bluuebunny/crossref_metadata_2025 huggingface dataset:
A general modeling scheme for spatiotemporal DGGS with emphasis on encoding and operating multiscale time grids
Authors: Zhou Jianbin , Ben Jin , Liang Qishuang , Huang Xinhai , Ding Junjie
Published: May 2024

One of the basic scientific problems concerning geographic information science is how to rapidly organize, query, and compute spatiotemporal big data. The spatiotemporal discrete global grid system (DGGS) provides a homogenized discrete structure for processing multiscale and multitype spatiotemporal data. To date, most research in spatiotemporal DGGS has focused on spatial discretization while neglecting temporal discretization. Here, we propose a general modeling scheme for spatiotemporal DGGS with emphasis on encoding and operating multiscale time grids. We subdivide continuous time into multiscale temporal grids, which are then encoded as integers. Moreover, we designed integer code operations, including hierarchical traversal, neighborhood finding, and temporal relationship calculations. Compared to the multiscale time segment integer coding (MTSIC) approach, the proposed method resulted in 22% higher encoding efficiency, 10.92 times faster decoding, 2.81 times better parent code finding efficiency, 41% improved efficiency, 100% accuracy in finding children codes (compared to less than 100% with MTSIC), and a 62% enhancement in temporal relationship calculation efficiency. The application of querying spatiotemporal trajectory data validates the feasibility and practicality of substituting conventional string‐based time and floating‐point location coordinates with spatiotemporal integer codes to query data. The time encoding and operation methods proposed here indicate high efficiency, superior accuracy, and broad application prospects.
Anti‐monkeypox virus‐neutralizing activities of human immunoglobulin manufactured between 1999 and 2021 and derived from donors in the United States and Japan
Authors: Yunoki Mikihiro , Kubota‐Koketsu Ritsuko , Shioda Tatsuo
Published: May 2024

Background and Objectives

In May 2022, the United Kingdom reported the first case of chained transmission of the monkeypox (mpox) virus without any known epidemiological links to west or central Africa. The monthly number of mpox patients currently has passed a peak and is declining globally, and infected patients include both non‐vaccinated and vaccinated individuals. Herein, the virus‐neutralizing (VN) activity against vaccinia viruses, which are considered to cross‐react with the mpox virus, in the intravenous immunoglobulin (IVIG) lots derived from donors, including vaccinated Japanese populations, was evaluated to clarify the status of the Japanese blood donor population.

Materials and Methods

VN titres against vaccinia and human mpox viruses in IVIG lots derived from donors in Japan and the United States manufactured between 1999 and 2021 and 1995 and 2001, respectively, were evaluated by neutralization testing.

Results

VN titres of IVIG derived from donors in Japan and the United States against vaccinia and mpox viruses showed a slowly decreasing trend between 1999 and 2021.

Conclusion

VN titres are expected to decrease in the future since the percentage of vaccinated donors in the donor population seems to have decreased. Therefore, continuous monitoring of VN titres is required.
Surgical treatment of headshaking by removal of a paracondylar process fragment via modified hyovertebrotomy approach: A detailed anatomical and surgical description in an adult horse
Authors: Spiesshofer Pius , Hawkins Alex E. , Berner Dagmar , Previdelli Renato L. , Fiske‐Jackson Andrew R.
Published: May 2024

Objective

To describe, in detail, the relevant anatomy and surgical approach to access the paracondylar process (PCP) and report its application in a clinical case of headshaking.

Animal

A seven‐year‐old, mixed breed mare.

Study design

Experimental study/case report.

Methods

A seven‐year‐old mixed breed mare was presented for investigation of acute onset progressing violent headshaking, resulting in the horse falling on multiple occasions. The horse was highly reactive to palpation over the right PCP. Standing computed tomographic (CT) investigation and ultrasonographic examination of the head detected a fracture of the right PCP. Five equine heads of mixed breeds and sizes were dissected to demonstrate the relevant anatomy surrounding the PCP with regard to surgical access. A modified hyovertebrotomy approach was used to remove the fracture fragment under general anesthesia.

Results

The anatomy surrounding the PCP was described. The fragment was successfully removed resulting in gradual resolution of clinical signs. The horse recovered well postoperatively and was back into light levels of work with no signs of headshaking present two and a half years following surgery.

Conclusion

The caudal meningeal artery and vein as well as the glossopharyngeal and hypoglossal nerves are adjacent to the PCP and must be avoided during dissections. The modified hyovertebrotomy approach allows safe surgical access to the PCP. Surgical excision of a PCP fragment can result in complete resolution of clinical signs of headshaking. Computed tomography and ultrasonography are valuable diagnostic tools to identify a fracture of the PCP.
La huerta familiar como instrumento de la teoría de agencia: acción femenina en los procesos de recuperación agrícola y cultural en Singuilucan (Hidalgo, México).
Authors:   Universitat de Barvcelona, Cañas López Jorge Eduardo
Published: May 2024

