bluuebunny/crossref_metadata_2025 huggingface dataset:
B-Lymphocyte Dysfunction in Chronic HIV-1 Infection Does Not Prevent Cross-Clade Neutralization Breadth
Authors: Boliar Saikat , Murphy Megan K. , Tran T. Cameron , Carnathan Diane G. , Armstrong Wendy S. , Silvestri Guido , Derdeyn Cynthia A.
Published: May 2012

Aberrant expression of regulatory receptors programmed death-1 (PD-1) and B- and T-lymphocyte attenuator (BTLA) is linked with dysregulation and exhaustion of T lymphocytes during chronic human immunodeficiency virus type 1 (HIV-1) infection; however, less is known about whether a similar process impacts B-lymphocyte function during HIV-1 infection. We reasoned that disruption of the peripheral B cell compartment might be associated with decreased neutralizing antibody activity. Expression of markers that indicate dysregulation (BTLA and PD-1), immune activation (CD95), and proliferation (Ki-67) was evaluated in B cells from HIV-1-infected viremic and aviremic subjects and healthy subjects, in conjunction with immunoglobulin production and CD4 T cell count. Viral load and cross-clade neutralizing activity in plasma from viremic subjects were also assessed. Dysregulation of B lymphocytes was indicated by a marked disruption of peripheral B cell subsets, increased levels of PD-1 expression, and decreased levels of BTLA expression in viremic subjects compared to aviremic subjects and healthy controls. PD-1 and BTLA were correlated in a divergent fashion with immune activation, CD4 T cell count, and the total plasma IgG level, a functional correlate of B cell dysfunction. Within viremic subjects, the total IgG level correlated directly with cross-clade neutralizing activity in plasma. The findings demonstrate that even in chronically infected subjects in which B lymphocytes display multiple indications of dysfunction, antibodies that mediate cross-clade neutralization breadth continue to circulate in plasma.
Complete Genome Sequence of the First Canine Circovirus
Authors: Kapoor Amit , Dubovi Edward J. , Henriquez-Rivera Jose Angel , Lipkin W. Ian
Published: May 2012

We found a highly divergent circovirus in serum samples from several dogs. Phylogenetic analysis indicates that canine circovirus genotype 1 (CaCV-1) represents the first circovirus reported in dogs and is genetically most closely related to the only known mammalian circovirus, porcine circovirus. Here we report the complete genome sequence of the CaCV-1 strain NY214, which will help toward understanding the evolutionary and pathogenic characteristics of mammalian circoviruses.
Genome Sequence of the First Human Adenovirus Type 14 Isolated in China
Authors: Zhang Qiwei , Seto Donald , Zhao Suhui , Zhu Li , Zhao Wei , Wan Chengsong
Published: May 2012

Emergent pathogens may be examined rapidly at high resolution on a molecular level using genomics, allowing an understanding of their evolution. China is a unique environment for studying pathogens, having a large, dense, and generally closed population. Human adenovirus type 14 (HAdV-14) was originally identified as an acute respiratory disease (ARD) pathogen in The Netherlands (1955), with a second isolation in England (1957). Since then, few reports of this virus appeared until an ARD pathogen with a similar genome caused multiple outbreaks in the United States (2006 to 2009). This report presents the first genome of HAdV-B14 isolated in China (2010). As China experienced two recent outbreaks of an emergent ARD pathogen, HAdV-B55, containing much of the HAdV-B14 genome, the availability of this HAdV-B14 sequence will facilitate studies of the epidemiology of these pathogens, as well as provide a foundation for studying adenovirus evolution and the genesis of emergent pathogens. These observations may be invaluable in predicting possible recombination between wild-type viruses and adenoviral gene delivery vectors, including adenovirus vaccines.
Complete Genome Sequence of a Dengue Virus Serotype 4 Strain Isolated in Guangdong, China
Authors: Zhao Hui , Yu Xue-Dong , Zhang Xia-Yi , Jiang Tao , Hong Wen-Xin , Yu Man , Hu Feng-Yu , Zhu Shun-Ya , Qin E-De , Deng Yong-Qiang , Qin Cheng-Feng , Zhang Fu-Chun
Published: May 2012

Here we report the first complete genome sequence of a dengue virus serotype 4 genotype II strain, GZ30, isolated in Guangzhou, Guangdong Province, China, in 2010. The sequence information provided herein will help us to understand the molecular epidemiology of dengue virus and predict the risk of severe diseases in mainland China.
Epstein-Barr Virus Protein Kinase BGLF4 Targets the Nucleus through Interaction with Nucleoporins
Authors: Chang Chou-Wei , Lee Chung-Pei , Huang Yu-Hao , Yang Pei-Wen , Wang Jiin-Tarng , Chen Mei-Ru
Published: May 2012

