278 The Paediatric Major Trauma Tertiary Survey: Are We Missing the Mark on Missed Injuries?

The tertiary survey is an integral part of assessment in major trauma. This has been shown to reduce missed injuries resulting in better patient care and favourable medico-legal outcomes. A formal tertiary survey should be carried out for all paediatric major trauma patients.

The primary aim of this audit was to assess completion rates of the tertiary survey proforma for major trauma admissions under the paediatric surgery team at the Bristol Royal Hospital for Children. The secondary aim was to evaluate the adequacy of the current proforma and detect areas for improvement.

Paediatric surgery major trauma admissions were audited over a 7-month period and data was collected retrospectively from patient notes on Evolve (n = 20).

A formal tertiary survey was completed for 6 patients which equated to a completion rate of 30%. A total of 1 missed injury was identified (lip laceration) which required no further treatment. Head-to-toe examination was documented in all of the completed surveys but lacked detail. Documentation of gait was absent in 85% and a body map was not filled in for any of the patients.

The audit was presented at a departmental meeting to increase awareness about the tertiary survey and requirements for completion. An MDT of doctors, nurses and trauma co-ordinators was consulted to design a more thorough proforma which included specific sections for review of bloods and imaging.

Re-audit of the new proforma is ongoing and it is hoped that, in combination with educational initiatives, this will lead to increased identification of missed injuries.

Changes in sow milk lipidome across lactation occur in fatty acyl residues of triacylglycerol and phosphatidylglycerol lipids, but not in plasma membrane phospholipids

Milk fats are vital to neonate survival and development, but vary highly by diet, maternal metabolic state and stage of lactation. To gain a better understanding of changes in lipid composition of sow milk across lactation, milk was collected from nine multiparous sows on days 0, 3, 7, and 14, relative to birth and lipids were profiled using multiple reaction monitoring (MRM) profiling. Percent fat was determined by creamatocrit, and found to be different (P < 0.05) between day 0 (12.36 ± 5.90%) and day 3 (16.22 ± 3.65%) but not between day 7 (13.13 ± 2.19%) and day 14 (12.13 ± 2.45%). Fat was extracted from milk (n = 6/day) using the Bligh-Dyer method and profiled using tandem mass spectrometry MRM to determine the abundance of lipids defined by class and fatty acyl residue composition. Lipid species relative concentration was calculated from internal standards, and data analysis was performed using Metaboanalyst 4.0. Concentration of phosphatidyl-choline, -serine, -ethanolamine, -inositol, cholesteryl ester and sphingomyelin did not vary across lactation days, nor did the distribution of associated fatty acyl residues. The total abundance of triacylglycerides (TGs) and phosphatidylglycerols (PGs) increased (P < 0.05) from colostrum (day 0) to transitional (days 3 and 7) and mature milk (day 14). As lactation days increased from day 0 to day 14, the number of carbons and unsaturation within fatty acyl residues decreased (P < 0.05) in both TGs and PGs. The proportion of TGs and PGs increased (P < 0.05) relative to other lipid classes. Changes in composition of milk triglycerides and phosphatidylglycerols likely reflect the metabolic activity of the mammary gland and developmental needs of neonates.

0112 Lucid Dreaming Associated with Positive Waking Mood

Introduction

Lucid dreaming (being aware that one is dreaming) is typically a positive experience that may enhance positive mood even after waking. There is concern, however, that lucid dreaming may interfere with sleep quality. In the current experiment, participants practiced common lucid dream induction techniques over the course of a week, and kept a daily sleep and dream diary. The study objective was to assess relationships between dream lucidity and subjective sleep quality, dream emotional content, and subsequent waking mood.

Methods

There were 32 participants aged 19–33 in this open label, single arm study (mean=22.63±3.48; 6 males, 24 females). All participants completed a sleep and dream diary for 7 days that included scaled items (1–7 scale) concerning subjective sleep quality, negative and positive emotional intensity of a dream (if recalled). Participants also completed a 19-item lucidity questionnaire, and the Positive and Negative Affect Schedule. Average scores for the week were computed for all measures and Pearson’s correlations conducted between lucidity and all other measures. Participants with no dream recall (n=5) were excluded. Within-subjects analyses were undertaken by selecting each participant’s highest and lowest lucidity night (n=22; 5 participants with only minimum lucidity excluded).

