bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution and adaptation of terrestrial plant‐associated Plantibacter species into remote marine environments
Authors: Liao Li , Qin Qilong , Yi Dian , Lai Qiliang , Cong Bolin , Zhang Huiming , Shao Zongze , Zhang Jin , Chen Bo
Published: May 2024

Microbes are thought to be distributed and circulated around the world, but the connection between marine and terrestrial microbiomes remains largely unknown. We use Plantibacter, a representative genus associated with plants, as our research model to investigate the global distribution and adaptation of plant‐related bacteria in plant‐free environments, particularly in the remote Southern Ocean and the deep Atlantic Ocean. The marine isolates and their plant‐associated relatives shared over 98% whole‐genome average nucleotide identity (ANI), indicating recent divergence and ongoing speciation from plant‐related niches to marine environments. Comparative genomics revealed that the marine strains acquired new genes via horizontal gene transfer from non‐Plantibacter species and refined existing genes through positive selection to improve adaptation to new habitats. Meanwhile, marine strains retained the ability to interact with plants, such as modifying root system architecture and promoting germination. Furthermore, Plantibacter species were found to be widely distributed in marine environments, revealing an unrecognized phenomenon that plant‐associated microbiomes have colonized the ocean, which could serve as a reservoir for plant growth‐promoting microbes. This study demonstrates the presence of an active reservoir of terrestrial plant growth‐promoting bacteria in remote marine systems and advances our understanding of the microbial connections between plant‐associated and plant‐free environments at the genome level.
Artificial intelligence in histopathological image analysis of central nervous system tumours: A systematic review
Authors: Jensen Melanie P. , Qiang Zekai , Khan Danyal Z. , Stoyanov Danail , Baldeweg Stephanie E. , Jaunmuktane Zane , Brandner Sebastian , Marcus Hani J.
Published: May 2024

The convergence of digital pathology and artificial intelligence could assist histopathology image analysis by providing tools for rapid, automated morphological analysis. This systematic review explores the use of artificial intelligence for histopathological image analysis of digitised central nervous system (CNS) tumour slides. Comprehensive searches were conducted across EMBASE, Medline and the Cochrane Library up to June 2023 using relevant keywords. Sixty‐eight suitable studies were identified and qualitatively analysed. The risk of bias was evaluated using the Prediction model Risk of Bias Assessment Tool (PROBAST) criteria. All the studies were retrospective and preclinical. Gliomas were the most frequently analysed tumour type. The majority of studies used convolutional neural networks or support vector machines, and the most common goal of the model was for tumour classification and/or grading from haematoxylin and eosin‐stained slides. The majority of studies were conducted when legacy World Health Organisation (WHO) classifications were in place, which at the time relied predominantly on histological (morphological) features but have since been superseded by molecular advances. Overall, there was a high risk of bias in all studies analysed. Persistent issues included inadequate transparency in reporting the number of patients and/or images within the model development and testing cohorts, absence of external validation, and insufficient recognition of batch effects in multi‐institutional datasets. Based on these findings, we outline practical recommendations for future work including a framework for clinical implementation, in particular, better informing the artificial intelligence community of the needs of the neuropathologist.
A Factor‐Augmented New Keynesian Phillips Curve for the European Union Countries
Authors: Norkute Milda , Westerlund Joakim
Published: May 2024

In this paper, a factor‐augmented version of the New Keynesian Phillips curve (NKPC) is assessed using a data set comprised of a large panel of European Union (EU) member countries. The factor‐augmentation is natural given that country‐level inflation rates are highly co‐moving. The presence of unattended common factors is important because it raises the issue of omitted variables bias, as the real marginal cost, which is a regressor of the NKPC, is likely to load on the same factors as inflation. One possibility here is to employ the regular instrumental variables approach. However, if the external instruments load on the same factors as the error term of the NKPC, the instruments would be invalid and the results would therefore likely be misleading. Motivated by this last observation, the present paper proposes a new estimator of the NKPC that allows for very general forms of factor dependencies and endogeneity. Our results provide evidence in support of the NKPC, but only after the presence of common factors has been appropriately accounted for.
Nitrogen‐mediated volatilisation of defensive metabolites in tomato confers resistance to herbivores
Authors: Li Zhi‐Xing , Wang Dan‐Xia , Shi Wen‐Xuan , Weng Bo‐Yang , Zhang Zhi , Su Shi‐Hao , Sun Yu‐Fei , Tan Jin‐Fang , Xiao Shi , Xie Ruo‐Han
Published: May 2024

Plants synthesise a vast array of volatile organic compounds (VOCs), which serve as chemical defence and communication agents in their interactions with insect herbivores. Although nitrogen (N) is a critical resource in the production of plant metabolites, its regulatory effects on defensive VOCs remain largely unknown. Here, we investigated the effect of N content in tomato (Solanum lycopersicum) on the tobacco cutworm (Spodoptera litura), a notorious agricultural pest, using biochemical and molecular experiments in combination with insect behavioural and performance analyses. We observed that on tomato leaves with different N contents, S. litura showed distinct feeding preference and growth and developmental performance. Particularly, metabolomics profiling revealed that limited N availability conferred resistance upon tomato plants to S. litura is likely associated with the biosynthesis and emission of the volatile metabolite α‐humulene as a repellent. Moreover, exogenous application of α‐humulene on tomato leaves elicited a significant repellent response against herbivores. Thus, our findings unravel the key factors involved in N‐mediated plant defence against insect herbivores and pave the way for innovation of N management to improve the plant defence responses to facilitate pest control strategies within agroecosystems.
Orthogonal polynomials on domains of revolution
Authors: Xu Yuan
Published: May 2024

