bluuebunny/crossref_metadata_2025 huggingface dataset:
P70 Neisseria gonorrhoeaeST26; emergence of an MSM associated strain within a heterosexual population during an outbreak
Authors: Shone J , Orange G , Allstaff S , Cunningham C , Yirrell D , Eastick K
Published: May 2012

Background

Neisseria gonorrhoeaesequence type (ST) 26 has been documented across Scotland since the introduction ofN gonorrhoeaemulti-antigen sequence typing (NG-MAST) in 2004. Scottish incidents of ST26 have historically been associated with men who have sex with men (MSM). In November 2010, it was noted that an increased proportion of ST26 isolates were documented among women within our local Health Board area.

Aims

To explore the epidemiology of ScottishN gonorrhoeaeST26 strains, with reference to a rising incidence of gonococcal (GC) diagnoses within our local area.

Methods

All Scottish GC isolates (2004–2011), and nucleic acid amplification positive specimens where no isolate was available (2009–2011), were analysed by NG-MAST.

Results

Abstract P70 Table 1

Scottish incidences ofNeisseria gonorrhoeaeST26 strains

Local health boardLocal health boardNon-local health boardsNon-local health boardsTime periodTotal isolatesMale isolates (%)Total isolatesMale isolates (%)2004–20070–4591.120080–0–2009201006100January 2010–April 20103100683.3May 2010–October 20100–0–November 2010–September 20113256.3250Total5559

Discussion

These data describe that up until November 2010,N gonorrhoeaeST26 in Scotland was predominantly found in men, indicating its association with MSM networks. The spike of ST26 strains in 2010/2011 in both men and women within our local Health Board area imply its introduction to a heterosexual network. These data demonstrate the utility of NG-MAST for the epidemiological study of GC infection. In particular, the data describe the manner in which gonococcal STs can become established and transferred between different regions and population groups, which may be assumed to have separate sexual networks.
P73 A review of diagnostic tools used in the detection ofNeisseria gonorrhoeae(GC) in women attending a London sexual health clinic (SHC)
Authors: Rosenvinge M , Storrar N
Published: May 2012

Background

Near-patient microscopy (NPM) has poor sensitivity in the identification of GC in women, with NPM of urethral (Ur) smears no longer recommended by BASHH.

Aim

To review the diagnosis of GC in women attending a London SHC and assess the relative merits of NPM, culture and Nucleic acid amplification tests (NAATs) in detecting GC.

Method

Female GC diagnoses from 1 January 2008 to 30 June 2011 were identified from the GU Medicine Clinic Activity Dataset and case notes reviewed. The results and sites of GC tests taken, were recorded. Slides stated as “suspicious” for GC on NPM were counted as positive. GC was cultured on selective medium. The Beckton Dickinson Probe Tec Strand Displacement Assay (dual NAAT for GC/CT) was used for endocervical (Cx) specimens from 22 June 2009.

Results

Notes were available in 334/369 (91%) of cases (317 women): median age 20 years (range 13–53); 92/334 (28%) White British; 87/334 (26%) Black Caribbean; 219/313 (70%) symptomatic; 160/321 (50%) had a previous STI; 42/317 (13%) had a history of GC; 58/334 (17%) were GC contacts. 289 cases had Ur/Cx cultures taken: 30 (10%) were positive on Ur culture; 148 (51%) on Ur and Cx culture; 88 (30%) on Cx culture. 11/142 (8%) Cx NAATs performed were negative for GC: 6/11 were positive on Ur culture; 5/11 on pharyngeal culture/NAAT; 1/11 on Cx culture. 104/125 (83%) with positive Cx NAATs were positive on Cx culture. 42 were diagnosed with GC on vaginal NAATs. 135/330 (41%) were also diagnosed withChlamydia trachomatis(CT) (see abstract P73 table 1).

Abstract P73 Table 1

Results of NPM for culture positives

UrethralEndocervicalNPM positive29 (12 Cx NPM negative)29 (12 Ur NPM negative)NPM negative99138NPM not done4969Sensitivity NPM29/128 (23%)29/167 (17%)False positives*313*

NPM was positive for GC but samples were culture negative

Conclusion

Cx NAAT was more sensitive than culture in detecting GC; supplementing Cx NAAT with Ur culture will reduce the potential for missed cases. Our data shows a poor sensitivity of Ur and Cx NPM for the detection of GC in women, highlighting a need to perform targeted training, review the criteria for NPM and develop additional point of care tests for GC.
P74 Epidemiology of anNeisseria gonorrhoeaeoutbreak in a low prevalence area
Authors: Shone J , Cunningham C , Orange G , Eastick K , Yirrell D , Allstaff S
Published: May 2012

Background

In January 2011, an increased number of gonococcal (GC) isolates was noted within the local bacteriology department. A “look back” exercise was initiated for all incidences of GC infections during the previous 13 months, while new episodes of GC infection were monitored to ascertain whether this increase represented an outbreak.

Aims

To determine the epidemiology of GC infection observed during an outbreak ofNeisseria gonorrhoeaewithin the local area.

Methods

Cases of GC infection within our Health Board area were identified by culture or nucleic acid amplification test (NAAT) for the period December 2009 to April 2011.N gonorrhoeaemulti-antigen sequence typing (NG-MAST) was performed on positive isolates or NAAT samples. Patient demographics were gathered at the local sexual and reproductive health (SRH) clinic.

