bluuebunny/crossref_metadata_2025 huggingface dataset:
Do changes in beliefs and behaviours moderate improvement in insomnia after acquired brain injury?
Authors: Ford Marthe E. , Verkaik Frank , Bouwmeester Samantha , Geurtsen Gert J.
Published: May 2024

Key mechanisms of change in cognitive behavioural therapy for insomnia in the general population encompass changing sleep‐related beliefs and behaviours. In a population with acquired brain injury, cognitive behavioural therapy for insomnia is effective as well, but little is known about the mechanisms of change. The aim of this study was to evaluate how changing sleep‐related beliefs and behaviours were associated with improvement in insomnia following blended cognitive behavioural therapy for insomnia in a population with acquired brain injury. A secondary analysis was performed on data of a randomized–controlled trial, including 24 participants that received blended cognitive behavioural therapy for insomnia, and 24 participants that received treatment as usual. Results showed that following blended cognitive behavioural therapy for insomnia, significantly more participants improved on dysfunctional beliefs and sleep‐related behaviours and this was associated to improvement in insomnia severity. For sleep‐related behaviours, the association between improvement on behaviour and improvement on insomnia was significantly moderated by blended cognitive behavioural therapy for insomnia. However, the relation between dysfunctional beliefs and insomnia was not moderated by type of treatment. Similar results were found for acquired brain injury‐adapted versions of the questionnaires in which up to half of the items were excluded as they could be regarded as not dysfunctional for people with acquired brain injury. These results show that improvement on insomnia severity is related to improvement in dysfunctional beliefs and behaviours, and cognitive behavioural therapy for insomnia efficacy may be moderated by the improvement in behaviours in particular. A focus on these behaviours can enhance treatment efficacy, but caution is needed regarding the behaviours that may reflect adequate coping with the consequences of the acquired brain injury.
Existence of a Periodic and Seasonal INAR Process
Authors: Ispány Márton , Bondon Pascal , Reisen Valdério Anselmo , Prezotti Filho Paulo Roberto
Published: May 2024

A spectral criterion involving the model parameters is given for the existence and uniqueness of a periodically correlated and seasonal non‐negative integer‐valued autoregressive process. The structure of the mean and covariance functions of the periodically stationary distribution of the model is derived using its implicit state‐space representation. Two infinite series representations for the process, the moving average, and the immigrant generation, are established. Based on the latter representation, a novel and parallelizable simulation method is proposed to generate the process.
Soil microbial identity explains home‐field advantage for litter decomposition
Authors: Shigyo Nobuhiko , Umeki Kiyoshi , Hirao Toshihide
Published: May 2024

Unraveling the mechanisms of home‐field advantage (HFA) is essential to gain a complete understanding of litter decomposition processes. However, knowledge of the relationships between HFA effects and microbial communities is lacking.

To examine HFA effects on litter decomposition, we identified the microbial communities and conducted a reciprocal transplant experiment, including all possible combinations of soil and litter, between sites at two elevations in cool‐temperate forests.

Soil origin, rather than HFA, was an important factor in controlling litter decomposition processes. Microbiome‐wide association analyses identified litter fungi and bacteria specific to the source soil, which completely differed at a low taxonomic level between litter types. The relative abundance of these microbes specific to source soil was positively correlated with litter mass loss.

The results indicated that the unique relationships between plant litter and soil microbes through plant–soil linkages drive litter decomposition processes. In the short term, soil disturbances resulting from land‐use changes have the potential to disrupt the effect of soil origin and hinder the advancement of litter decomposition. These findings contribute to an understanding of HFA mechanisms and the impacts of land‐use change on decomposition processes in forest ecosystems.
Levels of photoactivated phototropin modulate signal transmission during the chloroplast accumulation response
Authors: Hirano Satoyuki , Noguchi Minoru , Thagun Chonprakun , Nishio Haruki , Kodama Yutaka
Published: May 2024

Chloroplasts accumulate in regions of plant cells exposed to irradiation to maximize light reception for efficient photosynthesis. This response is mediated by the blue‐light receptor phototropin. Upon the perception of blue light, phototropin is photoactivated, an unknown signal is transmitted from the photoactivated phototropin to distant chloroplasts, and the chloroplasts begin their directional movement. How activated phototropin initiates this signal transmission is unknown. Here, using the liverwort Marchantia polymorpha, we analysed whether increased photoactive phototropin levels mediate signal transmission and chloroplast behaviour during the accumulation response. The signal transmission rate was higher in transgenic cells overexpressing phototropin than in wild‐type cells. However, the chloroplast directional movement was similar between wild‐type and transgenic cells. Consistent with the observation, increasing the amount of photoactivated phototropin through higher blue‐light intensity also accelerated signal transmission but did not affect chloroplast behaviour in wild‐type cells. Photoactivation of phototropin under weak blue‐light led to the greater protein level of phosphorylated phototropin in cells overexpressing phototropin than in wild‐type cells, whereas the autophosphorylation level within each phototropin molecule was similar. These results indicate that the abundance of photoactivated phototropin modulates the signal transmission rate to distant chloroplasts but does not affect chloroplast behaviour during the accumulation response.
Defining large‐scale arid island vegetation recovery targets through evaluating a reference ecosystem within an archipelago extent
Authors: Velasco Nicolás , Calle‐Loor Anna , Jaramillo Díaz Patricia
Published: May 2024

