bluuebunny/crossref_metadata_2025 huggingface dataset:
Membrane Requirement for Folding of the Herpes Simplex Virus 1 gB Cytodomain Suggests a Unique Mechanism of Fusion Regulation
Authors: Silverman Jessica L. , Greene Neil G. , King David S. , Heldwein Ekaterina E.
Published: May 2012

Herpes simplex virus type 1 (HSV-1) enters cells by fusion of its envelope with a host cell membrane, which requires four viral glycoproteins and a cellular receptor. Viral fusion glycoprotein B (gB) mediates membrane fusion through the action of its ectodomain, while its cytoplasmic domain (cytodomain) regulates fusion from the opposite face of the membrane by an unknown mechanism. The gB cytodomain appears to restrict fusion, because point or truncation mutations within it increase the extent of fusion (synmutations). Previously, we showed that the hyperfusion phenotype correlated with reduced membrane binding in gBsyntruncation mutants and proposed that membrane binding was important in regulating fusion. Here, we extended our analysis to threesynpoint mutants: A855V, R858H, and A874P. These mutations produce local conformational changes, with some affecting membrane interaction, which suggests that whilesynmutants may deregulate fusion by somewhat different mechanisms, maintaining the wild-type (WT) conformation is critical for fusion regulation. We further show that the presence of a membrane is necessary for the cytodomain to achieve its fully folded conformation and propose that the membrane-bound form of the cytodomain represents its native conformation. Taken together, our data suggest that the cytodomain of gB regulates fusion by a novel mechanism in which membrane interaction plays a key role.
Serotype-Specific Neutralizing Antibody Epitopes of Human Adenovirus Type 3 (HAdV-3) and HAdV-7 Reside in Multiple Hexon Hypervariable Regions
Authors: Qiu Hongling , Li Xiao , Tian Xingui , Zhou Zhichao , Xing Ke , Li Haitao , Tang Ni , Liu Wenkuan , Bai Peisheng , Zhou Rong
Published: May 2012

Human adenovirus types 3 and 7 (HAdV-3 and HAdV-7) occur epidemically and contribute greatly to respiratory diseases, but there is no currently available licensed recombinant HAdV-3/HAdV-7 bivalent vaccine. Identification of serotype-specific neutralizing antibody (NAb) epitopes for HAdV-3 and HAdV-7 will be beneficial for development of recombinant HAdV-3/HAdV-7 bivalent vaccines. In this study, four NAb epitopes within hexon hypervariable regions (HVRs) were predicted for HAdV-3 and HAdV-7, respectively, by using bioinformatics. Eight hexon chimeric adenovirus vectors with the alternation of only one predicted neutralizing epitope were constructed. Further
in vitro
and
in vivo
neutralization assays indicated that E2 (residing in HVR2) and E3 (residing in HVR5) are NAb epitopes for HAdV-7, and E3 plays a more important role in generating NAb responses. Cross-neutralization assays indicated that all four predicted epitopes, R1 to R4, are NAb epitopes for HAdV-3, and R1 (residing in HVR1) plays the most important role in generating NAb responses. Humoral immune responses elicited by the recombinant rAdH7R1 (containing the R1 epitope) were significantly and durably suppressed by HAdV-3-specific NAbs. Surprisingly, the rAdΔE3GFP-specific neutralizing epitope responses induced by rAdMHE3 (R3 replaced by E3) and rAdMHE4 (R4 replaced by E4) were weaker than those of rAdMHE1 (R1 replaced by E1) or rAdMHE2 (R2 relaced by E2)
in vitro
and
in vivo
. Furthermore, rAdMHE4 replicated more slowly in HEp-2 cells, and the final yield was about 10-fold lower than that of rAdΔE3GFP. The current findings contribute not only to the development of new adenovirus vaccine candidates, but also to the construction of new gene delivery vectors.
Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey
Authors: Paddison Charlotte , Elliott Marc , Parker Richard , Staetsky Laura , Lyratzopoulos Georgios , Campbell John L , Roland Martin
Published: May 2012

Objectives

Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care.

Design/setting

Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects.

Main outcome measures

Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services.

Results

Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors.

Conclusions

While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio-demographic groups.
O10 Should sexual health services participate in the HPV vaccination programme? A national survey assessing HPV vaccination uptake in young GUM attendees
Authors: Sacks R , Robinson A , Wilkinson D
Published: May 2012

Background

In 2008, a schools-based HPV vaccination programme was introduced for girls aged 12–13, with an accelerated catch up programme for those aged 14–18. A significant impact on cervical cancer rates requires 80% uptake of three vaccinations, however in England the completion rate was 58% in 2009/10.

Aim

To compare HPV vaccination outcomes and prevalence of risk factors, associated with HPV acquisition and cervical cancer development, in young women attending GUM clinics with national data.

Method

An anonymous questionnaire was given to 13–19 y/old women attending 19 participating GUM clinics from March to August 2011. Data were analysed using multivariate linear regression in SPSS.