BGLF4 of Epstein-Barr virus (EBV) encodes a serine/threonine protein kinase that phosphorylates multiple viral and cellular substrates to optimize the cellular environment for viral DNA replication and the nuclear egress of viral nucleocapsids. BGLF4 is expressed predominantly in the nucleus at early and late stages of virus replication, while a small portion of BGLF4 is distributed in the cytoplasm at the late stage of virus replication and packaged into the virion. Here, we analyzed systematically the functional domains crucial for nuclear localization of BGLF4 and found that both the N and C termini play important modulating roles. Analysis of amino acid substitution mutants revealed that the C terminus of BGLF4 does not contain a conventional nuclear localization signal (NLS). Additionally, deletion of the C-terminal putative helical regions at amino acids 386 to 393 and 410 to 419 diminished the nuclear translocation of BGLF4, indicating that the secondary structure of the C terminus is important for the localization of BGLF4. The green fluorescent protein-fused wild-type or C-terminal helical regions of BGLF4 associate with phenylalanine/glycine repeat-containing nucleoporins (Nups) in nuclear envelope fractionation. Both coimmunoprecipitation and
in vitro
pull-down assays further demonstrated that BGLF4 binds to Nup62 and Nup153. Remarkably, nuclear import assay with permeabilized HeLa cells demonstrated that BGLF4 translocated into nucleus independent of cytosolic factors. Data presented here suggest that BGLF4 employs a novel mechanism through direct interactions with nucleoporins for its nuclear targeting.
Arenavirus Nucleoproteins Prevent Activation of Nuclear Factor Kappa B
Authors: Rodrigo W. W. Shanaka I. , Ortiz-Riaño Emilio , Pythoud Christelle , Kunz Stefan , de la Torre Juan C. , Martínez-Sobrido Luis
Published: May 2012

Arenaviruses include several causative agents of hemorrhagic fever (HF) disease in humans that are associated with high morbidity and significant mortality. Morbidity and lethality associated with HF arenaviruses are believed to involve the dysregulation of the host innate immune and inflammatory responses that leads to impaired development of protective and efficient immunity. The molecular mechanisms underlying this dysregulation are not completely understood, but it is suggested that viral infection leads to disruption of early host defenses and contributes to arenavirus pathogenesis in humans. We demonstrate in the accompanying paper that the prototype member in the family, lymphocytic choriomeningitis virus (LCMV), disables the host innate defense by interfering with type I interferon (IFN-I) production through inhibition of the interferon regulatory factor 3 (IRF3) activation pathway and that the viral nucleoprotein (NP) alone is responsible for this inhibitory effect (
C. Pythoud, W. W. Rodrigo, G. Pasqual, S. Rothenberger, L. Martínez-Sobrido, J. C. de la Torre, and S. Kunz
, J. Virol. 86:7728–7738, 2012). In this report, we show that LCMV-NP, as well as NPs encoded by representative members of both Old World (OW) and New World (NW) arenaviruses, also inhibits the nuclear translocation and transcriptional activity of the nuclear factor kappa B (NF-κB). Similar to the situation previously reported for IRF3, Tacaribe virus NP (TCRV-NP) does not inhibit NF-κB nuclear translocation and transcriptional activity to levels comparable to those seen with other members in the family. Altogether, our findings demonstrate that arenavirus infection inhibits NF-κB-dependent innate immune and inflammatory responses, possibly playing a key role in the pathogenesis and virulence of arenavirus.
An institution-wide handoff task force to standardise and improve physician handoffs
Authors: Horwitz Leora I , Schuster Kevin M , Thung Stephen F , Hersh David C , Fisher Rosemarie L , Shah Nidhi , Cushing William , Nunes Judy , Silverman David G , Jenq Grace Y
Published: May 2012

Background

Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs.

Methods

An institution-wide physician handoff task force was developed to proactively address issues surrounding handoffs and to ensure a consistent approach to handoffs across the institution.

Results

This report discusses the authors' experiences with handoff standardisation, provider utilisation of a new electronic medical record-based handoff tool, and implementation of an educational curriculum; future work in developing hospital-wide policies and procedures for transfers; and the authors' consensus on the best methods for monitoring and evaluation of trainee handoffs.

Conclusion

The handoff task force infrastructure has enabled the authors to take an institution-wide approach to improving handoffs. The task force has improved patient care by addressing handoffs systematically and consistently and has helped create new strategies for minimising risk in handoffs.
Is lidocaine Bier's block safe?
Authors: Jakeman Nicola , Kaye Philip , Hayward James , Watson David P , Turner Stacy
Published: May 2012

Objectives

To assess the safety profile of lidocaine Bier's block when compared with that of prilocaine.

Method

A retrospective audit of patients undergoing Bier's block using 0.5% lidocaine during a 27-month period (April 2008–June 2010) at the Royal United Hospital Bath emergency department.

Results

416 patients with sufficient data were included in the study; 360 women and 56 men. The mean patient age was 65 years. Complications were reported in 39 cases; transient hypotension/vasovagal episodes and transient mild bradycardia were most frequent. No patients required any medical intervention. There was no occurrence of anaphylaxis, convulsion, hypotensive episodes requiring medical intervention, collapse or death.

Conclusion

No clinically significant morbidity or mortality as a consequence of lidocaine Bier's block was demonstrated in this audit.
O14 Investigating the recent infection testing algorithm (RITA): predictors of recent HIV infection among GUM clinic attendees
Authors: Rayment M , Aghaizu A , Toswill J , Murphy G , Hughes G , Delpech V
Published: May 2012

Background

Testing for recent infection with HIV has been part of routine national surveillance in the UK since 2009. These data can be used to estimate HIV seroincidence in populations. For these estimates to be accurate, HIV testing behaviour must be independent of HIV acquisition risk. This is unlikely to be true, as much testing may be motivated or clinically indicated.