Results

73 episodes of GC infection were recorded in one geographically distinct area of our Health Board between December 2010 and April 2011 (the outbreak). Nineteen cases were documented for the same period the previous year. No similar increase in GC diagnoses was observed in neighbouring areas. Chlamydia cases remained relatively stable. Patient demographics were available for 62 of the 67 cases diagnosed at the local SRH clinic. Of these, the majority of cases were male (66.1%) (of which 22% were MSM), under 25 years of age (71%), heterosexual (78.5%) and of White Scottish ethnicity (95.2%). 40 (64.5%) patients (29 male and 11 female) presented with symptoms of GC infection and 19 (29.2%) as GC contacts. The predominant NG-MAST sequence type was ST26.

Discussion

The epidemiology of this outbreak is atypical, since GC infection and NG-MAST ST26 has been more commonly found in men who have sex with men in Scotland. Despite enhanced surveillance, no sexual networks or links to specific venues were identified. A gonorrhoea awareness campaign was launched in May 2011.
P76 Equivocal Aptima Combo 2 results: what do they mean in clinical practice?
Authors: Cassidy S , Artykov R , White J
Published: May 2012

Background

Molecular diagnostic tests have become standard of care for detection of gonococcal (GC) and chlamydial (CT) infections. The Aptima Combo 2 (AC2) test is widely used and is highly sensitive and specific, even for non-genital specimens. Equivocal results occur when the initial AC2 assay detects target RNA but the confirmatory Aptima GC or CT assay fails to detect a different RNA sequence in the same specimen.

Aim

To determine whether equivocal AC2 (EAC2) results were predictive of subsequently confirmed infection in our GUM/HIV clinic population.

Methods

Retrospective review of all EAC2 results for GC or CT at 3 urban UK GUM/HIV clinics from January to December 2011. Patients with EAC2 results were routinely recalled for repeat testing unless treated at the initial visit.

Results

From a total of approximately 38 000 AC2 tests performed in 2011, 3118 (8.2%) were confirmed positive: 1189 GC and 1929 CT infections. There were 222 EAC2 results in 2011 (0.6% of total AC2 tests); 45 (20.3%) occurred in women, the majority (73%) of which were equivocal genital CT results. Of the 177 EAC2 results in men (mostly MSM), 70% were non-genital specimens. Equivocal pharyngeal GC was common, comprising one-third of all male EAC2. Of 34 EAC2 patients analysed in more detail, 5 were GC/CT contacts and 24/34 reported unprotected sex at the site of the EAC2. None with equivocal GC had GC positive culture results, at the time or subsequently. Of 19 men with EAC2 GC results, 6 (all MSM) had confirmed GC at another mucosal site at that visit. 30/34 patients had the AC2 test repeated (range 7–24 days after initial test); 29 were AC2-negative and one remained equivocal (see abstract P76 table 1).

Abstract P76 Table 1

Rates of equivocal GC and CT results according to gender and site

Gender and site of EAC2 test resultNo. of patients with equivocal GC resultNo. of patients with equivocal CT resultWomen EC618 SSVS215 RS10 TS11 Urine01Men RS2920 TS6014 Urine3022 Other11

EC, endocervical; RS, rectal swab; SSVS, self-collected vaginal swab; TS, throat swab.

Conclusions

EAC2 results are uncommon but seem to occur in those at higher risk for infection; yet the vast majority does not have infection confirmed on subsequent testing. This suggests that these are spurious results, possibly from contamination, or low organism load infections that do not persist; thus routine treatment is not necessarily warranted.
P77 Colposcopy of cervical warts
Authors: Evans J , Toeima E , Elsawy M
Published: May 2012

Background

BASHH guidelines for the management of genital warts do not recommend colposcopy for women with cervical warts unless there is diagnostic uncertainty or clinical concern. Our local cervical cytology guidelines advise colposcopy regardless of cervical cytology result.

Aim

To review the colposcopic outcome of women referred from our genitourinary medicine department because of cervical warts.

Method

Retrospective case note review of women referred for colposcopy because of cervical warts from December 2005 to November 2010.

Results

25 women with cervical warts underwent colposcopy. The median age was 22 years (range 17–52 years). Four of the 25 were found to have a normal cervix at the time of colposcopy. 21 of 25 had persistent cervical warts, three consistent with benign human papilloma virus (HPV) infection and in whom no further action was taken. 18 of 21 with persistent cervical warts underwent biopsy. Histological results indicated 10 had HPV only, six had CIN 1, one had CIN 2, and one had normal histology. The woman with CIN 2 and one with CIN 1 had a complete LLETZ excision of the lesion. All women with CIN were under 25 years old.

Conclusion

A third of the women biopsied had CIN, however only one had a high grade abnormality. No invasive cancers were found. Conservative management for young women with CIN 2 is acceptable in current colposcopic practice. Our study indicates unscheduled screening or referral to colposcopy is unrewarding.
P80 Genitourinary medicine physicians need further training in the management of HSV in late pregnancy
Authors: Fleury C , Clarke E , Baker A , Green J , Foley E , Patel R
Published: May 2012

Background

Transmission rates of neonatal herpes simplex virus (HSV) infection varies from 30% to 50% if shedding with primary infection during the third trimester of pregnancy, to <3% with active recurrent genital infection. Despite the low transmission risk of recurrent HSV in pregnancy, there remains confusion regarding appropriate management.