Results

2247 questionnaires were completed (median respondent age 17). Compared to national data, respondents were more likely to be smokers (48% vs 12% of 15 y/olds), have had coitarche aged <16 (52% vs 26%), have had an STI previously (29% vs 13% for <16 coitarche) or not be in education, employment or training (NEET) (8% vs 2% of 16 y/olds). Of the 74% offered the vaccination, 81% accepted. Of those accepting the vaccination, 81% had all three injections. Of those who had <3 doses, 65% reported no active recall. Overall, 47% of all respondents had received all three vaccine doses. Completion rates were lower in London, non-white ethnicities, 17–19 y/olds, NEETs, smokers and those with previous Chlamydia (all p<0.0001).

Discussion

The study population exhibited lower HPV vaccination completion rates than the national average, demonstrating that GUM attendees are a harder-to-reach group through current PCT delivery programmes. This population also exhibited higher rates of risk factors for HPV acquisition, highlighting GUM attendees as a priority target group for HPV vaccination. This data demonstrates the potential role of GUM clinics as supplementary HPV vaccination delivery sites, in targeting at-risk young women with low uptake of the HPV vaccination.
O12 HSV-1 counselling what actually happens in consulting rooms? A qualitative evaluation of practice using mystery shopping in English level 3 GUM clinics
Authors: Munday L , Foley E , Lamb T , Green J , Evans C , Barton SE , Patel R
Published: May 2012

Background

Guidelines indicate best practice for HSV management and topics that should be covered during counselling. Consultations can be difficult, since many complex issues must be explained carefully, and there is opportunity to confuse HSV-1 and HSV-2.

Aims

To evaluate the quality, accuracy and differences in advice given by staff (doctors (D), nurses (N) and health advisors (HA)) in Level 3 sexual health clinics (L3SH) on an initial consultation for HSV-1 infection recently diagnosed elsewhere. To assess whether a professional patient mystery shopping approach provides useful information for L3SH.

Methods

A prospective qualitative evaluation of 20 consultations was performed. Clinical leads within each unit gave permission for participation; details of the exact nature or time of visit were not shared. A professional patient visited each unit as a patient new to the area seeking advice for a standard complex scenario –various probes gauged management of different clinical scenarios. Field notes were made immediately following each consultation in the form of a written transcript and audio notes. Anonymised written transcripts were provided to a panel of clinicians to classify overall and specific aspects of care as ACCEPTABLE (A), UNACCEPTABLE (U) or a CAUSE FOR CONCERN.

Results

Consultations were supported well with written information (not HSV-1 specific). Staff frequently declined to give prognostic information and some confused HSV-1 and HSV-2 guidance. Although many centres are quick to offer patient-initiated therapy this was virtually always at doses that have been superseded in current guidance. The majority of N-led consultations were A with only limited trends in favour of D-provided consultations. HA did not always provide A consultations.

Conclusion

PPMS appears to be feasible for assessing some aspects of L3SH care which may otherwise be difficult to gauge. Some aspects of HSV-1 management are well handled but most units do not provide convenient patient-initiated therapy, or support consultations with disease-specific information.
O13 HIV incidence in an open national cohort of MSM attending GUM clinics in England
Authors: Desai S , Nardone A , Hughes G , Delpech V , Burns F , Hart G , Gill ON
Published: May 2012

Background

Endemic HIV transmission in men who have sex with men (MSM) is a major concern in England. Since 2008, a new national anonymised genitourinary medicine (GUM) clinic reporting system provides follow-up data on clinic attendees.

Objective

To calculate HIV seroconversion rates and identify predictors of acquisition in MSM clinic attendees to inform the development of further HIV prevention initiatives.

Methods

National cohort of MSM who tested HIV negative at a GUM clinic in England in 2009 and had a follow-up test within 1 year were included in these analyses. HIV seroconversion rates (per 100 person-years (py)) with 95% CI were calculated by subgroups and risk markers. HR with 95% CI are reported for significant (p<0.05) predictors of HIV seroconversion identified using Cox regression analyses. Population attributable risk was calculated to estimate the importance of each predictor for HIV infection.

Results

Among the 15 500 men who attended in 2009, there were 277 seroconversions, giving an overall incidence of 2.7/100 py (95% CI 2.4 to 3.1). Incidence was higher among MSM aged 35–49 years (3.4/100 py), of black ethnicity (4.1/100 py) and with a previous gonorrhoea or chlamydia infection (8.6/100 py and 9/100 py, respectively). In multivariable analysis, risk of acquiring HIV was higher among MSM with a previous gonorrhoea (HR: 2.4, 95% CI 1.4 to 4.1) or chlamydia infection (HR: 3.0, 95% CI 2.0 to 4.7) or who received treatment as a STI contact (HR: 1.8, 95% CI 1.1 to 2.9). Age predicted HIV acquisition in 30% of new infections and clinical risk markers from the previous year another 10%.