Island ecological restoration presents challenges in establishing historical frames and reference ecosystems. Our study takes place in the Galapagos Islands and focuses on North Seymour (NS), recognized as a reference ecosystem for Baltra Island, which has suffered significant degradation. We assessed NS's arid plant community, comparing it with early twentieth‐century records. A first survey identified that dominant woody species on NS include native Bursera graveolens, Cordia lutea, Castela galapageia, Parkinsonia aculeata, and Opuntia echios, while Cleome viscosa is the only exotic species registered. A second survey divided both islands into evenly distributed plots, recording adults and juveniles of the five dominant species from the first survey. NS showed a structured community with higher species richness and density compared to Baltra. Castela galapageia prevailed in disturbed areas on Baltra. Juvenile regeneration was scarce on both islands. NS exhibited high species richness throughout, while Baltra had only two areas with similar high richness. Co‐occurrence analysis revealed significant associations between P. aculeata and B. graveolens on both islands. However, Baltra's network displayed missing links, indicating the need for restoration efforts. In conclusion, the structured plant community of NS can serve as one of the reference ecosystems needed for framing a restoration model for Baltra.
Variation in labor skills and offshoring across time zones
Authors: Prasad Alaka Shree , Mandal Biswajit
Published: May 2024

We check the role of time‐zone difference on offshoring of service tasks when the skill of labors varies between the partner countries. We frame a model where partner countries are located in non‐overlapping time zones, and the skill level of the partner‐country labors is lower. In our model, service production is divided into two sequential stages, and output is a supermodular function of the skill of labors and time. The problem of the producers is to choose between domestic production and offshoring. Domestic production employs high‐skill labors though the time management is inefficient. On the other hand, offshoring to a non‐overlapping time zone helps to work round the clock and reduce the cost, but the lower expertise of skilled labor lowers the output. In such a framework, we check conditions for beneficial offshoring. The condition derived in our analysis provides combinations of skill and time that can make offshoring beneficial. Results show that offshoring across time zones is beneficial even when the complexity of stages of production vary. However, only the relatively less‐critical task is offshored. We further find that availability of domestic low‐skill labor does not benefit the firm, while foreign low‐skill labor may be beneficially utilized through time‐zone exploitation.
Epidemiology of cutaneous leishmaniasis in children of Khyber Pakhtunkhwa, Pakistan
Authors: Lu Chao , Khan Khurshaid , Khan Fawad , Shah Safeer Ullah , Jamal Muhsin , Badshah Noor
Published: May 2024

Objectives

In Pakistan, cutaneous leishmaniasis is an emerging tropical disease and a very high number (>70%) of children are afflicted by this marring infection. This study aimed to scrutinise the prevalence, spatial distribution and socio‐demographic and behavioural risk factors associated with cutaneous leishmaniasis in children aged <5–15  years in Khyber Pakhtunkhwa.

Methods

A total of 1, 559 clinically confirmed records of children diagnosed with cutaneous leishmaniasis (January–December) from 2020 and 2022 were obtained from selected district hospitals. In addition, a risk factors‐related questionnaire was administered to 1, 011 households (400 in 2020 and 611 in 2022) in nine districts during a household survey.

Results

The maximum number of cutaneous leishmaniasis cases was recorded in 2022 (n = 877, 56.25%) as compared to 2020 (n = 682, 43.75%). The hospital records showed a greater number of male patients in the 2022 cohort (n = 603, 68.76%). The highest number of cases were observed in children aged 5–9 years in 2022 (n = 282, 32.16%) and 2020 (n = 255, 37.39%). In 2020 and 2022, cutaneous leishmaniasis cases showed peak aggregation in March (n = 118, 17.3%) and January (n = 322, 36.72%). From a spatial analysis, the maximum number of cutaneous leishmaniasis cases was recorded at 59–1700 m elevation in various land‐use/land‐cover and climatic regions with quaternary alluvium rock formations. A multivariate logistic regression model analysis of risk factors from the households survey suggested that age group, socio‐economic status, construction materials of the house, use of insect repellents, Afghan refugee camps in the village/district, knowledge and biting times of sand flies, frequent use of mosquito bed nets, presence of domestic animals in the house, knowledge of the transmission period and peak month of leishmaniasis infection increased the risk of acquiring cutaneous leishmaniasis (p  value < 0.05).

Conclusion

Our analysis demonstrated that cutaneous leishmaniasis in children is influenced by a variety of environmental, socio‐demographic and behavioural risk factors in Khyber Pakhtunkhwa. The increase in recorded cases of cutaneous leishmaniasis in children in 2022 compared to 2020 suggests that the infection likely extended to new foci in the province.
Views of general practice staff on sharing general practice data for research: a scoping review protocol
Authors: Green Heidi , Fabrianesi Belinda , Carolan Lucy , Braunack-Mayer Annette
Published: May 2024

Objective:

The objective of this scoping review is to understand the range and types of evidence in relation to the views of general practitioner and other general practice staff on sharing general practice data for research purposes.

Introduction:

The use of general practice data for research has the potential to drive transformative improvements in health care. The vast amount of patient data collected in general practice is valuable and provides researchers with data to conduct large-scale studies and generate evidence that can inform policy decisions, support the development of personalized medicine, and enhance patient outcomes. However, despite there being clear benefits to using general practice data for research, there are also potential harms, such as data misuse, loss of trust between the general practitioner and patient, and data breaches.

