bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1 Does simple correspondence and feedback improve HIV testing rates in primary care in a low prevalence area?
Authors: Haddon L , Bendall R , Pollard K 
Published: May 2012

BackgroundDelayed diagnosis of HIV is a problem in both high and low prevalence areas. In Cornwall, the relatively low prevalence means that most general practitioners (GPs) have little or no experience in managing patients with HIV infection; they may be unfamiliar with indicator conditions and thus be unlikely to offer an HIV test.AimsTo see if simple correspondence and feedback regarding testing rates can lead to changes in practice.MethodsWe compared testing rates before and after the intervention which comprised of a letter to all individual GPs attached to a PCT weekly communication e-bulletin sent July 2011. This highlighted recent local delayed HIV diagnoses, benefits of earlier testing and contact details of the sexual health clinic. We included an anonymised “ski-jump” graph showing ranked testing rates by practice, an invitation to GPs and practice managers to find out where their practice fell on the graph and the 2008 HIV testing guidelines, drawing attention to the table of indicator conditions.ResultsInitial comparison of absolute numbers of tests and tests per head of practice population in GP practices in Cornwall during 2010 revealed large variation in testing rates between practices, from <0.5 tests per 1000 population to approximately 30 tests per 1000 population, with a total of 593 tests over 12 months. An interim analysis of HIV testing rates for the period April to September 2011 has shown an apparent increase in testing of 29% when projected for 12 months. Most practices showed increased rates of testing after the intervention.ConclusionOur findings suggest that a simple targeted communication may result in increased testing in a low incident GP population. Monthly figures leading up to and following the intervention will be presented.
P100 Assessment of bacterial sexually transmitted infection (STI) screening following sexual assault
Authors: Wilson S , Wardle D , Coia G 
Published: May 2012

BackgroundChlamydia trachomatisandNeiserria gonorrhoeascreening following sexual assault is undertaken primarily for sexual health purposes but can potentially facilitate criminal investigation in cases of penetration at sexually naive sites. Antibiotic prophylaxis at first attendance (within 7 days of the assault) is not routine but may be given when the return for screening is unlikely.AimTo improve bacterial STI screening and management in complainers attending our sexual assault referral centre (SARC).ObjectivesTo determine if complainers were adequately screened for bacterial STIs and if communication with health professionals regarding repeat screening was adequate.To review prophylactic antibiotic use.To review the forensic significance of STI screening.To identify factors which may improve the uptake of screening.Methods100 case records were reviewed and information relevant to our objectives extracted. Six cases were excluded.Results81% had a STI screen taken at presentation. Only 13% returned for repeat screen after incubation, confirming Chlamydia in two cases. All but one repeat screen correlated to the site of exposure. GPs were informed of the need for a repeat screen in 74% of cases. 59% had an alert sited on their sexual health record highlighting the need for a repeat screen. Antibiotic prophylaxis was given in 25 cases with reasons documented in only 4.Discussion and/or ConclusionSTI screening post sexual assault may be improved through better communication with complainers and other healthcare providers. Improvements to communication methods and training are required to facilitate this. The concern of emerging gonococccal resistance should be considered prior to administering prophylactic antibiotics. One individual, in whom there was no previous sexual contact and baseline screen was negative, had Chlamydia on repeat sample. This may be supportive of the assailant as the source of infection, indicative of the potential forensic role of STI screening.
P101 Olympic outreach: STI testing for construction workers
Authors: Shanmugaratnam S , Horne P , Coyne K M 
Published: May 2012

