bluuebunny/crossref_metadata_2025 huggingface dataset:
F‐actin/DRP1 axis‐mediated mitochondrial fission promotes mitophagy in diabetic submandibular glands
Authors: Zhu Hou‐Wei , Wang Yi‐Ping , Zhang Qiu‐Fang , Wang Kai‐Di , Huang Yan , Xiang Ruo‐Lan
Published: May 2024

Background

Diabetes is accompanied by a high prevalence of hyposalivation, causing severe damage to oral and systemic health. Mitochondrial dynamics play important roles in the pathogenesis of various diabetic complications; however, little is known about their roles in diabetic hyposalivation.

Materials and Methods

A diabetic mouse model and a high glucose (HG)‐induced diabetic submandibular gland (SMG) cell model were employed.

Results

More mitochondria surrounded by autophagosomes and higher expression of mitophagy‐related proteins were detected in the SMGs of diabetic mice and HG‐treated SMG cells. In diabetic SMGs, dynamin‐related protein 1 (DRP1) was upregulated, whereas mitofusin‐2 was downregulated both in vivo and in vitro. Shortened mitochondria and impaired mitochondrial functions were observed in the HG group. A DRP1‐specific inhibitor, mdivi‐1, suppressed mitochondrial fission and mitophagy, as well as restored mitochondrial functions in the HG condition. Moreover, the interaction of F‐actin and DRP1 was enhanced in the diabetic group. Inhibiting F‐actin with cytochalasin D repaired the injured effects of HG on mitochondrial dynamics and functions. Conversely, the F‐actin‐polymerization‐inducer jasplakinolide aggravated mitochondrial fission and dysfunction.

Conclusions

F‐actin contributes to HG‐evoked mitochondrial fission by interacting with DRP1, which induces mitophagy and impairs mitochondrial function in SMG cells, ultimately damaging the SMG.
Long‐term environmental flows restore benthic invertebrate communities in a highly regulated river
Authors: Brooks Andrew J. , Coleman Daniel W. , Bevitt Robyn C. , Haeusler Timothy , Russell Matthew D. , Rose Teresa , Williams Simon
Published: May 2024

The construction of dams and other in‐stream structures for human use has altered river ecosystems worldwide. Dams degrade rivers, and environmental flow releases aim to mitigate flow alterations and restore rivers downstream of dams by returning elements of the pre‐regulation flow regime, resulting in an ecosystem that resembles a more natural state. We examined the responses of benthic invertebrate communities in riffles and pool‐edge habitats to an environmental flow regime (EFR) in the highly regulated Snowy River over 17 years (2000–2016). Benthic invertebrate communities significantly changed in response to prolonged increases in the magnitude of all components of the flow regime. The composition of the benthos in the regulated river became more dissimilar to pre‐EFR communities and more closely resembled those of nearby unregulated rivers. These changes were apparent in both riffle and pool‐edge habitats and were most pronounced when flow magnitudes were highest. Scrapers increased as flows increased, and in contrast, the relative abundances of gatherers declined with prolonged high flows and could be attributed to increased daily flows and high flow events mobilizing fine sediment and scouring benthic substrates. These results indicated that the EFR altered abiotic conditions or resources that previously limited invertebrate abundances, facilitating changes to the benthic community. Community changes we observed were in response to a flow regime that remained drastically lower than natural, demonstrating that restoration targets can be achieved with small flow increases that mimic natural flow patterns.
A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls
Authors: Yavuz B. Ece , Turan Serkan , Mutlu Caner , Çamlı Şafak Eray
Published: May 2024

Introduction

Deficits in neurocognition and social‐cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social‐cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide.

Method

Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age‐ and sex‐matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social‐cognition and neurocognitive characteristics.

Results

Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246).

Conclusion

While the neurocognitive and social‐cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.
Exploring a practice‐based approach to elementary preservice science teacher preparation
Authors: Thompson Stephen L. , Fan Xumei , Adgerson Amber J.
Published: May 2024

The science methods course model presented here, called an immersed methods course (IMC), engaged preservice elementary teachers in reform‐based science instructional approaches within authentic classroom settings and with elementary students in a guided format. Questions guiding the study were: (1) Did participation in the IMC model impact preservice teachers (PTs') science teaching self‐efficacy? (2) Which science methods course model activities/experiences did PTs identify as the most impactful on their science teaching? (3) How did participation in the IMC model impact PTs' understandings of science teaching? Participants were 138 elementary PTs from a Southeastern United States university. Data were collected from seven course sections over 3 years and included pre/post science teaching self‐efficacy survey data, post written responses, and interviews. Member checking approaches were also used to refine and establish the validity of findings. Researchers completed qualitative data analysis, which was complimented by quantitative statistical analysis. Findings across data sources suggest participation positively influenced PTs' science teaching self‐efficacy and beliefs about the effectiveness of the instructional approaches. Participation also helped PTs apply theories to practice and develop competency using the practices. Findings highlight how the IMC model mitigates constraints associated with current science teacher preparation approaches.
Impacts of the tillage systems on the production of green corn (Zea mays L.) in long‐term plots in Northeastern Brazil
Authors: Santos Jusimara de Andrade , Pedrotti Alceu , Holanda Francisco Sandro Rodrigues , Santos Luiz Diego Vidal , Andrade Brisa Marina da Silva , de Araújo Filho Renisson Neponuceno , Villwock Ana Paula Schervinski , Filho Raimundo Rodrigues Gomes , Conceição Soenne França , Carvalho Larissa dos Santos
Published: May 2024

