should nongovernment organizations follow suit? Expert Mike Chapple discusses the risks of SMS-based 2FA to enterprises. Continue Reading
How does the Mazar malware take control of Android devices?
The Mazar malware can wipe an entire Android device once it has been installed. Expert Nick Lewis explains how this malware works, and how attacks can be prevented. Continue Reading
How can Kerberos protocol vulnerabilities be mitigated?
Microsoft's Kerberos protocol implementation has long-standing issues with its secret keys. Expert Michael Cobb explains how to mitigate the authentication vulnerabilities.Continue Reading
What's the difference between two-step verification and 2FA?
The terms two-step verification and two-factor authentication are used interchangeably, but do they differ from one another? Expert Michael Cobb explains.Continue Reading
The FIDO authentication framework: What do enterprises need to know?
Enterprises need a full understanding of the FIDO authentication framework before switching to its technology. Expert Randall Gamby looks at the most important points of the UAF.Continue Reading
Is third-party vendor management the next IAM frontier?
Identity and access management deployments are notoriously complex. And things are getting worse as legacy technology meets next-generation applications. As the traditional network perimeter continues to disappear, robust IAM becomes more important ...Continue Reading
Which authentication method is better: 2FA or MFA?
Which authentication method is better for securing enterprise devices and systems: two-factor authentication or multifactor authentication?Continue Reading
Is third-party access the next IAM frontier?
Identity and access management of employees is so complex that many companies have faltered when it comes to securing programs for trusted partners.Continue Reading
Can simple photography beat biometric systems?
Simple photography cracking biometric systems highlights the need for two-factor authentication in enterprises according to expert Randall Gamby.Continue Reading
What does bimodal IAM mean for user credentials?
Bimodal IAM may be a new term, but this new way to use user credentials should probably already be in practice among secure organizations.Continue Reading
What do organizations need to know about the final FFIEC guidance?
The final FFIEC guidance covers a wide range of security subjects, but there are specific takeaways regarding authentication that enterprises should pay attention to.Continue Reading
The evolution of MFA security tokens
Tokens secure IT software and services by serving as additional factors. This slideshow takes a look back at the humble beginnings of MFA technology and how well security tokens now secure enterprise IT assets.Continue Reading


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GOLFINO Knitted Crystal Ladies Polo Shirt
Select options:
- Choose Colour: Navy
- Choose Size: 12
Product Description
The elegant and stylish Knitted Crystal polo shirt has been designed to make you look and fell good on the golf course. This garment has been made with a blend of high quality fabrics with a blend of luxury rhinestones at the hem and troyer. The design features a quarter zip opening with Crystal GOLFINO zip hanger, and has a ribbed waist, collar, and sleeve cuffs. Finer details include golfer embroidery with silver elements on the left chest.
The Knitted Crystal Polo Shirt Features:
- Stylish Design
- Luxury Rhinestones Pattern at the Hem and Troyer
- With Golfer Embroidery with Silver Elements
- 58% Viscose, 25% Polyester, 13% Nylon, 4% Angora
GOLFINO Care Guide
"Hand Wash. Do Not Bleach. Iron at Low Temp. Dry Clean. Do not Tumble Dry"
Customer Reviews


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|Tipo de imóvel
|Estadia Mínima
|4 - 6 noites
Pronto para passar umas férias inesquecíveis com a sua família e / ou amigos na área de Orlando? Nosso costume decorados, recém-pintada, 5 quartos / 3 casa de banho (1 w / cama king size, 2 w / camas queen size e com duas camas de solteiro cada) irá acomodar confortavelmente 12 pessoas. Localizado em uma área muito segura, com belas paisagens, esta casa térrea é o seu local de férias perfeito. Nem adultos nem crianças nunca vai ficar entediado como você vai estar a poucos minutos de todas as atrações. Está garantida a ter um grande momento! Muito quente? Não é um problema! A casa tem um blindado, aquecida (opcional) piscina com uma vista deslumbrante da lagoa! Ao lado da piscina é uma varanda coberta com uma mesa para que à noite tranquila. (Tela guarda do bebê rodeia a piscina) .A casa tem TV de tela plana 4 high-tech de, um leitor de DVD e Wi-Fi. Sofá de couro em sua sala de estar confortável e acolhedor, encantador pequeno-almoço recanto na cozinha, bela sala de jantar - todos fazem a sua estadia confortável e conveniente.
Nice place to stay! My family and I loved our stay and everything was absolutely lovely.. Kids enjoyed the pool, From the beginning to the end, everything was great! Katia was absolutely Fantastic and I will rent this villa again.
We stay in this villa for 4 weeks and thoroughly enjoyed our time. The home is very clean and well maintained and is well equipped with all the necessities for a comfortable stay - kitchen wares, hair dryers, linens, iron, etc. The location is perfect for visiting the theme parks or browsing in the shopping areas. Most attractions can be reached in 10-15 minutes! After a day out, enjoy the pool which backs onto a conservation area. The owner is very available and will do her best to make your stay perfect!
The home was exactly as portrayed in the photos. Nothing was misleading. It was comfortable and nicely decorated. The owner responded to all my e-mails and handled our transactions without delay. Very short ride to Disney and just a bit longer to Universal.
I've never rented a home before and this was such a nice experience I would rent again and stay at the same home.
This house was close to Disney and is great for a big family.The pool was very big and the boys had a great time playing the games in the game room.Would diffently rent again.the place was just like the pictures and had No problem with the owners
Very good location for a relaxing get away or home away from home while you visit the resort parks. We rented this property for the months of February and March 2015. It is exactly as described in the listing. Clean and comfortable with the bedrooms situated off the 4 corners of the house for privacy. We didn't pay for pool heat but still used it for most of March. Wheather your in town for the attractions or looking for a place to relax and sun by the pool this house has it.
Overall experience from beginning to end was just perfect!
Katya was awesome and was very professional.
Me and my friend's family enjoyed every moment of our stay especially the kids who loved the pool.
Will definitely recommend to families visiting Orlando, FL and Disney.
|Validade da Tarifa
|por noite
|Noite (fim de semana)
|por semana
|por mês
|Pacote ou Evento
jan 5 2017 - fev 28 2017
Estadia mínima: 6 noite(s)
Tarifa Básica
Estadia mínima: 4 noite(s)
Canceled booking will not receive a refund.
Renters are advised to buy travel insurance.


text: Sure, there are a couple of even better restaurants around, but Jade Garden is like Old Faithful. We are never disappointed when we try something new and they keep their menu current but authentic, i.e. It's not your Asian fusion sort of cuisine. It's rare for us to not be able to walk in and get seated, and they do... More


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Diana Olick is an Emmy Award-winning journalist, currently serving as CNBC's real estate correspondent as well as the author of the Realty Check section on CNBC.com, which won the Gracie Award for "Outstanding Blog" in 2015. She also contributes her real estate expertise to NBC's "Today" and "NBC Nightly News."
Prior to joining CNBC in 2002, Olick spent seven years as a correspondent for CBS News.
Olick began her career as a local news reporter at WABI-TV in Bangor, Maine; WZZM-TV in Grand Rapids, Mich.; and KIRO-TV in Seattle. She joined CBS in 1994 as a New York-based correspondent for the "CBS Evening News with Dan Rather" and "The Early Show." She also contributed pieces to "48 Hours" and "Sunday Morning." During that time, she covered such stories as the World Trade Center conspiracy trial and the Boston abortion clinic shooting.
