Diversity in geoscience: Participation, behaviour, and the division of scientific labour at a Canadian geoscience conference

Effective policies promoting diversity in geoscience require understanding of how the values and practices of the community support the inclusion of different social groups. As sites of knowledge exchange and professional development, academic conferences are important culturing institutions that can alleviate or reproduce barriers to diversity in geoscience. This study examines diversity at a 2017 geoscience conference, the joint Canadian Geophysical Union and Canadian Society of Agricultural and Forest Meteorology annual meeting, through observation of participation, presentation content, and behaviour in conference sessions. Across 256 observed presentations, women constituted 28% of speakers, whereas women of colour made up only 5%. Participation rates differed between disciplinary sections, with the most populous sessions (Hydrology and Earth Surface) having the lowest percentage of women. Examination of presentation content reveals that the methods and scholarly contributions of both women and people of colour differed from the majority, suggesting an intellectual division of labour in geoscience. Examination of audience behaviours between presenters reveals how a “chilly climate” can be experienced by women and other marginalized demographics in conferences. We argue that there is more to be done than simply increasing numbers of women or other minorities in geoscientific spaces, and we suggest pathways to making geoscience a more inclusive and democratic pursuit.

Using tagging data and aerial surveys to incorporate availability bias in the abundance estimation of blue sharks (Prionace glauca)

There is worldwide concern about the status of elasmobranchs, primarily as a result of overfishing and bycatch with subsequent ecosystem effects following the removal of top predators. Whilst abundant and wide-ranging, blue sharks (Prionace glauca) are the most heavily exploited shark species having suffered marked declines over the past decades, and there is a call for robust abundance estimates. In this study, we utilized depth data collected from two blue sharks using pop-up satellite archival tags, and modelled the proportion of time the sharks were swimming in the top 1-meter layer and could therefore be detected by observers conducting aerial surveys. The availability models indicated that the tagged sharks preferred surface waters whilst swimming over the continental shelf and during daytime, with a model-predicted average proportion of time spent at the surface of 0.633 (SD = 0.094) for on-shelf, and 0.136 (SD = 0.075) for off-shelf. These predicted values were then used to account for availability bias in abundance estimates for the species over a large area in the Northeast Atlantic, derived through distance sampling using aerial survey data collected in 2015 and 2016 and modelled with density surface models. Further, we compared abundance estimates corrected with model-predicted availability to uncorrected estimates and to estimates that incorporated the average time the sharks were available for detection. The mean abundance (number of individuals) corrected with modelled availability was 15,320 (CV = 0.28) in 2015 and 11,001 (CV = 0.27) in 2016. Depending on the year, these estimates were ~7 times higher compared to estimates without the bias correction, and ~3 times higher compared to the abundances corrected with average availability. When the survey area contains habitat heterogeneity that may affect surfacing patterns of animals, modelling animals' availability provides a robust alternative to correcting for availability bias and highlights the need for caution when applying "average" correction factors.

An initial typology of contexts of dyadic sexual encounters between men and associations with sexual risk and pleasure: findings from an observational study

Background Although many within-subjects comparisons conducted on samples of men who have sex with men have sought to understand the association between specific situational characteristics (e.g. drug use or location of sex) and sexual risk behaviour, none have considered the 'clustering' of patterns of situational characteristics. An initial typology of sexual encounters is derived and the relationship of this typology to condomless anal intercourse (CAI) and pleasure is tested.

METHODS

Data from a longitudinal survey of men who have sex with men living in England were used. Multilevel latent class analyses were estimated to determine an optimal class solution on the situational characteristics, and then pseudo-imputation was used to estimate the association between class and both CAI and pleasure.

RESULTS

A three-class solution fit the data best, with a scaled relative entropy of 92.4%. Classes were characterised as featuring: regular steady partners in private locations with low drug use (class 1), casual partners with increased probability of sex occurring in a sex-on-premises venue (class 2), and high levels of polydrug use together with increased probability of casual partners (class 3). Encounters were different both in pairwise comparisons and overall on probability of CAI. They were different overall but not necessarily pairwise on pleasure.