BackgroundIt was feared that construction of venues for the 2012 Olympic and Paralympics Games would increase the burden of sexual ill-health in East London, due to a surge in migrant construction workers and commercial sex work.Aims/ObjectivesWe analysed data from outreach to construction sites at the Olympic Park and Village in Stratford, East London. We reported demographics, sexual risk factors and STI rates.MethodsAn outreach team visited the Olympic site between February 2009 and October 2011. Clients completed a triage form about symptoms and sexual risk factors. Clients were offered nucleic acid amplification tests for Gonorrhoea and Chlamydia, using urine samples from men, and self-taken vulvovaginal swabs from women. Serology was offered for HIV and Syphilis. Hepatitis B serology was offered to those who reported intravenous drug use or sex with commercial sex workers. Anyone diagnosed with an STI was offered treatment at Occupational Health services on site or a local sexual health clinic.ResultsIn total 614 clients were seen, with a median age of 28 years. 91% were men. There were 19 different ethnic groups. Nearly half (285/614, 46%) reported their ethnic group as English/Scottish/Welsh. The other large ethnic groups were 53 Indian (9%), 52 Eastern European (8%) and 39 Irish (6%). 20 clients (3%) had Chlamydia and one was diagnosed with Hepatitis B. Reported levels of sexual risk factors are shown in abstract P101 table 1.Abstract P101 Table 1Sexual risk factors of in the olympic site construction workersSexual risk factorNo. of people/ % of sampleSex between men5 (<1%)Previous STI20 (3%)More than one sexual partner in last 3 months173 (28%)Intravenous drug use3 (<1%)Use of commercial sex workers3 (n=76) (4%)ConclusionsThere was a low prevalence of STIs in these construction workers, contradicting prior fears of a high disease burden. Reported levels of sexual risk factors, including use of commercial sex workers, were low.
P109 Introduction of an electronic patient proformer contributes to an increase in uptake of HIV testing
Authors: Bhatt S , Clarke E , Roseaman K , Patel R , Samraj S 
Published: May 2012

BackgroundThe BASHH MEDFASH Standards for the Management of STIs 2010 recommend that 100% of GUM patients should be offered an HIV test with a minimum uptake of 60% at their first STI screen.AimTo assess whether the introduction of an electronic patient proformer resulted in an improvement in the uptake of HIV testing in a level 3 GUM service, and whether there was scope for further improvement.MethodsRetrospective case note review of new and rebook (patients who had not attended in the past 3 months) patients attending a level 3 GUM service in October 2007 (when a paper patient record was kept) and October 2010 (following introduction of an electronic patient proformer with a prompt for HIV test offered). Data on uptake of HIV testing was collected, and further data on the reasons for not being tested for HIV was collected on patients seen in October 2010.Results772 new or rebook patients were seen in October 2007, of whom 562 (72.8%) accepted HIV testing. 1141 new or rebook patients were seen in October 2010 of whom 891 (78.1%) accepted HIV testing, with a p value (calculated using Fisher's Exact test) of 0.009. Of 250 (21.9%) patients not tested for HIV in October 2010, 41.6% were not tested for clinical reasons, such as the patient having had a recent HIV test or being known HIV positive. 35.2% of patients not tested for HIV declined the test. Evidence of suboptimal management was also found, with 6.8% of patients not tested as they were within the window period, and 6% not tested due to needle phobia.ConclusionThe introduction of the electronic patient proformer with a prompt for HIV testing has improved uptake. There is further room for improvement including offering POCT to needle phobic patients, and testing those within the window period prior to follow-up testing. Adding a mandatory field to the patient proformer with reasons for declining may allow improved understanding of reasons for declining, which may then modify future practice.
P11 HIV test uptake in the GU clinic: juniors hot on the heels of the consultants
Authors: Isabel O , Portman M D , Giuntini R , Stewart CMW , Wilson J D 
Published: May 2012