Conclusions

Annual HIV incidence among MSM re-attending GUM clinics is very high at almost 3%. None of the clinical risk factors were important predictors of HIV acquisition. Therefore more discriminatory behavioural information is required to identify MSM at higher risk of HIV and facilitate better triaging of HIV prevention measures in GUM clinics.
O15 Primary HIV infection: lack of knowledge among men who have sex with men (MSM)
Authors: Conway K , Jack D , Dew C , Johnson S , Cooper V , Waters L , Fisher M
Published: May 2012

Introduction

Primary HIV infection (PHI) is commonly symptomatic, offers an opportunity for early diagnosis and is important for individual health and preventing transmission. At risk populations should be aware of PHI symptoms.

Aim

To ascertain PHI knowledge among UK MSM.

Methods

Online anonymous survey conducted by the National AIDS Trust using the GaydarTM website between 31 March 2011 and 6 April 2011. Questions were asked about likelihood/nature of PHI symptoms and transmission risk. Data on recent HIV testing, HIV status and response to symptoms was collected. Analysis was done using χ2tests.

Results

8561 men responded: 76% had tested for HIV (16% positive), 21% were untested and 3% did not disclose. 5159/8548 (60%) believed PHI to be asymptomatic and 799/8548 (9%) correctly answered that 70%–90% would have symptoms; HIV+ MSM were significantly more likely to be aware of this than HIV-/untested MSM (14.9% vs 8.2%, p<0.0001) and MSM who had tested were more likely to be aware than never testers (10.2% vs 5.8%, p<0.0001). 2926/8267 (35.4%) identified the fever/sore throat/rash triad as the most common presentation of PHI. MSM who had never HIV tested were less likely to correctly identify these symptoms than those who had (29.3% vs 37.0%, p<0.0001). 2964/8450 (35.1%) believed it is hard to transmit HIV in early infection; the remainder recognised PHI as highly infectious. HIV+ MSM were more likely to recognise this than HIV-/untested MSM (76.8% vs 62.5%, p<0.0001) and untested MSM were less likely to recognise this than those who had tested (60.4% vs 66%, p<0.0001). 4220/6918 (61%) of HIV-/untested MSM would seek medical advice if symptomatic; the remainder would ignore symptoms or await resolution. Of those who would seek advice 54.1% would attend GP/NHS walk-in centre and 34.6% would attend GU clinic or take community HIV test.

Discussion

This survey illustrates a concerning lack of knowledge among MSM regarding PHI symptoms and the urgent need for ongoing health promotion and education.
O18 Sexual behaviour, partnership patterns and STI diagnoses among HIV positive MSM: implications for HIV/STIs transmission and partner notification
Authors: Wayal S , Hart G , Copas A , Edwards S , Cassell JA
Published: May 2012

Aims

In the UK, HIV+ve men who have sex with men (MSM) are disproportionately affected with sexually transmitted infections (STIs). STIs can enhance HIV transmission. We examined factors associated with STIs diagnoses and partner notification, and explored preferred methods for STIs notification among HIV+ve MSM.

Methods

429 HIV+ve MSM attending a central London HIV clinic completed a computer-assisted survey (May–September 2010). Multivariate logistic regression analyses were conducted.

Results

86% men (368/429) were sexually active in the last year. Of these sexually active men, 84% (305/362) had tested for STIs. Among men who tested for STIs, 57% (174/305) reported engaging in unprotected anal intercourse (UAI) and 32% (98/305) were diagnosed with STIs. UAI, particularly non-concordant unprotected anal intercourse, age <35 years, concurrent sexual partnerships were independently associated with STIs diagnoses. 58% men had notified ¡Ý1 partner following STIs diagnosis. Being employed, born in the UK, concerns about breach of HIV confidentiality were negatively associated; while clinic advice and support were positively associated with partner notification following STIs diagnosis. 79% (339/429) men reported willingness to notify partners of STIs in the future. Of these, 76% men were willing to notify a boyfriend themselves. 11% men expressed preference for provider referral. Most men were willing to notify regular partners by phone. Men expressed willingness to notify casual partners by phone, text message, or anonymous provider-led methods.

Conclusions

The high level of risky sexual behaviour, STIs diagnosis and its association with non-concordant unprotected anal intercourse among HIV+ve MSM suggests that partner notification provides opportunities for HIV and STIs case-finding and treatment. The offer of a choice of notification methods to HIV+ve MSM, particularly young men and men with multiple/concurrent, casual partners, may override personal, partnership, and structural barriers to partner notification.
O19 Sexual partnership patterns and sexually transmitted infections in HIV positive men who have sex with men: implications for partner notification
Authors: Wayal S , Cassell J A , Edwards S , Hart G
Published: May 2012

Aims

It is essential to understand the implications of sexual partnerships, sexual networks and type of sexually transmitted infections (STIs) on partner notification to maximise its effectiveness. We examined the relationship of these factors with HIV+ve men who have sex with men's (MSM) attitudes towards partner notification.

Methods

24 purposively selected men participated in semi-structured interviews (May 2010–February 2011). Piloted vignettes about different types of STIs diagnosis and sexual partners were used to facilitate discussion. Framework analysis was conducted.