Aim

To investigate the level of knowledge of BASHH guidelines regarding the management of GH in the third trimester of pregnancy amongst BASHH conference attendees.

Methods

Attendees of two BASHH conferences completed a questionnaire consisting of case-scenarios regarding appropriate management of pregnant women and their partners with genital herpes infection. The first case-scenario was designed to assess familiarity with accepted guidance. The second was used to assess whether physicians followed RCOG or BASHH guidelines.

Results

94 attendees completed the survey. In line with current guidelines, 81 (74%) answered that primary HSV infection at term was an indication for Caesarian section (CS), and 37 (46%) of these 81 responders stated this CS should be carried out at 38 weeks gestation. Of these 37 responders, when questioned concerning recurrent genital infection at term, 27 (73%) believed that lesions present at delivery would necessitate a CS, and 35 (95%) felt that vaginal delivery was appropriate in the absence of lesions at delivery. Although there is specific guidance for the limited place of invasive techniques at term only 17% would advise avoidance of fetal scalp electrodes and artificial membrane rupture.

Conclusion

No-one demonstrated complete familiarity with the BASHH guidelines surrounding appropriate management of HSV. Of most concern is the limited awareness of the management need of CS in third trimester first episode disease. Further training of GUM physicians is required in order to ensure practice is compatible with the best available advice.
P82 What do phase 1 microbicide trial participants really think? Are they “only in it for the money?”
Authors: Morris G , Douglas S , Woodhall S , Lacey C
Published: May 2012

Background

Early-phase trials require multiple visits and procedures, which can lead to difficulties with recruitment and compliance.

Aims

To explore participants' experience of, and motivation for, taking part in a study of the safety and pharmacokinetics of an HIV microbicide.

Methods

28 women completed eight study visits including pelvic examinations, colposcopy, vaginal sampling (clinician performed and self-taken aspirate) and semi-structured, qualitative interviews. Additional requirements included daily vaginal gel use (12 doses) and sexual abstinence (16 days). Interviews were audio-recorded, transcribed, and analysed using a framework approach.

Results

Although renumeration was given by 64% of women as the main or a contributing reason for participating, 71% also stated that they had an interest in HIV or saw the value in the research. 46% volunteered after hearing positive reports from other participants. Difficulties included speculum examinations, sampling, and fitting study visits and gel use into a normal routine. Problems with self-sampling were identified by 12 women, including discomfort and concern about obtaining an adequate sample. 10 participants reported a preference for self-sampling, 11 for clinician sampling. Compliance with gel use was high. Leakage was common but varied with position and depth of insertion. Four women found abstinence difficult. Being single, or discussing the study with partners before enrolment made abstinence easier.

Conclusion

Qualitative interviews in early-phase trials capture useful additional information and help determine acceptability of procedures and products. Healthy subjects commonly have multiple non-exclusive reasons for participating in research. Understanding participants' motivation and experiences can aid recruitment and facilitate compliance with study requirements.
P84 Where do babies come from? A man's understanding of women's health
Authors: Appleby M F , Allen F , Dowsing B , Rich H , Douglass P
Published: May 2012

Background

As part of a student selected study component, five male fourth year medical students sought to examine young men's knowledge of women's reproductive health. The importance of raising awareness of women's health must not be underestimated. Education of men in basic women's health could result in a significant reduction in unwanted pregnancy, misuse of contraception and domestic violence.

Aim(s)/Objective(s)

The research question was simple—was our ignorance representative of our peers, and specifically, in which areas was knowledge most lacking?

Methods

24 questions were chosen for simplicity, guided by the developers' own lack of knowledge. Respondents were male pre-clinical medical students (n=41) aged 18–21, with a smaller but representative female cohort (n=12) to be used for comparison.

Results and Discussion

Male respondents' overall mean grade 48.3 % (SD 16.9%) compared poorly to the female respondents' 70.8% (SD 10.9%), significant on between samples t-test (p<0.01). Results for each category are represented in abstract P84 table 1. Male respondents scored poorly on contraceptive awareness. The majority believed A&E to be an appropriate place to access emergency contraception. Not one male was able to name a serious side effect of the COCP. Only 7% of respondents knew the age women should receive their first cervical smear, and less than half knew its purpose. The project was limited by the opportunity sample used - medical students are well educated but unworldly in many other ways and not representative of other men their age. However, this study outlined the key areas where male education needs to be improved in an effort to involve men in women's health and combat inequalities.

Abstract P84 Table 1

Correct male responses regarding female sexual health

Menstrual cycle60%Contraception47%Cervical Screening27%Menopause64%Anatomy49%
P86 Audit on the management of women with syphilis in the north east of England
Authors: Hew Y , Foster K , Mitchell L , Suchak T , Wholey V , Elawad B , Basta M , Hussey J
Published: May 2012

Background

The increase in syphilis in women over the last 10 years in the North East and re-emergence of congenital syphilis, as presented at BASHH spring meeting 2011, prompted a review of current management of pregnant women with syphilis.