In 1995, Olick was assigned to cover the Midwest as a Dallas bureau correspondent. In the three years she was there, she covered all forms of natural disaster, including the crash of TWA Flight 800, the JonBenet Ramsey murder mystery and was the exclusive correspondent for the trial of Oklahoma City bomber Terry Nichols. During that time, she also took a temporary assignment in CBS' Moscow bureau, where she chronicled the brief presidential campaign of Mikhail Gorbachev.
In 1998, Olick was reassigned to the New York bureau and then immediately posted to Bahrain for the buildup to a possible second Gulf War. A year later, she went to Albania to cover the U.S. military buildup during the conflict in Kosovo.
Upon her return, Olick was reassigned to CBS' Washington bureau and the Capitol Hill beat. During Campaign 2000, Olick covered the Senate campaign of First Lady Hillary Rodham Clinton and later joined the Bush campaign as a special correspondent for "The Early Show." That fall, she was named Supreme Court correspondent; her first case was Bush v. Gore.
Olick has a B.A. in comparative literature with a minor in soviet studies from Columbia College in New York and a master's degree in journalism from Northwestern's Medill School of Journalism.
Follow Diana Olick on Twitter @Diana_olick.
In an unexpected reversal, both newly started foreclosures and finalized foreclosures dropped precipitously in February.
The residential rebound is under way in fits and starts, but it is volatile, and it is local.
Thanks to high gasoline prices, today's home buyers want to be close in. D.C., with so many thriving suburbs and an expansive Metro system, offers ample opportunity.
The number of homes sold to investors more than doubled last year, as rising rents and low-priced distressed properties fueled demand.
CNBC's Diana Olick has new numbers on mortgage refis and what that might mean for the housing recovery.
The average rate on the 30-year fixed mortgage is up about a half a percentage point since the middle of February, when they hit a record low. Mortgage refinances, however, dropped 24 percent in the same period of time. That's a huge reaction to a small move from a record low.
The American dream of owning a home is still alive and well, but a large percentage of Americans today feel that for now, renting might be the better option.
As the wider economy begins to strengthen, and Americans start to feel better about their current and future finances, they are dipping their toes back into the housing waters, in the form of remodeling.
The housing market is ahead of where we were, but rising foreclosures will put added pressure on this market, and we may not be out of the woods yet.
Bank of America, the nation's second-largest lender, is launching a pilot program this week that will offer a limited number of customers behind on their mortgages to transition from owner to renter.


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Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
In Reply: We agree with Dr Cunningham that
while survival benefit is an important outcome, other outcomes that affect
quality of life need to be considered when making screening decisions. However,
the impact of screening on important outcomes such as pain, suffering, or
functional decline has not been studied. Therefore, while it is important
to consider the harms of metastatic cancer, little data are available to estimate
the likelihood that screening will prevent such harms, especially over time
intervals of less than 5 years. Cunningham is technically correct in saying
that if no screening had been done, published rates of cancer mortality might
be slightly higher, causing our estimates of the risk of cancer death to be
slightly lower. However, because rates of screening have historically been
very low in elderly persons, this effect is probably minimal.1
On the other hand, among persons who have had regular screening, our estimates
probably significantly overestimate the benefits of continued screening, as
we discuss in our article.
Walter LC, Covinsky KE. Discussing Cancer Screening With Elderly Patients—Reply. JAMA. 2001;286(10):1175-1176. doi:10.1001/jama.286.10.1173
© 2017


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Monster Signs Clip Art
The monster signs clip art set contains 6 monsters holding signs. The monsters with signs clip art set contains 12 image files, which includes 6 color images and 6 black & white images in png and jpg. All images are 300dpi for better scaling and printing.
The Monster Signs clip art set includes:
- Monster with an apple
- Monster with a blank sign
- Monster with a chalkboard
- Monster with a frame
- Monster with a piece of paper
- Monster with a star
You will receive:
- 6 color png images
- 6 black & white png images
- 6 color jpg images
- 6 black & white jpg images
* All clip art sets are delivered via a zip file
This product is a digital download that is contained in a zip file and available to download immediately after purchase.
* Each clip art set come with a Standard License Agreement. A Standard License Agreement includes usage for personal, educational, and small business. Click here to learn more about the Standard License Agreement.


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iPhone apps
Random Roll
The ultimate dice rolling app! No longer worry about finding dice for all your games. Perfect for tabletop and card games.-Roll up to 6 dice with up to 30 sides each!-Roll a random number up to 200!-Roll a random letter!-Shake to Roll!-Real dice….. Read more
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text: Venditore: sabine_london (191) 99%, Luogo in cui si trova l'oggetto: Chigwell, Essex, Spedizione verso: GB e molti altri paes, Numero oggetto: 302149513884 Ladies 2 piece Indian skirt top set in red and gold. Top is fully embroidered and pure silk. The skirt is long and flared with a heavily embellished border. It is pure chiffon. It should fit uk size 6. Please view all the photos to see detail. Returns not accepted. Condition: The zip on the side of the skirt is broken but can be fixed., Style: Choli, Gender: Women's, Size: XS, Main Colour: Red, Material: Chiffon


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Kids Aqua Lung Lanai LX / Paradise Dry Junior :: U.S. Divers Lanai LX/Paradise Dry Junior. Fun Blue 2-window youth mask with purge, submersible snorkel with purge. Hypoallergenic silicone face skirt is designed to fit smaller, narrower faces. 2-window mask features tempered glass lenses. 3-way adjust Pro-Glide buckles for easy adjustments.
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Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skills model to improve HAART adherence and reduce crack cocaine problems.
Participants were 54 adults with crack cocaine use and HIV with <90% HAART adherence. Most participants were African-American (82%) heterosexual (59%), and crack cocaine dependent (92%). Average adherence was 58% in the past 2 weeks. Average viral loads (VL) were detectable (log VL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (MI+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14-day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measures ANOVA assessed main effects of the interventions and interactions by condition.
Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition.
A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use.
Poor adherence to highly active antiretroviral therapy (HAART) and frequent crack cocaine use may result in a faster progression of disease, morbidity, and mortality among HIV positive individuals (Baum et al., 2008, Malta et al., 2008a; Malta et al., 2008b). Adherence to HAART medications must be nearly perfect to prolong health and to avoid antiviral medication resistance and treatment failure, although there is emerging evidence that some newer formulations of HAART medications may allow for slightly more nonadherence (Menendez-Arias 2010; Nieuwkerk and Oort, 2005; Paredes and Clotet, 2010; Bangsberg et al., 2006; Tozzi et al., 2006). Crack cocaine use has a particularly negative effect on HAART adherence (Arnsten et al., 2002; Ingersoll, 2004; Lucas et al., 2002; Lucas et al., 2007; Sharpe et al., 2004). Crack cocaine is an independent predictor of running out of HIV medications (Ingersoll, 2004). The binge pattern typical of crack cocaine use is especially problematic and can lead to the suspension of medication adherence during obtainment, use, and recovery from the drug (Harzke et al., 2009). In addition to its effects on adherence, cocaine use itself is independently associated with HIV accelaration and disease progression (Baum et al., 2008; Cook et al., 2008). HIV positive substance users often enter HIV care and treatment in more advanced states of disease (Celentano et al., 2001; Wang et al., 2004), making them more vulnerable to poor treatment outcomes and associated morbidity and mortality (Zolopa, 2010).