BackgroundData from the Health Protection Agency shows that 25% of people living with HIV in the UK are unaware of their diagnosis. This has serious health implications for them and others.The National Strategy for Sexual Health and HIV set a target of 60% testing uptake by 2007. 69% of STI attendees at GUM clinics in England in 2010 were tested for HIV. Regional data from the Health Protection Unit shows a 70% uptake of HIV testing in women attending our clinic. Recent data from the UK and Australia has documented variable HIV testing rates among clinicians with a trend towards more junior doctors being more likely to offer a test.ObjectivesTo identify HIV testing rates according to grade of clinician.MethodsWomen attending our service as new or rebook patients between March 2009 and January 2010 were seen by clinicians representing eight different grades of staff. The women's response to the offer of an HIV test was recorded. These data were analysed according to the grade of the staff member.Results3973 women were seen by 42 different clinicians. 2982 accepted an HIV test (P1A); 980 declined a test (P1B) and 11 deferred testing (P1C) (see abstract P11 table 1).Abstract P11 Table 1HIV testing rates by different health care professionalsBand 5 nursesBand 6 nursesFY1ST2GPSASRegConsTotalNo of staff6764229642No of consultations1694421402072528379969303973P1A1223251121711965727537312982P1B47115283652265239198980P1C0200404111% Patients who decline HIV test27.826.020.017.420.630.624.021.324.7OR (95% CI) patient having an HIV test compared to other grades1.18 (0.84 to 1.67)1.08 (0.86 to 1.36)0.76 (0.49 to 1.15)0.63 (0.44 to 0.19)0.78 (0.57 to 1.07)1.57 (1.33 to 1.86)0.95 (0.81 to 1.13)0.78 (0.66 to 0.93)p Value0.380.520.230.0160.14<0.00010.600.007ConclusionsThere are many perceived barriers to HIV testing and it is often quoted that testing rates are lowest among non-specialists. However, there is little published data on the impact of the individual clinician on HIV testing. Encouragingly, our data has shown that more junior staff, having trained in an environment where HIV is increasingly recognised as a treatable condition, are confident to offer HIV testing and do so as effectively as consultants. We should learn from them with respect to promoting HIV testing in our clinics and not underestimate the value of ongoing training and support in this important area.
P111 A user centred approach to the design of point-of-care and self-test mobile phone diagnostics for sexually transmitted infections (STIs)
Authors: Voula G , Balachandran W , Lowndes C , Howell-Jones R , Aicken C R , Mercer C H , Sutcliffe L , Sonnenberg P , Jackson M , Estcourt C S , Sadiq S T , Hone K 
Published: May 2012

BackgroundControl of STIs in vulnerable populations is difficult because of inadequate access to prompt diagnosis and treatment and may be enhanced by better community based STI surveillance. The high rates of mobile and smart phone use in these populations and the development of novel personalised diagnostic technologies which theoretically enable highly accurate self-testing diagnostics for STIs that can be electronically linked to clinical care pathways and STI data capture, may help address these challenges. A major challenge for these systems is the development of clinically relevant and acceptable Human Technology Interfaces (HTIs) for Mobile-Web Applications.ObjectivesTo describe a methodological approach to develop a mobile phone/web-based management system that can link rapid self-test diagnostics to clinical care pathways and community based surveillance.MethodsWe adopt a user centred approach to the development of a HTI for self-managing STI diagnosis with initial exploratory pilot studies to gather functional, user and clinical requirements of the HTI. Iterative development of functional prototypes exploring design possibilities and technology features is followed by the formative evaluation of interface design alternatives through qualitative and controlled usability studies with target users and existing surveillance capture mechanisms.ResultsA user centred, multi-disciplinary approach allows for successful capture and integration of social science methods to inform functional requirements for an effective and user acceptable mobile and web-based self-managing STI diagnostics and surveillance system.DiscussionFuture testing in simple and complex, community based studies are needed to primarily assess safety and then effectiveness for improving access to care, enhanced partner notification and development of community based capture of surveillance data.
P114 Is there a role for primary care clinicians in providing shared care in HIV treatment? A systematic literature review
Authors: Wong W , Luk C W , Kidd M R 
Published: May 2012

BackgroundDespite HIV being increasingly considered as a chronic illness, there is as yet no consensus about how primary care should be integrated with specialty care to provide optimal clinical management for people living with HIV.ObjectiveTo examine the effectiveness of shared care models of HIV between primary care and specialty care and how primary care providers can assist in improving the care of people with HIV.MethodsThree databases, PubMed, Medline and EMBase were searched for relevant terms from studies published in the period from 1996 to 2011. Studies were included that integrated primary care in HIV management and included highly active antiretroviral therapy (HAART) as part of the treatment modality.Results11 studies that met the inclusion criteria were included in this review. Primary care was found to be at least as effective in HIV counselling, testing and treatment and, to a lesser degree, prevention, when compared to specialty care alone. Screening for HIV at a primary care level was cost-effective, especially in a high HIV prevalence and high-risk community. There were no significant adverse clinical outcomes reported in a primary care approach. Effectiveness of various interventions using a primary care approach were demonstrated in the review, including HAART adherence programmes, home care, the involvement of peer health workers and perinatal use of HAART.ConclusionsPrimary care has an important role in the shared care of the diagnosis and management of people with HIV. Some improvements with current guidelines on the management in primary care of people with HIV in developing countries should be considered.
Behavior of pressure-grouted anchors in gravel
Authors: Hsu Shih-Tsung 
Published: May 2012