Aims

To identify demographic and behavioural differences between individuals diagnosed with recent (<6 months) vs longstanding HIV infection, and to assess the possible level of bias introduced by motivated testing.

Methods

Recent Infection Testing Algorithm (RITA) results were linked to Genitourinary Medicine Clinic Activity Dataset attendance records (providing data on attendance and sexual health) for the year preceding the date of RITA test and/or HIV diagnosis. Univariate analyses were performed examining age, sexual orientation, GUM clinic attendances, and STI history, to identify predictors of being diagnosed at early stages of HIV infection.

Results

Preliminary analyses show that among 628 newly diagnosed HIV-positive individuals, 14% (85/628) were diagnosed with recent HIV infection. Being diagnosed with a recent HIV infection was positively associated with younger age, men who have sex with men and having been diagnosed with any bacterial STI in the year preceding the HIV diagnosis (see Abstract O14 table 1). Those visiting a sexual health clinic more than twice in the previous year were also more likely to be diagnosed at early stages of HIV infection.

Abstract O14 Table 1

HIV infection according to patient demographics

Variable% (n) recent HIV infection% (n) longstanding HIV infectionUnadjusted RR of being diagnosed with recent infection (95% CI)Age (mean 35 years, SD 9.98, range 16–66 years)––0.98 (0.96 to 1.00)MSM (vs heterosexual)*76.5 (65)45.5 (180)1.68 (1.43 to 1.97)Previous STI† Chlamydia trachomatis21.2 (18)14.9 (81)1.42 (0.90 to 2.24) Syphilis8.2 (7)7 (38)1.18 (0.54 to 2.55) Gonorrhoea16.5 (14)10.5 (57)1.57 (0.92 to 2.69) Lymphogranuloma venereum (LGV)1.2 (1)0.9 (5)1.28 (0.15 to 10.8) Any STI‡37.6 (32)24.5 (133)1.54 (1.13 to 2.10)Visits in the year preceding date of HIV diagnosis/RITA test† >2 visits68 (34)54.8 (188)1.24 (1.00 to 1.54)*

n=481.

†

Recorded in the same GUM clinic.

‡

Includes Chlamydia, syphilis, gonorrhoea, LGV.

Conclusions

Important behavioural and demographic differences exist between individuals diagnosed with recent vs established HIV infections. Such differences must be considered when deriving incidence estimates among key at-risk groups. Further work to examine these trends among all RITA results, in particular the relationship with HIV testing patterns, is ongoing.
O16 Use of online assessment tools by risk taking men
Authors: Ward P , Power L , Nardone A , Hartney T , Delpech V
Published: May 2012

Background

Condom use by gay men has slipped since the 1990s. In late 2011 THT (as part of CHAPS) launched a condom campaign for younger men, promoting a web-based HIV risk assessment tool.

Methods

The Clever Dick/Smart Arse campaign encouraged use of an online risk assessment tool with prize incentives. This gave an instant rating on sexual activity in the past year, with a detailed risk report on request. This covered behaviours affecting HIV risk including PEP, poppers, condoms, HIV disclosure, receptive or insertive modality, monogamy, treatment and viral load.

Results

7240 risk assessments were undertaken in 10 weeks of whom 1810 requested their full risk assessment (“Sexscore”) and agreed to further contact. There were 101 248 page views by over 17 000 unique website visitors with average visit time of 3.03 min. Preliminary analysis of 4574 respondents shows high levels of risky behaviours. The majority were not in regular clinic contact while a third had never had a sexual health screen. 24% had never tested for HIV while 10% were knowingly HIV+ (of whom 62% had undetectable VL throughout the year). Over half (56%) had five or more sexual partners in the year. 53% of HIV+ men and 51% of other men reported UAI with one or more partners and 59% of all participants discussed serostatus before sex.

Conclusion

Gay men will engage about risk taking if feedback is instant and anonymous, including those never in contact with sexual health services. Men reporting risk behaviours can be targeted for subsequent interventions.
O20 Home sampling through social network websites: can we reduce undiagnosed HIV?
Authors: Elliot E , McCowan A , McCormak S , Rossi M , Van Every T
Published: May 2012

Background

Approximately 1 in 20 men who have sex with men (MSM) in London has undiagnosed HIV. It is a national priority to minimise time spent undiagnosed to reduce morbidity, mortality and onward transmission. Sigma reported that 29% of MSM recruited online in 2008 had never tested. We piloted an offer of home HIV sampling for MSM in partnership with the Gaydar social network website.

Objectives

The objectives of the pilot were to determine (1) uptake of an online HIV risk self-assessment (2) uptake of offer for home testing (3) the proportion of those completing the assessment that is high risk.

Methods

Each day 200 MSM in London were invited by Gaydar to assess their HIV risk. “High risk” was defined as unprotected anal sex (UAI) with HIV + partner or of unknown HIV status. Following assessment but regardless of risk, users were offered a postal HIV salivary sampling kit. Reactive results were confirmed in the clinic. Data were analysed using Google Analytics.

Results

4500 invites were issued between 7 November 2011 and 11 January 2012. 363 (8%) clicked through to the project website, 321 (88%) of whom completed the HIV risk assessment. Of these, 146 (45%) were defined as “high risk”. 209 clicked through for information on home sampling, 82 (39%) of whom had never HIV tested. 132 test kits were requested, 73 (55%) were returned, 4 of which were new HIV diagnoses (3% of kits sent and 5.5% of samples returned).