While some modest improvements in HAART adherence have been achieved by behavioral interventions (Amico, et al., 2006; Fogarty et al., 2002; Ickovics and Meade, 2002; Rueda et al., 2006; Sandelowski et al., 2009; Simoni et al., 2003; Simoni et al., 2006), little research has targeted high risk subpopulations such as crack cocaine users on HAART. Although there are no published intervention studies targeting both HAART adherence and cocaine, two clinical trials have applied Motivational Interviewing (MI, Miller and Rollnick, 2002) combined with Cognitive Behavioral Therapy (CBT) to dually target both alcohol use and HAART adherence. Parsons et al., (2007) developed an intervention using the Information Motivation Behavioral Skills (IMB) model of behavior change, which suggests that change occurs when the person becomes well-informed, highly motivated, and skilled (Amico et al., 2009; Fisher et al., 2006; Fisher et al., 2008). They compared an 8-session MI and CBT intervention to an 8-session video educational condition. Individuals in the counseling intervention showed improvements in adherence compared to the education condition at the post-treatment follow-up. However, adherence gains were not maintained three months later, and neither condition improved drinking outcomes (Parsons et al., 2007). Another multi-component intervention study tested MI plus problem solving and a medication timer device against treatment as usual for drinking and HAART adherence (Samet et al., 2005). This study yielded no main effects, and the intervention and treatment as usual groups did not differ on adherence, or alcohol consumption at 6 and 13 month follow-up points.
It is possible that crack cocaine users will respond differently than drinkers to interventions targeting both drug use and adherence. We developed the first dually-targeted intervention to address both crack cocaine use and HAART adherence using MI plus personalized feedback and relapse prevention skills building consistent with the IMB model. We developed the intervention following formative research in which we gathered input from the targeted patient population about their preferences for the content and delivery of interventions targeting cocaine use and HIV care (Cohen and Ingersoll, 2004; Cohen et al., 2004; Cohen and Ingersoll, 2005). The purpose of this pilot study was to test the feasibility and promise of the intervention (MI+) against an information condition (Video+) to improve two target behaviors: HAART adherence and crack cocaine problems, and to investigate the persistence of effects. We hypothesized that those assigned to the MI+ condition would show higher HAART adherence and lower Addiction Severity Index (ASI) Drug Composite Scores (primary outcomes) and lower percent of days using crack cocaine and HIV log VL (log VL) (secondary outcomes), than the those in the Video+ condition. Because this was a pilot study, we were also interested in whether treatments were feasible, administered with good fidelity to protocols, and were credible and able to retain and satisfy participants.
English speaking HIV positive adults with current crack cocaine use or a crack cocaine use disorder (abuse or dependence) and less than 90% self-reported adherence to a current prescription for HAART over the preceding 14 days were eligible to participate in the study. No specific history of lifetime HAART medications was required. Exclusion criteria included: (1) severe cognitive impairment, (2) inability to provide informed consent, (3) current participation in another adherence-enhancing intervention, (4) active suicidality, (5) current incarceration or hospitalization, (8) an inability to provide urine samples (as in end stage renal disease), or (9) plans to leave the area prior to study completion. Participants responded to flyers or provider referrals at community substance abuse treatment programs and HIV care sites. Interested volunteers were screened in person or by telephone to determine eligibility. Participant demographics are shown in Table 1 and the study flow chart is shown in Figure 1. Participants provided written informed consent. Study protocols were approved by university institutional review boards. Participants received up to $300 for their time spent completing measurements at each study visit, prorated by visit completed. Transportation to and from study sites, which were research clinics located in three university research buildings in two cities, was provided if needed.
Researchers conducted screening verbally using a structured interview guide. Researchers asked potential participants to recall HAART adherence behavior and crack cocaine use over the previous 14 days using the timeline follow-back (TLFB) method, a guided method using a calendar to prompt accurate recollection of daily behavior in clinical populations with excellent validity and reliability among substance users (Sobell and Sobell, 1992). A preliminary study showed good agreement of the 14 day TLFB for adherence with prospective, phoned-in daily adherence reports (Hettema and Ingersoll unpublished pilot data) and a previous study showed the utility of the TLFB for assessing proportion of HAART medications taken as prescribed (Ingersoll, 2004). Researchers screened for crack cocaine abuse and dependence using a DSM-IV checklist
Primary outcomes were mean 14-day HAART adherence and ASI Drug Composite Scores (McLellan et al., 1985). Adherence was defined as the percent of prescribed pills taken and was assessed using the TLFB. Researchers used visual aids to guide collection of self-reported information on each participant's prescribed regimen, including names of all prescribed medications, pills per dose, and doses per day. Total pills prescribed per day served as the denominator, while pills taken that day was the numerator to calculate adherence per day. We calculated Cocaine-specific Drug Composite Scores from data collected via the ASI, a brief semi-structured interview with accepted reliability and validity for assessing the existence, duration, and severity of substance-use-related problems in seven areas (drug, alcohol, medical, employment, legal, family/social, and psychiatric problems) over the previous 30 days (McLellan et al., 1985). The Drug Composite Scores from the ASI can show change in drug use problems over time, are considered more objective than ASI Severity Ratings, and offer an internally consistent estimate of drug use problems with higher scores reflecting more problems related to drug use (McGahan et al., 1986).
Secondary outcomes were HIV log VL and percent days using crack cocaine. We quantified plasma HIV-1 RNA (VL) using the Roche Amplicor® HIV-1 Monitor which has an assay range of 49–750,000 copies/mL. Undetectable VL was a result below the assay limit, or <49 copies/mL. To adjust for skew, we log-transformed VL results and we considered a change of +/−.5 log VL to be a useful clinical indicator (Holodniy, 2010). We calculated percent days using crack cocaine from the TLFB.
Measured characteristics included age, sex, race, ethnicity, education, employment, sexual orientation, criminal justice involvement, lifetime HIV risk behaviors, years since HIV diagnosis, immune health status, and comorbid health conditions. Researchers also evaluated cocaine and alcohol use, including abuse and dependence, and comorbid psychopathology with the Mini International Neuropsychiatric Interview (M.I.N.I., (Sheehan et al., 1997; Sheehan et al., 1998). The M.I.N.I. is a short, structured, diagnostic interview with adequate validity and reliability for identifying DSM-IV and ICD-10 psychiatric disorders (Sheehan et al., 1998).
Treatment fidelity is the extent to which an intervention was delivered as planned. The supervisors (S.C. and C.H.) and principal investigator (K.I.), all members of the Motivational Interviewing Network of Trainers, facilitated the training and supervision of therapists. Therapists also attended external MI workshops and trainings. All sessions were audio taped or videotaped and these recordings were used in weekly group and individual supervision. Immediately after each treatment session, therapists completed the study's Therapist Checklist, a 39-item instrument containing all of the major components that appeared in the MI+ or Video+ treatment manuals. The form included two activities relevant to the Video+ condition, including showing the video and asking debriefing stem questions, 35 activities relevant to the MI+ condition, including providing personalized feedback, completing a decisional balance worksheet, and using MI-consistent conversational strategies, and 2 activities that were relevant to both conditions, including role induction and providing informational handouts and pamphlets. Additionally, fidelity was assessed during weekly supervision of therapists conducting the interventions via review of videotaped sessions to ensure that the conditions were delivered consistent with treatment manuals, and were adequately differentiated.