Objectives

To identify any risk factors in women being diagnosed with syphilis in the region and to review the current management of pregnant women with syphilis.

Methods

A regional audit involving all Genitourinary Urinary Medicine (GUM) departments in the North East was conducted. Case notes of all women diagnosed with syphilis from 2006 to 2010 were obtained to identify risk factors in the women and to review the management, communication, follow-up and outcome of pregnant women with syphilis. Standards were set against current BASHH guidelines on syphilis management and local standards.

Results

A total of 98 women were diagnosed with syphilis over the 5 years. 61% of all women were White British. 42/98 women were pregnant. 27% of non-pregnant women had infectious syphilis compared to 42% of pregnant women. 23% had another concurrent sexually transmitted disease. Most women were in a regular relationship with only 17 women reporting a casual partner in the last 3 months. Overall 41%, but only 7% of white British women, had had sex with a man from overseas. There were two cases of confirmed congenital syphilis and five early miscarriages. Documentation of excluded congenital syphilis was poor (only three cases) in GUM records.

Conclusion

The high level of infectious syphilis in pregnant women and poorly documented outcomes has informed a multi-disciplinary good practice arrangement to be produced and promoted to improve communication between clinicians, ensure recommended treatment and follow-up. No clear risk factor groups were found to inform repeat testing in later pregnancy. A new enhanced surveillance form is soon to be piloted which includes collecting data on birth outcomes.
P88 Ulipristal acetate (UPA) is affordable as emergency contraception (EC) if used where levonorgestrel (LNG) is unlicensed
Authors: Jones A B , Garcia L Dominguez , Cohen C E , Nwokolo N , Day S L
Published: May 2012

Background/Aim

Our three GUM clinics are increasingly offering an integrated family planning (FP) service. We audited against three Faculty of Sexual and Reproductive Health EC standards. UPA is licensed to be given as EC following an extended window period (<120 h) after unprotected sex (UPSI)) compared to LNG (<72 h) but, is prohibitively more expensive (LNG £6.65, UPA £20.35). We estimated the anticipated cost to our service by introducing UPA to the GUM formulary.

Methods

Electronic notes review of patients prescribed EC between 1st December 2010 and 1st March 2011.

Results

The case notes of 163 EC prescriptions were reviewed. The median age was 24 years and 58.9% were Caucasian. The Faculty of Sexual and Reproductive Health standards were not achieved (Aim 100%): discuss future contraception (95%); offer STI screening (90%); offer an intrauterine device (Cu-IUD) (54%). 33% (54/163) of patients received a method of general contraception on the day of EC prescription. Of those that did not: 19% (21/109) booked an FP appointment at which 62% received general contraception and 38% did not attend; 12% (13/109) returned for more EC and at one site 4% (2/49) returned pregnant (not EC failures). 4.3% (7/163) of EC prescriptions were outside the product license for LNG but within license for UPA (UPSI 72–120 h ago or multiple episodes of UPSI within 120 h). Using this as an estimate of UPA service need, this equates to an additional expenditure of £383.60/year though, this is likely an underestimate given LNG may not be routinely offered outside its license and is of uncertain efficacy beyond 72 h.

Recommendations

Extended provision of Cu-IUD fittings is required to improve offer/uptake rates of this first line EC method—current availability is limited to 1–3 sessions/wk. In light of high default rates clinicians should consider quick starting/dispensing general contraception when prescribing EC. Further FP integration is planned to facilitate this. UPA seems affordable in GUM.
P89 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty
Authors: Shahmanesh M , Wayal S , Cowan F M
Published: May 2012

Background

Female sex workers (FSWs) in India remain most vulnerable to contracting HIV immediately after initiation into sex work. We explored the process of initiation to inform interventions.

Methods

In-depth interviews were conducted with sixteen purposively selected FSWs in Goa (December 2004–December 2005). The life narratives were interrogated using grounded theory.

Results

The narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and how women entered sex work: The ubiquitous mitigating theme that emerged was violence: dysfunctional and violent family life; sexual violence; and violence from intimate male partners. Other underlying vulnerabilities were also manifestations of gender disadvantage: being unwanted; sexual naïveté; early sexual debut; entrapment in loveless marriages; and lack of life skills. Loss of social support through bereavement and abandonment or financial need, were the commonest events that precipitated entry into sex work. The clearest division in the route into sex work was between traditional caste-based sex workers (devadassi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar.

Conclusion

The interplay between caste, economy, gender, and violence drives entry into sex work. HIV prevention interventions must work upstream on the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potential vehicles to “deliver” HIV prevention services. Ultimately, the challenge is to ensure that the structural vulnerabilities that prevent effective HIV prevention early after entry into sex work do not also become barriers preventing FSWs from accessing HIV treatment.
P9 Sustainable and embedded opt out HIV testing on an acute medical admissions unit
Authors: Palfreeman A , Mckinnon G
Published: May 2012

Background

Opt out testing for HIV in our hospital's acute medical unit (AMU) had been successfully piloted between August 2009 and September 2010. Our trust was selected a pilot site to implement the 2008 national HIV testing guidelines as an area of high HIV prevalence outside London. (Data from this pilot were presented at BASHH in Gateshead in 2010). However, could opt out testing for HIV on an AMU be sustained beyond the pilot?