This study consisted of field tests conducted on nine vertical and three inclined low-pressure-grouted anchors to investigate their behavior in gravel. An anchor can be categorized as a deep anchor when the overburden depth (free length) Z exceeds 8D (D is the diameter of the anchor). The shape of the heave on the ground surface of a shallow anchor is similar to a normal distribution curve. The extended diameter of the heave was between 170 and 300 cm, which could be divided into two zones, primary and secondary, based on the failure mode of the ground. As the fixed length of a shallow anchor increased, the extended diameter also increased. The ultimate load on an anchor increased with the free length and, to a greater degree, with the fixed length of an anchor: a fixed length of only 3 m generated an ultimate load of over 1100 kN. However, the permissible load, determined from the creep coefficient, is inapplicable for short anchors in gravel. The earth pressure coefficient K of vertical anchors was approximately 29 and for an anchor shaft inclined at 25º it was approximately 17.7.
MET Signaling Regulates Glioblastoma Stem Cells
Authors: Joo Kyeung Min , Jin Juyoun , Kim Eunhee , Ho Kim Kang , Kim Yonghyun , Gu Kang Bong , Kang Youn-Jung , Lathia Justin D. , Ho Cheong Kwang , Song Paul H. , Kim Hyunggee , Seol Ho Jun , Kong Doo-Sik , Lee Jung-Il , Rich Jeremy N. , Lee Jeongwu , Nam Do-Hyun 
Published: May 2012

Abstract
Glioblastomas multiforme (GBM) contain highly tumorigenic, self-renewing populations of stem/initiating cells [glioblastoma stem cells (GSC)] that contribute to tumor propagation and treatment resistance. However, our knowledge of the specific signaling pathways that regulate GSCs is limited. The MET tyrosine kinase is known to stimulate the survival, proliferation, and invasion of various cancers including GBM. Here, we identified a distinct fraction of cells expressing a high level of MET in human primary GBM specimens that were preferentially localized in perivascular regions of human GBM biopsy tissues and were found to be highly clonogenic, tumorigenic, and resistant to radiation. Inhibition of MET signaling in GSCs disrupted tumor growth and invasiveness both in vitro and in vivo, suggesting that MET activation is required for GSCs. Together, our findings indicate that MET activation in GBM is a functional requisite for the cancer stem cell phenotype and a promising therapeutic target. Cancer Res; 72(15); 3828–38. ©2012 AACR.
TPI-287, a New Taxane Family Member, Reduces the Brain Metastatic Colonization of Breast Cancer Cells
Authors: Fitzgerald Daniel P. , Emerson David L. , Qian Yongzhen , Anwar Talha , Liewehr David J. , Steinberg Seth M. , Silberman Sandra , Palmieri Diane , Steeg Patricia S. 
Published: May 2012