Results

Men perceived the personal and public health benefits of HIV/STIs notification. However, HIV was perceived as a “fatal illness” and partner notification as “imperative” to facilitate partners' access to antiretroviral treatment. Some men preferred immediate HIV partner notification to allow post-exposure prophylaxis; others preferred to wait due to their own emotional burden of HIV diagnosis. Men perceived HIV notification with greater fear of stigma and “blame culture” than STIs notification. Concerns regarding breach of confidentiality and long-term relationships were perceived barriers to HIV partner notification, while clinic advice and support was favoured. Men who intentionally engaged in bareback sex perceived STIs partner notification as “the norm”. However, some men emphasised their and partners' “personal responsibility” to test for STIs regularly. Men favoured notifying a boyfriend and regular partners personally, especially for non-curable STIs like Hepatitis C (HCV). However, fear of being blamed or blaming group/casual sex partners, especially for HCV, were barriers to STIs notification. Provider-led or anonymous-notification methods were preferred in such cases.

Conclusions

HIV+ve MSM should be offered clinic support for patient-led HIV notification, provider-led methods for HCV notification, and notifying group/casual sex partners to improve partner notification.
O5 Partner notification for gonorrhoea: analysis of outcomes using surveillance data
Authors: Savage E , Marsh K , Lowndes C M , Duffell S , Zaman A , Hughes G
Published: May 2012

Background

Partner notification (PN) is an essential component of STI control but can be difficult where index cases have multiple casual partners. Guidelines recommend that for gonorrhoea, a minimum of 0.4 contacts/case in large conurbations, and 0.6 contacts/case elsewhere, should be screened. We investigated the effectiveness of newly introduced surveillance codes for monitoring standards of PN in England.

Objectives

To investigate the relationship between PN ratios for gonorrhoea and patient socio-demographic characteristics.

Methods

Data on PN from the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) were analysed.

Results

Reporting on PN began on a rolling basis in 207 GUM clinics during 2011. Provisional data on PN were available from 171 clinics reporting data covering 951 clinic months in total, during which there were 7423 cases and 2749 contacts. In this period, the overall PN ratio for gonorrhoea was 0.37 contacts/case. PN ratios were highest for clinics in non-urban areas (0.42 vs 0.36 in urban areas) but there was no difference between PN ratios in London and the rest of England. PN was most successful for female partners of heterosexual male index cases (0.44 contacts/case). Of those attending as a contact 26% (707/2749) tested positive for gonorrhoea; 31% of females, 22% of heterosexual males and 24% of MSM.

Conclusions

Provisional data suggest that, on average, contact to index case ratios for gonorrhoea are below recommended standards but these are likely to vary considerably by clinic. The high prevalence of gonorrhoea among contacts emphasises the importance of PN for case finding and reducing transmission. Further analysis to better understand the strengths and limitations of these data is warranted.
O7 The diagnosis and treatment of chlamydia and gonorrhoea in general practice in England: analysis of electronic health records and surveillance data
Authors: Wetten S , Yung M , Mercer C , Cassell J , Hughes G
Published: May 2012

Background

Primary care has become increasingly important in STI management in England but data on diagnosis and treatment in this setting are not routinely analysed.

Aims

To investigate and assess the diagnosis and treatment of bacterial STIs in general practice (GP).

Methods

We calculated age and gender standardised estimates of the incidence of diagnoses of chlamydia and gonorrhoea in GP using data from the GP Research Database and national population statistics for the years 2003–2008. Since diagnoses made and treated elsewhere can be recorded in primary care notes, we estimated cases treated in primary care using an algorithm to identify appropriate prescriptions within defined window periods, accounting for other possible treatment indications. We estimated the proportion of all cases reported in England which were treated in GP, relative to other providers of sexual health services.

Results

An estimated 21 423 diagnoses of chlamydia (42.3/100 000 registered population) and 1494 diagnoses of gonorrhoea (2.96/100 000) were made in GP in England/annum between 2003 and 2008. 35% of chlamydia diagnoses were in those over 25 years. 70% of chlamydia and 36% of gonorrhoea diagnoses recorded in GP were treated, comprising respectively 12% and 3% of all cases diagnosed in England. Doxycycline and azithromycin were most commonly prescribed drugs for chlamydia. Despite revision of gonorrhoea treatment guidelines in 2005, quinolones remained most commonly prescribed for gonorrhoea (42% in 2006–2008), although the proportion treated with cephalosporins rose gradually over the study period (29% in 2006–2008). The algorithm identified 12% and 30% more treated cases of chlamydia and gonorrhoea compared with including same-day prescriptions only.

Conclusions

General practice makes an important contribution to the diagnosis and treatment of bacterial STIs. Efforts to ensure GPs are aware of and use recommended treatment guidelines are needed.
C3 An old friend, a new face: primary syphilis presenting as a bubo with balanitis and lymphocoele
Authors: Nori A , Goh B T
Published: May 2012

Background

Follman balanitis as an initial presentation of primary syphilis is well described and syphilis is a known cause of lymphocoele. Inguinal buboes are commonly seen in chancroid and lymphogranuloma venereum but not in syphilis. We report an unusual case of syphilis presenting with balanitis, lymphocoele and bubo together.