In the current global context of climate change and the increasing demand for sustainability, optimizing agricultural production is very important in order to meet the demands for food and to mitigate environmental impact. To achieve sustainable agricultural production, particularly in regions with tropical soil and climate conditions, is necessary to adopt conservation‐oriented techniques. This includes no‐tillage system, the use of soil‐cover crops, and the application of inoculants. The objective of this research was, at the end of the 22nd cropping season, to assess the influence of soil compaction in the production of green corn (Zea mays L.) in a long‐term field experiment. This study was conducted under different soil tillage systems in a Red‐Yellow Ultisol from the Coastal Tablelands of northeastern Brazil. Three soil tillage systems were applied: Conventional Tillage (CT), Minimum Tillage (MT), and No‐tillage (NT). These were combined with four previous crops: cowpea (Vigna unguiculata), crotalaria (Crotalaria juncacea), pigeon pea (Cajanus cajan), and millet (Pennisetum glaucum), as well as two levels of nitrogen fertilizer application: (1) 100% of the recommended N dose, and (2) 50% of the recommended N dose plus Azospirillum brasilense inoculant. The experimental design consisted of strip plots with subplots divided and randomized within each strip, with three replications. Soil compaction was assessed using parameters of soil density (SD) and soil mechanical resistance to penetration (MRP) in conjunction with moisture content (MC). The principal component analysis (PCA) highlighted that conservation‐oriented systems exhibited greater soil organic carbon (SOC) levels, leading to increased productivity of commercial green corn cobs. The synergistic effect of diversifying previous crops and adopting conservation tillage systems, especially in soils under long‐term tillage, resulted in heightened productivity of commercial green corn ears.
Thirsty nation: An investigation into water scarcity and public conservation behaviour in Pakistan
Authors: Zulqarnain Aimen , Khan Muhammad Ammad
Published: May 2024

Pakistan is on the brink of becoming a water‐scarce country as a result of a peak in population and rapid urbanization. This research investigates the awareness of water scarcity amongst the general public in Pakistan and their behaviour and attitude towards water conservation practices at the household level. The study incorporated the theory of planned behaviour to gain a better understanding of the phenomenon. Households were surveyed in Islamabad Capital City using a quantitative research approach. Descriptive analysis and Fischer's exact test were followed to measure the variables. Results demonstrated a significant awareness regarding water scarcity amongst the residents which influenced positive behaviour and attitudes towards water conservation in the households. Notably, the p‐value for water consumption patterns was found to be highly significant at 0.000 for activities such as laundry, gardening and car washing and less significant at 0.003 for bathing and 0.002 for housecleaning. It is concluded that water use is conditioned by dwelling characteristics and the types of devices employed in the houses. This comprehensive understanding is crucial for developing targeted interventions that resonate with diverse populations worldwide.
Shortest closed curve to contain a sphere in its convex hull
Authors: Ghomi Mohammad , Wenk James
Published: May 2024

We show that in Euclidean 3‐space any closed curve which contains the unit sphere within its convex hull has length , and characterize the case of equality. This result generalizes the authors' recent solution to a conjecture of Zalgaller. Furthermore, for the analogous problem in dimensions, we include the estimate by Nazarov, which is sharp up to the constant .
Wetzel families and the continuum
Authors: Schilhan Jonathan , Weinert Thilo
Published: May 2024

We provide answers to a question brought up by Erdős about the construction of Wetzel families in the absence of the continuum hypothesis: A Wetzel family is a family of entire functions on the complex plane which pointwise assumes fewer than values. To be more precise, we show that the existence of a Wetzel family is consistent with all possible values of the continuum and, if is regular, also with Martin's Axiom. In the particular case of this answers the main open question asked by Kumar and Shelah [Fund. Math. 239 (2017) no. 3, 279–288]. In the buildup to this result, we are also solving an open question of Zapletal on strongly almost disjoint functions from Zapletal [Israel J. Math. 97 (1997) no. 1, 101–111]. We also study a strongly related notion of sets exhibiting a universality property via mappings by entire functions and show that these consistently exist while the continuum equals .
Quasiregular curves and cohomology
Authors: Heikkilä Susanna
Published: May 2024

Let be a closed, connected, and oriented Riemannian manifold, which admits a quasiregular ‐curve with infinite energy. We prove that, if the de Rham class of is nonzero and a finite sum of nontrivial products, then there exists a nontrivial graded algebra homomorphism from the de Rham algebra of to the exterior algebra . As an application, we give examples of pairs , where is a closed manifold and is a closed ‐form for , for which every quasiregular ‐curve is constant.
Supplemental Material: Chlorite chemical refinement during giant quartz vein formation
Authors: González-Esvertit Eloi , et al.
Published: May 2024

Summary of the historic and current use of chlorite thermometry, extended methods description, geological setting of the study area (Supplemental File S1), and thin section petrography and raw data from punctual chlorite and whole-rock geochemical analyses, and statistic summary of the results (Supplemental File S2).
Supplemental Material: Tectonic inversion of an intracontinental rift basin: An example from the opening and closure of the Paleo-Tethys Ocean, northern Tibetan Plateau
Authors: Li Jie , al. et
Published: May 2024