Results

Positive correlations were found between lucidity and dream positive emotion (r=.490, n=27, p=.009) and positive waking mood (r=.638, n=27, p&lt;.001); there were no other significant correlations (all p&gt;.1). Higher lucidity was associated with more positive dream content (t(21)= -3.214, p=.004) and positive waking mood (t(25)=-4.568, p&lt;.001); no other significant differences were observed.

Conclusion

These data indicate that lucidity is associated with positive dreams and waking mood, with no detriment to self-reported sleep quality. The findings provide preliminary support of lucid dreaming as an intervention to improve wellbeing and mood in the short term.

Support

N/A

0159 Reduced REM Sleep Percent in Frequent Cannabis Versus Non-Cannabis Users

Introduction

THC (the main psychoactive component of cannabis) has been shown to suppress REM sleep and decrease sleep latency, although this is not consistently replicated. Increased dream vividness is reported to occur in abstinent cannabis users, although dream quality in active users is unstudied. The current study aimed to assess the effects of cannabis use compared to non-use on objective sleep measures, dream reports, and self-reported anxiety, memory, and sleep quality. To collect objective sleep data we piloted the use of a portable PSG headband that allows EEG and EOG recording at home.

Methods

12 regular cannabis users (&gt; 3 days per week) & 9 non-users (aged 19 - 27; 43% female) participated; participants used no other drugs or alcohol on study nights. The most common form of cannabis use was smoking in joints with tobacco (range = 1 - 15 per day). Participants wore the PSG headband (the Hypnodyne ZMax) over 2 nights at home (2nd night used for analysis), and were instructed to awaken 4 times across the night to fill out brief dream reports. Objective sleep measures included TST, Sleep latency, REM latency, and REM percent. Self-report measures included the Pittsburgh Sleep Quality Index, Everyday Memory Questionnaire, and State-Trait Anxiety Index. Dream measures included recall frequency, word length, and three attributes rated on a 1–7 Likert scale - sensory vividness, emotional intensity, and bizarreness.

Results

There were no group differences on self-report measures. Cannabis users showed longer REM latency (t=2.23, p=.04) and lower REM% (U=22, p=.02); there were no other objective group differences. Cannabis users reported higher bizarreness in their dreams (t=2.07, p=.05); there were no other dream differences.

Conclusion

The study presents a novel approach to assess sleep at home and cannabis use. Significant differences emerged between users and non-users on REM latency, REM%, and dream bizarreness.

Support

N/A

ALLIANCE perspectives on integration of humans and the environment into the system of radiological protection

Risks posed by the presence of radionuclides in the environment require an efficient, balanced, and adaptable assessment for protecting exposed humans and wildlife, and managing the associated radiological risk. Exposure of humans and wildlife originate from the same sources releasing radionuclides to the environment. Environmental concentrations of radionuclides serve as inputs to estimate the dose to man, fauna, and flora, with transfer processes being, in essence, similar, which calls for a common use of transport models. Dose estimates are compared with the radiological protection criteria for humans and wildlife, such as those developed by the International Commission on Radiological Protection. This indicates a similarity in the approaches for impact assessment in humans and wildlife, although some elements are different (e.g. the protection endpoint for humans is stochastic effects on individuals, whereas for wildlife, it is deterministic effects on species and ecosystems). Human and environmental assessments are consistent and complementary in terms of how they are conducted and in terms of the underlying databases (where appropriate). Not having an integrated approach may cause difficulties for operators and regulators, for communication to stakeholders, and may even hamper decision making. For optimised risk assessment and management, the impact from non-radiation contaminants and stressors should also be considered. Both in terms of the underlying philosophy and the application via appropriate tools, the European Radioecology Alliance (ALLIANCE) upholds that integration of human and ecological impact and risk assessment is recommended from several perspectives (e.g. chemical/radiological risks).

Marine radioecology after the Fukushima Dai-ichi nuclear accident: Are we better positioned to understand the impact of radionuclides in marine ecosystems?