To assess treatment credibility of both interventions, we adapted a 4-item, 1–10 scale instrument that assessed participants' self-report of how much the assigned intervention made sense to them, how successful they believed the intervention would be in helping them adhere HAART, how confident they would be in recommending the intervention to a friend with HIV, and how successful the intervention would be in helping them to reduce cocaine use. Treatment credibility measured before a treatment has been found to be a predictor of outcome in the area of chronic pain (Dennis Turk, 2000, personal communication). When asking participants to rate credibility before treatment, therapists (who were unblinded to assignment) explained the assigned intervention to the participant following randomization. For example, therapists stated "You have been randomly assigned to the Counseling intervention. That means that you will meet with a therapist for six sessions who will discuss your crack cocaine use and HIV medication adherence with you." Alternatively, they stated "You have been randomly assigned to the Video intervention. That means that you will view a series of six videos and answer some questions about them in discussion with a therapist." Following randomization and this discussion, blinded researchers administered the measure. Total scores could range from 4–40, with higher scores indicating higher credibility of the assigned intervention.
We assessed satisfaction with a 6-item, 1–5 scale that asked participants to rate their overall satisfaction with their treatment, their overall satisfaction with their therapist, whether the treatment had an effect on their cocaine use, whether the program had an effect on their HAART adherence, their overall satisfaction with the intervention setting (researchers, therapists, facility, etc.) and whether they would recommend the program to others. Some items were reverse scored. The scores could range from 5–30, with 5 representing the highest satisfaction and 30 the lowest.
Intervention components are shown in Table 2. When delivering the MI+ intervention, therapists used MI to explore participants' thoughts, feelings, motivations and behaviors related to adherence and cocaine use using a variety of strategies, including providing personalized feedback, emphasizing choice and control, goal setting, and change planning. Issues addressed in the personalized feedback included rate of crack cocaine use and its cost, rate of HAART adherence, recent urine drug screen results, general health status indicators that can be affected by cocaine use such as pulse rate and blood pressure, VL, and CD4 cell count, a marker of the number of immune helper cells remaining in the body. Data for the feedback were drawn from the baseline assessment. Sessions also explicitly incorporated strategies such as self-monitoring, exploring triggers for drug use or nonadherence with behavior chain analysis for relapse prevention, and development of problem-solving plans. Some of these strategies are often used in CBT, but study therapists did not directly target cognitive errors in this intervention. Rather, these strategies were delivered using the MI counseling style, with a focus on evoking the participant's ideas about change using extensive reflective listening. Therapists also offered participants educational handouts to take home with them that contained further information on the topics discussed in the sessions.
We developed a comparison condition equivalent for time and attention that provided information about HAART adherence and crack cocaine use. This comparison condition (Video+) included watching a 30–45 minute video, plus debriefing and reading materials. We selected videos that were accurate, included diverse peer role models, contained no "scare tactics" or counter-motivational communication strategies, and contained at least some personal narrative in addition to didactic information presented by peer role models and medical experts. Additionally, the videos selected addressed either crack cocaine use or drug use generally, HIV treatment, or both. Video titles are presented in Table 2. After participants viewed each video, therapists facilitated a 10-minute debriefing discussion by asking a brief list of questions intended to check that participants had watched and understood the information in the video. Therapists were trained to keep these conversations neutral and focused on checking that the participant had watched the video, and providing information instead of using reflective listening. Therapists also offered participants educational handouts that contained additional information on the topics discussed in the videos.
Researchers facilitated a 15-minute screening of interested potential participants in person or on the telephone. If the person met initial eligibility criteria, researchers obtained releases of information and confirmed HIV+ and HAART status with medical records. Researchers then offered eligible individuals participation and scheduled a baseline assessment visit at their convenience within the following 2 weeks.
During the baseline visit, researchers verified locator information and faciliated the informed consent process, then administered interview and self-report measures. Participants provided urine, blood samples, and vital signs to assess drug use, VL, CD4 count, blood pressure, and pulse rate. Immediately after the baseline assessment, a therapist informed the participant of their random assignment and scheduled the first treatment session for approximately 1 week later. Baseline assessment visits took 4–5 hours including a lunch break, with lunch provided for participants.
The first 4 intervention sessions were held on a weekly basis, and the final 2 sessions were scheduled biweekly. All sessions took place at university research clinics and not in HIV clinics. Study therapists were responsible for providing both interventions. Both interventions were delivered by 9 racially, ethnically, and culturally diverse therapists (7 women, 2 men) who had master's or doctoral degrees in clinical or counseling psychology, social work, or counseling. The same therapist met with each participant for all intervention sessions. In 2 cases, a new therapist completed the sessions with a participant who had initially begun with a therapist who departed during that participant's treatment. Each session lasted between 45 and 60 minutes.
Follow-up one (FU1) occurred 2–3 months post randomization (usually directly following the sixth treatment session in week 8 or as late as week 12), and follow-up two (FU2) occurred 5–6 months post randomization, which was 3 months after treatment completion. Researchers blinded to participants' assigned conditions administered the ASI, the HIV Medication Chart and Adherence Questions and the TLFB for HAART adherence and crack cocaine use, and treatment satisfaction forms. Participants provided urine to assess drug use at FU1 and at FU2, with the addition of blood to assess VL at FU2. At FU2, participants also completed treatment credibility forms. The FU1 session was typically completed in 1 hour and the FU2 session was typically completed in 2 hours.
We used descriptive statistics, t-tests, and chi-square tests to characterize the sample and the intervention measures including participant satisfaction, treatment credibility, and activities in each session reported on Therapist Checklists (i.e., treatment fidelity). We assessed the relationship between baseline adherence and viral load, and whether participant characteristics like age, years since HIV diagnosis, race, employment, and sexual orientation were related to outcomes using univariate analyses to determine if they should be considered as covariates. We examined the relationships between baseline ASI Drug Composite Scores and cocaine using days and adherence. We examined the relationships between baseline adherence and baseline log VL. We used a repeated measures mixed model analysis of variance (ANOVA) to assess main effects and between-group effects on the primary and secondary dependent variables. We tested for the normality of the distributions, homogeneity of covariance matrices, and sphericity. When violations of the sphericity assumptions were found, we used the Greenhouse Geyser Epsilon to adjust the probability of F (Lix and Keselman 2010). Omnibus F testing was followed by univariate tests of our a priori hypothesis that adherence and ASI Drug Composite Scores would differ by condition. Analyses were conducted using SAS Proc GLM, which allows for maximum use of observations across time even when some data are missing. To determine whether there was an effect of group, time, or a group × time interaction on the 2 primary outcome variables specified a priori: 1) HAART adherence, and 2) ASI Drug Composite Scores, and on the 2 secondary outcomes variables specified a priori: 1) percentage days using cocaine, and 2) log VL, we conducted 4 repeated measures ANOVAs with 2 levels of condition (MI+ and Video+) and 3 levels of time (baseline, FU1, FU2). When the null was rejected in omnibus testing, we conducted further univariate tests of hypotheses for between-groups and main effects and calculated effect sizes for the effects observed across time (Eta squared; ή2). Generally, ή2 is considered small at .02, medium at .13, and large at .26 (Bakeman, 2005). In addition, for each primary outcome variable at each follow up point, effect sizes and 95% confidence intervals (CIs) were computed. Between-group unbiased estimators of effect size (d) and 95% CIs were calculated. These effect sizes represent MI+ versus Video+ condition differences in post-treatment scores. Cohen's (1988) criteria for identifying the magnitude of d were used, where d = .2 is a small effect, d = .5 is a medium effect, and d = .8 is a large effect.