Table S1: LA-ICP-MS results of zircon U-Pb geochronology from this study. Table S2: LA-ICP-MS results of zircon U-Pb geochronology from previous studies. 
O01 Recent trends in HIV diagnoses and tests among men who have sex with men attending sexual health clinics in england
Authors: Ogaz Dana , Furegato Martina , Brown Alison E , Mohammed Hamish , Kirwan Peter , Yung Mandy , Nash Sophie , Connor Nicky , Gill Noel , Delpech Valerie , Hughes Gwenda
Published: May 2024

Introduction

Men who have sex with men (MSM) remain at highest risk of HIV acquisition in England. We assessed recent national trends in HIV diagnoses and tests among MSM attending specialist sexual health clinics (SHCs) in England.

Methods

Numbers of HIV diagnoses and tests in MSM were obtained from GUMCADv2, the national surveillance system for sexually transmitted infections. Trends were stratified by HIV testing history (new/repeat-testers in last 2 years) and service location (London/Outside-London). Student’s t-tests were used to assess the differences in mean numbers of HIV diagnoses and tests between Q4/2014–Q3/2015 and Q4/2015–Q3/2016.

Results

A decline in HIV diagnoses from 515 to 427 (17%) was observed between Q4/2014–Q3/2015 and Q4/2015–Q3/2016 (p=0.05). Greatest declines were in London SHCs (276–209; 24%; p=0.04) and among new-testers (390–308; 21%; p=0.03). In London SHCs, there was a 29% diagnosis decline among new-testers (195–138; p=0.03) with no evidence of a difference in repeat-testers (81–71; p=0.33); HIV tests in repeat-testers increased 15% (9,768–11,270; p=0.02) but remained stable among new-testers (7,166–6,638; p=0.28). In Outside-London SHCs, HIV diagnoses remained stable in new- (194–170; p=0.06) and repeat-testers (44–48; p=0.52) while HIV testing increased 14% in new- (7,679–8,734; p=0.05) and 16% in repeat-testers (7,423–8,602; p=0.02).

Discussion

HIV diagnoses among MSM have decreased despite overall increased testing at SHCs. Stable levels of testing in new-testers as well as scale-up of repeat-testing may be contributing to diagnosis declines by earlier identification of undiagnosed infections. Further investigation of treatment and prevention initiatives among new- and repeat-testers in London SHCs is necessary.
P054 2017 update of drug interactions detected using electronic care records (ECR)
Authors: Rafferty PJ , McCarty EM , Dinsmore WW , Donnelly CM , Emerson CR , Hunter M , Walker E , Quah SP
Published: May 2024

Introduction

In 2014 the pharmacy team completed an interaction screen of all HIV patients on a boosted antiretroviral (ARV) regimen using then recently launched NIECR. We concluded that there was a need for primary and secondary care teams to screen and manage drug-drug interactions (DDI). 56 patients in 2014 required urgent clinical intervention.

Methods

In 2014 we reported on patients taking a boosted ARV regimen for DDI; we continued this work for all patients and this year we reviewed our interaction screening database, to assess the following: Interaction screen documented, Number of patients issued medication by their GP, Percentage of interactions identified.

Results

1093 unique patient records, 887 (81.2%) have a recorded H&C number and interaction screen. 468/887 patients (53%) are prescribed medication by their GP with no or no significant interactions. 235/887 patients (27%) are prescribed medication by their GP where an interaction is identified by the MDT and managed. 122/887 patients (14%) do not obtain any medication from their GP. 9/887 patients (1%) have opted out of NIECR. No patients required an immediate clinical intervention.

Discussion

The number of patients prescribed medications by their GP has increased from 45% in our 2014 report compared with 79.3% in this review. There was a significant improvement in the latest review of interactions and no patients were identified with serious interactions. A medicines reconciliation and interaction screen before initiating/switching treatment and prior to a clinic review has enabled our cohort to avoid clinically significant DDI.
P069 Post exposure prophylaxis after sexual exposure: management in ed and gum
Authors: Kjerrstrom Anne , Witter Julie , Drummond Juliet , Turner Neil , Barber Tristan , Day Sara
Published: May 2024

Introduction

Post-exposure prophylaxis following sexual exposure (PEPSE) is a method of preventing HIV infection. 2015 BASHH guidelines identify criteria for when PEPSE should and could be offered. Our aim was to review patients prescribed PEPSE either at our local Emergency Department (ED) or via GUM between 1stJuly – 31stDec 2016 to establish if we are following the BASHH guidelines.

Methods

This retrospective study identified patients that were prescribed PEPSE through the ED or GUM using electronic records and paper notes to audit criteria.

Results

176 PEP recipients were identified. Twenty-two of these were not associated with sexual exposure. Two were extending a current course of PEPSE due to new exposure; prescribed according to guidelines. 14 patients received PEP according to the ED register but no documentation was available. 7 patients received PEP in ED with documented exposure risk consistent with the BASHH guidelines but were lost to follow up. 131 PEP patients were seen in GUM. 6 patients presented to GUM after PEP was initiated at a different ED, all these were provided PEP according to guidelines. 35 presented after PEP was started in ED and the rest presented directly. 98% were prescribed PEP according to guidelines. There were 2 that were started on PEP in ED that was discontinued in GUM.