Methods

HIV testing in the pilot was embedded into the normal working of the AMU, clinical aides did the phlebotomy, medical admission proformas were modified to include HIV testing and consent was obtained by a widely distributed information leaflet. One of the GU consultants attended the AMU to remind doctors to test several times a week. After the pilot finished, the GU consultant stopped attending the ward HIV testing is now part of routine care on the AMU. It is explained at each junior doctors induction which includes a patient video. Electronic blood test requests for AMU automatically include an HIV test as part of the AMU blood bundle set. A CQUIN target that 25% of all admissions are to be tested for HIV has been set by commissioners. Testing has been expanded from the 16–60 age range to the 16–80 age range.

Results

The rate of HIV testing has risen from 80 a month to 140 a month in 2011 the number of new +ves diagnosed has risen from 10 per year to 25 in 2011

Conclusion

Sustainable opt out testing for HIV on an AMU can be achieved by embedding the testing process in the clinical pathways that already exist upon an AMU. This requires no extra manpower or resources to achieve within an AMU setting. Since the withdrawal of consultant support our average testing rate has gone up. Our model for opt out HIV testing is therefore sustainable, requires little extra resource and should be easy to reproduce in other centres.
P90 Is a 100% antenatal HIV testing possible?
Authors: Tegally D , Doucas T , Green H , Apoola A
Published: May 2012

Background

Antenatal HIV testing in the UK has been a resounding success and is credited with reducing the rate of mother to child HIV transmission.

Aims

To explore the characteristics of women who did not have the HIV test at booking, the reasons for declining and adherence to local policy on re-offering tests later in pregnancy. Between April 2010 and April 2011 a review of maternity case notes was carried out.

Results

6723 women were booked in early pregnancy in the relevant time period and 33 (0.5%) of these women did not have a documented HIV test. Notes were only available for 32 of these women.

31/32 (96.8%) of the women were UK born, 27 (84.4%) partners were UK born. 11 (34.4%) women were pregnant for the first time. 13 (40.6%) women had no documentation of a HIV test within a year of booking. There was no documentation of intravenous drug use in any of the women or their partners. 7 (21.9%) women did not have any other blood borne virus testing done and none of these women had a recent documented HIV test either. Only in 8 (25%) women was there documentation of reasons for declining. 5 (12.5%) women were re-offered screening at about 28 weeks gestation in line with local policy with 4 (80%) accepting. 6 of 18 women were offered testing on admission to the labour ward and 2 (33.3%) were tested.

Discussion

The maternity unit has a policy for dealing with women declining HIV testing in pregnancy and achieved a 99.6% acceptance rate. This study shows that there are some problems with documentation of previous testing, risk assessment and consistently re-offering of the screening tests later on in pregnancy. When the test was re-offered later on in pregnancy there was a high acceptance rate emphasising the benefit of this approach. In view of these results further training of midwives with an emphasis on HIV risk assessment and re-offering testing later on in pregnancy will be implemented.
P91 Care of HIV+ women aged 50 and over: can we do better?
Authors: Samuel I , Welch J , Tenant-Flowers M , Poulton M , Taylor C
Published: May 2012

Background

The prevalence of ageing HIV infected females continues to increase due to greater survival, delayed diagnosis and new infections; management of specific issues in this group becomes more challenging.

Aims/Objective

To identify the specific care issues for women at and above 50 years.

Method

Female patients aged 50 and over were identified from a female cohort of 828 and data collected retrospectively from case notes and electronic patient records.

Results and Discussion

The sample consisted of 124 (15% of 828) women, mean age 52 y, range 50–75 y; 83% black ethnicity. 40.3% diagnosed at 50 y or over. CD4 counts, mean 217 cells/μl indicating 71% late diagnoses and 42% with advanced/very advanced HIV. 22.6% of the sample had attended hospital before and missed the opportunities for early diagnosis suggesting wider testing even in elderly. 4.5% women had premature menopause compared to <1% in the general population, 7.1% early menopause, 28% had menopausal symptoms, 10% had HRT. On opportunistic testing of BMD tests, 5/8 women had evidence of osteoporosis/osteopenia. 54% of the whole group had vitamin D deficiency. 38% had abnormal cervical cytology, of which 16.5% were high grade. A high degree of obesity (48%) and other co-morbidities (90%) identified.

Conclusions

Special care for premature/early menopause including early counselling regarding reproductive options, wider HIV testing regardless of age, screening for osteoporosis, breast and cervical cancer, holistic approach in the management of obesity and other co-morbidities. Consideration needed as to how care is provided for this group within current health care settings.
P94 Prevalence and correlates of sexual violence in female attendees at genitourinary medicine clinics
Authors: White J , Biros N , Holland D
Published: May 2012

Background

Sexual violence (SV) is common but under-reported in the UK. Victims of SV may be more likely to attend genitourinary medicine (GUM) clinics but there are no recent urban data.

Aims

To determine the prevalence and correlates of SV in female GUM attendees. To assess whether routine enquiry on SV is warranted and to gauge if specific SV resources are needed in GUM.

Methods

Questionnaire-based survey offered to all women attending our two urban walk-in GUM clinics. Participants self-completed anonymised proformas about any experiences of SV using a broad definition of SV. Demographic, clinical and behavioural data were also collected.