We study orthogonal polynomials (OPs) for a weight function defined over a domain of revolution, where the domain is formed from rotating a two‐dimensional region and goes beyond the quadratic domains. Explicit constructions of orthogonal bases are provided for weight functions on a number of domains. Particular attention is paid to the setting when an orthogonal basis can be constructed explicitly in terms of known polynomials of either one or two variables. Several new families of OPs are derived, including a few families that are eigenfunctions of a spectral operator and their reproducing kernels satisfy an addition formula.
Organic fertilizer prepared by thermophilic aerobic fermentation technology enhanced soil humus and related soil enzyme activities
Authors: Xu Hongli , Wang Shuqiang , Jiang Nan , Xie Hongtu , Chen Zhenhua , Zhang Yulan , Li Shouzhong
Published: May 2024

Organic fertilizer (OF) prepared from chicken manure in a high‐temperature aerobic fermenter contains high levels of nitrogen, phosphorus and potassium. The effect of high‐nutrient OF substitution for chemical fertilizer (CF) on soil organic carbon stability is worth exploring. We used OF to replace CFs for supplying crops, and we set five OF replacement rates as 0, 25%, 50%, 75% and 100% in the black soil zone of Northeast China. We explored the variations in soil humus carbon contents, enzyme activities and nutrient contents (0–10 cm and 10–20 cm). Two‐way ANOVA results showed that interaction between soil depth and OF substitution significantly affected soil pH, total nitrogen, organic carbon, available potassium, water‐soluble carbon substance (WSSC) and activities of soil β‐galactosidase (β‐gal), N‐acetyl‐β‐D‐glucosaminidase (NAG) and cellobiohydrolase. The treatments of OF75 and OF100 increased soil pH, and the content of soil organic carbon, humic acid carbon (HAC), fulvic acid carbon (FAC), WSSC, total phosphorus, available phosphorus (AP), total potassium and available potassium was increased in OF75 and OF100 treatment. Treatments of OF75 and OF100 increased the tested soil enzyme activities except for oxidase activities of 0–10 cm soil layer. There was a positive correlation between HAC and AP contents, and a positive correlation between FAC and soil pH, total nitrogen and available potassium contents. The key influencing factors of soil FAC were the activities of NAG, α‐galactosidase and β‐gal. It can be concluded that OF substitution promoted soil humus carbon accumulation by affecting hydrolase activity related to carbon conversion.
‘Are we invisible?’ Power‐geometries of conviviality in a superdiverse London neighbourhood
Authors: Stansfeld Katherine
Published: May 2024

This paper explores the complexities of conviviality in a London neighbourhood by using primary qualitative data to analyse the implications of the (in)visibility of difference for superdiverse social relations. It develops the concept of power‐geometries to examine the implications of how social differences are produced, imagined, and experienced in the neighbourhood's public spaces. Drawing on three situated examples from a visual ethnographic research project, it explores the affective intensities of how gender, sexuality, class, and race intersect with ethnicity, religion, and migrant status to shape urban conviviality. The paper argues the way different positions and identities are layered and intersect can shape the development of ‘cosmopolitan outlooks’ and intercultural relations. In doing so, the analysis refines understandings of superdiversity conceived narrowly within the remit of majority/minority relations. It promotes instead more critically ethnographic explorations of the complex and varied ways difference has meaning in everyday lives in superdiverse places and shapes everyday forms of recognition and equality. The paper contributes to debates on geographies of difference, encounter, and public space by analysing how power relations affect conviviality. It demonstrates how conviviality is an ambivalent process that is punctuated by both prejudices and solidarities and is shaped by structural inequalities and wider political discourses. The paper concludes by highlighting the role of agency and space for dialogue for residents negotiating differences among urban change.
Alpha9alpha10 knockout mice show altered physiological and behavioral responses to signals in masking noise
Authors: Mondul Jane A. , Burke Kali , Morley Barbara , Lauer Amanda M.
Published: May 2024

Medial olivocochlear (MOC) efferents modulate outer hair cell motility through specialized nicotinic acetylcholine receptors to support encoding of signals in noise. Transgenic mice lacking the alpha9 subunits of these receptors (α9KOs) have normal hearing in quiet and noise, but lack classic cochlear suppression effects and show abnormal temporal, spectral, and spatial processing. Mice deficient for both the alpha9 and alpha10 receptor subunits (α9α10KOs) may exhibit more severe MOC-related phenotypes. Like α9KOs, α9α10KOs have normal auditory brainstem response (ABR) thresholds and weak MOC reflexes. Here, we further characterized auditory function in α9α10KO mice. Wild-type (WT) and α9α10KO mice had similar ABR thresholds and acoustic startle response amplitudes in quiet and noise, and similar frequency and intensity difference sensitivity. α9α10KO mice had larger ABR Wave I amplitudes than WTs in quiet and noise. Other ABR metrics of hearing-in-noise function yielded conflicting findings regarding α9α10KO susceptibility to masking effects. α9α10KO mice also had larger startle amplitudes in tone backgrounds than WTs. Overall, α9α10KO mice had grossly normal auditory function in quiet and noise, although their larger ABR amplitudes and hyperreactive startles suggest some auditory processing abnormalities. These findings contribute to the growing literature showing mixed effects of MOC dysfunction on hearing.
Robust orbital-angular-momentum-based underwater acoustic communication with dynamic modal decomposition method
Authors: Li Liulin , Liu Bingyi , Guo Zhongyi
Published: May 2024