Discussion

Although low, the uptake appears to reach a population “less tested” than the population that took part in the Sigma online survey or typical of GUM clinics. The level of risk identified was similar to a clinic population with almost half reporting UAI. 55% of kits were returned and we report 5.5% or 1:18 new diagnoses. The project is now scaling up to message all 120 000 Gaydar users in Central London over 12 months and aims to provide evidence to inform the potential roll out of online strategies to enhance community based HIV testing in the UK.
O21 Should we opportunistically treat rectalChlamydia trachomatisinfection in men who have sex with men presenting with non-specific urethritis?
Authors: Rayment M , Bull L , Mandalia S , Boag F , Nwokolo N , Jones R
Published: May 2012

Background

Infection of the rectum withChlamydia trachomatis(CT) is highly prevalent among men who have sex with men (MSM) attending our service (c. 8%). Our guidelines advise different antibiotics for the treatment of non-specific urethritis (NSU) (azithromycin 1 g as a single dose) and for rectal CT infection (doxycycline 100 mg twice daily for 7 days). MSM receiving treatment for NSU require recall if they are latterly found to have concurrent rectal CT. Should we therefore use doxycycline first line in MSM presenting with NSU?

Aims

To determine the proportion of MSM diagnosed with NSU with rectal CT infection; to identify independent predictors of having rectal CT.

Methods

The clinic database identified sequential MSM diagnosed with NSU over 6 months. Co-variables collected: age, sexual history, HIV status, contact history and the presence of rectal symptoms. Only men accepting rectal sampling were included. Univariate and multivariable logistic regression analyses were undertaken.

Results

566 MSM presenting with NSU were identified, of whom 130 (23%) were diagnosed with CT infection of at least one anatomical site. Of this group, 99 were included in the analysis. The overall prevalence of rectal CT infection was 38% (38/99). In men reporting a history of unprotected receptive anal intercourse (UPRAI) in the preceding 6 months, the prevalence was 61% (31/51); in those without it was 7.1% (14/48). In MSM reporting rectal symptoms, the prevalence was 90% (9/10); in those without: 33% (29/89). In the multivariable model, the only independent predictors of risk of rectal CT infection were UPRAI and rectal symptoms (see Abstract O21 table 1).

Abstract O21 Table 1

Rate of rectal chlamydia according to history and rectal symptoms

VariableTotal (n=99)Number with rectal CT (%) (n=38)Adjusted RR95% CIWald statistics, p ValueHistory of unprotected receptive anal intercourse (UPRAI)Y5131 (60.8)10.002N487 (14.6)0.25(0.07 to 0.82)Rectal symptomsY109 (90)9.54(1.09 to 83.4)0.041N8929 (32.6)1

Discussion

First line treatment of NSU in MSM could be modified based on the likelihood of concurrent CT infection. In men reporting UPRAI in the preceding 6 months, or reporting rectal symptoms, it would be reasonable to offer treatment of NSU with doxycycline. In all other patients, we propose continuing to use azithromycin first line, with subsequent recall for further treatment as necessary.
C5 Two cases of acute encephalitis with neurological complications as a seroconversion illness in primary HIV infection (PHI)
Authors: Jain L , Lowe S , Crowe G
Published: May 2012

Background

Neurological complications as the presenting feature of PHI are rare and reported in <10% of cases. We describe two cases of sero-conversion illness with rapidly progressive neurological involvement.

Case 1

A 43-year-old man presented with diarrhoea, vomiting and rash. On examination he had widespread lymphadenopathy, mouth ulcers and tender hepatomegaly. HIV test was positive (avidity index 50%). 2 weeks later he was readmitted with headache and vomiting. On examination he had left sided weakness and left facial droop. CT head was normal. Cerebro-spinal fluid (CSF) showed an elevated protein 2.99 g/l, WC 48, with and numerous polymorphs visualised. Antibiotics for meningitis were commenced. Serial MRI scans were normal. CD4 count was 640 cell/mm and HIV viral load was 197 000. Antiretrovirals (ARV) were commenced at day 14 and symptoms improved within the next 4 days. 2 months later all weakness and headaches have resolved.

Case 2

A 47-year-old British man presented with a collapse following 2 days of personality change and confusion and 10 days of fever, headaches, diarrhoea, myalgia, photophobia and rash. On admission he was confused, pyrexial with a Glasgow Coma Score of 13. He had a normal CT head, CSF protein was 1.5 g/l, RC <5, WC<5, with no organisms seen. Subsequent CSF viral PCR was negative. MRI brain was also normal. No evidence of sepsis was identified. An HIV test on admission was positive (avidity index 65%). HIV test 3 months earlier had been negative. CD4 count was 594 (16%) cells/mm3and viral load 462 756 copies/ml. ARVs were commenced on day 7, symptoms improved markedly over the following week. Four weeks post discharge confusion had completely resolved but he reported ongoing mild coordination difficulties.

Discussion

Neurological complications of seroconversion are rare but do occur. Early recognition is important through prompt HIV testing and the introduction of ARVs may reduce the incidence of neurological sequelae markedly.
P1 Does simple correspondence and feedback improve HIV testing rates in primary care in a low prevalence area?
Authors: Haddon L , Bendall R , Pollard K
Published: May 2012

Background

Delayed diagnosis of HIV is a problem in both high and low prevalence areas. In Cornwall, the relatively low prevalence means that most general practitioners (GPs) have little or no experience in managing patients with HIV infection; they may be unfamiliar with indicator conditions and thus be unlikely to offer an HIV test.