In addition to analyzing the effects of time and group on log VL, we calculated difference scores in log VL from randomization to FU2 and classified participants with a decrease of −.5 log VL or greater (meaning a larger decrease in log VL) as clinically relevant decreased log VL, those with log VL difference score between −.5 and +.5 as unchanged log VL, and those with an increase of +.5 log VL or greater clinically relevant increased log VL (Holodniy, 2010). We analyzed these log VL difference score categories using a chi-square analysis to determine if the proportion of decreased log VL, unchanged log VL, and increased log VL differed between the MI+ and Video+ conditions. Additionally, we examined the proportion of participants whose VL were detectable and undetectable in each group at randomization and FU2 to determine if there were differences between the MI+ and Video+ conditions.
Baseline characteristics of the sample are shown in Table 1 for the full sample (n=54) and for the final sample (n=42). There were no significant differences between conditions at baseline for the full sample or the final sample on demographic, HIV risk, VL or CD4 counts, drug use, psychiatric, adherence, percentage of days of cocaine use, or ASI Drug Composite Scores. Fifty-four patients on HAART participated in the study, including 28 women, 25 men, and 1 transgendered individual; 82% were African-American, and 1 participant was Hispanic. Their mean age was 45 (SD=6.4); the modal age was 41. Thirty-seven percent of the sample had less than a high school education, but 31.5% had high school and 31.5% had some college education. Most (82%) were not employed. Most (44; 82%) had a history of involvement with the criminal justice system. More than half of this sample was heterosexual (32, 59.3%). On average, participants had been diagnosed with HIV 11.3 years ago (SD=6.5); the most recent diagnosis was four months before, and the most distant diagnosis was 22 years before. On average, participants took 58.27% (SD =27.5) of their prescribed HAART pills in the two weeks prior to enrollment. At baseline, there was a significant inverse relationship between adherence and viral load (r = −.34, p<.05). The participants had detectable HIV VL (mean log VL 2.97, SD = 1.18) and compromised immune functioning as indicated by low CD4 cells (mean 433, SD = 317). While not shown in the table, the full sample reported significant health problems beyond HIV; 31.5% had a current diagnosis of AIDS, while other common current co-morbidities included Sexually Transmitted Infections (93%), Hepatitis A (5.6%), B (18.5%), or C (35.2%), hypertension (42.6%) and Type 2 Diabetes Mellitus (7.4%). Participants were prescribed 6.4 medications per day, with 2.5 for HIV disease. Despite high unemployment, 94.4% reported stable housing.
Table 1 also shows the drug use and positive psychiatric screens for the sample by assignment condition. On average, participants used crack cocaine on a third of days in the past month prior to enrollment in the study. On urine toxicology screens at randomization, half screened positive for cocaine, consistent with their self-report of using crack cocaine on a third of days. Some also screened positive for marijuana, benzodiazepines, opioids, barbiturates, and methamphetamine. Most were classified as crack cocaine dependent on the M.I.N.I., and 38.5% were also classified with alcohol use disorders. Psychiatric problems were common, with nearly half experiencing current Major Depression. Current suicidal and homicidal ideations were also present in the sample; whenever these were endorsed, study therapists and supervisors reviewed responses while the participant was there, and assessed current risk using a standardized protocol.
Retention rates did not vary by group at any of the assessment or treatment sessions. The 2 mistaken enrollments had both been randomized to the MI+ condition and had completed the study, but were dropped from analyses. Forty of 54 enrolled participants (74.1%%) received all 6 treatment sessions, 45 of 54 (83.3%%) completed FU1, and 42 of 54 (77.8%) completed FU2 (see Figure 1 for the study flow chart and completion by condition).
Figure 2 shows the mean differences for the primary dependent variables (mean adherence and ASI Drug Composite Scores) and secondary dependent variables (days using cocaine and log VL) across time. There were main effects of both interventions on HAART adherence and ASI Drug Composite Scores. Table 3 shows the ANOVA results for the sample of 54 at baseline, 45 at FU1, and 42 at FU2. In some instances, missing data resulted in changes to the n's when variables for that analysis were missing as noted below.
There was a moderately negatively skewed distribution of adherence at baseline (skewness = −.837), but this deviation from the normal distribution was within the acceptable range to proceed with the repeated measures ANOVA. There was a significant main effect of time on adherence. In the MI+ condition, adherence improved from 60.2% (SD =26.7%; n =26) at baseline to 93.3% (SD =10%; n =22) at FU1 and 93.9% (SD =13.7%; n =19) at FU2. In the Video+ condition, adherence improved from 56.4% (SD =28.5%; n =28) at baseline to 87% (SD =25.3%; n =23) at FU1 and 86% (SD =29.1%; n =23) at FU2. There was no significant between-groups effect on adherence. Between groups effect sizes for adherence were small and nonsignificant at FU1 [d =.33 (−.26, .91); p =.28] and FU2 [d =.34 (−.28, .95); p =.28]. When collapsing across conditions, participants improved their adherence from 58.27% (SD =27.5%) at baseline (n =54) to 90% (SD =19.5%) at FU1 (n =45) and 90% (SD =24%) at FU2 (n =42). Follow-up contrasts showed that mean adherence was lower at baseline than at FU1, F (1, 37) =32.11, p<.0001 and FU2, F (1, 37) =43.81, p<.0001; repeated measures effect sizes are shown in Table 3.
There was also a significant main effect on ASI Drug Composite Scores, which range from 0–1, with lower scores indicating fewer problems from drug use. In the MI+ condition, ASI Drug Composite Scores decreased from .18 (SD =.11) at baseline (n =26) to .10 (SD =.08) at FU1 (n =20) and rose slightly to .11 (SD =.09) at FU2 (n =18). In the Video+ condition, ASI Drug Composite Scores decreased from .16 (SD =.09) at baseline (n =28) to .09 (SD =.09) at FU1 (n =21) and .08 (SD =.08) at FU2 (n =22). Mean composite scores were higher at baseline than at FU1, F (1, 35) =17.27, p<.001, and FU2, F (1,35) =14.32, p<.001. There was no significant between-groups effect on ASI Drug Composite Scores. Between groups effect sizes for composite scores were small, nonsignificant, and in different directions at FU1 (d =.12 (−.72, .48); p =.72) and FU2 (d =−.12 (−.72, .48); p =.70). Across conditions, participants decreased their ASI Drug Composite Scores from .17 (SD =.10) at baseline (n =54) to .09 (SD =.09) at FU1 (n =41) and .09 (SD =.09) at FU2 (n =40).