Las protagonistas de este caso de estudio reformulan el compromiso ancestral del cuidado de la tierra, la recuperación de las plantas nativas y la organización, producción y socialización de saberes. Sus relatos, sus representaciones y el paisaje son el punto de encuentro simbólico entre el lugar y el espacio familiar y social. La intención es transmisión comunitaria e intergeneracional de conocimientos y la huerta familiar es usada como infraestructura, interfase y medio difusor de dichos conocimientos; así se construye un modelo de economía circular (economía solidaria). Recuperar la cultura tradicional desde una perspectiva comunitaria en busca del logro como intervención retributiva y bienestar social, recuperación que no solo significa la reforestación sino una “restauración integral” que conlleva el rescate de toda una cosmovisión y de construcción de un cotidiano afianzando los procesos culturales locales. Resultado (i). La huerta familiar como: a). Un sitio generador de encuentro familiar y vecinal. b). Un lugar para la organización social. c). Un espacio contenedor y difusor de los saberes tradicionales y populares. d). Un área para ejercitar esquemas de producción alimentaria orgánica. e). Un punto de documentación e interpretación de conocimiento. f). Un territorio de aprendizaje para reciclar, reutilizar y reducir. Resultado (ii). El sistema comunitario: a). Afirma la sabiduría tradicional, las técnicas y el saber popular de la comunidad. b). Consolida las formas comunitarias de actuar (ética y moral de la organización agrícola). c). Recupera las semillas y las técnicas tradicionales de la agricultura orgánica. d). Genera prácticas agricultura comunitaria a manera de huerta familiar. e). Desarrolla principios de liderazgo natural y agencia femenina. f). Construye espacios de diálogo interpersonal e intergeneracional. g). Registra el proceso como método de acopio de la sabiduría tradicional y popular. h). Motiva a vecinos y productores agrícolas a construir redes de consumo solidario.
Sum-frequency vibrational spectroscopy, a tutorial: Applications for the study of lipid membrane structure and dynamics
Authors: Taylor Joshua M. , Conboy John C.
Published: May 2024

Planar supported lipid bilayers (PSLBs) are an ideal model for the study of lipid membrane structures and dynamics when using sum-frequency vibrational spectroscopy (SFVS). In this paper, we describe the construction of asymmetric PSLBs and the basic SFVS theory needed to understand and make measurements on these membranes. Several examples are presented, including the determination of phospholipid orientation and measuring phospholipid transmembrane translocation (flip-flop).
Mixed-cation, mixed-halide perovskite ToF-SIMS spectra
Authors: Taddei Margherita , Graham Daniel J.
Published: May 2024

We report positive and negative ion time-of-flight secondary ion mass spectrometry (ToF-SIMS) spectra of metal-halide perovskite (MHP) films used for photovoltaic applications. This ToF-SIMS spectral library is of importance because it identifies the major peaks in most MHP films from organic [formamidinium (FA+)] and inorganic (Cs+) cations and anions (I− and Br−).
Long-term outcomes after acute primary angle closure: case series from Moorfields Eye Hospital, UK
Authors: Hamid Sana , Matarazzo Francesco , Sun Zihan , Baboolal Sandika , Muhundhakumar Dhakshi , Foster Paul J
Published: May 2024

Background

There is limited data regarding the morbidity and progression to primary angle closure glaucoma in those presenting with acute primary angle closure (APAC) in the UK. We aim to report on the vision and intraocular pressure (IOP) outcomes and treatment required after an APAC episode and to identify any risk factors that could predict worse outcomes.

Methods

A retrospective observational case series review including 117 consecutive patients (121 eyes) attending Moorfields Eye Hospital, at a tertiary referral unit in the UK, with APAC was performed.

Results

Most patients (73%) had visual acuities of ≥6/12, meeting the UK driving standard, at the final follow-up. Only 15% (17 eyes) had severe visual impairment, as defined by the WHO, in the affected eye, of which 6.6% (eight eyes) were due to glaucoma. The delayed presentation was linked to a higher need for further medical treatment (OR=2.83, 95% CI 1.09 to 7.40, p=0.03). Patients who underwent phacoemulsification were at lower risk of having blindness in the affected eye (OR 0.18, 95% CI 0.05 to 0.69, p=0.01), having elevated IOP (OR 0.10, 95% CI 0.01 to 0.75, p=0.02) or requiring further medical treatment (OR 0.34, 95% CI 0.12 to 0.99, p=0.04). Older age (OR 1.26, 95% CI 1.08 to 1.48, p<0.01) was associated with worse visual outcomes.

Conclusions

APAC causes low long-term visual and treatment morbidity in this largely Caucasian patient group in the UK. Phacoemulsification as a treatment may enhance visual outcomes and reduce the need for further IOP-lowering treatment.
P055 Using the electronic patient record to support capacity planning by linking need to level of service
Authors: Spelman Kez , Hughs Taylor
Published: May 2024

Introduction

Planning service capacity is key to ensuring that sexual health services continue to be functional and sustainable. We have reviewed and categorised data recorded in our electronic records system and by categorising activity and then identifying appropriate staff level associated with that activity we can more effectively plan capacity.

Methods

We established agreement about service activity and assigned these activities to the categories of: integrated sexual health 1 and 2, integrated sexual health 3, online and telephone. Using 2016/17 quarter 2 and 3 data we grouped individual attendance records to these categories. Our analysis, based on a combination of item of service, SHHAPT coding and prescription, allowed us to robustly assign attendance to category. This was then compared with the level of care and access clients actually received in terms of staff level, and the variations showing the potential for shift across levels was established. We then audited at patient record level to provide assurance about assumptions made in the categorisation process.

Results

The results indicated that a significant percentage of clients currently being seen in a face to face setting are appropriate for online and telephone consultations. We further identified a number of clients seeing doctors who were appropriate to be seen by nurses, indicating further shift potential.