Aims

To see if simple correspondence and feedback regarding testing rates can lead to changes in practice.

Methods

We compared testing rates before and after the intervention which comprised of a letter to all individual GPs attached to a PCT weekly communication e-bulletin sent July 2011. This highlighted recent local delayed HIV diagnoses, benefits of earlier testing and contact details of the sexual health clinic. We included an anonymised “ski-jump” graph showing ranked testing rates by practice, an invitation to GPs and practice managers to find out where their practice fell on the graph and the 2008 HIV testing guidelines, drawing attention to the table of indicator conditions.

Results

Initial comparison of absolute numbers of tests and tests per head of practice population in GP practices in Cornwall during 2010 revealed large variation in testing rates between practices, from <0.5 tests per 1000 population to approximately 30 tests per 1000 population, with a total of 593 tests over 12 months. An interim analysis of HIV testing rates for the period April to September 2011 has shown an apparent increase in testing of 29% when projected for 12 months. Most practices showed increased rates of testing after the intervention.

Conclusion

Our findings suggest that a simple targeted communication may result in increased testing in a low incident GP population. Monthly figures leading up to and following the intervention will be presented.
P100 Assessment of bacterial sexually transmitted infection (STI) screening following sexual assault
Authors: Wilson S , Wardle D , Coia G
Published: May 2012

Background

Chlamydia trachomatisandNeiserria gonorrhoeascreening following sexual assault is undertaken primarily for sexual health purposes but can potentially facilitate criminal investigation in cases of penetration at sexually naive sites. Antibiotic prophylaxis at first attendance (within 7 days of the assault) is not routine but may be given when the return for screening is unlikely.

Aim

To improve bacterial STI screening and management in complainers attending our sexual assault referral centre (SARC).

Objectives

To determine if complainers were adequately screened for bacterial STIs and if communication with health professionals regarding repeat screening was adequate.

To review prophylactic antibiotic use.

To review the forensic significance of STI screening.

To identify factors which may improve the uptake of screening.

Methods

100 case records were reviewed and information relevant to our objectives extracted. Six cases were excluded.

Results

81% had a STI screen taken at presentation. Only 13% returned for repeat screen after incubation, confirming Chlamydia in two cases. All but one repeat screen correlated to the site of exposure. GPs were informed of the need for a repeat screen in 74% of cases. 59% had an alert sited on their sexual health record highlighting the need for a repeat screen. Antibiotic prophylaxis was given in 25 cases with reasons documented in only 4.

Discussion and/or Conclusion

STI screening post sexual assault may be improved through better communication with complainers and other healthcare providers. Improvements to communication methods and training are required to facilitate this. The concern of emerging gonococccal resistance should be considered prior to administering prophylactic antibiotics. One individual, in whom there was no previous sexual contact and baseline screen was negative, had Chlamydia on repeat sample. This may be supportive of the assailant as the source of infection, indicative of the potential forensic role of STI screening.
P101 Olympic outreach: STI testing for construction workers
Authors: Shanmugaratnam S , Horne P , Coyne K M
Published: May 2012

Background

It was feared that construction of venues for the 2012 Olympic and Paralympics Games would increase the burden of sexual ill-health in East London, due to a surge in migrant construction workers and commercial sex work.

Aims/Objectives

We analysed data from outreach to construction sites at the Olympic Park and Village in Stratford, East London. We reported demographics, sexual risk factors and STI rates.

Methods

An outreach team visited the Olympic site between February 2009 and October 2011. Clients completed a triage form about symptoms and sexual risk factors. Clients were offered nucleic acid amplification tests for Gonorrhoea and Chlamydia, using urine samples from men, and self-taken vulvovaginal swabs from women. Serology was offered for HIV and Syphilis. Hepatitis B serology was offered to those who reported intravenous drug use or sex with commercial sex workers. Anyone diagnosed with an STI was offered treatment at Occupational Health services on site or a local sexual health clinic.

Results

In total 614 clients were seen, with a median age of 28 years. 91% were men. There were 19 different ethnic groups. Nearly half (285/614, 46%) reported their ethnic group as English/Scottish/Welsh. The other large ethnic groups were 53 Indian (9%), 52 Eastern European (8%) and 39 Irish (6%). 20 clients (3%) had Chlamydia and one was diagnosed with Hepatitis B. Reported levels of sexual risk factors are shown in abstract P101 table 1.

Abstract P101 Table 1

Sexual risk factors of in the olympic site construction workers

Sexual risk factorNo. of people/ % of sampleSex between men5 (<1%)Previous STI20 (3%)More than one sexual partner in last 3 months173 (28%)Intravenous drug use3 (<1%)Use of commercial sex workers3 (n=76) (4%)

Conclusions

There was a low prevalence of STIs in these construction workers, contradicting prior fears of a high disease burden. Reported levels of sexual risk factors, including use of commercial sex workers, were low.
P109 Introduction of an electronic patient proformer contributes to an increase in uptake of HIV testing
Authors: Bhatt S , Clarke E , Roseaman K , Patel R , Samraj S
Published: May 2012

Background

The BASHH MEDFASH Standards for the Management of STIs 2010 recommend that 100% of GUM patients should be offered an HIV test with a minimum uptake of 60% at their first STI screen.