Results

Analysis of the initial 164 surveys showed a median age of 27 (IQR 23–31). Ethnicity was typical of the clinics' populations: 62% UK born; 40% White British, 21% White other, 16% Black British, 8% Black African and 7% Black Caribbean. When asked about a history of SV ever, 17% responded yes; in 36% of these women SV had happened more than once. Median age at the time of SV was 19 years (range 6–40); 22/164 (13%) described the SV as rape/sexual assault and in two women this was in the last year. Only two women described their assailant as a stranger; one confirmed her SV was gang-related. Additional women responded to queries on forced oral sex 5%, forced touching 7%, forced sex without a condom 11%. Of 32 women who told someone it included a health professional in only 28% and the police in 25%. 78% of all participants agreed it was helpful to ask routinely about SV and 87% felt that a SV worker was needed in the clinic; four women indicated that their reason for attending GUM today was SV-related. Qualitative comments were mostly positive and accepting of SV enquiry, though several women expressed negative comments about the difficult emotions it had evoked.

Conclusions

Women attending GUM have a high prevalence of SV. Further study is warranted within GUM settings to establish if routine enquiry and SV service provision should be core business.
P96 Characteristics and sexual health outcomes of sex workers seeking sexual health care in England
Authors: Marsh K , Savage E , Ward H , Wetten S , McGrath L , Hughes G
Published: May 2012

Background

Until recently the only data on sexual health of sex workers (SWs) were from special studies. We used new STI surveillance data to investigate the characteristics and health outcomes of SWs visiting GUM clinics in England.

Aim

To assess the sexual health needs of SWs.

Methods

Provisional data from the GUM Clinic Activity Dataset (GUMCAD) on consultations by SWs (SHHAPT code SW) were analysed.

Results

Reporting began on a rolling basis in 207 GUM clinics during 2011; 2305 SWs were reported from 83 clinics to date. Of these, 1908 were female and 397 male (including 29 MSM). Among female SWs, median age was 29 years, 69% were white and 65% born abroad (migrants). Of the migrants, 35% were from Eastern Europe (60% Romania) and 31% from South America (93% Brazil). The 1908 women made 3131 visits with 63% having a repeat visit within 6 months; 5.4% having chlamydia, 1.2% gonorrhoea, 1.8% genital warts, 1.6% genital herpes, 0.1% syphilis and 0.1% HIV. Migrant SWs were more likely than UK-born women to be seen in London clinics, and less likely to have a sexual health screen (67% vs 83%) or HIV test (67% vs 82%). Migrants were less likely to be diagnosed with chlamydia (4.4% vs 7.3%) or gonorrhoea (1.0% vs 1.5%) but more likely to have genital warts (2.4% vs 1.0%) or genital herpes (1.8% vs 1.3%).

Conclusions

Overall STI rates among female SWs are low, particularly among migrants. Lower rates of HIV testing among migrants should be analysed further.
p–y curve and lateral response of piles in fully liquefied sands
Authors: Ashour Mohamed , Ardalan Hamed
Published: May 2012

This paper provides a technique to assess the response of laterally loaded piles and associated p–y curves in fully liquefied soils (where p is the soil–pile reaction and y is the pile deflection). The technique accounts for the variation of water pressure in the liquefied soils around the pile and its impact on the shape of the p–y curves and the pile lateral response. A constitutive undrained stress–strain model for fully liquefied saturated sands using the basic properties of sand is established to predict the post-liquefaction varying resistance of liquefied sands at different levels of loading assuming fully undrained conditions. The degradation in soil strength due to the free-field excess pore-water pressure (uxs,ff), caused by an earthquake and resulting in full liquefaction, is considered along with the near-field excess pore-water pressure (uxs,nf) induced by lateral loading from the superstructure. The presented procedure also accounts for the influence of the overburden pressure and sand density on the variation of excess water pressure in the near-field soil, the rebound of sand strength, and the shape of the p–y curve due to the dilative behavior of sands.
Centrifuge modeling of buried continuous pipelines subjected to reverse faulting
Authors: Rojhani Mahdi , Moradi Majid , Galandarzadeh Abbas , Takada Shiro
Published: May 2012

Seismic ground faulting is a severe hazard for continuous buried pipelines. Over the years, researchers have attempted to understand pipeline behavior mostly via numerical models such as the finite element method. The lack of well-documented field case histories of pipeline failure due to faulting along with the costly and complex facilities needed for full-scale experimental simulation make a centrifuge-based method to determine the behavior of pipelines subject to faulting the best method to verify numerical approaches. This paper presents results from four centrifuge tests investigating the behavior of continuous buried steel pipelines that were subjected to reverse faulting. The axial and bending strains induced in a pipeline are presented. Also investigated is the influence of factors such as faulting offset, burial depth, and pipe diameter on the axial and bending strain of pipelines and on the ground soil failure and pipeline deformation pattern. Finally, the initial strain at the wrinkling point of the pipe under reverse faulting is studied and compared with theoretical values. It was found that the pipe deformation mechanism and damage type are significantly altered by variations in pipe diameter, burial depth, and pipe section slenderness ratio (diameter to thickness ratio). Increasing the diameter and burial depth of a pipe changes the deformation mechanism from beam buckling to wrinkling. The wrinkling strains from these tests are in good agreement with the findings of Hall and Newmark.
Intermittent freezing mode to reduce frost heave in freezing soils — experiments and mechanism analysis
Authors: Zhou Yang , Zhou Guoqing
Published: May 2012