Discussion

The majority of patients with available documentation were prescribed PEP according to guidelines. We intend to support our ED service in better documentation of patients presenting for, and prescribe, PEPSE.
P071 PRE PREP PREP
Authors: Street Emma , Short Lindsay
Published: May 2024

Introduction

Sexual health of MSM has worsened over the last decade and with NHS PREP provision on the horizon we needed to assess the current sexual health of MSM attending our small integrated sexual health clinic to ascertain who may be eligible for PREP.

Methods

Retrospective case notes review of all MSM attending as a new or rebook attendance in 2015.

Results

140 attendances of MSM in 2015 were analysed. 136/140 (97%) had a HIV test. 36/140 (26%) were diagnosed with an STI of which 10 were rectal STIs. 62/140 (44%) had a previous STI. Documented recent unprotected anal sex occurred in 80/140 (57%), 3 patients were in a sero-discordant relationship- all had partners with an undetectable viral load. Recreational drugs were used by 9/140 (6%) of which 4 patients were engaged in chem-sex.

80/140 (57%) patients would fulfil the baseline criteria for PREP.

Discussion

MSM in our clinic have a high rate of STIs and more than half have had recent unprotected anal sex. There is a low rate of recreational drug use. Over half would be eligible for PREP if they continued in engage in unprotected sex. Repeated attendances through 2015 will be analysed to assess behaviour change.
P072 Do we meet the criteria? consideration for PrEP provision locally
Authors: Wilson Yvonne , Quah Say , Emerson Carol
Published: May 2024

Introduction

With various studies demonstrating Pre-Exposure Prophylaxis (PrEP) as highly effective in reducing HIV transmission, Health Departments are under pressure to provide the treatment.

Methods

Questionnaire feedback from 60 men who have sex with men (MSM) attending sexual health clinic, questions were based around the eligibility criteria for the PROUD study and some additional information we felt may be useful.

Results

58 MSM & 2 Trans women: 35 (58%) reported unprotected anal intercourse (UPAI) in the past 3 months, average number of partners 7. 6/35 had treatment for an infection in the past 6 months, all Gonorrhoea. 25 MSM (42%) reported no UPAI in past 3 months, average number of partners 2. 2 treated for infections, 1 GC and 1 had Syphilis and Chlamydia. Overall 16 (27%) reported drug use, no IVDU. 43 (72%) used social media to meet partners, 16 (27%) used male only saunas. 56 (93%) would use PrEP if available. 24/60 was asked if using PrEP may encourage them to have UPAI, 5 (20%) responded yes. 6 (10%) had used Post Exposure Prophylaxis following Sexual Exposure (PEPSE). In the last 2 years we provided 216 MSM with PEPSE, 29 (14%) used it more than once, 5 (2%) are now HIV positive.

Discussion

There appears to be high risk behaviour within our MSM cohort. PrEP has a role to play in prevention of HIV transmission, if funding became available for PrEP the service may need to find ways to target the higher risk individuals. 58% met the recommended criteria by BASHH/BHIVA.
P075 Efficacy and safety of switching to EVG/COBI/FTC/TAF in virologically suppressed women
Authors: Hodder Sally , Squires Kathleen , Kityo Cissy , Avihingsanon Anchalee , Plotnikova Yulia , Jiang Shuping , Kulkarni Rima , Cheng Andrew , Elliott Cindy , Cao Huyen
Published: May 2024

Introduction

Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate(E/C/F/TDF) demonstrated superior efficacy when compared with atazanavir boosted by ritonavir(ATV/r+F/TDF) in 575 treatment naïve women at Week(W) 48. We now report the safety and efficacy of subsequent switching to E/C/F/tenofovir alafenamide(TAF) versus remaining on ATV/r+F/TDF.

Methods

After completing the initial randomised, blinded 48-week trial,women on ATV/r+F/TDF were randomised 3:1 to receive open label E/C/F/TAF versus remaining on their current regimen. Viral suppression by FDA snapshot analysis, pre-defined bone and renal safety and tolerability endpoints 48 weeks after switch are reported. Women who become pregnant while on study are given the option to continue study drug.

Results

212 HIV-infected, virologically suppressed women were randomised(E/C/F/TAF n=159, ATV/r+F/TDF n=53). Virologic suppression(<50c/mL) was maintained in 94.3% on E/C/F/TAF vs 86.8% on ATV/r+F/TDF with virologic failure in 1.9%, 3.8%, respectively. More women on E/C/F/TAF achieved <20c/mL at W48 compared with ATV/r+F/TDF (84.9% versus 71.7%p=0.041). No treatment emergent resistance was detected in either group. Mean% increase in BMD was higher in the TAF group for both lumbar spine and total hip. Multiple markers of renal safety were improved for participants randomised to TAF. No cases of proximal renal tubulopathy were reported. Nineteen women became pregnant during the switch study 13 E/C/F/TAF, 6 ATV/r+F/TDF,3 normal infants have been delivered in each group to date.