Discussion

This approach informs service capacity plans and drives efficiency. The potential for capacity release is tangible and can be applied to other service requirements such as training and service development. We are developing a dashboard system for responsive monitoring.
P089 PJP diagnosis in the haart & PCR era
Authors: McCorry Louise , Coyle Peter , Walker Eoin , Todd Suzanne , Bell Laura , Megarity Stephen , Kinghan Emma , Hunter Michael
Published: May 2024

Introduction

In the HAART era, Pneumocystis jirovecii Pneumonia (PJP) continues to be a major opportunistic infection. PJ PCR is increasingly available to support the diagnosis of PJP. A ‘low level’ PCR result may represent PJ colonisation or a poor-quality specimen. Upper airway samples such as throat swabs (T/S) are also more likely to yield a negative or low level positive.

Method

Retrospective review of all HIV-infected adults with respiratory tract PCR-confirmed PJP and pneumonia over an 18 month period. Demographics, clinical features, management, clinical outcome and laboratory parameters were recorded.

Results

4/12 patients had negative T/S PJP PCR test before the diagnosis was confirmed. The mean cycle threshold (CT) value for throat swabs was34.04. The mean CT value for sputum was32.05.

Discussion

PJP PCR is a useful investigation. PCR will detect more cases than traditional tests (direct organism visualisation). This leads to earlier PJP treatment and earlier screening for HIV. While there is a trend towards lower CT value results in sputum when compared with throat swabs, any positive PJP result should trigger the offer of a HIV test. Patients with a negative URT PCR and clinical suspicion of PJP should receive empiric treatment and where appropriate proceed to BAL, as per national guidance.

Abstract P089 Table 1

Patients with PJP (in order of immunosuppression)

Age at HIV diagnosis, gender, behavioural riskCategoryCD4+ count at PJP diagnosis, PJP severityPJP test 1
(Ct value, site)PJP test 2 (Ct value, site)Clinical outcomeKnown HIV39/M/IDUOn ART for 4 weeks, not on PJP prophylaxis200, mild37.0, TSn/aSurvived38/M/MSMDefaulted from care, not on ART10, severeNeg., TS32.5, TSICU care, survivedMissed opportunity to diagnose HIV53/M/MSMUnexplained diarrhoea and weight loss70, severe30.0, SPU26.2, SPUICU care, deceased43/F/heterosexualUnexplained lymphadenopathy and weight loss50, severe26.4, SPUNeg., TSReadmitted with hypoxia, survived32/F/heterosexualCampylobacter gastroenteritis50, severe36.4, TS25.3, SPUICU care, survived56/M/unknown–30, severeNeg., TS31.5, SPUICU care, deceased39/M/heterosexualUnexplained weight loss20, mildNeg., TS25.0, SPUSurvived62/M/MSMUnexplained weight loss20, mild26.0, BALn/aSurvived55/M/MSMBacterial pneumonia20, mild33.0, SPUn/aSurvived52/M/heterosexual–10, severe30.3, SPU34.9, SPUICU care, survived57/M/MSMUnexplained weight loss10, severe39.0, SPUn/aICU care, survived52/M/heterosexualChronic diarrhoea, bacterial pneumonia0, severeNeg., SPU28.0, SPUICU care, hypoxia requiring long-term home-O2

Note-BALbroncho-alveolar lavage;F: female;M: male;ICU: intensive care unit;IDU: intravenous drug user;

MSM men who have sex with men;n/a: not available;Neg.: PCR not detected;SPU: sputum,TS: throat swab

PJP severity(‘mild’: mild-moderate, or ‘severe’: moderate-severe, by BHIVA criteria)
P091 New hiv diagnoses among women in a large teaching hospital
Authors: Walker Eoin , Quah Say , McCarty Emma , Dinsmore Wallace , Donnelly Claire , Emerson Carol
Published: May 2024

Introduction

In 2014 there were an estimated 103,700 people living with HIV (PLHIV) in the UK, approximately one third were women. In 2015 there were 965 PLHIV in our cohort, 215 were women. There are few data available on HAART in women, other than in pregnancy. Socio-economic and cultural factors may also affect their ability to access care. Other factors affecting women include contraception, conception and pregnancy.

Methods

A retrospective chart analysis was carried out on all new diagnoses among women over a 3-year period, from April 2013 to April 2016. Patients who had previously been diagnosed elsewhere were excluded.

Results

There were 286 new diagnoses of HIV in this period; 44 (15%) were women. 41% of patients were local, 39% were of African origin. 57% of patients were diagnosed late, having CD4 <350 at diagnosis. 8 patients were pregnant; there were no vertical transmissions. Existing children were tested were possible; no positive diagnoses were made. A number of male partners were diagnosed through partner notification. The majority of patients commenced HAART and reported good adherence.

Discussion

Women make up a significant proportion of PLHIV, though rates in our region are lower than in the rest of the UK. The majority of positive women in the UK are of black African origin, though in our cohort a higher proportion were born locally. Many of these women are diagnosed late, and with no identifiable traditional risk factors. There are a number of important gender-specific factors associated with HIV-positive women and these should not be underappreciated.
P104 Self-service sexual health: pipedream or reality?
Authors: Horn Kate , Hawkins Michelle
Published: May 2024

Introduction

Finding smarter ways of working which meet the needs of increasingly IT-savvy clients and support their busy lifestyles is a priority and an opportunity to innovate.

To meet these demands, we developed a national web-based hub, streamlining access to sexual health information and local services, while signposting to services nationally. User insight helped inform the design which was mobile first.

Methods

Following launch of the hub, we recorded a number of metrics to assess acceptability to users and impact on existing services.