Recently, acoustic communication employing orbital angular momentum (OAM) opens another avenue for efficient data transmission in aquatic environments. Current topological charge (TC) detection of OAM beams relies on the orthogonality among different-order OAM beams. However, such strategy requires measurements of the complete azimuthal acoustic pressure, which inevitably reduces the efficiency and increases the bit error rate (BER). To address these challenges, this study proposes a modified dynamic modal decomposition (DMD) method by partially sampling the acoustic field for precise TC detection. Numerical simulations confirm the accuracy of this approach in extracting single or multiple TCs magnitudes within a partially sampled acoustic field. We theoretically compare the performance of the modified DMD approach with conventional orthogonal decoding method. Simulation results indicate that our modified DMD scheme exhibits lower BER under the same noise interference and is more robust to the array misalignment. This research introduces an efficient demodulation solution for acoustic OAM communication, offering potential benefits for simplifying receiver array design and enhancing long-distance underwater data transmission.
Investigating Psychological Disparities Across Gamers: A Genre-Based Study
Authors: Griffith Oliver J. , Sharpe Benjamin T.
Published: May 2024

Objective: While video games have become a widespread form of entertainment, the exploration of their relationship with psychological factors remains relatively limited. The primary aim of this study was to examine potential disparities in levels of everyday stress, perceived stress, and positive mental health among individuals involved in three distinct video game genres: horror, competitive shooters, and sandbox. Although the study maintains an exploratory nature, we anticipated the emergence of significant differences between these genres. Method: A total of 54 participants were recruited, queried about their primarily favored video game genre, and then asked to complete an online survey consisting of three questionnaires, each corresponding to one of the dependent variables. Results: Three 1 × 3 between-subject analyses of variance indicated that levels of everyday and perceived stress were notably higher in the competitive shooter gamers, with sandbox gamers having the lowest levels. No significant differences were observed for levels of positive mental health. Conclusions: It is possible that competitive shooters either elevate everyday and perceived stress levels in individuals, or that already-stressed gamers are drawn to this genre. Finally, the absence of significant variations in levels of positive mental health across genres suggests that individuals may simply choose to play whichever game aligns with their personal sources of enjoyment.
Complete circular assembly of
Histophilus somni
PDS1537697-81-1 genome and phenotypic characterization of its antibiotic susceptibility
Authors: Trokhymchuk Anatoliy , Erickson Nathan , Waldner Cheryl L. , Links Matthew G.
Published: May 2024

A
Histophilus somni
isolate from a clinically healthy, fall-placed calf was obtained upon arrival to a commercial feedlot. Fall-placed calves are commonly viewed to be at high risk for the development of bovine respiratory disease. The isolate was phenotyped for antimicrobial susceptibility and sequenced to obtain a complete, circular, genome assembly.
Schwinger-Like Pair Production of Baryons in Electric Field
Authors: Gorsky A. , Pikalov A.
Published: May 2024

In this work, we evaluate the probability rate for the Schwinger production of baryons in an external electric field in the worldline instanton approach in holographic QCD. The new exponentially suppressed processes in a constant electric field involving the composite worldline instantons are suggested which include the non-perturbative decay of a neutron into proton and charged meson and the spontaneous production of $$p\bar {n}{{\pi }^{ - }}$$ and $$n\bar {p}{{\pi }^{ + }}$$ states.
O10 Aetiology of and trends in anogenital herpes diagnoses in england from 2006–2015
Authors: Smolarchuk Christa , Town Katy , Woodhall Sarah C , Hughes Gwenda , Mohammed Hamish
Published: May 2024

Introduction

Anogenital herpes (AH), associated with significant physical and psychological morbidity, is the second most commonly diagnosed viral sexually transmitted infection (STI) in England and is caused by infection with Herpes Simplex Virus (HSV) Type-1 or Type-2. We investigated the epidemiological and serotype characteristics of AH diagnoses in England and changes over time.

Methods

We performed a descriptive analysis of socio-demographic and clinical characteristics of AH using data from the national surveillance system for STIs (GUMCADv2), and calculated the proportion of new episodes by serotype using data from the national laboratory surveillance system in England from 2006–2015.

Results

There were 31,312 first and 25,356 recurrent AH episodes in 2015, and diagnosis rates of first episode AH increased 55% from 38 to 59 per 100,000 population since 2006. In 2015, diagnosis rates were highest among women (73.5), people aged 20-24 (243.1), those of Black Caribbean ethnicity (176.3), and London residents (93.8). Although MSM only accounted for 4.6% (n=1430) of diagnoses in 2015, there was an 18% increase in diagnoses since 2011; overall 28% of MSM diagnosed with AH were HIV-positive. The distribution of HSV-1/HSV-2 has remained stable since 2006: in 2015, 48% of women and 36% of men with AH were diagnosed with HSV-1 infection.