This paper focuses on how a community of researchers under the COMET (CO-ordination and iMplementation of a pan European projecT for radioecology) project has improved the capacity of marine radioecology to understand at the process level the behaviour of radionuclides in the marine environment, uptake by organisms and the resulting doses after the Fukushima Dai-ichi nuclear accident occurred in 2011. We present new radioecological understanding of the processes involved, such as the interaction of waterborne radionuclides with suspended particles and sediments or the biological uptake and turnover of radionuclides, which have been better quantified and mathematically described. We demonstrate that biokinetic models can better represent radionuclide transfer to biota in non-equilibrium situations, bringing more realism to predictions, especially when combining physical, chemical and biological interactions that occur in such an open and dynamic environment as the ocean. As a result, we are readier now than we were before the FDNPP accident in terms of having models that can be applied to dynamic situations. The paper concludes with our vision for marine radioecology as a fundamental research discipline and we present a strategy for our discipline at the European and international levels. The lessons learned are presented along with their possible applicability to assess/reduce the environmental consequences of future accidents to the marine environment and guidance for future research, as well as to assure the sustainability of marine radioecology. This guidance necessarily reflects on why and where further research funding is needed, signalling the way for future investigations.

Application of an ecosystem model to evaluate the importance of different processes and food web structure for transfer of 13 elements in a shallow lake

In environmental risk assessments of nuclear waste, there is need to estimate the potential risks of a large number of radionuclides over a long time period during which the environment is likely to change. Usually concentration ratios (CRs) are used to calculate the activity concentrations in organisms. However, CRs are not available for all radionuclides and they are not easily scalable to the varying environment. Here, an ecosystem transport model of elements, which estimates concentrations in organisms using carbon flows and food transfer instead of CR is presented. It is a stochastic compartment model developed for Lake Eckarfjärden at Forsmark in Sweden. The model was based on available data on carbon circulation, physical and biological processes from the site and identifies 11 functional groups of organisms. The ecosystem model was used to estimate the environmental transfer of 13 elements (Al, Ca, Cd, Cl, Cs, I, Ni, Nb, Pb, Se, Sr, Th, U) to various aquatic organisms, using element-specific distribution coefficients for suspended particles (K_{d PM}) and upper sediment (K_{d sed}), and subsequent transfer in the foodweb. The modelled CRs for different organism groups were compared with measured CRs from the lake and literature data, and showed good agreement for many elements and organisms, particularly for lower trophic levels. The model is, therefore, proposed as an alternative to measured CR, though it is suggested to further explore active uptake, assimilation and elimination processes to get better correspondence for some of the elements. The benthic organisms (i.e. bacteria, microphytobenthos and macroalgae) were identified as more important than pelagic organisms for transfer of elements to top predators. The element transfer model revealed that most of the radionuclides were channelled through the microbial loop, despite the fact that macroalgae dominated the carbon fluxes in this lake. Thus, element-specific adsorption of elements to the surface of aquatic species, that may be food sources for organisms at higher trophic levels, needs to be considered in combination with generic processes described by carbon fluxes.

Evaluation of factors influencing accumulation of stable Sr and Cs in lake and coastal fish

As a result of nuclear accidents and weapons tests, the radionuclides Cs-137 and Sr-90 are common contaminants in aquatic ecosystems. Concentration ratios (CR) based on concentrations of stable Cs and Sr in biota and media are used for the estimation of transfer of their radioisotopes for radiation dose calculations in environmental and human safety assessments. Available element-specific CRs vary by over an order of magnitude for similar organisms, thus affecting the dose estimates proportionally. The variation could be reduced if they were based on a better understanding of the influence of the underlying data and how that affects accumulation and potential biomagnification of stable Cs and Sr in aquatic organisms. For fish, relationships have been identified between water concentrations of K and CR of Cs-137, and between water concentrations of Ca and CR of Sr-90. This has not been confirmed for stable Cs and Sr in European waters. In this study, we analysed an existing dataset for stable Cs and Sr, as well as K and Ca, in four Swedish lakes and three Baltic Sea coastal areas, in order to understand the behaviour of these elements and their radioisotopes in these ecosystems. We found significant seasonal variations in the water concentrations of Cs, Sr, K and Ca, and in electrical conductivity (EC), especially in the lakes. CR values based on measurements taken at single or few time points may, therefore, be inaccurate or introduce unnecessarily large variation into risk assessments. Instead, we recommend incorporating information about the underlying variation in water concentrations into the CR calculations, for example by using the variation of the mean. The inverse relationships between fish CR(Cs)-[K]water and fish CR(Sr)-[Ca]water, confirmed that stable Cs and Sr follow the same trends as their radioisotopes. Thus, they can be used as proxies when radioisotope data are lacking. EC was also strongly correlated with K and Ca concentrations in the water and could potentially be used as a quick and cost-effective method to estimate water chemistry to obtain less variable CR. We also recommend some simple improvements to data collection that would greatly enhance our ability to understand Cs and Sr uptake by fish.