CONCLUSIONS

These initial findings demonstrate the possibility of understanding sexual encounters in terms of the contexts, or classes, within which they occur. This may have implications for tailoring HIV prevention to specific encounter types. Future research should seek to extend encounter-level typologies to specific drug use variables.

The need for triple assessment and predictors for diagnosis of breast cancer in patients <40 years of age

AIM

To assess the safety of selective use of triple assessment with omission of radiological assessment proposed in patients <40-years old.

MATERIALS AND METHODS

Data were collected retrospectively for all patients seen in the one-stop breast clinic between January 2014 and August 2015. Demographics, symptoms, diagnostics, and treatment details were recorded. Subgroup and logistic regression analysis was performed to identify predictors for breast cancer.

RESULTS

Of the 3,305 patients included, 95.6% (n=3,161) were first-time referrals. 57.6% (n=1,903) had a breast lump, and 4% (n=133) had a high-risk family history; 75.6% (n=2,499) underwent imaging and 16.7% (n=552) underwent a biopsy. The median age was 29 years (interquartile range [IQR]=25-34). Breast cancer was diagnosed in 29 cases (0.88%) and 3.2% (n=105) had surgery. Median referral-to-diagnosis time was 13 days (IQR=9-14) and referral-to-surgery time was 44 days (IQR=34-95). Patients with breast cancer were significantly older (33 versus 28 years, p=0.016). All patients were first-time referrals. Most patients had a breast lump with low suspicion on clinical examination and breast cancer identified on imaging. Time-to-diagnosis (12 versus 14 days, p=0.017) and time-to-surgery (37 versus 67 days, p=0.012) was significantly shorter in the breast cancer group. Comparative older age (odds ratio [OR]=1.08, 95% confidence interval [CI]: 1.01-1.15) and breast lump (OR=11.43,95% CI: 2.72-48.07) were the only significant predictors of cancer on uni/multivariate regression.

CONCLUSIONS

Triple assessment is also the best practice for all patients in the younger age group. This cohort should not be treated any differently regarding one-stop clinic infrastructure as the cancers detected were not clinically malignant. Missed cancers in this age group would have significant personal, clinical, and legal consequences.

The Acceptability and Feasibility of Implementing a Bio-Behavioral Enhanced Surveillance Tool for Sexually Transmitted Infections in England: Mixed-Methods Study

BACKGROUND

Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs.

OBJECTIVE

This study aimed to assess the acceptability and feasibility of implementing a bio-behavioral enhanced surveillance tool, comprising a self-administered Web-based survey among sexual health clinic attendees, as well as linking this to their electronic health records (EHR) held in England's national STI surveillance system.

METHODS

Staff from 19 purposively selected sexual health clinics across England and men who have sex with men and black Caribbeans, because of high STI burden among these groups, were interviewed to assess the acceptability of the proposed bio-behavioral enhanced surveillance tool. Subsequently, sexual health clinic staff invited all attendees to complete a Web-based survey on drivers of STI risk using a study tablet or participants' own digital device. They recorded the number of attendees invited and participants' clinic numbers, which were used to link survey data to the EHR. Participants' online consent was obtained, separately for survey participation and linkage. In postimplementation phase, sexual health clinic staff were reinterviewed to assess the feasibility of implementing the bio-behavioral enhanced surveillance tool. Acceptability and feasibility of implementing the bio-behavioral enhanced surveillance tool were assessed by analyzing these qualitative and quantitative data.