Discussion

Increased diagnoses of AH may be due to changes in sexual practices or improved test sensitivity. Differences by socio-demographic characteristics can be used to inform prevention strategies, while those by serotype are essential for guiding vaccine development.
P056 Providing written information in the electronic era – is it time for a re-think?
Authors: Brady Sophie , Fearnley Nicola
Published: May 2024

Introduction

Recent BASHH guidelines state that patients should be directed to clear, accurate written or web-based information and this is often an auditable outcome. We stopped providing paper leaflets in 2016 as our electronic patient record (EPR) allows a link to web based patient information leaflet (PIL) to be sent by short message service (SMS). Our aim was to identify if this had improved uptake of written information.

Methods

We identified 200 patients who received a positive chlamydia or gonorrhoea result and returned to clinic for treatment. Records were reviewed for offer and uptake of PIL.

Results

41 patients (20.5%) were sent a PIL link, 20 (10%) were documented to have declined and 139 (69.5%) had no documentation regarding PIL.

Discussion

Provision of links to PIL was low in this patient group. This compares to our 2012 audit of chlamydia, a time of paper records, where 59% accepted a leaflet. Our EPR shows the link has been sent but requires free text to record offer or refusal, so the actual offer may have been higher and not documented. Half had the name of the infection specified in a results SMS and therefore many may have already sought web based information prior to treatment. Plans to improve our documentation of offer of PIL include consideration of a PIL link with the initial positive SMS. Patients are increasingly likely to access information online, sometimes prior to attendance and BASHH may wish to consider this in their guideline recommendations and auditable outcomes.
P057 Trends in recorded abortions in uk general practice – cohort study using clinical practice research datalink (CPRD)
Authors: Ma Richard , Cecil Elizabeth , Saxena Sonia
Published: May 2024

Introduction

Clinical Practice Research Datalink (CRPD) is a database of health records from participating general practices in the UK. Patients in the CPRD are broadly representative of UK population. We studied trends in recorded abortions between 2004 to 2014 in participating general practices in England and Wales.

Methods

We created a cohort of females between ages of 15 to 44, registered with practices in England or Wales, during period 2004 to 2014. We identified abortions using Read codes. We removed records that were: misclassified, inaccurate in event and birth dates, and duplicates. We present trends in abortion data in women aged 15 to 44 in England and Wales using descriptive statistics and compared them with national data published by Department of Health (DH).

Results

There were over 114,000 recorded episodes of abortion between 2004 and 2014, with almost 5 million women of target age groups in the cohort. There appeared to be a consistent, year-on-year decrease in crude abortions rates from 2004 to 2014 using abortions data recorded on CPRD. The rate of decrease is less marked in the same period using national data. The age group 20–24 had the highest rate of abortions in every year, which correlates with national statistics.

Discussion

There are similarities and differences in abortion data between CPRD and DH which might reflect differences in the way data are collected and recorded. We suggest abortion records on CPRD need further work on data validation before conducting robust epidemiological studies.
P062 Accessing the prep population: what is the best service model?
Authors: Shaw Jozef , Dufaur Laurence , Bayley Jake
Published: May 2024

Introduction

Pre-Exposure Prophylaxis (PrEP) is effective to prevent HIV infections. Optimal service models for delivering this intervention are as yet unclear. We looked at our dedicated PrEP clinic in East London to identify who was accessing our service.

Methods

Retrospective case note review collected demographics, PrEP use, STI rates and ‘chem’ use from January to November 2016. Data was analysed with STATA.

Results

116 visits from 54 patients were returned with a median age 42 years (IQR 32 – 44.5). 90% were white. Of these 54 patients, only 27 started PrEP and engaged in care. For our population, there were lower than expected rates of STI’s (6% for CT and 9% for GC – any site) and a median of 4 partners in the preceding 90 days; much lower than encountered in the PROUD trial. 40% (21/54) had used ‘chems’ at some point, with 21% (4/21) of those ‘slamming’ (using intravenously) in the last 3 months. Routine urinalysis showed 30% abnormalities, but no subsequent abnormal uPCR.

Discussion

As the interest and use of PrEP grows, new service models may have to be developed to accommodate this population. We saw varying levels of engagement with patients who were predominantly white with low sexual risk. Young MSM were also underrepresented. Engagement with BME and MSM communities, along with drug services, may be needed to inform effective delivery of this intervention to those most at risk.
P064 Audit of post-exposure prophylaxis with associated risk profiles at the gay men’s health services, dublin, 2016
Authors: Moloney Geraldine , O’Dea Siobhan , O’Sullivan Colm , Clarke Susan
Published: May 2024

Introduction

The incidence of HIV infection is rising in Ireland, reaching a rate of 10.6/100,000 people in 2015. MSM is the most common route of transmission, reported as 50.9% of new diagnoses. There is a comparative surge in requests for HIV post-exposure prophylaxis (PEP) in Gay Men’s Health Services (GMHS), Dublin: 44% increase in 2016, vs. 2015. In 2016, a PEP proforma was devised for consistent clinical assessment of PEP requests and decisions.

Methods

We performed a retrospective review of all PEP requests from June-December 2016, following the introduction of this proforma. We investigated exposure types, reported use of condoms, alcohol, drugs, and partners STI status. We assessed appropriateness of PEP decisions in accordance with national guidelines, and compared risk profiles to published findings from 56 Dean Street.

Results

116 PEP assessments occurred in this time, with the specific proforma. All were evaluated as appropriate for PEP. GMHS attendees had same median age (31 years) as those of Dean Street. However, GMHS attendees reported significantly elevated risks of no condoms used (73 vs 54%; p <0.0001), more recreational drugs (30 vs 20%; p = 0.01), with an additional 13% using both drugs and alcohol. GMHS attendees reported more IAI, and significantly less group sex activity (3.5 vs 11%; p =0.02). Partner’s viral or bacterial STI status was rarely known.