There was a significant main effect of the interventions on percent of days using cocaine, but not on log VL or the proportion of participants with detectable or undetectable VL. In the MI+ condition, percent days using cocaine decreased from 35.4% (SD =31%) at baseline (n =26) to 15.4% (SD =15.1%) at FU1 (n =20) and 10.9% (SD =14.7%) at FU2 (n =19). In the Video+ condition, percent days using cocaine decreased from 30.4% (SD 29%) at baseline (n =28) to 13.8% (SD =19.7%) at FU1 (n =23) and 12.1% (SD =20.4%) at FU2 (n =23). Percent days using cocaine was higher at baseline than at FU1, F (1, 37) =22.32, p<.0001, and FU2, F (1, 37) =26.49, p<.0001. No significant between-groups effects were identified for any of these secondary outcomes. Across conditions, participants decreased the percent days they used cocaine from 32.8% (SD =30%) at baseline (n =54) to 14.6% (SD =17%) at FU1 (n =45) and 11.6% (SD =18%) at FU2 (n =42).
There was no significant main effect of time on log VL and no significant between-groups effect. Thirty-five percent of 26 MI+ participants and 41% of 27 Video+ participants had detectable VL at baseline, (χ2(1 df) =.21, p=.65), while 26% of the 19 MI+ and 43% of the 23 Video+ had detectable VL at FU2, (χ2(2 df) =.2.32, p=.31). Similarly, the proportion of people in each condition with decreased, unchanged, or increased log VL did not differ. Only 1 MI+ participant and 3 Video+ participants had significantly decreased log VL, while 14 MI+ and 14 Video+ participants had unchanged log VL, and 4 MI+ and 3 Video+ participants had increased log VL (χ2(2 df) =1.12, p =.57).
Both recruitment and retention were feasibility challenges. It required over 2 years to enroll 56 participants, 2 of whom were mistakenly enrolled despite reporting 100% adherence at baseline. Screening 201 potential participants yielded 76 eligible participants, a 38% gross eligibility rate and a net rate of participants to screens of 28%. The accrual rate was 2 new enrolled participants per month with approximately 8 screened per month. The primary reason for ineligibility was that potential enrollees reported over 85% HAART adherence, and in many cases, reported 100% adherence.
An additional challenge with this crack cocaine-using population was that it took considerable effort to retain participants in the study. Several participants were incarcerated long enough that they timed out of the study and missed either intervention or follow-up visits. Given both the drug dependence and psychiatric disorders that were present in the sample, we often engaged in crisis management (including two emergency hospitalizations for homicidality) and referrals to psychiatric care. Retention was quite good despite these challenges.
As discussed previously, all sessions were reviewed weekly by therapists and supervisors to ensure that each condition was delivered as planned, and that drift across conditions was prevented. In addition, post-session Therapist Checklists indicated that the activities conducted within the 2 conditions differed as planned. Specifically, all of the activities occurred in the MI+ condition, varying as planned by session. In contrast, only role induction, education about HIV adherence, education about cocaine, showing videos, using stem questions to guide debriefing, and providing tip sheets and reading materials occurred in the Video+ condition, consistent with the protocol for that condition. In the Video+ condition, therapists showed no use of reflective listening or other MI skills or strategies; rather, they asked scripted questions as written. All Therapist Checklist items differed significantly by condition (data not shown for χ2 analysis of each activity by each session by condition; all p values <.05).
Pre-treatment, both MI+ and Video+ participants rated their assigned interventions favorably. MI+ participants scored a mean of 35.5 (SD = 5.4) out of 40, while Video+ participants had a mean score of 33.3 (SD = 7.5). Post-treatment, both groups rated their condition higher, with a mean for MI+ of 36.8 (SD = 4.3) and a mean for Video+ of 35.6 (SD = 4.8). These scores indicate that participants rated treatments as equally credible before and after they received them.
Both MI+ and Video+ participants reported total satisfaction scores indicating excellent satisfaction. MI+ participants' satisfaction with their condition was a mean of 8.1 (SD = 3.0; 5 is most satisfied; 30 is least satisfied) at FU1, and was a mean of 8.3 (SD = 2.5) at FU2. Video+ participants' satisfaction with their condition was a mean of 9.3 (SD = 2.7) at FU1 and 9 (SD =1.3) at FU2; none of these means were significantly different. These scores indicate that participants were satisfied with their assigned condition immediately and three months after completing treatment, and that the satisfaction rates did not differ by condition.
In this pilot randomized control trial (RCT), a Motivational Interviewing plus feedback and skills building intervention (MI+) and a Video information plus scripted debriefing intervention (Video+) significantly increased HAART adherence and decreased drug-related problems and days of cocaine use among crack cocaine users with poor adherence. Effect sizes were medium to large. Moreover, these improvements were attained quickly (by the post-treatment follow-up), and were maintained across time (3 months post-treatment), in contrast to prior studies targeting adherence among drinkers in which effects faded after treatment. Additionally, these interventions were credible and satisfying to participants.
We had expected significant differences by condition, but both MI+ and Video+ interventions resulted in significant improvements to both targeted behaviors. As we expected, the MI+ condition was associated with large effects on cocaine use and HAART adherence. We did not anticipate significant main effects in the Video+ condition, because early studies of video education interventions were associated with changes in knowledge and attitudes, but not with changes in treatment compliance (Healton and Messeri 1993). Additionally, Parsons et al., (2007) had used a video information condition as the control condition and found no significant benefit for nonadherent HIV+ drinkers. However, other studies published after this study was underway found that video interventions may be more potent than previously thought. Recent RCTs (Brock and Smith, 2007; Purcell et al., 2007; Sampaio-Sa et al., 2008) and quasi-experimental studies (Brock and Smith, 2007; Wong et al., 2006) have found that informational videos can lead to improvements in HAART knowledge (Brock and Smith 2007; Wong et al., 2006), adherence behavior (Brock and Smith, 2007; Purcell et al., 2007; Sampaio-Sa et al., 2008), and substance use (Gilbert et al., 2008; Purcell et al., 2007). Some studies have found durable effects, with video interventions reducing drug use (Gilbert et al., 2008; Purcell et al., 2007) among HIV+ (Gilbert et al., 2008; Purcell et al., 2007) and mixed serostatus (Chiasson et al., 2009) samples for three to twelve months.
In this study, therapists delivering the Video+ intervention adhered to debriefing scripts and asked stem questions designed to elicit participants' new factual knowledge. However, in response to these questions, participants often gave answers that personalized their own risk, demonstrated that they were considering or planning change, and that they had learned some behavioral skills through vicarious learning. Some participants gave change talk, a correlate of positive outcomes in previous MI research (Miller and Rollnick, 2002). Thus, participants may have received Information, Motivation, and Behavioral Skills benefits from the Video+ intervention despite our intent for it to be primarily informational, and despite the therapists succeeding in delivering it to be completely distinguishable from the MI+ condition.
The results of this pilot study should be considered in light of several limitations. Preliminary power analysis of a similar MI-based intervention for cigarette smoking among HIV+ patients were conducted before the trial. Those analyses indicated that 50 participants would allow more than 90% power to show differences between conditions, but the methodological and analytical differences between that pilot study and this pilot trial encouraged us to revisit the issue of insufficient power to detect real differences between conditions, or the probability of type II error.