Case report

A 24-year-old man presented with a painless lump in the right groin for 2 weeks and a swelling and red spot on the glans penis for 2 days. He had three casual male partners all within the UK in the preceding 3 months and had an episode of unprotected insertive anal intercourse 2 months before, with no episodes of vigorous intercourse or masturbation. There was a 2 cm fluctuant non-tender lymph node in the right groin, a non-tender cord-like swelling under the coronal sulcus on the same side and a well defined erythematous patch with an infiltrated base on the glans. No other local or systemic signs. A dark field microscopy preparation from the balanitis was negative; one from the lymph node aspirate showed characteristic motile spirochaetes typical ofTreponema pallidum; a positive Treponemal EIA-IgM and RPR (titre of 1:4) confirmed a diagnosis of syphilitic bubo with Follman balanitis and lymphocoele. The lymph node aspirate on gram staining showed pus cells. Chlamydia NAAT (SDA) was negative from the balanitis and lymph node aspirate. The rest of the STI screen including HIV serology was negative. He was treated with Benzathine penicillin 2.4 m IU IM weekly for 2 weeks with clinical resolution. All three contacts had been informed.

Discussion

(1) Balanitis is a common presentation in GUM clinics and this case highlights the importance of including syphilis in the differential diagnosis. (2) Early syphilis can cause lymphocoele and inguinal bubo. (3) Aspiration of lymph nodes for dark field microscopy examination enabled point of care diagnosis and facilitates early treatment and partner notification.
C4 A case of the great and little imitator
Authors: MacDonald R , Fox R
Published: May 2012

We present a case of Acute Intermittent Porphyria (AIP) exacerbated by HAART and review the complications of managing these two conditions. Only one previous case of these two conditions has been published. AB is a middle aged man who was diagnosed with HIV with baseline CD4 of 518. He was well until 2011 when he was admitted to our department with severe abdominal pain, hypotension and a penile ulcer. CT, MRCP, OGD and ultrasound were normal but syphilis serology was positive. He was treated with benzathine, his pain reduced and was discharged. He was then started on Atripla with a CD4 of 162. After 3 weeks he developed severe abdominal pain, hypertension and complained of ‘bloody’ urine but no blood on analysis. Biochemistry showed a sodium of 117. With these new symptoms urinary porphyrins were requested which were elevated at 4002 nmol/l representing an acute episode of AIP. It was felt this second admission was triggered by HAART which was stopped and he was treated with haem arginate and his symptoms improved. On further discussion with AB he admitted to taking a ‘legal high’ prior to the first admission which may have triggered this episode. There have been no reported cases of AIP due to syphilis. AIP is a disorder of the haem pathway and is known as the Little Imitator in contrast to syphilis the Great Imitator as it is often misdiagnosed. While it is a rare condition its importance with HIV is that it is triggered by most drugs needed in managing HIV. Drugs which induce cytochrome p450, anti PCP, TB and fungal agents have all been implicated. NRTI's are thought to be safe while Saquinavir is the only PI recommended for use and there is no evidence of newer HIV agents. AB was started on Truvada and boosted Saquinavir and 4 months on his symptoms are controlled with no further AIP attacks and viral load is 42 c/ml. Reports such as this are important in increasing the limited knowledge of safely co-treating HIV and AIP.

Correction notice

This article has been corrected since it was published. The text has had minor edits made to protect patient anonymity.
P105 The internet as a source of sexual health information; what do service users want?
Authors: Eddy F , Brady M
Published: May 2012

Background

Access to information is a key challenge in sexual health, with poor knowledge associated with poor outcomes. Internet interventions have been shown to improve sexual health knowledge, highlighting the potential of the web as a source of information.

Aims

To assess sexual health service users' use of the Internet to obtain sexual health information, and to use the data to inform the design of a local sexual health website.

Methods

243 participants were recruited from a busy walk-in sexual health clinic in July and September 2011. A structured questionnaire assessed their use and rating of the Internet for various aspects of sexual health information (STIs, contraception, clinic information, homosexuality, virginity and body worries) and gauged opinion on the content of a local sexual health website.

Results

62% of participants were female. 44% identified as black African, black Caribbean or black British and 42% were white. 44% were aged under 25. 67% of respondents use the internet for sexual health information. It was the most popular resource for information on STIs, clinic information and homosexuality (compared to doctor/nurse, friends, family, school, TV and magazines). The next most popular choices were doctor/nurse and friends. 67% stated they would use a local sexual health website with STIs, clinic information and contraception being the topics they would most like information on. “Detailed” and “Basic” information were highlighted as important aspects of website content. Only 19% selected “original design” as being important.

Conclusions

The internet is a popular source for sexual health information. For STIs it was selected over doctors/nurses indicating the need for good online information. Both basic and detailed information were requested highlighting the importance of a range of educational resources. Originality was not as important as having a site they could trust. These findings will inform the development and content of a local website.
P113 Primary health providers' adherence to national chlamydia guidelines
Authors: Morgan J M , Mills L A , Bell A J
Published: May 2012

Aim

To re-audit district-wide management of genital chlamydia infection following implementation of NZ national chlamydia guidelines.