Discussion

PEP is appropriately assessed and provided for GMHS attendees. High risk sexual behaviours are common, requiring comprehensive HIV prevention strategies for the continuing epidemic.
P067 All better now?: completing the audit cycle for pepse in the edinburgh gum service
Authors: Pollitt Helen , Raha Durba
Published: May 2024

Introduction

Over 2014-2015 in the GUM clinic in Edinburgh we audited PEPSE (post exposure prophylaxis for sexual exposure) as per 2011 BHIVA guidelines. The initial audit results showed that we fell short of the BHIVA auditable standards, most noticeably for proportion of prescriptions within recommended criteria, completion of PEPSE course and STI testing. Based on the results of the audit and the updated 2015 BHIVA guidelines, changes were incorporated into a new local PEPSE pathway. Changes included more detailed patient discussion about whether PEPSE is recommended, providing full 28 day course at first visit if indicated and STI screening at initial visit. We have re-audited PEPSE prospectively August 2016 onwards to see if there was improvement in the standards after the new local guideline was implemented.

Method

The following and demographics were documented on Excel Spreadsheet for patients who were prescribed PEPSE and compared with the results of the original audit.

Results

For the initial audit in 2014–2015 n= 100, for the re-audit in 2016 at the time of submission n=80.

Abstract P067 Table 1

PEPSE Audit

Percentage of patients with (%)2014–20152016BHIVA guidance recommendation (2011/2015)Baseline HIV test8190100Prescriptions that fit recommended indications557190Prescriptions administered within 72 hours of exposure8310090Prescriptions within 24 hours of exposure364490Completion of 4-week course of PEPSE4749 completed,19 ongoing,32 unknown or incomplete75STI screen518090

Discussion

The results suggest marked improvement, though we still fall short of the auditable standards.
O12 LGV testing: are we identifying all cases in a timely manner?
Authors: Maxwell Alexandra Z , Cliff Penelope R , White John A
Published: May 2024

Introduction

BASHH recommendsLymphogranuloma venereum(LGV) testing ofChlamydia trachomatis(CT)-positive specimens from men who have sex with men (MSM) presenting with proctitis, and all rectal CT from HIV-positive MSM. Until recently in England, LGV testing was only available as a referred test at the Sexually Transmitted Bacteria Reference Unit (STBRU). In July 2016 we implemented a validated in-house version of the STBRU LGV PCR on all CT-positive specimens from MSM, regardless of symptoms or HIV status. We assessed the time from specimen collection to result (turnaround time, TRT) and defined clinical features of LGV cases.

Methods

From July 2016 to March 2017 we reviewed all positive LGV tests, recording patients’ demographics, HIV status, chemsex behaviour, presence of symptoms and LGV result TRT.

Results

We conducted 587 LGV tests on CT-positive specimens from MSM, of which 50 (8.5%) were positive. Median age of LGV cases was 38 (range 23 to 65), 28 (56%) were Caucasian, 38 (76%) were HIV positive and chemsex behaviour was reported by 20 (40%); 12 patients (24%) had a past history of LGV. Nine (18%) cases were asymptomatic and three of these were HIV-negative MSM. The mean TRT was 12 days (range 8 to 20); compared with 35 days (range 15 to 118) in the six months prior to in-house testing.

Discussion

LGV continues to occur mainly in HIV-positive MSM as symptomatic proctitis. Testing all CT-positive MSM increased detection of LGV compared with following BASHH guidelines, and in-house testing reduced TRT significantly.
P080 Dramatic reductions in new hiv diagnoses for MSM in england are not uniform for all ethnicities in a large london clinic
Authors: Bayley Jake , Williams Andy , Singh Selena
Published: May 2024

Introduction

Along with many other GUM clinics, we are seeing a reduction in new HIV diagnoses in MSM. Our clinic is based in East London and sees MSM of all ethnicities. Preliminary data analysis suggests that this reduction may not apply to the BME MSM population.

Methods

We analysed HIV testing rates from our large London GUM clinics. HIV tests, along with demographic data, sexual risk and ethnicity are collected routinely. We then compared positivity rates between ethnicities in 2015 and 2016.

Results

Over 2015 and 2016 there were 48,512 HIV tests performed, of which 12,248 (25%) were on MSM. There was a slight decrease in the number of HIV tests in MSM from 6,688 in 2015 to 5,560 in 2016. We saw a significant reduction in the numbers of new HIV diagnoses in MSM from 43 in 2015 to 25 in 2016. This reduction in new HIV diagnoses was seen in those of white ethnicity (from 30 in 2015 to 15 in 2016) and black ethnicity (from 5 to 3). However, this reduction was not seen in Asian MSM (2 diagnoses each year).

Discussion

New diagnoses of HIV are declining in MSM, likely due to treatment as prevention and PrEP. However, it appears that these significant drops are not uniform. Asian MSM may be less likely to engaged with traditional GUM services. Targeted work is needed to engage this group and help reduce HIV diagnoses further.
P082 Implementing and sustaining hiv testing in acute medicine – results from the first 2 years
Authors: Gann Hugh Mc , Mclaren Jos , Baggott Amy
Published: May 2024

Introduction

Leeds is an area of high HIV prevalence of 2.3/1000 and in accordance with National UK guidelines for HIV testing we introduced routine opt out HIV testing to the acute medicine unit at St. James’s University hospital in January 2015. Opt out testing is offered to patients between 16 and 65 years of age admitted to any of the acute medical areas.