In the current trial, given the mean differences and within-group variability observed, 202 participants would be needed to have an 80% chance of rejecting the null hypothesis at the p<.05 level of significance for adherence rates at FU1 and 470 participants would be needed at FU2. Thus, it is possible that the study was underpowered to discern between-groups differences in adherence. Increased power would not likely influence the probability of type II error for the ASI Drug Composite Scores outcomes as effects were not in the predicted direction. To further assess the probability of type II error, we examined between-groups effect sizes because their magnitude is not affected by sample size. Overall, the between-group effect sizes we observed were small and nonsignificant. The high similarity in treatment effect sizes across conditions, and adherence and substance use rates that are clinically comparable across conditions, increase our confidence in the real lack of between-group differences. Furthermore, as a stage 1a/2b project, this pilot study was designed to provide information on the feasibility and promise of the interventions, in order to determine whether either or both interventions should be tested further in a larger clinical trial. Data from this investigation will provide future researchers with important parameter estimates on which to base the methodology of future investigations.
It is possible that time alone led to improvements rather than either intervention. However, in examining the data, there was considerable individual variability in both adherence and cocaine use, and history alone does not seem a likely reason for mean improvements in both behaviors. Even though patient demographic characteristics were unrelated to outcome and therefore were not used as covariates in repeated measures analyses, it is possible that study findings may generalize only to other patient groups including primarily people living with HIV who are unemployed, African-Americans, and heterosexuals. Another limitation was that, once enrolled, some participants received intervention sessions spaced over more weeks than we planned, up to a limit of 12, due to the acuity of health problems, mental disorders, and incarceration in this sample The extended time-frame might have changed the impact of either intervention. Additionally, providing elements such as transportation may limit the generalizability of findings beyond a clinical trial setting. Specifically, it is unknown whether the setting of a clinical trial is required to yield the benefits seen in the Video+ condition. Simply showing videos without the accoutrements of the trial, including personal attention, payment, time spent in an attractive and congenial setting, and other intangible factors may not yield the same benefits.
Neither intervention was related to significant changes in immune health (CD4 count) or reductions in VL. There are several potential explanations for this discrepancy. Little methodological evidence is available regarding the specific level or duration of adherence improvements required to improve VL at specific follow-up time points (Gross et al., 2008). The relationship between adherence level and VL and the "lag time" required to observe biological changes are likely highly confounded by baseline adherence and VL. Additionally, while adherence and VL were significantly inversely related at baseline, adherence and logVL were inversely related, but the relationship was not significant. This may be in part because the relationship between VL and logVL is imperfectly but significantly correlated (r =.66; p<.0001), as expected due to the nature of the log transformation. Therefore, while it is appropriate to examine logVL as the outcome, the truncation of the overall range of values and variance makes it more difficult to observe change. It also is possible that while adherence improved across time, it was insufficient in level or duration to reliably improve these biomarkers. It is also possible that the absolute level of adherence obtained was insufficient to overcome the high VLs and active HIV disease experienced by most participants. This is a limitation of our interventions, because ultimately, adherence interventions must translate improvements in biomarkers. Lastly, we used a self-report measure of adherence. Self-report can result in increased estimates of adherence compared to electronic monitoring, but TLFB methods improve self-report over simpler quantity-frequency measures in the area of alcohol use, and have been useful in other studies of adherence among drug users and drinkers (Parsons et al., 2007; Arnsten et al., 2001; Ingersoll, 2004). While it is possible that self-reported levels of adherence in this study are inflated, there was variability in reported adherence, reducing concern that there was a universal bias toward social desirability. However, it is possible that while adherence appeared to improve significantly in both conditions, the absolute level of improvement may not be accurate.
We required poor adherence for study entry, and this was a challenge for our study. While this may have reduced the risk of ceiling effects, the cost was in feasibility. Recruitment was slow and it required an extended period of time to recruit participants given that the settings were a medium sized city and a small city, neither of which has a large population of HIV+ cocaine users. Additionally, we found that some referral sources "prescreened" their patients, assuming they did not use crack cocaine. Thus, in retrospect, we might have disguised the specific type of drug user being sought; these tactics might have improved our flow of referrals.
Our study had several strengths. The sample included a good proportion of women, African-Americans, and heterosexual participants compared to most other adherence studies. The design was a longitudinal RCT with blinded assessments occurring up to 6 months after randomization. Other strengths included participants' perceptions that both interventions were credible and satisfying. Lastly, the study retained the majority of study participants despite the challenges they presented.
Both the MI+ and Video+ interventions were efficacious at improving adherence and crack cocaine use at post-treatment and they maintained their efficacy 3 months later. This means that this study has developed 2 useful interventions targeting 2 behaviors with better durability than others tested so far. The Video+ intervention should be tested further among underserved sub-populations of drug users taking HAART. The MI+ intervention may also merit further testing among nonadherent patients who have drug use disorders other than cocaine abuse or dependence. In addition, future investigations could provide valuable information by identifying factors that may moderate the impact of treatment on outcome, including baseline severity of drug use and psychiatric disorders and readiness for change.
In the present report, we provided evidence of treatment fidelity based on therapist checklists. Future studies should endeavor to explicate the relationship between treatment processes and outcomes. Currently, our team is objectively coding taped visits for future process-outcomes analyses that will include measures of interpersonal characteristics completed by therapists and participants.
The finding that the Video+ intervention resulted in significant, sustained behavior change is surprising, and has implications for future intervention research. While we employed therapists with master's and doctoral degrees as study therapists, it may be possible to utilize less highly trained staff or even peers to deliver the Video+ intervention, and this is a fruitful area for further investigation. Compared to the MI+ intervention, the Video+ intervention requires fewer resources for implementation and can potentially be made portable to allow patients to view video content at the time and place of their choosing. While recently a few others have found similar results, most adherence and drug use treatment studies have not included video as an active intervention. As a field, we may be overlooking the promise of video-based interventions based on older findings that video-delivered information alone was not enough to achieve behavior change. Future dual-focused adherence and substance use intervention studies could include cost-effectiveness analyses (Gold et al., 1996; Goldie et al., 2003; Tate et al., 2009). Future studies should investigate how, when, and where best to deliver video-based interventions to address HAART adherence and drug use problems that undermine adherence.
*A table showing the components of treatment sessions and overlap with the Therapist Checklist Activities can be found as supplementary materials by accessing the online version of this paper at http://dx.doi.org by entering doi:…
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Climate of New Jersey
Summers in New Jersey are mostly hot and humid, with the average
temperature in July around 82°F (28°C). The winter
months are cold, with a January average of 38°F (3°C).
However, it is not unusual for temperatures to go below freezing
for short periods. Rainfall falls uniformly throughout the
year, with a monthly average of around 50 inches. Snowfall
during the winter season can vary across the regions, but
averages around 12 inches in the south, to 17 inches in central
and north eastern areas. Due to the humid summers, thunderstorms
are not uncommon during these months.
Cost of living in New Jersey
The cost of living in New Jersey is very high, and is reported
to be 30% higher than the US national average. Residents of
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City are better off than many workers in New Jersey, who are
trying to balance lower incomes with increased costs.