Post-natal outcomes of antenatally diagnosed intra-abdominal cysts: a 22-year single-institution series

PURPOSE

The aim of this study was to establish the post-natal diagnosis and outcome of antenatally diagnosed intra-abdominal cysts between 1991 and 2013 at our institution.

METHODS

All antenatally diagnosed intra-abdominal cysts between 1991 and 2013 were identified using a foetal anomaly database. The cysts were monitored for resolution. In all cases where the cyst had not resolved antenatally, additional post-natal scans were conducted. Antenatal diagnosis, post-natal diagnosis and outcomes were also recorded.

RESULTS

118 cases of antenatal intra-abdominal cysts were identified over the 22-year study period with a 98 % live birth rate. The overall accuracy of an antenatal diagnosis at our institution was 92 %. 26 cases (22 %) resolved spontaneously in utero, the majority of which (77 %) were ovarian in nature. Four tumour cases were identified in the series, which included two neuroblastomas, one yolk sac tumour and one teratoma. 90 cysts persisted post-natally with 52 % requiring surgery. These primarily included choledochal and enteric duplication cysts as well as symptomatic solid organ cysts. Diagnostic revision was limited to 8 % of cases over the study period with an overall improvement over the last decade. Overall, 40 % of all antenatally diagnosed cysts required surgical intervention. In those cysts that persisted post-natally, 52 % required surgery.

CONCLUSIONS

A fifth of prenatally diagnosed intra-abdominal cysts will resolve with most ovarian cysts regressing in utero. Half of all persistent cysts will, however, require surgical intervention. These data are useful for prenatal counselling and demonstrates the important role played by the paediatric surgeon in the overall management of intra-abdominal cysts.

Retention of radioactive particles and associated effects in the filter-feeding marine mollusc Mytilus edulis

Radioactive particles are aggregates of radioactive atoms that may contain significant activity concentrations. They have been released into the environment from nuclear weapons tests, and from accidents and effluents associated with the nuclear fuel cycle. Aquatic filter-feeders can capture and potentially retain radioactive particles, which could then provide concentrated doses to nearby tissues. This study experimentally investigated the retention and effects of radioactive particles in the blue mussel, Mytilus edulis. Spent fuel particles originating from the Dounreay nuclear establishment, and collected in the field, comprised a U and Al alloy containing fission products such as (137)Cs and (90)Sr/(90)Y. Particles were introduced into mussels in suspension with plankton-food or through implantation in the extrapallial cavity. Of the particles introduced with food, 37% were retained for 70 h, and were found on the siphon or gills, with the notable exception of one particle that was ingested and found in the stomach. Particles not retained seemed to have been actively rejected and expelled by the mussels. The largest and most radioactive particle (estimated dose rate 3.18 ± 0.06 Gyh(-1)) induced a significant increase in Comet tail-DNA %. In one case this particle caused a large white mark (suggesting necrosis) in the mantle tissue with a simultaneous increase in micronucleus frequency observed in the haemolymph collected from the muscle, implying that non-targeted effects of radiation were induced by radiation from the retained particle. White marks found in the tissue were attributed to ionising radiation and physical irritation. The results indicate that current methods used for risk assessment, based upon the absorbed dose equivalent limit and estimating the "no-effect dose" are inadequate for radioactive particle exposures. Knowledge is lacking about the ecological implications of radioactive particles released into the environment, for example potential recycling within a population, or trophic transfer in the food chain.