Methods

Ensuring high testing rates in this busy environment with rapidly changing medical staff is challenging and we have used a number of interventions to help sustain a high testing rate. These include providing weekly feedback and training to the acute medicine doctors and nurse practitioners, an electronic prompt on the Ordercoms pathology system and for patients who have blood tests in the emergency department, the facility to have HIV testing performed on samples sent to biochemistry. We employ a 0.5 WTE nurse to support this project.

Results

Between January 2015 and February 2017 there have been 11,715 eligible patients admitted of which 7263 (61%) patients underwent HIV testing. HIV testing was highly acceptable to patients with almost no patients refusing the offer of an HIV test. 16 patients (0.22%) had a positive HIV test and 2 partners were subsequently tested positive. 10 of the 16 patients had a very late diagnosis with a CD4 count <200 cells/mm3and we identified many missed opportunities for earlier diagnosis. 2 patients had primary HIV infection and would almost certainly not have been tested otherwise.
P092 National hiv testing week 2016: increasing hiv awareness and testing opportunities through a coordinated national event
Authors: Kifetew Chamut , James Cary , Dobb Paul
Published: May 2024

Introduction

National HIV Testing Week (NHTW) is an annual event co-ordinated by HIV Prevention England (HPE) which aims to increase HIV testing in England, as well as to increase awareness and acceptability of HIV testing among key populations. It takes place each November in the lead-up to World Aids Day.

Methods

Digital and print promotion of: the event and postal testing services, as well as digital interactive information tools which seek to reduce barriers to testing. Provision of printed resources, including customizable and community-language posters to promote local testing events. A post-event evaluation to assess the effect of the campaign was also completed by the organisations involved.

Results

For NHTW 2016, 100 organisation representatives responded to the post-event evaluation. 65% agreed that NHTW increased their capacity to impact their community/clients. The biggest impact was through increasing awareness of the importance of HIV testing in the local community (86%), followed by delivering more HIV tests (57%). Of those organisations who provide HIV testing, 33% provided at least twice as many tests in testing week compared with a regular week.

Nearly 320 organisations ordered 400,931 NHTW resources. 211 testing events were registered on the website and 5,740 HIV home-sampling kits were ordered by the public, driven by social media and mobile app advertising.

Discussion

NHTW is a high-impact event which promotes HIV testing, uniting community, clinical, government and statutory stakeholders. The campaign in the future will hope to engage more partners and keep amplifying local HIV testing and raising awareness.
P096 HIV testing in tertiary healthcare settings – staff beliefs and concerns
Authors: Weber Martin , Barrett Afra , Finnerty Fionnuala , Richardson Daniel
Published: May 2024

Introduction

Undiagnosed HIV remains a problem in the UK. Locally, we have an extremely high prevalence of HIV (>8:1000). BASHH, BHIVA and NICE recommend routine HIV testing in medical admissions in areas of high prevalence. We wanted to identify current practices and knowledge of HIV testing in our large acute urban hospital trust.

Methods

An electronic survey of clinical staff was distributed via email and Trust website in November 2016.

Results

42 responses were collected from 21/42(50%) nurses, 6/42(17%) medical staff and 15/42(36%) other staff. 33/42 of responses were from non-traditional settings (non-GUM, HIV, ID). 39/42(93%) agreed that HIV testing should be part of regular healthcare and most (32/42(76%)) agreed that it does not interfere with other healthcare services and (24/42(57%)) that they have the resources to perform a test 30/42 (75%) feel comfortable in discussing HIV with patients and 20/42 (71%) feel comfortable in offering and performing an HIV test. 18/42(43%) said they believed patients would be offended by offering an HIV test. 14/42(34%) do not know if patients receive adequate pre-test information, while 20/42 (48%) said patients are not receiving adequate post-test information. 17/42 (41%) do not know if test results are being given in an appropriate and confidential manner to patients.

Discussion

Overall clinical staff believe that HIV testing is a good idea and does not interfere with the provision of regular health care services. However the clinical teams offering tests need more information on what pre and post-test discussion is required and how patients receive results.
P099 TV or not TV: using naats to improve the cost effectiveness of testing
Authors: Oxenham Chantal , Palmer Kayleigh , Narayana Srinivasulu , Browne Rita
Published: May 2024

Introduction

In April 2016, we changed from TV culture to BD Viper NAATs testing and from testing all women to only testing women who were symptomatic, STI contacts, had previous TV and male contacts of TV.

Methods

Laboratory data and SHHAPT codes retrospectively identified all patients diagnosed with TV between 1 May – 30 November 2016. Electronic patient records (EPR) were reviewed and data analysed in Excel.

Results

There were 96 new diagnoses, 93 females and 3 males, median age 31 (IQR 24–40). 66% Black Afro-Caribbean; 3 were sex workers. 91% symptomatic, 22% had STI co-infection, 26% bacterial vaginosis, 7% candida and 32% previous TV.

Wet prep microscopy (WPM) detected 65% of symptomatic cases. Treatments were Metronidazole or Tinidazole.