Aim

To assess whether the introduction of an electronic patient proformer resulted in an improvement in the uptake of HIV testing in a level 3 GUM service, and whether there was scope for further improvement.

Methods

Retrospective case note review of new and rebook (patients who had not attended in the past 3 months) patients attending a level 3 GUM service in October 2007 (when a paper patient record was kept) and October 2010 (following introduction of an electronic patient proformer with a prompt for HIV test offered). Data on uptake of HIV testing was collected, and further data on the reasons for not being tested for HIV was collected on patients seen in October 2010.

Results

772 new or rebook patients were seen in October 2007, of whom 562 (72.8%) accepted HIV testing. 1141 new or rebook patients were seen in October 2010 of whom 891 (78.1%) accepted HIV testing, with a p value (calculated using Fisher's Exact test) of 0.009. Of 250 (21.9%) patients not tested for HIV in October 2010, 41.6% were not tested for clinical reasons, such as the patient having had a recent HIV test or being known HIV positive. 35.2% of patients not tested for HIV declined the test. Evidence of suboptimal management was also found, with 6.8% of patients not tested as they were within the window period, and 6% not tested due to needle phobia.

Conclusion

The introduction of the electronic patient proformer with a prompt for HIV testing has improved uptake. There is further room for improvement including offering POCT to needle phobic patients, and testing those within the window period prior to follow-up testing. Adding a mandatory field to the patient proformer with reasons for declining may allow improved understanding of reasons for declining, which may then modify future practice.
P11 HIV test uptake in the GU clinic: juniors hot on the heels of the consultants
Authors: Isabel O , Portman M D , Giuntini R , Stewart CMW , Wilson J D
Published: May 2012

Background

Data from the Health Protection Agency shows that 25% of people living with HIV in the UK are unaware of their diagnosis. This has serious health implications for them and others.

The National Strategy for Sexual Health and HIV set a target of 60% testing uptake by 2007. 69% of STI attendees at GUM clinics in England in 2010 were tested for HIV. Regional data from the Health Protection Unit shows a 70% uptake of HIV testing in women attending our clinic. Recent data from the UK and Australia has documented variable HIV testing rates among clinicians with a trend towards more junior doctors being more likely to offer a test.

Objectives

To identify HIV testing rates according to grade of clinician.

Methods

Women attending our service as new or rebook patients between March 2009 and January 2010 were seen by clinicians representing eight different grades of staff. The women's response to the offer of an HIV test was recorded. These data were analysed according to the grade of the staff member.

Results

3973 women were seen by 42 different clinicians. 2982 accepted an HIV test (P1A); 980 declined a test (P1B) and 11 deferred testing (P1C) (see abstract P11 table 1).

Abstract P11 Table 1

HIV testing rates by different health care professionals

Band 5 nursesBand 6 nursesFY1ST2GPSASRegConsTotalNo of staff6764229642No of consultations1694421402072528379969303973P1A1223251121711965727537312982P1B47115283652265239198980P1C0200404111% Patients who decline HIV test27.826.020.017.420.630.624.021.324.7OR (95% CI) patient having an HIV test compared to other grades1.18 (0.84 to 1.67)1.08 (0.86 to 1.36)0.76 (0.49 to 1.15)0.63 (0.44 to 0.19)0.78 (0.57 to 1.07)1.57 (1.33 to 1.86)0.95 (0.81 to 1.13)0.78 (0.66 to 0.93)p Value0.380.520.230.0160.14<0.00010.600.007

Conclusions

There are many perceived barriers to HIV testing and it is often quoted that testing rates are lowest among non-specialists. However, there is little published data on the impact of the individual clinician on HIV testing. Encouragingly, our data has shown that more junior staff, having trained in an environment where HIV is increasingly recognised as a treatable condition, are confident to offer HIV testing and do so as effectively as consultants. We should learn from them with respect to promoting HIV testing in our clinics and not underestimate the value of ongoing training and support in this important area.
P111 A user centred approach to the design of point-of-care and self-test mobile phone diagnostics for sexually transmitted infections (STIs)
Authors: Voula G , Balachandran W , Lowndes C , Howell-Jones R , Aicken C R , Mercer C H , Sutcliffe L , Sonnenberg P , Jackson M , Estcourt C S , Sadiq S T , Hone K
Published: May 2012

Background

Control of STIs in vulnerable populations is difficult because of inadequate access to prompt diagnosis and treatment and may be enhanced by better community based STI surveillance. The high rates of mobile and smart phone use in these populations and the development of novel personalised diagnostic technologies which theoretically enable highly accurate self-testing diagnostics for STIs that can be electronically linked to clinical care pathways and STI data capture, may help address these challenges. A major challenge for these systems is the development of clinically relevant and acceptable Human Technology Interfaces (HTIs) for Mobile-Web Applications.

Objectives

To describe a methodological approach to develop a mobile phone/web-based management system that can link rapid self-test diagnostics to clinical care pathways and community based surveillance.

Methods

We adopt a user centred approach to the development of a HTI for self-managing STI diagnosis with initial exploratory pilot studies to gather functional, user and clinical requirements of the HTI. Iterative development of functional prototypes exploring design possibilities and technology features is followed by the formative evaluation of interface design alternatives through qualitative and controlled usability studies with target users and existing surveillance capture mechanisms.