Inclusion criteria:

This scoping review will focus on the views of general practice staff, including general practitioners, practice nurses, and practice managers, about sharing general practice data for the purposes of research. This scoping review will exclude sources of evidence that are conducted outside of the general practice setting, and papers that report on public, patient, or community views on data sharing.

Methods:

This scoping review will be conducted in accordance with JBI methodology for scoping reviews. A 3-step search strategy will be used to acquire both published and unpublished sources of evidence. Two reviewers will independently select sources of evidence in line with the inclusion and exclusion criteria. No limits on the date of the search or language will be applied. Data will be extracted and the results will be summarized descriptively and presented in a tabular format.

Review registration:

Open Science Framework https://osf.io/49yw5
Role of tin clustering in band structure and thermodynamic stability of GeSn by atomistic modeling
Authors: Karthikeyan Sengunthar , Hudait Mantu K.
Published: May 2024

Synthesis of device-quality GeSn materials with higher Sn compositions is hindered by various factors, such as Sn segregation, clustering, and short-range ordering effects. In the present work, the impact of the clustering of Sn atoms in a GeSn semiconductor alloy was studied by density functional theory using SG15 pseudopotentials in a Synopsys QuantumATK tool, where the thermodynamic stability, effective band structure, indirect and direct bandgaps, and density of states (DOS) were computed to highlight the difference between a cluster-free random GeSn alloy and a GeSn alloy with Sn–Sn clusters. A 54-atom bulk Ge1–xSnx (x = 3.71%–27.77%) supercell was constructed with cluster-free and a first nearest neighbor Sn–Sn clustered GeSn alloy at each composition for this work. Computation using the generalized gradient approximation exchange-correlation functional showed that the thermodynamic stability of GeSn was reduced due to the clustering of Sn, which increased the formation energy of the GeSn alloys by increasing the Hartree potential energy and exchange-correlation energy. Moreover, with the effective band structure of the GeSn material at a Sn composition of ∼22%, both direct (Eg,Γ) and indirect (Eg,L) bandgaps decreased by a large margin of 40.76 and 120.17 meV, respectively, due to Sn–Sn clustering. On the other hand, Eg,Γ and Eg,L decrease is limited to 0.5 and 12.8 meV, respectively, for Sn composition of ∼5.6%. Similar impacts were observed on DOS, in an independent computation without deducing from the electronic band structure, where the width of the forbidden band reduces due to the clustering of Sn atoms in GeSn. Moreover, using the energy bandgaps of GeSn computed with the assumption of it being a random alloy having well-dispersed Sn atoms needs revision by incorporating clustering to align with the experimentally determined bandgap. This necessitates incorporating the effect of Sn atoms clustered together at varying distributions based on experimental characterization techniques such as atom probe tomography or extended x-ray absorption fine structure to substantiate the energy bandgap of the GeSn alloy at a particular composition with precision. Hence, considering the effect of Sn clusters during material characterization, beginning with the accurate energy bandgap characterization of GeSn would help in mitigating the effect of process variations on the performance characteristics of GeSn-based group IV electronic and photonic devices such as varying leakage currents in transistors and photodiodes as well as the deviation from the targeted wavelength of operation in lasers and photodetectors.
Discordant results between Xpert MTB/RIF assay and Bactec MGIT 960 culture system regarding the detection of rifampin-resistant
Mycobacterium tuberculosis
isolates in Wenzhou, China
Authors: He Guiqing , Zheng Qingyong , Wu Jing , Wu Lianpeng , Geng Zhi , Jiang Guanglu , Huang Hairong , Jiang Xiangao , Yu Xia
Published: May 2024

This study aimed to assess the possible causes of discordant results between Xpert MTB/RIF (Xpert) and Bactec MGIT 960 Culture System (MGIT960) regarding rifampicin (RIF) susceptibility in
Mycobacterium tuberculosis
. Patients with previous RIF-resistant tuberculosis who were admitted to Wenzhou Central Hospital from January 2020 to December 2022 were enrolled. The isolates obtained from these patients were subjected to RIF susceptibility tests using Xpert and MGIT960, and the minimum inhibitory concentration (MIC) of RIF was determined by the MYCOTB MIC plate test. Additionally, molecular docking and molecular dynamics (MD) simulations were performed to evaluate the binding efficacy of rpoB and RIF based on rpoB mutations detected in the isolates with discordant RIF susceptibility results. A total of 28 isolates with discordant RIF susceptibility test results were detected, 15 of them were RIF susceptible with MICs ≤ 0.5 µg/mL. Twelve out of 15 isolates contained borderline RIF resistance-associated mutations [L430P (
n
= 6), H445N (
n
= 6)], 1 isolate had D435Y and Q429H double mutation, and the remaining 2 isolates had a silent (Q432Q) mutation. Compared with the affinity of RIF toward the wild type (WT) (−45.83 kcal/mol) by MD, its affinity toward L452P (−55.52 kcal/mol), D435Y (−47.39 kcal/mol), L430P (approximately −69.72 kcal/mol), H445N (−49.53 kcal/mol), and Q429H (−55.67 kcal/mol) increased. Borderline RIF resistance-associated mutations were the main cause for the discordant RIF susceptibility results between Xpert and MGIT960, and the mechanisms of the resistance need further investigated.