RESULTS

Prior to implementation of the bio-behavioral enhanced surveillance tool, sexual health clinic staff and attendees emphasized the importance of free internet/Wi-Fi access, confidentiality, and anonymity for increasing the acceptability of the bio-behavioral enhanced surveillance tool among attendees. Implementation of the bio-behavioral enhanced surveillance tool across sexual health clinics varied considerably and was influenced by sexual health clinics' culture of prioritization of research and innovation and availability of resources for implementing the surveys. Of the 7367 attendees invited, 85.28% (6283) agreed to participate. Of these, 72.97% (4585/6283) consented to participate in the survey, and 70.62% (4437/6283) were eligible and completed it. Of these, 91.19% (4046/4437) consented to EHR linkage, which did not differ by age or gender but was higher among gay/bisexual men than heterosexual men (95.50%, 722/756 vs 88.31%, 1073/1215; P<.003) and lower among black Caribbeans than white participants (87.25%, 568/651 vs 93.89%, 2181/2323; P<.002). Linkage was achieved for 88.88% (3596/4046) of consenting participants.

CONCLUSIONS

Implementing a bio-behavioral enhanced surveillance tool in sexual health clinics was feasible and acceptable to staff and groups at STI risk; however, ensuring participants' confidentiality and anonymity and availability of resources is vital. Bio-behavioral enhanced surveillance tools could enable timely collection of detailed behavioral data for effective commissioning of sexual health services.

Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey

Background

Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men.

Methods

Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London).

Results

Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partner and living in London were protective of mental health.

Conclusion

Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes.

Typology of drug use in United Kingdom men who have sex with men and associations with socio-sexual characteristics

BACKGROUND

Analysis of specific drug use patterns in men who have sex with men (MSM) is important in targeting HIV prevention and harm reduction interventions and in developing a fuller picture of drug use in context beyond consideration of use of specific drugs in isolation.

OBJECTIVES

We sought to develop a typology of recent drug use in MSM, and to explore how distribution of MSM across the classes in this typology differs by socio-sexual characteristics.

METHODS

We examined last-year drug use reported by 16,814 MSM as part of a cross-sectional, internet-based survey of MSM living in the UK for which data were collected in late summer 2014. We tested models with between two and six classes for types of specific drug use, and related socio-sexual covariates to the classes in the best model using multinomial regression.

RESULTS

Our five-class model described a range of drug use patterns, including minimal users, low-threshold users, old-skool users, chemsex-plus users and diverse users. MSM identifying as gay were more likely to not be minimal users. HIV-positive MSM were more likely to be chemsex-plus users than HIV-negative MSM. Number and type of non-steady partners, ethnicity and education were each related to class membership, though trends were complex.

CONCLUSIONS

Findings from associations between correlates and latent classes suggest avenues for service development beyond current attention to opiates or chemsex drugs. Our findings draw attention to heterogeneity in drug use patterns in MSM beyond what current discourse on chemsex drugs would suggest.

Prevalence of catatonic signs in acute psychiatric patients in Scotland

Aims and method

Concerns have been raised that catatonia is underdiagnosed. Prevalence varies (1.3-32%) depending on diagnostic criteria. We used the Modified Rogers Scale to rate catatonic signs in patients consecutively admitted to three psychiatric wards over a 10-month period.

Results

The prevalence of patients demonstrating any catatonic signs was at least 7.9-19.1%. The most common catatonic signs were marked underactivity (not sedated), echolalia/palilalia, marked overactivity (not restlessness) and gegenhalten. In those with catatonic signs, the most common diagnoses were schizophrenia, schizoaffective disorder and dementia.

Clinical implications

Most of the most common catatonic signs in our sample were motor signs. Antipsychotic-induced motor signs reflect interaction between drug and disease. Catatonic signs are not anchored in any one diagnosis and are on a spectrum of severity and quantity. Prevalence of these signs is higher than often presumed.

Who's assessing needs-led assessment?

Pre- and post-change audits of the effect of the changes in community care assessments and funding intro-duced in April 1993 were carried out on a psychiatric in-patient rehabilitation unit in Dundee. There was a substantial reduction in throughput in the rehabilitation unit (from 43 to 22) and in placements to funded staffed accommodation (from 11 to three) despite an increase in void community tenancies. By three months, 17 of 22 referrals for needs assessment were still incomplete, and at one year only three patients had had their needs assessed and appropriately met. Recommendations arising from these findings are discussed.

Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study

Objectives

To explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics.

Methods

Qualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted.

Results

Attending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental.

Conclusions

A range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.

Exploring learning content and knowledge transfer in baccalaureate nursing students using a hybrid mental health practice experience

BACKGROUND

Little research has been completed exploring knowledge development and transfer from and between simulated and clinical practice settings in nurse education.

OBJECTIVES

This study sought to explore the content learned, and the knowledge transferred, in a hybrid mental health clinical course consisting of simulated and clinical setting experiences.

DESIGN

A qualitative, interpretive descriptive study design.

SETTINGS

Clinical practice consisted of six 10-hour shifts in a clinical setting combined with six two-hour simulations.

PARTICIPANTS

12 baccalaureate nursing students enrolled in a compressed time frame program at a large, urban, Canadian university participated.

METHODS

Document analysis and a focus group were used to draw thematic representations of content and knowledge transfer between clinical environments (i.e., simulated and clinical settings) using the constant comparative data analysis technique.

RESULTS

Four major themes arose: (a) professional nursing behaviors; (b) understanding of the mental health nursing role; (c) confidence gained in interview skills; and, (d) unexpected learning.

CONCLUSIONS

Nurse educators should further explore the intermingling of simulation and clinical practice in terms of knowledge development and transfer with the goal of preparing students to function within the mental health nursing specialty.

HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities

OBJECTIVES

To examine ethnic group differences in HIV testing and sexual behaviours among a large sample of gay and bisexual men (GBM), 13 years after similar observations were made, assess national HIV prevention responses and inform planning priorities.

METHODS

Cross-sectional convenience self-completion online survey in summer 2014, designed and recruited in collaboration with community-based health promoters and gay internet services; comparison with earlier findings reporting on similarly designed survey in 2001.

RESULTS

We recruited 15 388 GBM living in England who self-reported as follows: 18.5% from ethnic minorities; 9.0% tested HIV positive (cf. 17.0% and 5.4% in 2001). Compared with the white British, Asian men were no longer less likely to report diagnosed HIV but had an equal probability of doing so (2001 OR=0.32, 95% CI 0.13 to 0.79; 2014 OR=1.04, 95% CI 0.71 to 1.54); black men remained significantly more likely to report diagnosed HIV (2001 OR=2.06, 95% CI 1.56 to 3.29; 2014 OR=1.62, 95% CI 1.10 to 2.36) as did men in the other white group (2001 OR=1.54, 95% CI 1.23 to 1.93; 2014 OR=1.31, 95% CI 1.10 to 1.55). Overall annual incidence of reported HIV diagnoses in 2014 was 1.1%. Black men were significantly more likely to report diagnosis with HIV in the last 12 months than the white British (adjusted odds ratios (AOR) 2.57, 95% CI 1.22 to 5.39). No minority ethnic group was more or less likely to report condom unprotected anal intercourse (CUAI) in the last year but men in the Asian, black and all others groups were more likely than the white British to report CUAI with more than one non-steady partners.

CONCLUSIONS

Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences.

Precision of EMR Data: The Case for a Drug and Alcohol Service

Error-laden data can negatively affect clinical and operational decision making, research findings and funding allocation. This study examined the number and types of data errors in an electronic medical record (EMR) system in a Drug and Alcohol service. Specifically, errors in service data were examined. Three months after the implementation of the EMR system, 9,379 errors were identified from ten error reports generated between March 2015 and May 2016. The errors were grouped into four types: mismatched data fields (60.5%), duplicate medical record error (3.2%), date/time error (8.8%) and blank field error (27.4%). The errors can be prevented by adding functions, such as alert messages in the EMR system. How and why the errors occur need to be investigated in future studies.