Two types of freezing tests have been conducted on Xuzhou silty clay. The intermittent freezing test results show that the frost heave increases step by step after the initial freezing stage, and its total amount is only 48.8% that resulting from the continuous freezing test. A model describing the growth process of the active ice lens in saturated, rigid soils has been established, and the importance of the frozen fringe is investigated in the model. The growth processes of the final ice lenses in the two freezing tests have been used for laboratory validation of the model, and the calculated results are in general agreement with the experimental data. The mechanism of using an intermittent freezing mode to reduce frost heave has been revealed by analyzing the growth process of the final ice lens. We indicate that, during the noncooling stage, the backward movement of the freezing front, which causes the disappearance of the frozen fringe, stops the growth of the final ice lens. This effect results in a step-type frost heave curve in the intermittent freezing test and reduces the heave amount effectively. Finally, problems concerning the practical application of the intermittent freezing mode are discussed in a preliminary manner.
Correlating acoustic emission sources with damaged zones during direct shear test of rock joints
Authors: Moradian Z.A. , Ballivy G. , Rivard P.
Published: May 2012

Applicability of acoustic emission (AE) for localizing asperity damaged zones and damage intensity in joint surfaces was evaluated in this paper. With this attempt, rock joint samples obtained from tension splitting of the rock cores were tested under constant normal load condition. The locations of the AE sources were determined from propagation velocity of acoustic waves and by measuring the transferring time from event source to AE sensor. These sources correspond to asperity damaged zones. The AE signals generated from asperity degradation of joint surfaces were detected during shear testing. The energy of the generated signals was also measured to assess the intensity of the asperity failure. The results of this study showed that the AE method has a good capability in localizing the asperities’ failure points and the intensity (energy) of the asperities’ failure.
Seismic measurements in sand specimens with varying degrees of saturation using piezoelectric transducers
Authors: Valle-Molina Celestino , Stokoe Kenneth H.
Published: May 2012

Small-strain seismic measurements in sand specimens were undertaken in the laboratory using piezoelectric transducers. The measurements involved determining both constrained compression wave and shear wave velocities, Vpand Vs, respectively. The piezoelectric transducers were discs (PDs) for Vpmeasurements and bender elements (BEs) for Vsmeasurements. An instrumented triaxial chamber (ITC) was developed and associated support instrumentation was assembled to perform the seismic measurements. The same PDs and BEs were installed in a combined resonant column and torsional shear (RCTS) device. The soil tested in both devices was washed mortar sand. The sand was tested in dry, unsaturated, and saturated conditions in the ITC, while only dry sand was tested in the RCTS. Development, calibration, and operation of the PDs and BEs are discussed. Example waveforms are presented, which are associated with different stress levels, saturation conditions, and frequencies of excitation for P and S waves. A critical factor in performing successful measurements is the driving of each type of piezoelectric transducer at the optimum frequency, which depends on the effective confining pressure ([Formula: see text]), degree of saturation, and soil type. The excitation frequency used for PDs was found to be important when the sand specimens were at nearly or fully saturated conditions.
Strength and deformation behavior of red sandstone under multi-stage triaxial compression
Authors: Yang Sheng-Qi
Published: May 2012

Based on multi-stage triaxial experimental results of red sandstone with circumferential deformation control, the influence of confining pressure on strength and deformation behavior of red sandstone under multi-stage triaxial compression is investigated. The results show that the confining pressure has an obvious effect on the deformation parameters of red sandstone under multi-stage triaxial compression. A multi-stage triaxial compression experiment with only one specimen can be used to confirm the peak strength of rock under different confining pressures. Under single-stage and multi-stage triaxial compression, the peak strength behavior of red sandstone agrees better with the nonlinear Hoek–Brown criterion than the linear Mohr–Coulomb criterion. However, the difference between single-stage and multi-stage triaxial strength changes with different post-peak deformation values, and the reason for the difference, is discussed. To predict single-stage triaxial strength using the obtained multi-stage triaxial strength with only one specimen, a new method is put forward to revise multi-stage triaxial strength of red sandstone, which testifies to being reasonable. The concluding remarks are very useful and significant for deep geotechnical and underground structural engineering.
The Staffa Lava Formation: graben-related volcanism, associated sedimentation and landscape character during the early development of the Palaeogene Mull Lava Field, NW Scotland
Authors: Williamson Ian T. , Bell Brian R.
Published: May 2012