IMPORTANCE

This study is aimed at assessing discordant results between Xpert MTB/RIF (Xpert) assay and Bactec MGIT 960 Culture System (MGIT960) regarding the detection of rifampicin (RIF)-resistant
Mycobacterium tuberculosis
isolates in Wenzhou, China. The discordant results of RIF between these two assays were mainly caused by borderline RIF resistance-associated mutations, subsequently by silent mutations of rpoB. Borderline RIF resistance- associated mutations detected in our study were demonstrated to not be affected by the affinity of rpoB and RIF by molecular dynamics, and the mechanism of resistance was needed to be clarified. For the discordant results of RIF by Xpert and MGIT960 that occurred,
rpoB
DNA sequencing was recommended to investigate its association with resistance to RIF.
Rapid biotransformation of STW 5 constituents by human gut microbiome from IBS- and non-IBS donors
Authors: Thumann Timo A. , Pferschy-Wenzig Eva-Maria , Kumpitsch Christina , Duller Stefanie , Högenauer Christoph , Kump Patrizia , Aziz-Kalbhenn Heba , Ammar Ramy M. , Rabini Sabine , Moissl-Eichinger Christine , Bauer Rudolf
Published: May 2024

STW 5, a blend of nine medicinal plant extracts, exhibits promising efficacy in treating functional gastrointestinal disorders, notably irritable bowel syndrome (IBS). Nonetheless, its effects on the gastrointestinal microbiome and the role of microbiota on the conversion of its constituents are still largely unexplored. This study employed an experimental
ex vivo
model to investigate STW 5’s differential effects on fecal microbial communities and metabolite production in samples from individuals with and without IBS. Using 560 fecal microcosms (IBS patients,
n
= 6; healthy controls,
n
= 10), we evaluated the influence of pre-digested STW 5 and controls on microbial and metabolite composition at time points 0, 0.5, 4, and 24 h. Our findings demonstrate the potential of this
ex vivo
platform to analyze herbal medicine turnover within 4 h with minimal microbiome shifts due to abiotic factors. While only minor taxonomic disparities were noted between IBS- and non-IBS samples and upon treatment with STW 5, rapid metabolic turnover of STW 5 components into specific degradation products, such as 18β-glycyrrhetinic acid, davidigenin, herniarin, 3-(3-hydroxyphenyl)propanoic acid, and 3-(2-hydroxy-4-methoxyphenyl)propanoic acid occurred. For davidigenin, 3-(3-hydroxyphenyl)propanoic acid and 18β-glycyrrhetinic acid, anti-inflammatory, cytoprotective, or spasmolytic activities have been previously described. Notably, the microbiome-driven metabolic transformation did not induce a global microbiome shift, and the detected metabolites were minimally linked to specific taxa. Observed biotransformations were independent of IBS diagnosis, suggesting potential benefits for IBS patients from biotransformation products of STW 5.

IMPORTANCE

STW 5 is an herbal medicinal product with proven clinical efficacy in the treatment of functional gastrointestinal disorders, like functional dyspepsia and irritable bowel syndrome (IBS). The effects of STW 5 on fecal microbial communities and metabolite production effects have been studied in an experimental model with fecal samples from individuals with and without IBS. While only minor taxonomic disparities were noted between IBS- and non-IBS samples and upon treatment with STW 5, rapid metabolic turnover of STW 5 components into specific degradation products with reported anti-inflammatory, cytoprotective, or spasmolytic activities was observed, which may be relevant for the pharmacological activity of STW 5.
High-Frequency Hall Effect and Transverse Electric Galvanomagnetic Waves in Current-Biased 2D Electron Systems
Authors: Petrov A. S. , Svintsov D.
Published: May 2024

We derive the electrodynamic conductivity tensor for 2DESs with dc drift with account for the high-frequency Hall effect (interaction of dc current with ac magnetic field). We demonstrate the limitations of the quasistatic approach which neglects this effect. With the help of electrodynamic conductivity we find a novel two-dimensional transverse electric (TE) electromagnetic mode. This mode is non-reciprocal with dispersion $$\omega = {\mathbf{k}}{{{\mathbf{u}}}_{0}}$$ and manifests itself in lowering the reflection coefficient of 2DES at the resonance frequency. In addition, we predict birefringence of an incident evanescent TE wave on a 2DES system with drift and find hints of Cerenkov amplification in the low frequency limit. We discuss the limiting cases when the quasistatic approach is suitable.
Improving knowledge of rare disorders since 1993: the Australian Paediatric Surveillance Unit
Authors: Elliott Elizabeth J , Teutsch Suzy , Nunez Carlos , Morris Anne , Eslick Guy D
Published: May 2024

The Australian Paediatric Surveillance Unit (APSU), established in 1993 to address the paucity of national data on rare childhood disorders, has become an invaluable research resource. It facilitates prospective, active surveillance for a variety of rare disorders, with monthly reporting by ~1500 paediatricians, who are invited to notify incident cases and provide demographic and clinical data. APSU is highly collaborative (used by >400 individuals/organisations), patient-informed and productive (>300 publications). In 30 years, 72 studies have been initiated on rare infections, and genetic, psychological and neurological disorders, and injuries. Return rates of monthly report cards were >90% for 30 years and paediatricians have provided data for >90% of notified cases. Although there are limitations, including case underascertainment in remote regions, APSU often provides the only available national data. APSU has assisted the government in reporting to the WHO, developing national strategies, informing inquiries and investigating disease outbreaks. APSU data have informed paediatrician education, practice, policy, and service development and delivery. APSU was integral in establishing the International Network of Paediatric Surveillance Units (INoPSU) and supporting development of other units. APSU’s expanded remit includes one-off surveys, hospital audits, systematic reviews, studies on the impacts of rare disorders on families, surveillance evaluations, and joint studies with INoPSU members. Paediatricians value the APSU, reporting that APSU data inform their practice. They must be congratulated for an outstanding collective commitment to the APSU, in providing unique data that contribute to our understanding of rare disorders and support optimal, evidence-based care and improved child health outcomes.
Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study
Authors: Fang Zhe , Rossato Sinara Laurini , Hang Dong , Khandpur Neha , Wang Kai , Lo Chun-Han , Willett Walter C , Giovannucci Edward L , Song Mingyang
Published: May 2024