The audit standards our service achieved (BASHH performance standards target- 97%) were: 100% received appropriate antibiotics, 51% written information receipt documented, 90% had partner notification recommended (PN) and 28% PN confirmation.

Abstract P099 Table 1

Cost analysis summary

2015 (Culture)2016 (NAATs)Tested30541859Positive84117New infections7396Cost£19,851£15,486

Discussion

TV NAATs cost more than culture but changing our protocol reduced the overall cost while increasing the number of new diagnoses; enabling us to target testing to patients at highest risk. 35% (27) were missed on WPM. 9.3% (9) were asymptomatic and detected because of testing as contacts of TV/sex worker/cervical cytology detection. Recommendations include: staff training to improve completion of PN and modifying our EPR fields to improve documentation of leaflets having been given.
P108 Closing the audit cycle after updated proctitis guidelines: are we treating too much or too little?
Authors: Gostick Benjamin , Bayley Jake , Singh Selena
Published: May 2024

Introduction

There are currently no national guidelines for the management of proctitis. Given the rising rates of STI’s, we modified our current guidelines and audited the outcomes pre and post-guideline change.

Methods

Retrospective case note analysis was performed on all patients who were coded as proctitis (C4NR) before and after the guidelines were modified. We collected information on demographics, HIV status, symptoms, investigations, treatment and outcomes.

Results

We returned 64 patient records over 67 visits, 39 pre and 25 post-guideline changes. 31% (20/64) were HIV positive. Commonest presentations were PR bleeding (49%), rectal discharge (44%) and diarrhoea (28%). 55/64 (88%) had rectal microscopy, with 42/55 (76%) having pus cells present; of these 3/42 (7%) had GC seen on microscopy. There were very low levels of urethral STI rates (just one case of each), but high rates of rectal GC and CT (24% and 13% respectively). LGV was positive in 5% (3/54) and rectal HSV was found in 25% (10/40). There were more HSV swabs sent before versus after guideline modification (19/40 versus 21/27, p=0.01).

Discussion

The audit has shown that the addition of HSV swabs and treatment into the guideline had a positive effect, with more cases of HSV proctitis being diagnosed and treated. Our guidelines were also modified to include LGV treatment, but given the low prevalence this may be rationalised. On-going work around coding is also planned as many were coded as proctitis without rectal microscopy.
P112 Retrospective study of the results of taking of blind swabs versus speculum-assisted swabs in women with vaginal discharge
Authors: Dolan Zac , Ahenkora Abena , Gebru Eden , Brook Gary
Published: May 2024

Introduction

Although a speculum is generally recommended to aid the taking of swabs for microscopy in women with vaginal discharge, many women dislike this and ask for a blind swab, in which a plastic loop is inserted high into the vagina to take a sample. We have agreed to this for some women and have therefore retrospectively looked at the diagnostic rates for each method.

Methods

We looked at 150 consecutive women clinically coded as ‘TS’ (microscopy performed) in 2015 and 2016 and looked at the proportion of women tested by each method and the vaginal-discharge-causing infections diagnosed.

Results

In 2015, 129 women had clear documentation of the method used of which 120 (93%) where speculum-taken and 9 (7%) were ‘blind’. In 2016, of 101 women with documentation of the method used 52 (51%) were speculum-taken and 49 (49%) were ‘blind’. The diagnostic rates for each infection are given in the table.

Abstract P112 Table 1

Blind.v. speculum testing

Method used to take sampleTotal number of women tested by each methodTVBVCandidaBV + CandidaBlind583 (5%)18 (31%)9 (16%)*0**Speculum1728 (5%)75 (44%)58 (34%)*24**

* P=0.008

** P=0.0001

Discussion

The blind swab method appears to be accurate in the diagnosis of TV and possible BV, but is clearly inferior in the diagnosis of candida and mixed candida/BV infections.
P119 A comparison of the clinical safety of independent nurse prescribing (INP) and use of patient group directions (PGDS) by nurses in uk sexual health clinics
Authors: Black Adam , Courtenay Molly , Gage Heather , Norton Christine , Franklin Bryony Dean
Published: May 2024

Introduction

Under UK legislation, nurses independently prescribe or supply medications using PGDs, but evidence on safety in clinical practice is limited.

Methods

Clinical record review across five UK sexual health services, July–December 2015. Sample size quota stratified based on the number of INP/PGD practising nurses. Documented patient presentations, diagnoses, autonomy and safety/appropriateness of medication delivery were compared between INP and PGDs.

Results

From 1,851 (INP=711, 38%; PGD=1,140, 62%) clinical records, 50% (n=933) involved medication delivery. INP delivered medication more frequently (INP= 385/711, 54% vs. PGD=548/1,140, 48%; p=0.01). A total of 879 medication assessments were undertaken (INP=399, PGD=480), 69% (n=609/879) were ‘new’ care episodes. Past medical history, concurrent medications and allergy risk assessments were recorded >85% (n=755/879) of cases. INP managed more symptomatic presentations (n=181/399, 45%: asymptomatic n=121/399, 30%); PGD managed marginally more asymptomatic (n=221/480, 46%; symptomatic n=200/480, 42%). INP worked more autonomously than PGDs (INP=310/399, 78%; PGD=308/480, 64%, p<0.01). INP most frequently managed chlamydia (n=53/399, 13%), PGDs most frequently administered vaccinations (n=80/480, 17%). Nurses delivered 66 different products, 1,351 individual medicines, azithromycin being most common (n=231/1351, 17%). Overall, 88% (n=775/879) of episodes were assessed against guidelines as ‘safe and appropriate’ (INP=359/399, 90%; PGD=416/480, 87%). Main reason for not ‘safe and appropriate’ was lack of documentation (n=56/104, 54%). PGDs were, although clinically appropriate, used outside their limits in 5% (n=24/480) of consultations.