Results

In the first 5 months of operation we have seen: 45% more people visiting our national website than all local websites combined, with users staying longer and engaging with well-being content. 75+% accessing from a mobile device. Peak use in 18–34 year olds, with all age groups represented. 151% increase in visits to LARC self-help online content and use of pre-consultation videos. 10% reduction in call volumes to services, equating to 213 hours of admin time. Improved patient experience and choice as evidenced through user survey. Very easy or easy to find information and advice online: 92%. Very likely or likely to recommend to a friend: 96%

Discussion

Initial results are encouraging and suggest the online hub is acceptable and helpful to users. Increasing available self-management options in the next phase of this project will include free postal sampling kits for asymptomatics (aged 16+), with the aim of increasing access to screening, reducing unnecessary clinic visits and releasing capacity in services for those requiring clinician input.
P113 Domestic violence – do we ask? will they tell?
Authors: Dearing Nicola , Akala Oyeyemi , Peycke Jennifer , Carter Helen
Published: May 2024

Introduction

Experience of domestic violence is reported as 28.3% in women and 14.7% in men. It causes significant harm and screening sexual health clinic attendees is recommended. Proformas used within our service include a question on domestic violence however screening practice among clinicians varies.

Aim

Investigate the prevalence of domestic violence among our clinic attendees and determine if current practice is successful at identifying this.

Methods

Patients attending a clinic on 9th January 2017 were asked to complete an anonymous questionnaire including questions on domestic violence, mental health, unplanned pregnancy and STI’s. A retrospective audit of documentation of domestic violence in patient’s records was then undertaken for all patients attended on that day.

Results

Total number of attendees on 9th January was 111, 57 completed questionnaires (52% female and 50% male attendees). Domestic violence was reported by 27% female attendees and 16% male attendees (10% in heterosexual male, 33% in MSM). Females suffering domestic violence more commonly reported sexual assault, mental health problems and unwanted pregnancy.

34% female attendees had a documented enquiry regarding domestic violence. 24% of these reported domestic violence. Among male attendees 38% had a documented enquiry with 9% reporting domestic violence. Reporting of domestic violence by men to clinicians was lower than predicted by the survey.

Discussion

With our current practice we can expect to miss 10 women and 5 men a day who have suffered domestic violence. Routine enquiry is to be recommended. Reluctance to disclose domestic violence may still be a barrier to identifying this hidden problem.
P120 Detection of syphilis and other pathogens associated with genital lesions using plexpcr
Authors: Erskine Simon , Windsor Madeline , Njuguna Peter , Tucker Rachel , Wee Rachel , Tan Litty , Azzato Franca , Mokany Elisa
Published: May 2024

Introduction

Syphilis is an STI caused by the bacteriumTreponema pallidumthat can result in substantial morbidity and mortality. Recently, there has been an alarming global resurgence of syphilis with infections rising to unprecedented rates. As such, it is increasingly pertinent to test genital lesions for syphilis. Moreover, Herpes simplex virus types 1 and 2 (HSV–1 and HSV–2) and Varicella zoster virus (VZV) cause lesions in cutaneous and mucocutaneous sites. Recent publications have found VZV in genital specimens, suggesting that reactivation of VZV in this atypical presentation is not as uncommon as previously believed, further necessitating the importance of identifying these organisms at these sites.

Methods

The PlexPCR HSV-1&2, VZV, Syphilis test (SpeeDx) is a single-well multiplex qPCR for testing genital lesions for the targets HSV-1, HSV-2, VZV andT. pallidium. The performance of the assay was evaluated on 90 genital specimens for which in-house PCR results for syphilis had been determined.

Results

The multiplexed assay detected 54/57 syphilis positives, corresponding to a sensitivity and specificity of 94.7% and 100.0%, respectively. The assay also detected four HSV–1 and two HSV–2 infections (2 and 1 syphilis co-infections, respectively). All assays demonstrated analytical sensitivity to 10 copies per assay.

Discussion

The lesion assay offers simultaneous detection and differentiation of pathogens that cause genital lesions. In response to the current emerging syphilis outbreak, this assay could provide a rapid and effective method of determining the infectious agent responsible for genital lesions, supporting earlier detection and rapid treatment to reduce morbidity or worse outcomes.
P124 Exploring health care professionals’ perceptions and knowledge of trans* patients’ sexual health needs: a need to update the curriculum?
Authors: Crow Madeleine
Published: May 2024

Introduction

No current competencies for transgender issues exist in genito-urinary or community sexual and reproductive health training curricula. This gap is currently being addressed and curriculum changes on the topic are being proposed. The aim of this study is to assess doctor’s knowledge regarding specific trans* issues and their attitudes to proposed curriculum changes.

Methods

Purposive, convenience sampling was used. A self-completed questionnaire was distributed via the British Association for Sexual Health and HIV newsletter and at the Faculty of Sexual and Reproductive Health annual conference. It consisted of 15 closed and open-ended questions on demographics, previous experience and training, knowledge of specific trans* health issues, and attitudes to curriculum changes. Analysis was done using Stata.

Results

From the 110 eligible responses only 37% had received previous training on trans* issues and 81% supported adding trans* issues to the curriculum. The need for training was demonstrated in the high proportion, 86%, with concerns around managing trans* patients. Confidence was lacking in clinical scenarios, especially performing genital examinations and cervical screening. Knowledge gaps were identified in all areas, particularly regarding management of post-operative complications.