Results

A user centred, multi-disciplinary approach allows for successful capture and integration of social science methods to inform functional requirements for an effective and user acceptable mobile and web-based self-managing STI diagnostics and surveillance system.

Discussion

Future testing in simple and complex, community based studies are needed to primarily assess safety and then effectiveness for improving access to care, enhanced partner notification and development of community based capture of surveillance data.
P114 Is there a role for primary care clinicians in providing shared care in HIV treatment? A systematic literature review
Authors: Wong W , Luk C W , Kidd M R
Published: May 2012

Background

Despite HIV being increasingly considered as a chronic illness, there is as yet no consensus about how primary care should be integrated with specialty care to provide optimal clinical management for people living with HIV.

Objective

To examine the effectiveness of shared care models of HIV between primary care and specialty care and how primary care providers can assist in improving the care of people with HIV.

Methods

Three databases, PubMed, Medline and EMBase were searched for relevant terms from studies published in the period from 1996 to 2011. Studies were included that integrated primary care in HIV management and included highly active antiretroviral therapy (HAART) as part of the treatment modality.

Results

11 studies that met the inclusion criteria were included in this review. Primary care was found to be at least as effective in HIV counselling, testing and treatment and, to a lesser degree, prevention, when compared to specialty care alone. Screening for HIV at a primary care level was cost-effective, especially in a high HIV prevalence and high-risk community. There were no significant adverse clinical outcomes reported in a primary care approach. Effectiveness of various interventions using a primary care approach were demonstrated in the review, including HAART adherence programmes, home care, the involvement of peer health workers and perinatal use of HAART.

Conclusions

Primary care has an important role in the shared care of the diagnosis and management of people with HIV. Some improvements with current guidelines on the management in primary care of people with HIV in developing countries should be considered.
Discussion of “Use of geophysical methods for soil profile evaluation” 1Appears in the Canadian Geotechnical Journal, 48(9): 1364–1377 [doi: 10.1139/t11-044].
Authors: Aung A.M.W. , Leong E.C.
Published: May 2012

This discussion highlights that the presence of higher modes in the dispersion curve of an inversely dispersive soil profile is expected. It is demonstrated that such higher modes should be accounted for to achieve more accurate inversion results.
Discussion of “One-dimensional consolidation behavior of cement-treated organic soil” 1Appears in the Canadian Geotechnical Journal, 48(7): 1100–1115 [doi: 10.1139/t11-020].
Authors: Juárez-Badillo Eulalio
Published: May 2012

This discussion is an application of theoretical equations of compressibility given by the principle of natural proportionality to the interpretation of experimental oedometer test data of cement-treated organic soil.
Behavior of pressure-grouted anchors in gravel
Authors: Hsu Shih-Tsung
Published: May 2012

This study consisted of field tests conducted on nine vertical and three inclined low-pressure-grouted anchors to investigate their behavior in gravel. An anchor can be categorized as a deep anchor when the overburden depth (free length) Z exceeds 8D (D is the diameter of the anchor). The shape of the heave on the ground surface of a shallow anchor is similar to a normal distribution curve. The extended diameter of the heave was between 170 and 300 cm, which could be divided into two zones, primary and secondary, based on the failure mode of the ground. As the fixed length of a shallow anchor increased, the extended diameter also increased. The ultimate load on an anchor increased with the free length and, to a greater degree, with the fixed length of an anchor: a fixed length of only 3 m generated an ultimate load of over 1100 kN. However, the permissible load, determined from the creep coefficient, is inapplicable for short anchors in gravel. The earth pressure coefficient K of vertical anchors was approximately 29 and for an anchor shaft inclined at 25º it was approximately 17.7.
Soluble epoxide hydrolase expression in a porcine model of arteriovenous graft stenosis and anti-inflammatory effects of a soluble epoxide hydrolase inhibitor
Authors: Sanders William G. , Morisseau Christophe , Hammock Bruce D. , Cheung Alfred K. , Terry Christi M.
Published: May 2012

Synthetic arteriovenous (AV) grafts, placed between an artery and vein, are used for hemodialysis but often fail due to stenosis, typically at the vein-graft anastomosis. This study recorded T lymphocyte and macrophage accumulation at the vein-graft anastomosis, suggesting a role for inflammation in stenosis development. Epoxyeicosatrienoic acids (EETs), products of cytochrome P-450 epoxidation of arachidonic acid, have vasculoprotective and anti-inflammatory effects including inhibition of platelet activation, cell migration, and adhesion. EETs are hydrolyzed by soluble epoxide hydrolase (sEH) to less active diols. The effects of a specific inhibitor of sEH (sEHI) on cytokine release from human monocytes and mouse bone marrow–derived macrophages (BMMΦ) from wild-type (WT) and sEH knockout (KO) animals were investigated. Expression of sEH protein increased over time at the anastomosis as evaluated by immunohistochemistry. Pre-exposure of adherent human monocytes to sEHI (5 μM) significantly inhibited lipopolysaccharide-induced release of monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-α and enhanced the EET-to-diol ratio. Release of MCP-1 from WT BMMΦ was significantly inhibited but release from sEH KO BMMΦ was not attenuated indicating the specificity of the sEHI. In contrast, sEHI did not inhibit the release of macrophage inflammatory protein-1 or interleukin-6. Nuclear translocation of NF-κB, as assessed by immunocytochemical staining, was not decreased with sEHI in monocytes, but the phosphorylation of JNK was completely abrogated, suggesting this pathway is the target of sEHI effects in monocytes. These results suggest that sEHI may be useful for inhibition of inflammation and subsequently stenosis in AV grafts.
ZnT4 provides zinc to zinc-dependent proteins in the trans-Golgi network critical for cell function and Zn export in mammary epithelial cells
Authors: McCormick Nicholas H. , Kelleher Shannon L.
Published: May 2012