Objective

To examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality.

Design

Population based cohort study.

Setting

Female registered nurses from 11 US states in the Nurses’ Health Study (1984-2018) and male health professionals from all 50 US states in the Health Professionals Follow-up Study (1986-2018).

Participants

74 563 women and 39 501 men with no history of cancer, cardiovascular diseases, or diabetes at baseline.

Main outcome measures

Multivariable Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for the association of ultra-processed food intake measured by semiquantitative food frequency questionnaire every four years with all cause mortality and cause specific mortality due to cancer, cardiovascular, and other causes (including respiratory and neurodegenerative causes).

Results

30 188 deaths of women and 18 005 deaths of men were documented during a median of 34 and 31 years of follow-up, respectively. Compared with those in the lowest quarter of ultra-processed food consumption, participants in the highest quarter had a 4% higher all cause mortality (hazard ratio 1.04, 95% confidence interval 1.01 to 1.07) and 9% higher mortality from causes other than cancer or cardiovascular diseases (1.09, 1.05 to 1.13). The all cause mortality rate among participants in the lowest and highest quarter was 1472 and 1536 per 100 000 person years, respectively. No associations were found for cancer or cardiovascular mortality. Meat/poultry/seafood based ready-to-eat products (for example, processed meat) consistently showed strong associations with mortality outcomes (hazard ratios ranged from 1.06 to 1.43). Sugar sweetened and artificially sweetened beverages (1.09, 1.07 to 1.12), dairy based desserts (1.07, 1.04 to 1.10), and ultra-processed breakfast food (1.04, 1.02 to 1.07) were also associated with higher all cause mortality. No consistent associations between ultra-processed foods and mortality were observed within each quarter of dietary quality assessed by the Alternative Healthy Eating Index-2010 score, whereas better dietary quality showed an inverse association with mortality within each quarter of ultra-processed foods.

Conclusions

This study found that a higher intake of ultra-processed foods was associated with slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases. The associations varied across subgroups of ultra-processed foods, with meat/poultry/seafood based ready-to-eat products showing particularly strong associations with mortality.
Early versus late parenteral nutrition in term and late preterm infants: a randomised controlled trial
Authors: Moon Kwi , McKinnon Elizabeth , Croft Kevin , Mori Trevor A , Simmer Karen , Patole Sanjay , Rao Shripada
Published: May 2024

Background

There is limited evidence regarding the optimal time to commence parenteral nutrition (PN) in term and late preterm infants.

Design

Single-centre, non-blinded, exploratory randomised controlled trial.

Setting

A level-3 neonatal unit in a stand-alone paediatric hospital.

Patients

Infants born ≥34 weeks of gestation and ≤28 days, who needed PN. Eligible infants were randomised on day 1 or day 2 of admission.

Interventions

Early (day 1 or day 2 of admission, N=30) or late (day 6 of admission, N=30) PN.

Main outcome measures

Plasma phenylalanine and F2-isoprostane levels on day 4 and day 8 of admission. Secondary outcomes were amino-acid and fatty-acid profiles on day 4 and day 8, and clinical outcomes.

Results

The postnatal age at randomisation was similar between the groups (2.3 (SD 0.8) vs 2.3 (0.7) days, p=0.90). On day 4, phenylalanine levels in early-PN infants were higher than in late-PN (mean (SD) 62.9 (26.7) vs 45.5 (15.3) µmol/L; baseline-adjusted percentage difference 25.8% (95% CI 11.6% to 39.9%), p<0.001). There was no significant difference in phenylalanine levels between the two groups on day 8. There was no significant difference between the groups for F2-isoprostane levels on day 4 (early-PN mean (SD) 389 (176) vs late-PN 419 (291) pg/mL; baseline-adjusted percentage difference: −4.4% (95% CI −21.5% to 12.8%) p=0.62) and day 8 (mean (SD) 305 (125) vs 354 (113) pg/mL; adjusted mean percentage difference −16.1 (95% CI −34.1 to 1.9) p=0.09).

Postnatal growth restriction for weight was less severe in the early-PN group (change in weight z-score from baseline to discharge: −0.6 (0.6) vs −1.0 (0.6); p=0.02). The incidence of hyperglycaemia was greater in the early-PN group (20/30 (66.7%) vs 11/30 (36.7%), p=0.02).

Conclusions

The timing of the commencement of PN did not seem to affect the degree of oxidative stress in critically ill term and late preterm infants. The effect of transiently high plasma phenylalanine with early PN on clinical outcomes requires further investigation.