Discussion

This study highlights the need for doctors’ training to improve knowledge and confidence on trans* issues, as well as the positive receptivity of training. Concerns mostly revolve around how to make competencies logistically feasible in the face of an already packed mandatory curriculum and lack of opportunities for exposure to these patients.
P133 Using a cross sectional survey to establish a national picture of the activity, governance and delivery of condom distribution schemes in england, in the financial year 2015/16
Authors: Ratna Natasha , Nardone Anthony , Hadley Alison , Brigstock-Barron Owen
Published: May 2024

Introduction

Condoms remain a key intervention to prevent sexually transmitted infections (STI), pregnancy and HIV. C-Card is a type of condom distribution scheme (CDS) with condom demonstration and risk assessment at registration, after which free condoms are available to young people, in accessible locations.

Aim

Review delivery and C-Card activity in England and its regions in financial year 2015/16, to inform policy, best practice, future monitoring and evaluation.

Methods

An online survey was disseminated to sexual health commissioners of 152 upper tier local authorities (UTLA) in England between 17/12/2016 and 10/02/2017. Questionnaire domains collated information on service delivery structure, governance, user information, spend, product availability and provision, and other CDS.

Results

64% (98/152) of UTLAs completed the survey. 20 had both C-Card schemes and CDS, 57 had C-Card schemes, 14 had CDS and 7 had neither. 60 reported 4,560 C-Card outlets. The three most common settings for C-Card schemes were pharmacies (1,363, 30%), youth organisation and educational settings (1,105, 24%) and general practice (996, 22%). In 2015/16, 77 UTLAs reported 65,762 new C-Card user registrations, of which 70% were repeat users. Of 70 reporting product availability, 60 (86%) distributed condoms and lubricants. 28 distributed 896,221 products, of which 85.8% were condoms, 13.7% were lubricants and 0.5% other. Estimated spend on condom schemes were £1,491,937.

Discussion

Availability of CDS in most UTLAs and high repeated use of C-Card schemes suggest acceptability and popularity. Improved evaluation of C-Card schemes for STI, pregnancy and HIV prevention is needed to demonstrate their value.
P142 Recreational drug use in heterosexual men in a sexual health clinic in east london: the forgotten majority?
Authors: Samra Ranjit , Khan Palwasha , Bansal Ciara , Bayley Jake
Published: May 2024

Introduction

Recreational drug use is widely reported in the MSM population, however its use in the male heterosexual population is less well-described. We undertook a short survey to determine the prevalence of chemsex use in all men.

Methods

Self-directed questionnaires were given to all male attendees at a GUM clinic for three weeks in December 2016. Data on demographics, level of education, sexual risk and drug use (including ‘chemsex’ drugs and other recreational drugs).

Results

268 questionnaires were returned. 70% (182/260) were heterosexual and 63% (155/246) were of white ethnicity. 41% of both the heterosexual and MSM groups had ever tried one drug. Prevalence of recent use (less than 1 year) was 27% (40/149) in heterosexuals and 35% (24/68) in MSM. There was much less use of ‘chemsex’ drugs in heterosexuals versus MSM (20% versus 9%, p=0.03). Use of crystal methamphetamine and GHB were much lower in the heterosexual population. The highest prevalence of any previous drug use was found in white men vs non-white men (73/133 (55%) versus 11/65 (17%), p <0.05) a pattern was seen in both heterosexual and MSM groups.

Discussion

There were surprisingly high levels of recreational drug use in heterosexual men, especially those of white ethnicity. ‘Chemsex’ drugs still seem to be much more common among MSM, especially crystal methamphetamine and GHB, but the difference in mephedrone use is much less marked. These data highlight the necessity of asking all patients that attend GUM clinics about their drug use, and not only MSM.

Abstract P142 Table 1

Recreational drug use in Heterosexual and MSM.

Ever UsedMSM n (%)Heterosexual men n (%)All29/70(41)59/144(41)Cocaine21/66(32)47/139(34)MDMA23/67(34)42/134(31)GHB11/65(17)3/131(2)Ketamine9/63(14)15/130(12)Mephedrone9/65(14)11/131(8)Crystal methamphetamine5/64(8)2/130(2)Legal1/61(2)9/128(7)Steroids0-3/130(2)Other4/62(6)12/124(10)
P144 Optimising chlamydia screening – a city and countywide approach in nottinghamshire
Authors: Handley Sally , Shaw Deborah , Neal Carl , Ford Carol , Romilly Nick , Gribbin Jonathan , Saunders John , Taylor Ruth , Carlin Elizabeth
Published: May 2024

Introduction

The Public Health Outcomes Framework detection rate indicator (DRI) sets a target of ≥2,300 chlamydia diagnoses per 100,000 15 to 24 year-olds. The 2014 DRI in Nottingham City and Nottinghamshire County was 2,807 and 1,900, respectively.

We used the National Chlamydia Screening Programme’s Chlamydia Care Pathway (CCP) approach to review 2014 data and identify opportunities to improve the quality of screening and increase the DRI.

Methods

Routine surveillance data from GUMCAD and CTAD was used to populate the CCP for the region. Findings were discussed at the local strategic sexual health group and actions agreed.

Results

Issues identified were around unknown test offer-rate, low coverage in some districts and low retesting rates following treatment. In response: existing GUMCAD codes were used to infer the offer of a test; health promotion activities focused on raising awareness of testing among key populations, primary care and providers of other young person services; re-testing pathways were audited and a text reminder system for re-screening at 3months was implemented in one of the units.