Discussion

These data demonstrate that women who switch to an integrase inhibitor+TAF-based regimen maintain high levels of virologic suppression with improvement in BMD and renal function biomarkers compared with those remaining on their ATV/r+TDF-based regimen.
P076 Five years of feedback for the newly diagnosed course – an evaluation of a peer-led intervention for people diagnosed with HIV
Authors: Oxenham Chantal , Haddow Lewis , Sandulescu Cristian , Bayakwaga Angela , Sandford Christopher , Sultan Binta , Williams Ian , Waters Laura , Edwards Simon , Tariq Shema
Published: May 2024

Introduction

New diagnosis of HIV can be psychologically challenging, and presents an important opportunity to improve health literacy and engagement in care. Peer-led interventions are an effective means of providing support to people living with HIV (PLWH). We present an evaluation of a newly-diagnosed course (NDC) in London.

Method

The NDC, established in its current form in 2011, is accessible to ‘those recently diagnosed or struggling with diagnosis’. Providing a structured, peer-led, group-based, participatory programme delivered by experienced facilitators. NDC comprises 6 sessions (21 contact hours). All participants were invited to complete pre-and post-course questionnaires (using a 4-or 5-point scale), most did at the first and last sessions. This analysis presents data from 2011-2016. Data were analysed in STATA using Wilcoxon signed rank test.

Results

Across 30 NDCs, 314 participants completed both questionnaires (response rate 87%). The majority were men who have sex with men (91.3%), 72% of whom were of white ethnicity. Approximately 15% were female, the majority Black-African ethnicity (56%) and heterosexual (88%). Heterosexual men and transgender individuals represented 6.5% and 0.3% respectively. The table summarises participant’s responses for selected questions (P Values <0.001 for all comparisons):

Pre- and Post-Course Questions:•Pre-course n/N (%)•Post-course n/N (%)*Current emotional state144/136 (43)287/339 (85)*Confidence in dealing with HIV status130/335 (39)307/339 (91)*Confidence around sex and relationships46/336 (14)172/279 (62)*Confidence in the future130/338 (39)290/332 (90)How confident do you feel about disclosing your HIV status?26/338 (8)136/340 (40)How satisfied are you with your ability to get more information about HIV medications?97/336 (29)130/314 (41)How much knowledge do you have about how HIV is transmitted?183/337 (54)324/340 (95)How much do you know about how to access Post Exposure Prophylaxis (PEP)?169/337 (28)274/340 (81)How much knowledge do you have about CD4 count and HIV viral load?82/337 (24)300/340 (88)Personal satisfaction with NDC overall n/N (%) rating ‘mostly’ or ‘fully’ useful324/328 (99)

*Questions headed: ‘Thinking about your HIV how would you rate the following’ Respondents rating highest using 4- or 5-point scale

Discussion

This innovated peer-led NDC engaged over 300 PLWH since 2011, resulting in short-term self-reported improvements. 6-and 12-month questionnaires would assess durability of changes, and we’re exploring the association with attendance at NDC and clinical outcomes (e.g. viral suppression and retention in care). In conclusion, the NDC is a sustainable and acceptable model, providing holistic support and promoting self-management in PLWH.
P081 The cost of cost-saving HIV drug switches in a small DGH HIV unit
Authors: Street Kerry , Priestley Cecilia , Scofield Sara
Published: May 2024

Introduction

In July 2016 NHSE circulated a letter regarding Commissioning for Value and antiretroviral drug switches. The letter noted that ‘These switches have been identified as not needing to recall patients to clinic or to introduce additional monitoring arrangements unless clinically indicated or the patient requires further support’. However the e-GFR decreases after starting cobicistat and checking at 4/52 is recommended.

Methods

Patients suitable for antiretroviral drug switches were identified by pharmacy, a total of 50 patients (53% of our cohort). A review of the outcomes up to Jan 2017 was undertaken.

Results

Eleven patients switched successfully from Kivexa to generic abavavir/lamivudine. Fifteen switched from Atripla to Truvada/efavirenz. Of these, four switched back due to side effects. In one case 4 months of drugs, costing £1384, were wasted. Two patients did not tolerate Rezolsta (AKI & diarrhoea). There were ten extra visits for safety bloods. The first prescription for the switches for all regimens was for two months to minimise waste. Additional staff time was required to generate the prescriptions, and the additional deliveries cost £1215 to date.

Discussion

Switches from Atripla to Truvada/efavirenz and from PI/r to PI/cobicistat involved additional costs in terms of staff time, delivery charges and drug wastage. In December 2016, we decided to halt the switches to PI/cobicistat, as it was felt that the cost savings were insufficient to compensate for the additional workload, and also it might be a challenge to switch patients back to two drugs when generic darunavir and atazanavir become available.
P085 An audit of nice guidance PH33; increasing the uptake of HIV testing in black africans
Authors: Jones Bethan , McCathie Radhika
Published: May 2024

Introduction

In 2015, Wolverhampton had the highest rates (15.8 per 100,000) of newly diagnosed HIV in West Midlands and In the West Midlands incidence rates in the black African ethnic group remain much higher than those for other ethnic groups, with a relative risk of 34 compared with the white group in 2015. This clearly shows the importance of the NICE Guidelines PH33 which was published in 2011 which aimed to increase the uptake of HIV testing in Black Africans and we wanted to audit this guidance.