Methods

All healthcare settings in a single NZ health district that diagnosed 20 or more cases of chlamydia during September 2010–2011 were invited to participate and were asked to complete an audit proforma for 20 consecutive cases. Sexual Health clinic cases were excluded. Collated results were compared to findings of a similar audit of 394 cases diagnosed during 2008, which was undertaken before guideline implementation in 2009.

Results

19 of 22 eligible sites participated, providing data for 424 cases; of these, 302 (71.2%) were managed in General Practice, with the remainder from a range of settings including Family Planning, student health services, and A&E. 405 of 424 (95.5%) cases in 2010–2011 had documented treatment compared to 354 of 394 (89.8%) in 2008. Notifying current sexual partners was noted in 314 cases (74%), compared to 58.1% in 2008. 126 of 424 (29.7%) of cases were noted to have informed at least 50% of their sexual partners compared to 17.8% in 2008.

Conclusion

Improved case management and partner notification may reflect better documentation than in the initial audit but more appropriate choice of diagnostic sampling, more testing for other STIs and more appropriate dosage and duration of prescribed antibiotics supports that primary care chlamydia case management in this district has improved following local implementation of national guidelines. More work is needed to enhance documented partner management outcomes.
P116 Assessing the sexual violence services currently provided in genitourinary medicine clinics
Authors: Emerson C R , Sacks R , Foster G E
Published: May 2012

Background

Many patients present to Genitourinary medicine (GUM) clinics following sexual violence (SV) occurring in circumstances including sexual assault (SA), domestic violence (DV), sex work (SW) and trafficking. BASHH has guidelines for SA but not for addressing SV in other situations. Are GUM clinics providing services for these needs?

Aims

To assess services currently available in GUM for those disclosing SV.

Methods

A cross sectional anonymous online survey of UK GUM clinics was performed. The survey was designed by the authors and piloted. Information was gathered on specific clinics for SV, how often they occur and which members of the multidisciplinary team are involved, and training available for SV. Links with other support services was ascertained. The data were analysed using Microsoft Excel.

Results

The response rate was 66/178 (37%), with all regions and deaneries being represented. All responding clinics provide PEP, emergency contraception, STI screen, hepatitis prophylaxis and advice for those presenting after SA. 24% of clinics never use chain of evidence procedures. 80% have a local sexual assault referral centre (of these 87% were happy with this service). 80%, 77%, 50% and 38% have no dedicated clinic for female genital mutilation, sexual trafficking, DV and SW respectively and less than 50% have local training or procedures for these facets. 32% ask about non-consensual sex in all GUM consults, 53% ask this in special groups only. 47% routinely ask about SW.

Discussion

There is a wide variation in the SV services available at GUM clinics. Sexual assault services meet guideline recommendations for GUM but SV occurring in other contexts may not be addressed. Sexual violence is increasingly reported and GUM clinics may be the first or only location of presentation. We recommend further training and guidelines to ensure clinics are equipped to meet this need.
P118 Rape in young adolescents: risk factors for attending a sexual assault referral centre and ensuring adequate sexual health follow-up
Authors: Wilson-Brown B , Steele G , Fargie F
Published: May 2012

Background

We are an urban sexual assault referral centre (SARC) also covering a large rural area. We see men and women over the age of 13 who have been sexually assaulted in the last 7 days. In 2011 we saw 53 attendences from adolescents between 13 and 15 years (13% of all SARC attendences).

Aims

(1) To review the profile of young victims of rape and sexual assault. (2) Retrospectively review the sexual and emotional health follow-up received by this client group post sexual assault. Method 2 data sets were reviewed. The SARC database were used to identify all clients attending in 2011 aged between 13 and 15 and to collect information including demographics/details of the assault/particular vulnerabilities including alcohol use and whether looked after and accommodated (LAAC) or known to social work. The National Sexual Health electronic patient record (NASH) was then used to review whether these clients attended for any sexual/emotional health follow from their local sexual health services to which they are routinely referred post assault. (A few clients requested referral to their GP.)

Results

32/53 (60%)of clients had been drinking alcohol prior to the assault. 14/53 (26%) of clients were LAAC and a further 12/53 (23%) were known to social work. 5/53 clients had previously attended the SARC and were attending after a second sexual assault and all five clients were LAAC. 36/53 (67%) had specialist sexual health input post assault with five clients due to attend in the next few weeks. Four clients were referred to their GP. Eight clients failed to attend any follow-up and social work were informed.

Conclusion

A significant proportion of young adolescents attending our SARC have one or more markers for vulnerability. Health services need to be aware of the increased risk of sexual violence for these clients. Successful follow-up is possible with close liaison between health and social care workers.
P120 Correlation of patient completed triage tools with patient symptoms in an integrated sexual health service
Authors: Bhaduri S , Gosling C
Published: May 2012

Background

Triage tools (TT) were introduced in an integrated sexual health service to enable patients to be streamed to the most appropriate healthcare professional. The tool used is a patient completed questionnaire to ascertain reasons for attendance and any presenting symptoms.