Discussion

The CCP provided a strategic focus to increase understanding of screening at all stages of the pathway. It confirmed the need for an integrated screening approach across sexual health providers, primary care and broader health services who engage with young people. There was potential to achieve ‘quick wins’ by using the CCP to focus on each specific stage of the programme. 2017 data will be reviewed using the CCP to evaluate the impact of the plans which have been implemented.
O02 What are the motivations and barriers to effective HIV pre-exposure prophylaxis (PREP) use for black men who have sex with men (BMSM) aged 18–45 in london? results from a qualitative study
Authors: Witzel T Charles , Nutland William R , Bourne Adam H
Published: May 2024

Introduction

PrEP has the potential to transform the HIV epidemic in the UK. BMSM experience a significantly higher HIV prevalence compared with other MSM meaning that PrEP rollout should be attentive to reducing health inequalities in this group. This research aims to describe the motivations and barriers to PrEP use for BMSM aged 18–45 in London.

Methods

Twenty-five BMSM were recruited through social sexual apps for semi-structured interviews. All participants reported sexual behaviours consistent with PrEP candidacy. Interviews were transcribed verbatim and analysed using a thematic framework informed by inter-sectionality theory.

Results

An ‘ideal’ PrEP candidate was frequently perceived to embody characteristics that participants themselves did not necessarily identify with (e.g. that they were insufficiently risky or sexually active to require PrEP). Many already felt marginalised by virtue of being both black and gay, or felt ‘type-cast’ as sexually dominant within the gay scene. Concern was expressed that taking PrEP may exacerbate such marginalisation by suggesting that they were also promiscuous. For others, however, taking PrEP meant avoiding another marginalised identity: that of someone with HIV. Participants tended to prefer conveniently located clinics outside of traditionally ‘black’ areas. Accessing services from staff of similar ethnic backgrounds was difficult for many, except for staff also perceived as gay.

Discussion

Marginalisation remains a key barrier for this group, and should be considered when developing PrEP interventions. Existing services are acceptable for delivering PrEP interventions, but staff need to be mindful, sex affirmative and focus on developing rapport with BMSM of similar ethnic backgrounds as themselves.
P160 To see or not to see
Authors: Seacombe Sarah , Lomax Nicola , Cousins Darren
Published: May 2024

Introduction

Determining which patients need to be seen on the day they attend. Sexual Health Services are challenging given the increasing demand for services and limited capacity. A new questionnaire based triage system was implemented in a busy, urban, Level 3 Sexual Health Service. We have reviewed the outcomes of implementing this triage process to assess how many triaged patients were seen the same day and the symptoms they reported, how many received future appointments and of those, how many returned. We also assessed the safety of a questionnaire based process for triage.

Methods

Patients triaged in November 2016 were identified and their notes reviewed.

Results

Of 255 recorded triages, 119 notes have been reviewed to date. Of these, 92 (77%) were seen the same day but 2 left before being seen. 27(23%) received a follow-up appointment, and 89% of these attended.

Of the 92 given a same day appointment, 36 (39%) reported pain/dysuria, 23 (25%) were contacts of an STI, 2 required PEP, 6 had discharge, 3 recurrent HSV, 2 patients had been diagnosed with Chlamydia elsewhere, 2 had non-specific symptoms, 1 requested a TOP and 1 reported sexual assault. 12 had lumps or itching, 4 were asymptomatic.

Discussion

This review demonstrated that questionnaire based triage is effective and as it is quicker than face to face triage, capacity can be increased. 77% of patients were offered same day review which highlights the importance of flexibility within services to ensure patients can be seen within 48hrs when appropriate.
P164 Audit of the management of genital herpes infection in colchester sexual health clinic
Authors: Munasinghe Sujeevani , Shah Michael , Ramogi Malaki
Published: May 2024

Introduction

Genital Herpes infection, caused by Herpes simplex virus is one of the common sexually transmitted infections in the UK. According to Public Health England STI report (2015) the percentage increase of newly diagnosed Herpes infection from 2006 to 2015 is 67%. BASHH published new Herpes management guidelines in 2014. We evaluated the management of Herpes infection at our clinic against these guidelines using electronic patient records over a six month period in 2015.

Methods

Retrospective case notes review of all patients diagnosed with genital herpes infection (coded C10A) from July to December 2015. Individual case records were scrutinised and evaluated against auditable outcome measures outlined in BASHH 2014 guidelines.

Results

There were 102 newly diagnosed Cases of HSV in this 6 month period. All patients had HSV detection by PCR confirmation and 100% had at least one detected HSV typed. Recommended antiviral therapy offered to 95% of the patients who presented within 5 days of onset of symptoms (target 97%). The percentage of patients who were given verbal and written information about HSV was 54%.

Discussion

Our audit shows we met the BASHH standards by virologically confirming and typing all diagnoses of genital herpes infection. We failed to meet the standards on patient education and documentation. Since April 2016, our service has switched to new electronic patients records which has a dedicated section on patient education This will help improve our performance. This will be re audited next year.
P172 Enjoy yourself, its later than you think!
Authors: Megarity Stephen , Dinsmore Wallace , Bell Laura , McCarty Emma
Published: May 2024

Introduction

Erectile Dysfunction (ED) affects 10% of men and those affected may present at Genitourinary Medicine clinics. It may indicate significant underlying pathology and is often the first presenting symptom of cardiovascular disease (CVD) and diabetes.

Methods

All new referrals to the sexual dysfunction clinic in 2006 were identified. Electronic medical records were reviewed to determine clinical outcomes 10 years after initial attendance.