Trial registration number

ACTRN12620000324910.
P073 Do financial incentives (FI) and motivational interviewing (MI) promote adherence in vertically infected HIV positive adolescents?
Authors: Charania Asad , Webb Helen , Cox David , Jackson Charlotte , Prime Katia
Published: May 2024

Introduction

Funding was received for 10 patients to participate in a FI & MI scheme aiming to achieve viral load (VL) reduction.

Methods

Eligibility criteria: 16-25 years, vertically acquired HIV-1 infection, CD4 <350 cells/ul, agrees to ART with treatable virus, poor adherence since diagnosis & failure to achieve VL <40 copies/ml. FIs received for VL reductions ≥ 1 log weeks 2 & 4 and VL <40 week 8, 3/12, 6/12, 9/12 and 1 year. £20 given for VL reduction ≥ 1 log and £50 for VL <40. Adherence support with motivational interviewing (MI) was provided at each visit.

Results

8 patients enrolled 1/8/12–1/12/15. 5 females, median age 24 years (range 20–26). Mean baseline VL 35750, this reduced to 1390 (mean VL reduction 21842 copies/ml). 5/8 patients achieved VL <40. N=1 had never achieved VL <40, yet during the scheme achieved VL <40 for 8/12. 3 patients were unable to achieve VL <40. Their lowest VL was 71, 883 and 90, representing a 1–2 log VL drop from baseline after 52/12, 4/12 and 1/12, respectively. 1 patient passed away following a Steven-Johnson reaction, never achieving VL <40. Financial incentives given totalled £640.

Discussion

Despite widely available treatment options for HIV, preventable deaths still occur each year due to a lack of adherence. Within this cohort, 5 patients were able to achieve periods of VL <40 after years of detectability. These results highlight that FI in conjunction with MI, may have a role in improving adherence for the adolescent HIV infected population.
P083 How do HIV testing initiatives impact on HIV testing rates and diagnosis in primary care?
Authors: Rickwood Lucinda , Perera Sean , Soni Suneeta , Dean Gillian
Published: May 2024

Introduction

Undiagnosed HIV leads to late presentation, increased morbidity, and contributes to onward transmission. It is estimated that in our area approximately 17% of those living with HIV are undiagnosed. Little is known about the impact of National HIV Testing Week (NHTW) initiatives in general practice (GP). In 2016 we implemented a ‘pop-up’ message alerting GPs that it was NHTW, with a ‘one-click’ pathway to adding an HIV-test to bloods requested for other reasons.

Methods

Number of HIV tests carried out in GP and new HIV diagnoses made were collected between 20thAugust 2016 and 20thFebruary 2017 and separated into the time period spanning 3 months pre-NHTW, NHTW itself and 3 months post-NHTW.

Results

464 HIV tests were performed in 37 GP practices in the pre-NHTW period (approx. 36/week), 96 test during NHTW and 534 tests in 3 month post-NHTW (approx. 41/week). 1 HIV-diagnosis was made in GP during the pre-NHTW period (c.f. 20 across all services), no new diagnoses in NHTW and 1 case (7 across all services) in the 3 month post-NHTW period.

Discussion

Testing initiatives result in greater awareness across the city and an increase in HIV testing, which was sustained, although no increase in new HIV diagnoses. The decrease in HIV diagnoses in this study reflects the national trend of a reduction in HIV diagnoses despite increased testing; this is attributed partly to the efficacy and increased use of Pre-exposure prophylaxis (PrEP).
P087 Information gaps for HIV positive patients detained in immigration referral centres (IRCS)
Authors: Scofield Sara , Priestley Cecilia , Fowler Jane
Published: May 2024

Introduction

HIV is over-represented in this high risk, vulnerable population. Detainees often have complex health needs which present challenges to chronic disease management. Transfer of information between care providers is crucial to maintain appropriate management of these vulnerable patients. We aimed to look at the information shared between health care providers for detainees referred to our HIV service.

Methods

We reviewed all referrals from the local IRC to our HIV service between September 2014 and January 2017, looking at information provided on the IRC referral letter and supplied by their previous care provider.

Results

Out of 24 referrals, the notes were available for 17. CD4 count, HIV RNA and HAART regimen were missing from 9, 10 and 1 of the IRC referrals respectively. Information was missing about adherence in 9, treatment interruption in 10, and co-medications in 11 referrals. 9 reported requesting information from previous HIV provider; this was not received in 4 cases. In the 11 cases where information was received from the previous HIV care provider, information was not included on co-medications in 8, hepatitis B status in 6, hepatitis C status in 8, resistance testing in 5, and HLAB*5701 status in 6 summaries.

Discussion

We highlight the need for standardised information transfer between care providers in these patients. In Dec 2016 we devised a form to send to previous HIV service providers to collect the required information for safe prescribing prior to their GUM appointment. We plan to review whether this improves the quality of information received.
P088 Antiretroviral treatment algorithm compliance: a regional audit and survey
Authors: Howe Bridie , White Conrad , Bushby Stephen , Lavender Thomas , Price Ashley , Foster Jonathan , Elawad Babiker , Hussey Jane
Published: May 2024

Introduction

In 2015 BHIVA introduced new treatment guidelines and NHS England produced an algorithm for antiretroviral (ARV) treatment initiation, with a requirement to have regional and local multidisciplinary team (MDT) arrangements to aid decision making.

Methods

6 services within our regional clinical HIV network carried out a retrospective audit of 20 (or total if fewer) cases started on ARVs in 2015, and completed a survey of each centres MDT arrangements. Data from each centre was collated and analysed regionally.