Aim

To determine whether the TT is a good indicator of patient symptoms and predictor of the skill mix required for the service.

Method

A retrospective analysis of case notes reviewed gender, reported symptoms stated on TT and whether these symptoms correlated with the history taken from the patient.

Results

360 notes were analysed (178 females, 182 males), 125/178 (70%) of females were symptomatic according to TT. In 17/178 (9%) the correlation between TT and history taking was deficient. In 8/17 of these cases, issues related to contraception or referral for termination of pregnancy. 53/178 (30%) were asymptomatic according to TT. In 13/53 cases, symptoms were later disclosed on history taking (dyspareunia, vulval discomfort, disclosure of assault or contraception issues). In males, 82/182 (45%) were symptomatic and 7/182 (4%) of cases demonstrated a correlation deficit (eg, disclosure of assault). 100/182 (54%) of cases were asymptomatic on TT of which 24/100 were not on history taking.

Conclusion

In 61/360 (17%) of patients the correlation of symptoms was incomplete on history taking compared to the TT. This indicates that although the tool remains a useful guide to patient presentation, clinics require a broad skill mix, including those with experience in dealing all aspects of integrated sexual health.
P123 Non-medical prescribing by nurse practitioners in a walk-in sexual health clinic
Authors: Black A , Roberts C , Smith A
Published: May 2012

Background

Non-medical prescribing legislation in the UK provides suitably qualified nurses with prescribing powers comparable with doctors. This facilitates autonomous practice and allows independent completion of care episodes. There is however limited evidence regarding the application and safety of nurse prescribing.

Aim

Investigate the application of non-medical prescribing in sexual health.

Methods

A cross-sectional study explored non-medical prescribing in a London based GUM department between 1 January 2010 and 30 June 2010. A retrospective review of randomly selected clinical notes was performed. This included 382 nurse prescriber led and 255 non-prescriber led GUM consultations. Prescribing frequency; range of medications and diagnoses; independent episode completion and prescribing safety were investigated.

Results

Medication was dispensed in 52.9% (n=337) of consultations in the 637 combined episodes. A total of 427 diagnoses were identified that required 34 different medicinal products and 452 treatments to be dispensed in total by nurse practitioners. The management of sexual contacts accounted for 22.1% (n=60) of treatments. A statistical difference in independent practice existed between practitioners (χ2test p<0.001), with prescribers 15.52 times (CI 9.41 to 25.59) more likely to independently complete episodes of care. Safe appropriate prescribing was identified in 99.1% (n=210) of cases. On two occasions a lack of documentation of concurrent medication or allergies made it difficult to assess safety. There were no serious errors in prescribing practice found.

Conclusions

In our GUM clinic widespread use of prescribing skills was demonstrated. Nurses with prescribing skills were able to work more independently. Non-medical prescribing has been applied safely in accordance with clear treatment guidelines.
Final state of soils under vacuum preloading
Authors: Robinson Retnamony G. , Indraratna Buddhima , Rujikiatkamjorn Cholachat
Published: May 2012

Vacuum preloading of clay deposits is becoming an increasingly popular ground improvement technique. Although many studies have been reported in literature, the mechanism of vacuum preloading is still not properly understood. Soil under vacuum preloading is expected to undergo an inward lateral deformation, therefore the influence of lateral deformation on volumetric strain requires further analysis. This paper addresses this aspect through laboratory studies on reconstituted samples of kaolinite. The Rowe cell apparatus was modified to measure lateral deformation under various states of stress because lateral and vertical deformation of soil depends on its state of stress and associated lateral pressure. A method for predicting the volumetric and lateral strains under vacuum consolidation is proposed and then applied to two case studies in China.
Speciation in the cardioceratinid ammonites of the Costicardia Subzone (Cordatum Zone) of the Oxfordian of Skye
Authors: Wright J. K.
Published: May 2012

Synopsis

The Middle Callovian/Oxfordian/Early Kimmeridgian Staffin Shale Formation at Staffin Bay, Isle of Skye contains one of the most complete, fossiliferous successions through Oxfordian strata in Britain, with Cordatum Zone (Chronozone) strata very well developed. During several visits to Staffin over the last 40 years, the author has collected some eighty ammonites from the Cordatum Zone. Well-preserved cardioceratid ammonites are common in the Costicardia Subzone of the Cordatum Zone, and these are the subject of the present study. Cordatum Subzone ammonites are less common and less well preserved at Staffin and, consequently, more problematic for such detailed study. Detailed analysis of Cordatum Zone cardioceratids as a whole shows that it is likely that almost all these Costicardia Subzone cardioceratinids belonged to the one species
Cardioceras costicardia
biosp.; all other morphospecies of
Cardioceras
recognized by previous authors from this subzone are regarded here as varieties of
C. costicardia
biosp.
Goliathiceras
, however, is regarded here as a separate Lower Oxfordian cardioceratid genus.
Precambrian sedimentary basins of India: an appraisal of their petroleum potential
Authors: Ojha Prem Shanker
Published: May 2012