Results

138 patients identified; 9 were excluded due to unavailable records. Mean age at referral was 47 years. 68% (n=88) had predominantly organic ED (mean age 52 years) while 32% (n=41) were diagnosed with an underlying psychological cause (mean age 37). Of those with an organic cause, 20% (n=18) had known CVD and 17% (n=15) had diabetes. By 2016, 10% (n=13) of all patients had died. Of those alive, 30% (n=35) remained on treatment for ED. In the intervening years, a further 10 patients were diagnosed with CVD, 9 diabetes, 3 peripheral vascular disease, 3 Parkinson’s disease and 2 with stroke. Of those initially referred with ED, after 10 years, 41% had proven CVD, 27% were diabetic and 10% developed other associated conditions.

Discussion

10-year outcomes for patients presenting with ED are associated with significant levels of morbidity and mortality. The incidence of underlying vascular disease and chronic conditions in this cohort of patients is significant. Recognition of ED is important in GUM settings to enable early detection of significant underlying co-morbidities.
P176 Clinical pharmacology of the HIV integrase strand transfer inhibitor bictegravir
Authors: Zhang Heather , Custodio Joseph , Wei Xuelian , Wang Hui , Wu Amanda , Ling John , Martin Hal , Quirk Erin , Elliott Cindy , Kearney Brian
Published: May 2024

Introduction

Bictegravir(BIC), an investigational, once-daily, HIV integrase strand transfer inhibitor(INSTI) with potent in vitro activity against most INSTI-resistant variants, is currently in development as a single tablet regimen(STR) coformulated with FTC/TAF.

Methods

BIC exposure was dose proportional following SD of 25–100mg. Steady-state accumulation was approximately 1.6x, consistent with the observed half-life of approximately 18 hours. Balanced glucuronidation and oxidation contributed to the major clearance pathways. The DDI study showed increased BIC AUC(61-74%) by CYP3A4 inhibitors voriconazole and DRV/COBI but showed a greater increase(~4x) by potent dual inhibitors of UGT1A1 and CYP3A4, ATV and ATV+COBI. Coadministration with a potent CYP3A4/UGT1A1/P–gp inducer, rifampin resulted in a 75% decrease of BIC AUC a lesser reduction(38%) was associated with the moderate CYP3A4/P–gp inducer, rifabutin. BIC was well tolerated at all doses studied.

Results

The favourable BIC PK profile supports once daily dosing. DDI results are consistent with its ADME profile in which both CYP3A4 and UGT1A1contributed to BIC elimination. BIC was safe and well tolerated in healthy volunteers.

Discussion

The favourable BIC PK profile supports once daily dosing. DDI results are consistent with its ADME profile in which both CYP3A4 and UGT1A1contributed to BIC elimination. BIC was safe and well tolerated in healthy volunteers.
P182 Chlamydia positive testing to treatment turnaround time (TAT) april to december 2016
Authors: Proctor Gordon , Sarner Liat , Symonds Merle
Published: May 2024

Introduction

Reduction in time to treatment for those with STIs is key for reducing negative sequelae, identifying and treating STIs in partners and preventing onward transmission. BASHH 2014 Standards stipulate that results should be available within 10 working days of testing but there are no standards published for time from test to treatment. In our service patients are told to access results after 7 days. Our results management team contact untreated patients 7 days after testing.

Aims

To ascertain the time period between STI test date, availability of result and receipt of treatment for those testing positive for chlamydia within a large multi-site service.

Methods

A retrospective audit of the sexual health service electronic patient record (EPR) was undertaken from April to December 2016 identifying all chlamydia positive results across our service. Date of test, availability of result and treatment received was analysed. The following data was analysed.

Results

2897 patient records were identified for analysis. 550 were excluded due to incomplete data. 2347 records were analysed. 63.9% of results were available in 72 hours (mean 48 hours) and 96.2% in 7 days. 51.7% were treated within 48 hours of result availability, 56% within 7 days, 92.2% within 14 days and 97.5% by 28 days.

Discussion

The majority of results are available within 72 hours however <60% of patients were treated within 5 days. Patients will now be advised to access the results within 3 days and the service will contact untreated patients within 5 days of a positive result.
P186 The usefulness of diagnostic genital skin biopsies in genito urinary clinical settings
Authors: Patrick Helen , Jayasekara Niroshan , Fitzpatrick Colin , Finnerty Fionnuala , Wijerathna I , Murdock Rebecca , Richardson Daniel
Published: May 2024

Introduction

It can be difficult to ascertain the exact aetiology of genital dermatoses as there are a several causative factors including inflammatory, neoplastic & infective. Genital skin biopsy can be a useful tool to provide definitive diagnosis.

Methods

We reviewed the electronic patient records of patients diagnosed with genital dermatoses in our clinic over a six month period. We compared clinical diagnoses with final histological diagnoses.

Results

A total of 56 patients were given a clinical diagnosis of genital dermatosis during the study period – Lichen Planus (8), Lichen Sclerosus (27), Seborrheoic Keratosis (1), Psoriasis (5), Zoon’s Balanitis (7), malignancy (3) and atypical lesions (5). Of these, 32 (57%) underwent a genital biopsy (see table one). Clinical and histological diagnosis correlated in 21 cases (66%). No additional malignant lesions were found following biopsy.

Discussion

In our clinic, correlation between clinical and histological diagnosis of genital dermatoses was good and no additional malignancies were found over and above clinical suspicion. 32 patients (57%) of patients seen with genital dermatoses underwent a genital skin biopsy.