New Jersey has seven tax brackets ranging from 1.4% to 8.9%,
with sales tax applicable to nearly all retails sales is a
standard 7%. New Jersey is commonly regarded as being the
highest taxed state in the USA. Ironically it is also considered
to be the state that has the largest disparity in giving and
receiving of federal taxes.
The economy in New Jersey is focused around the pharmaceutical
industry, financial industry and telecommunications. Agriculturally,
New Jersey is a major producer of blueberries, cranberries
and spinach.
Visa requirements for New Jersey
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Whilst moves to New Jersey are likely to be for a longer
period, it is handy to be aware of the Visa Waiver Program
in the USA. This means that if you are a passport holder from
any of 36 qualifying countries, you may enter the USA without
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When moving to New Jersey for a longer period, you will need
to arrange either an immigrant or non-immigrant visa. If you
are planning on relocating to the USA permanently, then the
immigrant visa is required. For temporary stays, you can apply
for the non-immigrant visa. and you should ensure that you
have the following documents to arrange one:
Always check with your local embassy for the exact visa requirements
for your specific situation for staying in the USA, no matter
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have the most up to date information regarding immigration
rules and visa regulations.
No need to ring around international movers
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text: It is of course, a very long time since I left, but not so long that I'm without the lingering memory that we all used to be posted every two or three years and there's always a danger of out-staying both your welcome and usefulness. I've now got to the stage where I've past both here. In fact, I've got to the stage when I'm just getting irritated and angry, instead of being amused with quick wit and challenged by informed and original thinkers. On posting, we all used to be granted the pleasure of a reply to the CO's dining out speech and my, there where some howlers of replies. This is mine.... not a howler, just a note of disappointment and disgust. Whilst the site has no direct affiliation to anyone or anything, the informal "house," charity is Holidays4heroes. It is the bastard orphan child of this site and something to be very proud of. It embodies the , "buddy," or "mates helping mates," philosophy of helping one another out; what the Gurkhas would call the "Kaida," or the "Way." Unfortunately, (although you wouldn't think it looking at most of the posts), there are actually only a very few number of decent and generous souls who help and contribute on a sustained and repeated basis. The rest do the square root of fvck all. Whats grabbed me by the balls and made me squeal like a little girl with her hand trapped in a slamming door? Last weekend 5 teenagers tabbed over 14 peaks in Snowdonia to raise £1500 for Hols4heroes, ( http://www.arrse.co.uk/Forums/viewtopic/t=152114.html ) Three weeks ago, a bunch of teenagers from the same school raised £1200. The thread on their last effort solicited 736 views and only 3 messages of support. Three people out of the grand standing "I've been there and done it," membership could be bothered to say "good effort, thanks." Well, I'm embarrassed and ashamed to be associated with this site - most of you are not fit to stand in the shadows of those teenage kids. They're not hanging around bars complaining about what should be done... they're doing it and making a difference. So, thank you to those individuals who have made it a fun, upbeat and rewarding experiance. The rest of you losers can mostly fvck off. Bumper


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Hotels near Slavic Island
Search hotels near Slavic Island in Prague
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Trending now in Prague
- Most bookedBest Western Hotel Pav
71 people looked at this hotel in the last hour
Most recent review
"Basic hotel (as we expected for the money) but clean and comfortable. Friendly and helpful staff. Excellent choice at breakfast. Within walking distance of all the city has to offer."
A Traveller, Feb 2017, GB
59 people looked at this hotel in the last hour
Most recent review
"Helpful staff, amazing old building in central location."
A Traveller, Nov 2016, GB
45 people looked at this hotel in the last hour
Most recent review
"Overall had a great stay. The staff were all very friendly and helpful, even if they were very busy at times! Our private room was very comfortable and clean. Our only issue was that we had a shared bath and there were definitely too many people for the one bathroom on the floor--we often had to ..."
A Traveller, Jun 2015, AS
41 people looked at this hotel in the last hour
Most recent review
"Great stay and exteremly comfortable and roomy. Perfect place to stretch out and relax! Had a nice time and enjoyed the proximity to all the great sights and locations."
A Traveller, Jan 2016, US
19 people looked at this hotel in the last hour
Most recent review
"Very nice room. Modern design inside and very clean. Near great bars and restaurants. It does get a bit noisy at night from clubs downstairs. Also bring your own soap and coffee. They will not provide these. I would stay here again."
A Traveller, Sep 2014, US
- Centrum Apartments PstrossovaNo Guest Reviews yet
12 people looked at this hotel in the last hour
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6 people looked at this hotel in the last hour
Hotels in Prague near Slavic Island
Are you looking for a cheap Slavic Island hotel, a 5 star Slavic Island hotel or a family friendly Slavic Island hotel? You just landed in the best site to find the best deals and offers on the most amazing accommodations for your stay.
When you search for hotels near Slavic Island with Hotels.com, you need to first check our online map and see the distance you will be from Slavic Island, Czech Republic.
Our maps are based on hotel search and display areas and neighborhoods of each hotel so you can see how close you are from Slavic Island and refine your search within Prague or Czech Republic based on closest public transportation, restaurants and entertainment so you can easily get around the city. All the hotels details page show an option for free or paid onsite parking.
If you wish to see the hotels with the highest featuring discounts and deals near Slavic Island, simply filter by price/ average nightly rate. We recommend you filter by star rating and read our genuine guest reviews so you can get the best quality hotel with the best discount.
One of the new features on Hotels.com guest reviews is that also show reviews from Expedia for Slavic Island hotels and the TripAdvisor Slavic Island hotels reviews so you can make sure that you checking with a reliable source. See the review scores on our Prague hotel information pages.
Make the most out of your family vacation when you book your accommodation with Hotels.com – book your hotel near Slavic Island, Prague after reviewing the facilities and amenities listed for each hotel.
After booking your hotel near Slavic Island, expect to receive your reservation confirmation in the mail in less than 10 minutes. The confirmation email contains more information on all nearby attractions, local directions and weather forecast, so you can better plan the days during your trip.
After getting the best hotel rates you can still save more by winning 1 free night! That's right, book 10 nights in any hotel near Slavic Island, Prague and after you sign up for the Welcome Rewards program, you are eligible hotel you receive 1 night free*
The best hotel deals are here: We have Slavic Island hotel deals, Slavic Island last minute deals and offers to get you the cheapest Slavic Island hotel with our lowest price guarantee.
Prague travel guides
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Where to eat in Prague – your go-to guide for grub
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A Japanese student was charged yesterday with the rape and murder of the British teacher Lindsay Hawker in 2007.
Tatsuya Ichihashi, 30, was arrested last month after more than two-and-a-half years on the run.
Ms Hawker's father Bill said that his family was "relieved" that the prime suspect would now face trial.
Mr Ichihashi was arrested at a ferry port in Osaka, southern Japan, after a surgeon came forward with information suggesting that he had had surgery to change his appearance. It is thought he may have been attempting to board a ferry to Okinawa.
After a month of questioning


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Doctor Who TV Show Watchlist
Season 8, Episode 12 The Claws of Axos
"The Claws of Axos," Part 2. The Doctor discovers that the spaceship is a living creature. Dr. Who: Jon Pertwee.
Cast & Details See all »
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