Synopsis

The name ‘Staffa Lava Formation’ is proposed for the early sequence of volcanic and associated sedimentary rocks of the Palaeogene Mull Lava Field in the Inner Hebrides, off western Scotland. The Formation is defined as the sequence between the sub-Palaeogene unconformity and the base of the so-called (Mull) Plateau Lava Formation. Observations across the outcrop reveal that the Staffa Lava Formation is a complex, laterally variable sequence of lava facies, hyaloclastites and other breccias, and various interflow sedimentary rocks; also present are peperites and a single occurrence of silicic ignimbrite. The sedimentary rocks and associated palaeo-surfaces represent significant pauses in the volcanism, enabling us to subdivide the Formation into a number of allostratigraphical units termed ‘genetic sequences’. Each sequence is essentially a couplet comprising a ‘basal’ sedimentary unit and an ‘upper’ volcanic unit. In detail, some sequences comprise more than one, laterally restricted, sub-couplet. There are systematic patterns in both the distribution and thickness of the sedimentary and volcanic lithofacies that make up these units. The individual sequences appear to show a strong structural control of thickness, distribution and lithofacies, which we link to palaeo-topographic effects, especially their position within existing Palaeogene fault-controlled valley systems or active, syn-volcanic graben. The presence and significant role played by contemporaneous drainage systems and topography during the evolution of the Staffa Lava Formation is demonstrated by the number and variety of intercalated sedimentary units and the nature and facies of the volcanic products. The clearest example of the latter is the close association of hyaloclastite breccias and thick, impounded lava flows exhibiting classical two-tiered columnar joint sets. Palaeontological data, most especially palynological analysis, allow further detailed ecological characterization of the sedimentary units and palaeo-surfaces, and the development of a model for the early landscape evolution of the lava field. The taxa associated with the sedimentary sequence at the top of the Formation are typical of the early Eocene and contain floral elements characteristic of Paleocene–Eocene Thermal Maximum sites throughout the NE Atlantic region.
Functional dissociation between PIKfyve-synthesized PtdIns5P and PtdIns(3,5)P2 by means of the PIKfyve inhibitor YM201636
Authors: Sbrissa Diego , Ikonomov Ognian C. , Filios Catherine , Delvecchio Khortnal , Shisheva Assia
Published: May 2012

PIKfyve is an essential mammalian lipid kinase with pleiotropic cellular functions whose genetic knockout in mice leads to preimplantation lethality. Despite several reports for PIKfyve-catalyzed synthesis of phosphatidylinositol 5-phosphate (PtdIns5P) along with phosphatidylinositol-3,5-biphosphate [PtdIns(3,5)P2] in vitro and in vivo, the role of the PIKfyve pathway in intracellular PtdIns5P production remains underappreciated and the function of the PIKfyve-synthesized PtdIns5P pool poorly characterized. Hence, the recently discovered potent PIKfyve-selective inhibitor, the YM201636 compound, has been solely tested for inhibiting PtdIns(3,5)P2 synthesis. Here, we have compared the in vitro and in vivo inhibitory potency of YM201636 toward PtdIns5P and PtdIns(3,5)P2. Unexpectedly, we observed that at low doses (10–25 nM), YM201636 inhibited preferentially PtdIns5P rather than PtdIns(3,5)P2 production in vitro, whereas at higher doses, the two products were similarly inhibited. In cellular contexts, YM201636 at 160 nM inhibited PtdIns5P synthesis twice more effectively compared with PtdIns(3,5)P2 synthesis. In 3T3L1 adipocytes, human embryonic kidney 293 and Chinese hamster ovary (CHO-T) cells, levels of PtdIns5P dropped by 62–71% of the corresponding untreated controls, whereas those of PtdIns(3,5)P2 fell by only 28–46%. The preferential inhibition of PtdIns5P versus PtdIns(3,5)P2 at low doses of YM201636 was explored to probe contributions of the PIKfyve-catalyzed PtdIns5P pool to insulin-induced actin stress fiber disassembly in CHO-T cells, GLUT4 translocation in 3T3L1 adipocytes, and induction of aberrant cellular vacuolation in these or other cell types. The results provide the first experimental evidence that the principal pathway for PtdIns5P intracellular production is through PIKfyve and that insulin effect on actin stress fiber disassembly is mediated entirely by the PIKfyve-produced PtdIns5P pool.
Orosensory detection of sucrose, maltose, and glucose is severely impaired in mice lacking T1R2 or T1R3, but Polycose sensitivity remains relatively normal
Authors: Treesukosol Yada , Spector Alan C.
Published: May 2012

Evidence in the literature supports the hypothesis that the T1R2+3 heterodimer binds to compounds that humans describe as sweet. Here, we assessed the necessity of the T1R2 and T1R3 subunits in the maintenance of normal taste sensitivity to carbohydrate stimuli. We trained and tested water-restricted T1R2 knockout (KO), T1R3 KO and their wild-type (WT) same-sex littermate controls in a two-response operant procedure to sample a fluid and differentially respond on the basis of whether the stimulus was water or a tastant. Correct responses were reinforced with water and incorrect responses were punished with a time-out. Testing was conducted with a modified descending method of limits procedure across daily 25-min sessions. Both KO groups displayed severely impaired performance and markedly decreased sensitivity when required to discriminate water from sucrose, glucose, or maltose. In contrast, when Polycose was tested, KO mice had normal EC50 values for their psychometric functions, with some slight, but significant, impairment in performance. Sensitivity to NaCl did not differ between these mice and their WT controls. Our findings support the view that the T1R2+3 heterodimer is the principal receptor that mediates taste detection of natural sweeteners, but not of all carbohydrate stimuli. The combined presence of T1R2 and T1R3 appears unnecessary for the maintenance of relatively normal sensitivity to Polycose, at least in this task. Some detectability of sugars at high concentrations might be mediated by the putative polysaccharide taste receptor, the remaining T1R subunit forming either a homodimer or heteromer with another protein(s), or nontaste orosensory cues.