Results

Local MDT arrangements varied widely in number and composition of professionals. All centres reported a change in practice and discussed non-first line regimens. 98 case notes were included. 43/98 started due to CD4 <350, 17 for primary HIV infection or symptoms, 16 for Treatment as Prevention, and 14 patient choice. An increase in abacavir/lamivudine based regimens was seen after algorithm instigation in April 2015. Mental illness, HIV viral load >100K, patient choice and shift work were the commonest reasons for choosing non-first-line regimen. 90% overall compliant with the NHS England treatment algorithm.

Discussion

MDT arrangements and interpretation of the algorithm varied in our network. Prescribing practices have changed throughout the region since algorithm introduction. Further work is needed as a network to ensure standardised ARV prescribing for both cost and equity of patient care.
P090 Formalised look-back in newly diagnosed hiv to identify missed opportunities in other clinical settings: first get our own house in order!
Authors: Horn Kate , Ramsden Sophie , Fernandes Arnold
Published: May 2024

Introduction

HIV late diagnosis is one of three key indicators on sexual health in the Public Health Outcomes Framework. The British HIV Association (BHIVA) Standards of Care for People Living with HIV advocates the use of ‘look backs’ in the case of late and very late diagnosis of previous engagement with health care services to identify missed opportunities and areas for shared learning and development.

Methods

Further to the look-back exercise undertaken on late and very late diagnoses presenting 2012–2016, we extended the use of the standardised look-back tool to ALL new diagnoses from late 2016 onwards.

Results

In addition to anticipated missed opportunities being identified in the late and very late presentations, we identified 2 missed opportunities in much earlier presentations from within our own service! They related to failure to repeat the HIV test at test of cure (TOC) for gonorrhoea and subsequent Hepatitis vaccination appointments. In both cases the initial negative HIV test had been within the potential window period.

Discussion

As a result of the look-back exercise we have learnt a valuable lesson about the fallibility of our own service and shared the learning within our multi-disciplinary team. We have encouraged all to remember to re-visit the sexual history and timing of sex in relation to testing at ‘quickie’ follow up visits for vaccination or TOC and repeated education about window periods.

We shall continue to utilise the look-back tool in all new HIV presentations and encourage colleagues to do likewise to maximise on identifying learning opportunities.
P093 HIV testing for hospital inpatients in a priority area
Authors: Pool Erica , Vickers Laura , De’Ath Tom , Cubbon Marc
Published: May 2024

Introduction

Department of Health advises that HIV testing should be routinely offered to patients in priority areas; where prevalence ≥1–2/1000, such as Brighton. We sought to increase HIV testing in the Cardiology department. Local microbiology department advises HIV testing on all inpatients with suspected or proven infective endocarditis (IE), as such we investigated testing in this group.

Aim

Assess the proportion of patients with suspected or proven IE offered a HIV test at baseline, and following an intervention to promote testing.

Methods

Patients with IE are discussed at a weekly multi-disciplinary team (MDT). We retrospectively reviewed MDT meetings from June – November 2016 (cycle one). Data on HIV testing were extracted from MDT proforma and hospital results system. Initial results were presented to cardiology junior doctors and testing encouraged. We prospectively reviewed MDT meetings and HIV testing in the 10 weeks after the intervention (cycle two).

Results

In cycle one, 29 patients (25 males, 4 females) had suspected or proven IE, 16 (55%) were tested. In cycle two the proportion of patients tested for HIV decreased; of the 8 patients with suspected/proven IE (6 males, 2 females); 2 (25%) were tested, 6 (75%) were not.

Discussion

HIV testing rate decreased by 46% between cycles, representing multiple missed opportunities for testing. The reason for this trend is not clear but barriers to HIV testing remain, including poor awareness of indications to test, uncertainty around consent, and assumption of low risk. We plan further interventions to increase HIV testing locally.
P103 A psychosexual needs assessment of patients attending five london sexual health clinics
Authors: Malik Aiysha , Grayer Justin , Gibson Stuart
Published: May 2024

Introduction

The aim of this psychosexual needs assessment was to investigate the prevalence and range of sexual problems; to understand the distress, causal attributions and functional impairment associated with these; and to explore patients’ service-related needs, in a sample of patients attending sexual health clinics in London.

Methods

Questionnaires were disseminated to patients attending five sexual health clinics in London, over a one week period. Nine hundred and thirty four patients responded to the questionnaire. Patients were aged 29.4 years (SD=8.8) and predominantly female (61.4%).

Results

31.1% of patients indicated they were experiencing a sexual problem. Premature ejaculation, delayed ejaculation, or difficulty having an orgasm were the most prevalent problems reported by patients (13.5%). Female and male patients did not differ in their report of overall sexual problems (32.5% and 28.6%, respectively), however more women reported sexual pain (14.8%, X2=11.3,p=.001) and male patients reported difficulties with hypersexuality (9.5%, X2=25.2,p<.001). The majority of sexual problems had commenced within the past year, however orgasm, chemsex and hypersexuality problems were longer-standing (>1year). Associated distress was reported by 79.5% of patients. Emotional reasons were attributed as the most likely cause of sexual problems (21.1%). Male patients reported higher functional impairment (U=1862.0, z=2.3,p=.02). Patients were interested in a range of interventions, and expressed preference to be supported in a sexual health clinic (67.8%).