Abstract
Brain metastases of breast and other cancers remain resistant to chemotherapeutic regimens that are effective systemically, in part due to the blood–brain barrier. We report that TPI-287, a new microtubule-stabilizing agent, displays in vitro cytotoxic activity similar to taxanes and epothilones. Unlike the taxanes, TPI-287 is permeable through the blood–brain barrier. Brain-to-plasma ratios of TPI-287 after a single injection typically exceeded one and were as high as 63.8 in the rat and 14.1 in the mouse. A brain-tropic derivative of the MDA-MB-231 triple-negative breast cancer cell line, 231-BR, was used to test whether TPI-287 may be efficacious at preventing or treating brain metastases. TPI-287 had growth inhibitory effects comparable with paclitaxel when 231-BR tumor cells were injected into the mammary fat pad. Brain metastatic colonization was determined by intracardiac injection of 231-BR cells, with treatment beginning on day 3 to 4 postinjection, culminating in a histologic count of brain metastases in brains necropsied days 25 to 28 postinjection. In this assay, paclitaxel, ixabepilone, and nab paclitaxel did not have significant inhibitory activity. TPI-287 was ineffective in the same assay using a 6 mg/kg every week schedule; however an 18 mg/kg dose delivered on days 3, 7, and 11 significantly reduced the outgrowth of brain metastases (55% reduction, P = 0.028) and reduced proliferation in brain metastases (16% reduction, P = 0.008). When TPI-287 treatment was delayed until days 18, 22, and 26 postinjection, efficacy was reduced (17% reduction, not significant). These data suggest that TPI-287 may have efficacy when administered early in the course of the disease. Mol Cancer Ther; 11(9); 1959–67. ©2012 AACR.
Duration of Dual Antiplatelet Therapy and Long-Term Clinical Outcome After Coronary Drug-Eluting Stent Implantation
Authors: Tada Tomohisa , Natsuaki Masahiro , Morimoto Takeshi , Furukawa Yutaka , Nakagawa Yoshihisa , Byrne Robert A. , Kastrati Adnan , Kadota Kazushige , Iwabuchi Masashi , Shizuta Satoshi , Tazaki Junichi , Shiomi Hiroki , Abe Mitsuru , Ehara Natsuhiko , Mizoguchi Tetsu , Mitsuoka Hirokazu , Inada Tsukasa , Araki Makoto , Kaburagi Satoshi , Taniguchi Ryoji , Eizawa Hiroshi , Nakano Akira , Suwa Satoru , Takizawa Akinori , Nohara Ryuji , Fujiwara Hisayoshi , Mitsudo Kazuaki , Nobuyoshi Masakiyo , Kita Toru , Kimura Takeshi 
Published: May 2012

Background—
Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated.

Methods and Results—

We assessed the influence of prolonged thienopyridine therapy on clinical outcomes with landmark analysis at 4 and 13 months after DES implantation. Among 6802 patients with at least 1 DES implantation in the CREDO-Kyoto Registry Cohort-2, 6309 patients (on thienopyridine, 5438 patients; off thienopyridine, 871 patients) and 5901 patients (on thienopyridine, 4098 patients; off thienopyridine, 1803 patients) were eligible for the 4- and 13-month landmark analyses, respectively. The majority of patients had stable coronary artery disease (73%) and received sirolimus-eluting stents (93%), and approximately 90% of thienopyridine was ticlopidine. Patients taking thienopyridine had more complex comorbidities and more complex lesion and procedural characteristics as compared with patients not taking thienopyridine. After adjusting for confounders, thienopyridine use was not associated with decreased risk for death/myocardial infarction/stroke (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.89–1.43,
P
=0.32 in the 4-month landmark analysis; HR, 1.14; 95% CI, 0.90–1.45,
P
=0.29 in the 13-month landmark analysis, respectively), whereas the risk for GUSTO moderate/severe bleeding tended to be higher in patients taking thienopyridine (HR, 1.51; 95% CI, 1.00–2.23,
P
=0.049 in the 4-month landmark analysis; HR, 1.44; 95% CI, 0.99–2.09,
P
=0.057 in the 13-month landmark analysis, respectively).

Conclusions—
Prolonged thienopyridine therapy beyond 4 and 13 months appeared not to be associated with reduction in ischemic events but to be associated with a trend toward increased bleeding. Optimal duration of DAPT after DES implantation might be shorter than the currently recommended 1-year interval.
Posttraumatic Stress Disorder and Adherence to Medications in Survivors of Strokes and Transient Ischemic Attacks
Authors: Kronish Ian M. , Edmondson Donald , Goldfinger Judith Z. , Fei Kezhen , Horowitz Carol R. 
Published: May 2012

Background and Purpose—
Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications.

Methods—
We surveyed 535 participants, age ≥40 years old, who had at least 1 stroke or TIA in the previous 5 years. PTSD was assessed using the PTSD Checklist-Specific for stroke; a score ≥50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression.

Results—

Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke ≥50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%,
P
<0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7–4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke <25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence.

Conclusion—
PTSD is common after stroke/TIA. Patients who have PTSD after stroke or TIA are at increased risk for medication nonadherence.