Methods

A list of patients classified as being of Black African ethnicity who were admitted to the Acute Medical Unit at Royal Wolverhampton NHS Trust between April 2015 and January 2016 was obtained. Their medical notes and blood test results were retrospectively analysed for evidence of testing or any discussion of HIV tests.

Results

50 case notes were retrospectively reviewed. An HIV test was not offered in 87% of admissions despite 15% of them presenting with signs of clinical indicator diseases. Only 6 patients were offered a test during their admission, of which 5 of them accepted. 1 of these tests was HIV positive and the patient was referred for further care to the HIV service within the trust.

Discussion

There remains a barrier to HIV testing in high risk populations in non-GUM settings despite NICE guidance published several years ago. Recommendations include the need to identify existing barriers by surveying doctors and providing education on how to overcome them, and the addition of prompts on clerking proformas may encourage universal testing.
P098 Evaluation of the performance of HCV AG in routine screening for hepatitis C in high-risk populations
Authors: Houlihan Catherine , Vora Nina , Waters Laura , Ghosh Indrajit , Gilson Richard , Nastouli Eleni
Published: May 2024

Introduction

Screening high-risk populations for hepatitis C (HCV) using antibody (anti-HCV) does not immediately distinguish resolved and active infections and may miss acute infections. HCV core-antigen (HCVAg) screening has been introduced in laboratories supporting some UK sexual health clinics. We evaluated Abbott Architect’s automated HCVAg immunoassay for HCV screening.

Methods

Testing was introduced in May 2015 for those reporting HCV risk in the past 6 months, and annual screening for all HIV-positive individuals. HCVAg-positive samples were tested in duplicate, then tested for HCV–RNA. Few samples were tested for both HCVAg and HCV-RNA in the initial few months. Results for all tests performed May 2015–April 2016 were reviewed.

Results

5132 samples were tested for HCVAg. 113/5132(2%) were HCVAg positive. 139 samples had both HCVAg and HCV-RNA tested. Using HCV-RNA as the gold standard, HCVAg sensitivity was 99%; positive predictive value 63%. Specificity was 39%; negative predictive value 96%.

Abstract P098 Table 1

Evaluation of HCV Ag test

HCV-RNA detectedHCV-RNA not detectedHCVAg+ve7141**HCVAg-ve1*26

The HCVAg negative/HCV-RNA positive individual had low viral load (130c/ml).

Of the 41 HCVAg positive/HCV-RNA negative individuals; 30(73%) were retested later and were HCVAg negative and HCV-RNA or anti-HCV negative. 3(7%) were persistently HCVAg positive but HCV-RNA negative; 7 had no follow up samples; 1 subsequently became HCV-RNA positive.

Discussion

The specificity of HCVAg in our cohort is lower than that published in a recent systematic review (93% sensitivity/99% specificity). False positive results cause distress for patients and additional laboratory costs, however the increased sensitivity for acute infection may lead to earlier diagnosis in high-risk populations.
P106 The inbetweeners: 16 & 17 year olds attending SRH are vulnerable
Authors: Forbes Kimberley , West Richard , Cassidy Seán , Daniels David
Published: May 2024

Introduction

Legally, 16 and 17 year olds can consent to sex but may still be vulnerable to sexual exploitation; opportunities to identify vulnerability may be lost when transitioning into adult services.

Methods

In the financial year 2015–16 there were 1975 attendances of 998 individuals <18 at a sexual & reproductive health service. A risk assessment proforma was used in 98.8% (n=505/511) of those 16 or under and 72.9% (n=355/487) of those aged 17. These were analysed using an electronic report.

Results Discussion

Using arisk assessment proforma with16 and 17 year olds enabledstaff to recognise vulnerabilities related to child sexual exploitation, 53% of all concerns were among this age group. When transitioning to online and adult services care modelsshould include assessment to identifyvulnerabilities such as pre-existing involvement with social care, older partners & mental health difficulties. Staff should be competent in managingdisclosures and have aworking knowledge of social care, referral thresholds and pathways within local networks for those at risk of CSE.

Abstract P106 Table 1

The inbetweeners

Under 16 n=205Age 16 n=300Age 17 n=355New safeguarding concern14 (7%)8 (4.3%)8 (3.8%)Known to social care52 (34%)61 (20%)70 (20%)> 10 sexual partners2 (1%)9 (3.2%)14 (4.2%)Age of current or last partner 18–24 years9 (4.3%)66 (23.8%)195 (58.9%)Age of current or last partner 25 years or >04 (1.4%)5 (1.5%)Mental health difficulties47 (23%)63 (21%)93 (26%)
P107 Exploring the awareness and acceptability of screening methods for anal intraepithelial neoplasia (AIN) in the HIV-positive men who have sex with men (MSM) population
Authors: Johnson Maximilian , Mulka Larissa , Richardson Daniel
Published: May 2024

Introduction

Rates of AIN and anal squamous cell carcinoma (SCC) are increasing worldwide, particularly within high-risk populations, such as HIV-positive MSM. Although screening programmes for AIN exist, evidence supporting their benefit is currently limited and ongoing studies will provide crucial data regarding their efficacy.

Aim(s)/Objectives

To determine awareness of AIN and acceptability of potential screening methods in a large HIV-positive MSM cohort with high rates of anal SCC, to assist in the development of future services and to evaluate a patient information leaflet.