Discussion

INP deliver medications more frequently and work more autonomously than PGD users. Both groups were comparable in safe/appropriate medication delivery. Improved documentation is recommended.
P132 An audit of the use of suppressive aciclovir in patients on stable art with suppressed HIV viraemia in plasma
Authors: Longley Imogen , Barber Tristan J , Selway Dean
Published: May 2024

Introduction

BASHH guidelines state suppressive therapy for HSV in HIV+ individuals as aciclovir 400mg BD. Anecdotally some HIV+ patients report better control of genital HSV on different antiretroviral (ART) regimens. Previous studies have shown HIV protease inhibitors (PI) may induce antiviral effects against HSV. We audited our suppressive aciclovir (sACV) use in undetectable HIV patients on stable ART against BASHH standards. We noted frequency of genital HSV outbreaks in those on PI vs non-boosted ART regimens to see any signal that PIs may confer protection against HSV reactivation.

Methods

Patients were eligible if they were receiving prophylactic aciclovir, male, 18–50 years of age, with HIV viral load below 50 copies/ml on current ART. The dose of aciclovir was recorded. We also collected information on: HSV outbreaks 1/10/16-31/1/17, ART regime, CD4 count, age/ethnicity, and duration of HIV infection.

Results

60 patients were identified. 47/60 patients were taking aciclovir 400mg BD. 13/60 were prescribed ACV 400mg OD only. For those on BD:

Abstract P132 Table 1

HSV suppression by ART

OutbreakNo outbreakPI/boosted111Non boosted629

This gave a relative risk of HSV outbreak on a PI of 0.49 over the time studied.

Discussion

Of eligible patients 78.3% of prescriptions met BASHH standards. Patients on sACV dosed at 400mg BD had a lower risk (RR 0.49) of symptomatic HSV recurrence if they were on PI based ART. This is important in the therapeutic management of co-infected patients and warrants further studies to better define the relationship.
P196 The cost to find one case of syphilis
Authors: Menon-Johansson Anatole , Artykov Ruslan
Published: May 2024

Introduction

Cost effectiveness is an important consideration especially in the context of constrained budgets. For the National Chlamydia Screening Programme, doubling Partner Notification (PN) was modelled to reduce the cost per diagnosis by £60 and improves gender equity (Turner et al, BMJ. 2011; 342:c7250. doi: 10.1136/bmj.c7250); however, it is not known how PN impacts on a less common but growing Syphilis epidemic. We therefore looked at the impact of PN for patients with Syphilis using a new PN tool.

Methods

The Syphilis diagnoses and testing for one year from February 2016-2017 were determined for two clinics, prices for testing and PN were derived from the integrated sexual health tariff (www.pathwayanalytics.com) and PN data was obtained from SXT (www.sxt.org.uk).

Results

The Syphilis incidence was 257/30,641 and the cost of a full screen £75; consequently, the cost per Syphilis diagnosis was £8,941. Ten percent of patients coded as partners were found to be infected with Syphilis. The PN outcomes of 248 (96%) patients with early infectious Syphilis were known: 132 partners were verified as seen and tested (KPI=0.53), representing 13 new diagnoses. The cost to deliver PN was £4903 [248*(£17.33 tariff & £2.40 SXT)] and ten partners need to test at £750 [10*£75] to diagnose one case, making the overall cost per Syphilis diagnosis £5,653. PN initiated testing was estimated to reduce the cost per syphilis diagnosis by £3,288.

Discussion

PN services reduce the cost to diagnose Syphilis and support case finding. More work is required to target testing and improve PN.
P224 Agile, design led approach to online service development
Authors: Howroyd Chris , Baraitser Paula , Courtenay Molly , Parry Glyn , Holdsworth Gillian
Published: May 2024

Introduction

Sexual health services lead innovative thinking in the NHS with integrated service provision, online access and testing in non-traditional venues. Agile design-led thinking creates services that are intuitive, easy to use and valued by users (both staff and patients). It offers an alternative to pre-specifying a whole system (waterfall approach) frequently associated with unpredicted problems, identified late and requiring costly fixes.

Methods

SH:24 uses an agile, design-led approach to service development delivering value by: Focusing on user need (understanding and empathising rather than assuming); Reducing cost (failing quickly, cheaply); Reducing risk (avoiding unnecessary, costly development); Creating tangible, visual, measurable outputs early (promoting understanding, collaboration and buy-in). Our agile, design-led approach included extensive user involvement; building the minimum from cycles of build, test, learn; responding to feedback, continuously improving and optimising.

Results

This presentation will provide three examples describing the contribution of agile to development of:

1. Self-sampling kit instructions which delivered 76–84% return rate

2. User friendly information pages on contraception – 2000 hits daily

3. Online chlamydia treatment – 95% uptake

We will demonstrate the added value of design and agile for these examples.

Discussion

An agile design led approach is championed by Government Digital Services - it involves re-framing issues as opportunities and rapidly iterating thinking by building and testing user centred prototypes - this approach minimises cost and risk while improving user experience - an approach that could add value in NHS services.