Abstract P186 Table 1

Genital Dermatoses

Clinical DiagnosisNumberNumber BiopsiedClinical Diagnosis ConfirmedLichen Planus80503Lichen Sclerosus271308Sebhorreic Keratosis010101Psoriasis050403Zoon’s Balanitis070504Malignancy030301other050101
O23 Impact of service relocation on neisseria gonorrhoeae culture sensitivities
Authors: Wallace Harriet , T Coates Marshall , Inns Helen , Wilson Janet , Page Emma
Published: May 2024

Introduction

Our hospital-based GUM clinicNeisseria gonorrhoeae(NG) cultures were directly plated, stored in a CO2-enriched incubator and portered twice daily to onsite microbiology. Service relocation in November 2015 to a citycentre hub and 4 community sites forced change due to distance from microbiology. Community samples are taken on charcoal swabs, taxied to the hub at close of clinic for plating. Hub samples are directly plated. All plates are incubated 48–72hrs and transported daily in CO2-enriched environment (not temperature controlled).

Aims/objectives

Evaluate sensitivity for NG culture against positive NAAT before and after service relocation.

Methods

Cases of NAAT positive NG with a culture taken January–June 2015 were compared with cases January–June 2016. Hub and community results were merged in 2016 due to small numbers from community.

Results

Overall sensitivity per infected patient (any positive NAAT and culture from any site) 2016 176/253 (70%) versus 2015 218/279 (78%), OR 0.64 (95% CI 0.43–0.94), p=0.02. Total sites with positive NAAT and associated culture processed: 2015 n=375, 2016 n=333.

Culture sensitivity by site of positive NAAT 2016 versus 2015: Urogenital 78% versus 85% (OR 0.63(0.37–1.08);p=0.09), Rectal 39% versus 55% (OR 0.52(0.29–0.94);p=0.03), Pharynx 33% versus 51% (OR 0.49(0.25–0.96);p=0.04).

Discussion

Despite extensive review of evidence to identify systems that would maintain NG culture sensitivity, the overall sensitivity of NG culture has dropped significantly since the community move. There has been a non-significant decline in urogenital culture sensitivity but significant reductions in rectal and pharyngeal sensitivities. A new method for NG transportation is now under consideration.
P190 Genitourinary medicine: more than just sti screening and treatment
Authors: Priestley Cecilia , Scofield Sara
Published: May 2024

Introduction

Since the transfer of commissioning, some local authorities have taken a narrow view of sexual health, defining it as STIs and contraception only, and some have not funded the complex non-STI genital conditions that are a core part of GUM. However patients attend because they have a problem, which may or may not be an STI, that affects their sexual health. We aimed to give a snapshot of a GUM consultant’s clinical caseload.

Methods

A record was kept of all GUM patient consultations over a 2 week period.

Results

A total of 43 patients were seen. All but one were follow-ups. Nine (21%) were long-term attenders. The rest were referred by other clinic staff 20 (47%), consultants in other specialties 10 (23%) and GPs 4 (9%). The average age was 41 (19–87).

The commonest conditions seen were genital dermatoses (20), chronic/recurrent PID (13), recurrent candida (9; two with resistant species), VIN (6), atrophic vulvo-vaginitis (6), vulvodynia (5), and CPPS (4). STIs included HSV (3), chlamydial PID (3) SARA (1) and conjunctivitis (1), and an MSM with syphilis, rectal gonorrhoea and warts.

Nine patients had more than one genital infection and nine both a genital infection and a genital dermatosis.

Discussion

This snapshot demonstrates both the complexity of patients and the holistic care provided by a GUM consultant. While other specialties are able to manage some of the conditions seen in GUM, few would have the expertise to manage patients with co-existing STIs and other genital infections, chronic pain conditions and genital dermatoses.
P195 How prepared are gum and hiv clinics in london to respond to the hepatitis a outbreak? a survey of vaccination policy and logistics
Authors: Brook Gary , Mindlin Miranda , Menon-Johansson Anatole
Published: May 2024

Introduction

From late 2016, Hepatitis A virus (HAV) infection in MSM increased in incidence in the UK and has reached outbreak status. By February 2017, 42 confirmed or suspected cases had been reported in London. An outbreak committee was convened by Public Health England and as part of this work data was gathered to ascertain current levels of vaccination and future needs in MSM attending GUM/HIV clinics.

Methods

Clinical leads for GUM and HIV services in London were e-mailed a survey asking about past HAV vaccination policy, requirements for vaccine, logistics of vaccine provision, acute HAV infection reporting and contact tracing policy.

Results

14/17 (82%) NHS Trusts, representing 23 clinics responded to the survey.

Abstract P195 Table 1

HAV Vaccination Provision for MSM in GUM and HIV clinics in London

Never stopped in GUMStopped in GUM in last 2 yearsStopped in GUM in last 2–10 yearsStopped in GUM >10 years ago3/23 (13%)6/23 (26%)7/23 (30%)7/23 (30%)Offered to all HIV+ patientsOffered to selected HIV+ patients only20/23 (87%)3/23 (13%)

4/23 (17%) GUM clinics restarted routine vaccination in 2017. Only 3 HIV clinics were able to estimate background HAV immunity in their MSM as being 70–90% immune/vaccinated. The barriers to roll out of vaccination were identified as cost/funding (17/23 74%); logistics of provision (11/23 48%) and vaccine supply difficulties (7/23 30%). All clinics would contact trace acute HAV cases internally, 6/23 (23%) would notify the Health Protection Team by phone and the rest would notify using the BASHH/PHE notification form.

Discussion

The provision of HAV vaccination for MSM in London GUM clinics has been variable, leading to a significant proportion of MSM potentially remaining non-immune. The main barriers to vaccination have been funding, logistics and vaccine supply. If the outbreak is to be halted, these barriers need to be overcome.