Methods

A patient information leaflet was designed providing information about AIN and screening methods. Respondents read the leaflet and completed a survey determining both its usefulness and attitudes towards screening services.

Results

172 HIV-positive MSM completed the survey with a modal age-range of 45–54. 146 (84.9%) read the leaflet and found it useful. Though only 23 (13.4%) were previously aware of AIN, 119 (69%) were concerned. 23 (13.4%) self-examined regularly though 88 (51.2%) were not aware of self-examination. However, 119 (83.2%) were willing to self-examine and 142 (99.3%) would accept examination by a healthcare professional. Support for a screening programme was strong with 143 (83.1%) of respondents stating they would be willing to participate.

Discussion

In this well-informed HIV-positive MSM population, awareness of AIN and screening methods is low, however self-examination and screening is acceptable. It appears that our information leaflet is a useful tool to raise understanding and promote self-examination.
P126 Characterising admissions to a specialist HIV inpatient centre: demographics, diagnosis and ideas for service development
Authors: Bentley Alexander , Lawrence David , Roche Mark , Richardson Daniel
Published: May 2024

Introduction

Effective antiretroviral therapy has reduced HIV inpatient admissions and patients are increasingly admitted with non-HIV related pathologies. Increasing pressure on NHS hospitals emphasise the need to minimise admissions, maintain patient flow and understand how inpatient facilities are used. We aim to review the demographics and causes of acute medical admissions to a single HIV-specialist unit.

Methods

Retrospective analysis of patients admitted under the HIV team at a single referral centre including demographics, reason for admission, length of stay and discharge destination.

Results

114 patients admitted in 2016. Median age 46 years (range 18–79). 86% male. 14/114 (12%) were newly diagnosed with HIV. 24/114 (21%) admitted with HIV-associated illness, 16/114 (14%) with AIDS-defining illness, 59/114 (52%) with non-HIV associated illness. Respiratory infections were the commonest cause of admissions with 14/114 (12%) cases of PCP and 27/114 (24%) of lower respiratory tract infections. 16/114 (14%) admissions were secondary to drugs and alcohol. Median length of stay 7 days (range 1–135). Discharge destination was home 89/114 (78%), a bespoke HIV-intermediate care facility 19/114 (17%), other healthcare facility 3/114 (3%) and 3/114 patients (3%) died.

Discussion

Inpatients were younger and had a much longer length of stay when compared with the average for acute internal medicine. Majority of admissions were for non-HIV associated illness suggesting adequate viral suppression for most patients. Service adaptations are needed to address the high incidence of mental health disorders, importantly drug/alcohol addiction. We also highlight the importance of a HIV-intermediate care unit to aid rehabilitation and facilitate discharges.
P127 Is there a need for pelvic ultrasound within an integrated sexual health service?
Authors: Pinto-Sander Nicolas , Rela Mariam , Yarrow Kate
Published: May 2024

Introduction

Sexual health services see a number of women who once infection is excluded, may require the use of pelvic ultrasound to aid diagnosis. Without in-house scanning facilities, they often end up on a convoluted route involving several appointments across clinical specialities.

Methods

This observational study examined two consecutive years of referrals for pelvic ultrasounds from a busy integrated sexual health service, where in-house scanning was not available. Information from referrals to radiology was gathered from an imaging database where indication and outcomes were analysed from scan reports.

Results

190 patients were scanned with a mean age of 31. 184/190(97%) were outpatients. 79/190(42%) were scanned for pelvic pain, and 42/190(22%) for coil related concerns. 141/190(74%) of scans had normal findings. Of coil related referrals, only 1/42(2%) needed intervention. 19/190(10%) of pelvic ultrasounds had incidental findings not requiring follow up, and 30/190(16%) had findings requiring intervention or follow up.

Discussion

In this study, all coils with ‘lost threads’ were found to be intrauterine – and therefore could be managed within an integrated sexual health service. Only a small number of those scanned needed onward referral or follow-up. With scanning expertise and resources, patients would be seen more quickly, with a reduction in appointments and fewer referrals. This would result in improved patient satisfaction and reduced costs to the NHS. The set-up costs would be offset in the long-term by keeping patients out of the acute setting.
P128 Exploring chemsex in the north east of england
Authors: Gilmore Katherine , Loberg Anna , Knox Joanne , Chauhan Mayur
Published: May 2024

Introduction

Recreational drug use is higher in men who have sex with men (MSM) with use of psychoactive drugs facilitating group sex sessions (chemsex). Public health implications include increased sexual risk taking with potential for HIV/STI transmission and associated physical and mental health harms. Our aims were to assess the extent of chemsex in the North East of England to inform local/national policy and tailor service provision.

Methods

A regional self-administrated survey was conducted in five sexual health/HIV care providers and a local LGBT and young people’s charity in the North East over a three-month period. All service users were invited to complete an anonymous paper or online survey about chemsex.

Results

This is provisional data from 954 surveys. 18 respondents reported engaging in chemsex (mean age 37 years,) 71% of which took place in the North East. 94% were male and 78% of these identified as gay (17% heterosexual, 6% bisexual.) 33% were HIV positive, 60% had a previous STI and 13% were ‘slamming’ (injecting.) 9% of all male respondents who identified as gay, had engaged in chemsex.