Zinc (Zn) transporter 4 (ZnT4) plays a key role in mammary gland Zn metabolism. A mutation in ZnT4 ( SLC30A4) that targets the protein for degradation is responsible for the “lethal milk” ( lm/lm) mouse phenotype. ZnT4 protein is only detected in the secreting mammary gland, and lm/lm mice have ∼35% less Zn in milk, decreased mammary gland size, and decreased milk secretion. However, the precise contribution of ZnT4 is unknown. We used cultured mouse mammary epithelial cells (HC11) and determined that ZnT4 was localized to the trans-Golgi network (TGN) and cell membrane and transported Zn from the cytoplasm. ZnT4-mediated Zn import into the TGN directly contributed to labile Zn accumulation as ZnT4 overexpression increased FluoZin3 fluorescence. Moreover, ZnT4 provided Zn for metallation of galactosyltransferase, a Zn-dependent protein localized within the TGN that is critical for milk secretion, and carbonic anhydrase VI, a Zn-dependent protein secreted from the TGN into milk. We further noted that ZnT4 relocalized to the cell membrane in response to Zn. Together these studies demonstrated that ZnT4 transports Zn into the TGN, which is critical for key secretory functions of the mammary cell.
Tributyrin attenuates obesity-associated inflammation and insulin resistance in high-fat-fed mice
Authors: Vinolo Marco Aurélio Ramirez , Rodrigues Hosana G. , Festuccia William T. , Crisma Amanda R. , Alves Vitor S. , Martins Amanda R. , Amaral Catia L. , Fiamoncini Jarlei , Hirabara Sandro M. , Sato Fabio T. , Fock Ricardo A. , Malheiros Gabriella , dos Santos Marinilce F. , Curi Rui
Published: May 2012

The aim of this study was to investigate whether treatment with tributyrin (Tb; a butyrate prodrug) results in protection against diet-induced obesity and associated insulin resistance. C57BL/6 male mice fed a standard chow or high-fat diet were treated with Tb (2 g/kg body wt, 10 wk) and evaluated for glucose homeostasis, plasma lipid profile, and inflammatory status. Tb protected mice against obesity and obesity-associated insulin resistance and dyslipidemia without food consumption being affected. Tb attenuated the production of TNFα and IL-1β by peritoneal macrophages and their expression in adipose tissue. Furthermore, in the adipose tissue, Tb reduced the expression of MCP-1 and infiltration by leukocytes and restored the production of adiponectin. These effects were associated with a partial reversion of hepatic steatosis, reduction in liver and skeletal muscle content of phosphorylated JNK, and an improvement in muscle insulin-stimulated glucose uptake and Akt signaling. Although part of the beneficial effects of Tb are likely to be secondary to the reduction in body weight, we also found direct protective actions of butyrate reducing TNFα production after LPS injection and in vitro by LPS- or palmitic acid-stimulated macrophages and attenuating lipolysis in vitro and in vivo. The results, reported herein, suggest that Tb may be useful for the treatment and prevention of obesity-related metabolic disorders.
Hormone secretion in transgenic rats and electrophysiological activity in their gonadotropin releasing-hormone neurons
Authors: Gay Vernon L. , Hemond Peter J. , Schmidt Deena , O'Boyle Michael P. , Hemond Zoe , Best Janet , O'Farrell Laura , Suter Kelly J.
Published: May 2012

Expression of GFP in GnRH neurons has allowed for studies of individual GnRH neurons. We have demonstrated previously the preservation of physiological function in male GnRH-GFP mice. In the present study, we confirm using biocytin-filled GFP-positive neurons in the hypothalamic slice preparation that GFP-expressing somata, axons, and dendrites in hypothalamic slices from GnRH-GFP rats are GnRH1 peptide positive. Second, we used repetitive sampling to study hormone secretion from GnRH-GFP transgenic rats in the homozygous, heterozygous, and wild-type state and between transgenic and Wistar males after ∼4 yr of backcrossing. Parameters of hormone secretion were not different between the three genetic groups or between transgenic males and Wistar controls. Finally, we performed long-term recording in as many GFP-identified GnRH neurons as possible in hypothalamic slices to determine their patterns of discharge. In some cases, we obtained GnRH neuronal recordings from individual males in which blood samples had been collected the previous day. Activity in individual GnRH neurons was expressed as total quiescence, a continuous pattern of firing of either low or relatively high frequencies or an intermittent pattern of firing. In males with both intensive blood sampling (at 6-min intervals) and recordings from their GnRH neurons, we analyzed the activity of GnRH neurons with intermittent activity above 2 Hz using cluster analysis on both data sets. The average number of pulses was 3.9 ± 0.6/h. The average number of episodes of firing was 4.0 ± 0.6/h. Therefore, the GnRH pulse generator may be maintained in the sagittal hypothalamic slice preparation.