Discussion

The findings present implications for the provision of psychosexual services in sexual health clinics.
O15 A service evaluation comparing home-based testing to clinic-based testing for chlamydia and gonorrhoea in birmingham and solihull
Authors: Banerjee Prita , Thorley Nicola , Radcliffe Keith
Published: May 2024

Introduction

Public Health England recommends that local authorities should work towards making STI testing more accessible. Since August 2015, sexual health services in Birmingham and Solihull area (Umbrella) have provided online home-based testing.

Methods

We conducted a retrospective analysis of the clinic and online database to identify patients who undertook home-based and clinic-based testing in the Birmingham and Solihull clinics between January and June 2016.

Results

Abstract O15 Table 1

Home based v clinic based testing

Home-based testing (n=9258)Clinic-based testing (n=19193)P valueAge16–24 >256033 (65%)3225 (35%)9654 (50%)9539 (50%)<0.001Gender Female Male Transgender5986 (65%)3258 (35%)14 (0%)10861 (57%)8306 (43%)26 (0%)<0.001Ethnicity White Black/British Black Asian/British Asian Other: Not specified:6648 (72%)892 (10%)558 (6%)920 (10%)240 (3%)7996(42%)4026 (21%)2167(11%)2160 (11%)2844 (15%)<0.001Asymptomatic7408/9258 (80%)9729/19193 (51%)<0.001Return rate4476 (48%)–Prevalence rates382/4476 (9%)2141/19193 (11%)<0.001Treatment rate174/382 (46%)1663/2141 (78%)<0.001

Discussion

Home-based testing appears to be popular among asymptomatic, younger (16–24 years), white and female patients, with poor overall return rates. There may be a need for promotion of this method of testing among ethnic minorities. The current method of recall needs to be reviewed to improve treatment rates in the home-based testing group.
P111 Reaching out – gum in the general practice setting
Authors: Watt Joanne , Streeter Thomas , Ashton Susan , Battersby Cara , Herbert Sophie
Published: May 2024

Introduction

Providing accessible GU services in rural areas is difficult. Providing a service in General Practice (GP), close to patients’ homes may increase access (particularly to those who might not otherwise test) and avoid the perceived stigma of attending a GUM clinic. A GUM service was set up in 2008 within a general practice setting (syndromic management), in an area of high need (HIV prevalence 2.58 PHE 2015).We aim to describe the outcomes of running a GU clinic within GP.

Methods

Demographic, attendance and diagnoses data was collected and analysed from 2008–2016.

Results

A total of 1081 patients were seen (1826 attendances) with a median of 200(186–221) per year. 604 diagnoses of infection were made (33.1%). 922(85%) lived in the town where the clinic was held. 53.8%(582) had never been seen in GU in our county before compared with 32.6% in the hubs. 440 (41%) were men of which 40(9%) were MSM. Mean age for attendees was 29 (28 at the main GU hub). Total number <20 year olds fell from 2007-2016 but those aged 21–35yrs and 45–60yrs increased. Table 1 shows the distribution of GUMCAD diagnoses. There were 426 DNAs (18.9%), 42% were follow-ups. Overall HIV testing was refused in 15.5% cases, (30% in 2007 but 7% in 2016).

Discussion

In rural areas where transport links are limited, a GU clinic run in GP offers an efficient, anonymous service. Services can be offered in this setting with few extra resources providing an alternative point of access for patients.

Abstract P111 Table 1

GUM in general Practice

Diagnosisn=604% all diagnoses% all patients% attendancesChlamydia19031.4%17.5%10.4%Gonorrhoea71.2%0.6%0.4%Syphilis10.2%0.09%0.05%HIV10.2%0.09%0.05%Other40667.0%37.6%22.2%
P121 Choose to test
Authors: Syred Jonathan , Howroyd Chris , Holdsworth Gillian , Spelman Kes , Baraitser Paula
Published: May 2024

Introduction

Choice is an increasingly important element of health care. We introduced choice of test into an online sexual health service.

Methods

Users were offered testing based on their risk profile (table 1) with an option to request additional tests. Routinely collected anonymised data were collected on choice of test.

Abstract P121 Table 1

Results from Choose to test

<2424+BMEMSMGenital GC/CT*YesYesYesYesOral GC/CT*NoNoNoYesAnal GC/CT*NoNoNoYesSyphilisNoNoNoYesHIVNoNoYesYes

Results

2550 users ordered tests (30/10/16 – 19/12/16). 56% were <24, 10% were from black or ethnic minority (BME) groups and 17% were men who have sex with men (MSM). 1853 (72.6%) returned a test, 6.7% were positive for any STI. Of the non-BME/non-MSM users offered chlamydia/gonorrhoea testing, 66% chose to add HIV + syphillis testing. Of the BME/non-MSM users offered chlamydia/gonorrhoea + HIV testing, 71% chose to add syphilis testing. Of the MSM users offered chlamydia/gonorrhoea (genital, oral, anal) + HIV + syphilis testing, 85% chose this option. 6% chose to omit the HIV/syphilis test. User choice resulted in 611 fewer HIV tests, 596 fewer syphilis tests and 27 fewer chlamydia/gonorrhoea tests.

Discussion

Online service users actively exercise choice in STI test selection. The majority of users choose to test for chlamydia, gonorrhoea, HIV and syphilis regardless of what they are offered. User choice of test reduces the total number of tests offered online.