The Indian Proterozoic Super Basins were part of the Northern Rim of Gondwanaland prior to its break-up along six major radial fractures. The Proterozoic rocks of these basins are extensively exposed in the northern as well as the southern parts of the Indian Peninsula. Based on recently conducted geochemical and seismic surveys within these basins, followed by well drilling in the Son Valley, Ganga Valley, and the Bikaner–Nagaur basin, it is concluded that hydrocarbons have been generated within these basins and conditions conducive to hydrocarbon accumulation exist within them. The discovery of gas within Son Valley has indicated the existence of an active Mesoproterozoic petroleum system that is likely to have continued up to Infracambrian times. Based on the correlation of Indian Proterozoic Super Basins with their analogous Chinese and Australian basins, it appears that elements of a similar petroleum system exist within these basins, together with the possibility of an active Ordovician–Silurian petroleum system within the northernmost Ganga Valley Vindhyans, where sedimentation continued up to the lower Devonian. Modelling and empirical data show that the Chambal Valley, as well as the probably trap-concealed Vindhyans, underwent intense wrenching during Neoproterozoic times, accompanied by good entrapment conditions. Even the peninsular SW Cuddapah Superbasin also appears worth exploring as an element of the Meso–Neoproterozoic petroleum system.
Modulation of endothelial SK3 channel activity by Ca2+-dependent caveolar trafficking
Authors: Lin Mike T. , Adelman John P. , Maylie James
Published: May 2012

Small- and intermediate-conductance Ca2+-activated K+ channels (SK3/Kcnn3 and IK1/Kcnn4) are expressed in vascular endothelium. Their activities play important roles in regulating vascular tone through their modulation of intracellular concentration ([Ca2+]i) required for the production of endothelium-derived vasoactive agents. Activation of endothelial IK1 or SK3 channels hyperpolarizes endothelial cell membrane potential, increases Ca2+ influx, and leads to the release of vasoactive factors, thereby impacting blood pressure. To examine the distinct roles of IK1 and SK3 channels, we used electrophysiological recordings to investigate IK1 and SK3 channel trafficking in acutely dissociated endothelial cells from mouse aorta. The results show that SK3 channels undergo Ca2+-dependent cycling between the plasma membrane and intracellular organelles; disrupting Ca2+-dependent endothelial caveolae cycling abolishes SK3 channel trafficking. Moreover, transmitter-induced changes in SK3 channel activity and surface expression modulate endothelial membrane potential. In contrast, IK1 channels do not undergo rapid trafficking and their activity remains unchanged when either exo- or endocytosis is block. Thus modulation of SK3 surface expression may play an important role in regulating endothelial membrane potential in a Ca2+-dependent manner.
Cyclic AMP-Rap1A signaling activates RhoA to induce α2c-adrenoceptor translocation to the cell surface of microvascular smooth muscle cells
Authors: Jeyaraj Selvi C. , Unger Nicholas T. , Eid Ali H. , Mitra Srabani , Paul El-Dahdah N. , Quilliam Lawrence A. , Flavahan Nicholas A. , Chotani Maqsood A.
Published: May 2012

Intracellular signaling by the second messenger cyclic AMP (cAMP) activates the Ras-related small GTPase Rap1 through the guanine exchange factor Epac. This activation leads to effector protein interactions, activation, and biological responses in the vasculature, including vasorelaxation. In vascular smooth muscle cells derived from human dermal arterioles (microVSM), Rap1 selectively regulates expression of G protein-coupled α2C-adrenoceptors (α2C-ARs) through JNK-c-jun nuclear signaling. The α2C-ARs are generally retained in the trans-Golgi compartment and mobilize to the cell surface and elicit vasoconstriction in response to cellular stress. The present study used human microVSM to examine the role of Rap1 in receptor localization. Complementary approaches included murine microVSM derived from tail arteries of C57BL6 mice that express functional α2C-ARs and mice deficient in Rap1A (Rap1A-null). In human microVSM, increasing intracellular cAMP by direct activation of adenylyl cyclase by forskolin (10 μM) or selectively activating Epac-Rap signaling by the cAMP analog 8-pCPT-2′- O-Me-cAMP (100 μM) activated RhoA, increased α2C-AR expression, and reorganized the actin cytoskeleton, increasing F-actin. The α2C-ARs mobilized from the perinuclear region to intracellular filamentous structures and to the plasma membrane. Similar results were obtained in murine wild-type microVSM, coupling Rap1-Rho-actin dynamics to receptor relocalization. This signaling was impaired in Rap1A-null murine microVSM and was rescued by delivery of constitutively active (CA) mutant of Rap1A. When tested in heterologous HEK293 cells, Rap1A-CA or Rho-kinase (ROCK-CA) caused translocation of functional α2C-ARs to the cell surface (∼4- to 6-fold increase, respectively). Together, these studies support vascular bed-specific physiological role of Rap1 and suggest a role in vasoconstriction in microVSM.