Discussion

Data suggests that although chemsex is relatively uncommon in the North East, it is more prevalent in the MSM population and those who are HIV positive. Screening for chemsex in these groups should be standard practice and included in UK national guidance. Consequently service provision can be tailored to address local need by simple interventions or instigate clear pathways into specialist services.
P130 A comparison of demographic characteristics and workloads of independent nurse prescribers (INP) and nurses using patient group directions (PGDS) in sexual health clinics
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean
Published: May 2024

Introduction

Nurses legally deliver medication independently using INP or PGDs. Despite growing evidence of clinical application, there is limited sexual health research.

Methods

INP and PGD nurses from five UK sexual health services completed a questionnaire, and recorded two weeks of clinical activity in a specifically designed diary, Aug 2015–Aug 2016.

Results

Questionnaire response rate: 64% (61/95; INP=26/28, 93%; PGD=35/67, 52%). Respondents were mostly female (n=55/61, 90%), aged 35–44years (n=21/61, 34%). INP were mainly Band 7 or above (n=18/26, 69%), educated to Masters Level (n=16/26, 62%); PGD users were mostly Band 6 (n=24/35, 68.6%), educated to Diploma Level (n=13/35, 37%). INP had mean of 2.9 years more sexual health experience than PGD users (mean: INP=13.0; PGD=10.1years). Both groups reported access to medications was essential (n=56/61, 92%) and made their roles easier (n=60/61, 98%).

Overall 61% (INP=17/26, 65%; PGD=20/35, 57%) of questionnaire respondents completed the diary. Of the total diary entries (INP=737; PGD=593), INP managed more ‘new’ care episodes (n=512/737, 70%) than PGD users (n=294/593, 50%). There was no difference in medication delivery frequency (INP=460/737, 62%; PGD=348/593, 59%; p=0.16). However, PGD users required additional medication delivery support from other healthcare professionals more often than INP (INP=419/460, 91%; PGD=240/348, 69%; p<0.01). PGD users had marginally shorter patient consultations than INP (mean 22.8 vs. 24.9mins). Mean consultation support was 8mins/consultation (both groups).

Discussion

Sexual health nurses require independent access to medication for their roles. INP are more likely to practice autonomously, but may spend longer with patients.
P131 An audit of home testing kits
Authors: Carozzi Becca , Barrett Sarah
Published: May 2024

Introduction

Umbrella Health recently introduced sexually transmitted infections (STI) home testing kits for asymptomatic adults from Birmingham and Solihull. An audit was undertaken to consider patient demographics, service utility and effectiveness.

Methods

All patients registering for home testing kits between 1st– 10thMarch 2016 were included. Patient demographics, results and follow up were accessed from the laboratory and clinical database. Data was compared with a clinic comparator group of 50 randomly selected patients attending clinic during the same timeframe. Statistics were performed using Microsoft Excel.

Results

536 patients were included of which 331(61.7%) were female. 103(19%) of patients were symptomatic. 536(100%) of requested kits were distributed. 280(52%) nucleic acid amplification tests (NAAT) and 209(39%) blood samples were returned. 86(41%) returned blood samples were insufficient for analysis. 25(100%) patients with a positive result were informed via text. 10(40%) attended for treatment. 3(30%) agreed to contact tracing. Compared with the clinic attendees, users were younger (60% 16-24yrs cf 28%), more likely to be Caucasian (73% cf 44%), with lower rates of STIs (4.7% vs 16%). 16–24-year-old Caucasian females accounted for 17.5%(N=94) of the home-testing group.

Discussion

Home STI testing kits are popular with 536 distributed with 10days. Patients requesting kits were more likely to be asymptomatic, younger, Caucasian and female with lower rates of STIs. Return rates may be improved by provision of a STI fact sheet and lancet change. Linkage of laboratory and clinical databases may improve governance. Low treatment rates need further investigation.
P134 Patient group directions use in sexual health
Authors: Manns Victoria
Published: May 2024

Introduction

Patient Group Directions (PGDs) provide a legal framework for nurses (and other health professionals) to supply/administer medication without a prescription to facilitate speedy access to medications by patients. An audit was carried out to assess local compliance and use of PGDs (anti-infective and contraception) used with in a sexual health clinic.

Methods

Using Trust wide auditable criteria for PGDs, over a 6-month period (July to December 2016) 715/721 notes were audited. In particular documentation relating to administration/supply of medication and whether the PGD was used in accordance to PGD policy. These data were compared with a pervious audit (January to June 2016) where 306 notes were audited, which identified that 96% were used and documented correctly in line with policy.

Results

In the audited notes (n=715) There had been an improvement with 99% of medications were issued/supplied and documented correctly in line with the PGD policy, compared with 96% in the previous audit. Those notes where practice did not meet the required standard related to documentation issues (lack of signature or indicating issued/supplied under PGD). All care provided met the eligibility requirements of the PGD.

Discussion

This audit highlights importance of auditing PGD use and having a system that records errors, to help improve patient safety and staff development. Additionally, this audit demonstrates that PGDs can be safely and effectively used within the sexual health setting. Comparison of the audits demonstrates increased PGD’s use, attributed to improved training and staff support.