Radionuclide transfer in marine coastal ecosystems, a modelling study using metabolic processes and site data

This study implements new site-specific data and improved process-based transport model for 26 elements (Ac, Ag, Am, Ca, Cl, Cm, Cs, Ho, I, Nb, Ni, Np, Pa, Pb, Pd, Po, Pu, Ra, Se, Sm, Sn, Sr, Tc, Th, U, Zr), and validates model predictions with site measurements and literature data. The model was applied in the safety assessment of a planned nuclear waste repository in Forsmark, Öregrundsgrepen (Baltic Sea). Radionuclide transport models are central in radiological risk assessments to predict radionuclide concentrations in biota and doses to humans. Usually concentration ratios (CRs), the ratio of the measured radionuclide concentration in an organism to the concentration in water, drive such models. However, CRs vary with space and time and CR estimates for many organisms are lacking. In the model used in this study, radionuclides were assumed to follow the circulation of organic matter in the ecosystem and regulated by radionuclide-specific mechanisms and metabolic rates of the organisms. Most input parameters were represented by log-normally distributed probability density functions (PDFs) to account for parameter uncertainty. Generally, modelled CRs for grazers, benthos, zooplankton and fish for the 26 elements were in good agreement with site-specific measurements. The uncertainty was reduced when the model was parameterized with site data, and modelled CRs were most similar to measured values for particle reactive elements and for primary consumers. This study clearly demonstrated that it is necessary to validate models with more than just a few elements (e.g. Cs, Sr) in order to make them robust. The use of PDFs as input parameters, rather than averages or best estimates, enabled the estimation of the probable range of modelled CR values for the organism groups, an improvement over models that only estimate means. Using a mechanistic model that is constrained by ecological processes enables (i) the evaluation of the relative importance of food and water uptake pathways and processes such as assimilation and excretion, (ii) the possibility to extrapolate within element groups (a common requirement in many risk assessments when initial model parameters are scarce) and (iii) predictions of radionuclide uptake in the ecosystem after changes in ecosystem structure or environmental conditions. These features are important for the longterm (>1000 year) risk assessments that need to be considered for a deep nuclear waste repository.

An invitation to contribute to a strategic research agenda in radioecology

With intentions of integrating a portion of their respective research efforts into a trans-national programme that will enhance radioecology, eight European organisations recently formed the European Radioecology ALLIANCE (www.er-alliance.org). The ALLIANCE is an Association open to other organisations throughout the world with similar interests in promoting radioecology. The ALLIANCE members recognised that their shared radioecological research could be enhanced by efficiently pooling resources among its partner organizations and prioritising group efforts along common themes of mutual interest. A major step in this prioritisation process was to develop a Strategic Research Agenda (SRA). An EC-funded Network of Excellence in Radioecology, called STAR (Strategy for Allied Radioecology), was formed, in part, to develop the SRA. This document is the first published draft of the SRA. The SRA outlines a suggested prioritisation of research topics in radioecology, with the goal of improving research efficiency and more rapidly advancing the science. It responds to the question: "What topics, if critically addressed over the next 20 years, would significantly advance radioecology?" The three Scientific Challenges presented within the SRA, with their 15 associated research lines, are a strategic vision of what radioecology can achieve in the future. Meeting these challenges will require a directed effort and collaboration with many organisations the world over. Addressing these challenges is important to the advancement of radioecology and in providing scientific knowledge to decision makers. Although the development of the draft SRA has largely been a European effort, the hope is that it will initiate an open dialogue within the international radioecology community and its stakeholders. This is an abbreviated document with the intention of introducing the SRA and inviting contributions from interested stakeholders. Critique and input for improving the SRA are welcomed via a link on the STAR website (www.star-radioecology.org).

Bottom trawling resuspends sediment and releases bioavailable contaminants in a polluted fjord

Sediments are sinks for contaminants in the world's oceans. At the same time, commercial bottom trawling is estimated to affect around 15 million km(2) of the world's seafloor every year. However, few studies have investigated whether this disturbance remobilises sediment-associated contaminants and, if so, whether these are bioavailable to aquatic organisms. This field study in a trawled contaminated Norwegian fjord showed that a single 1.8 km long trawl pass created a 3-5 million m(3) sediment plume containing around 9 t contaminated sediment; ie. 200 g dw m(-2) trawled, equivalent to c. 10% of the annual gross sedimentation rate. Substantial amounts of PCDD/Fs and non-ortho PCBs were released from the sediments, likely causing a semi-permanent contaminated sediment suspension in the bottom waters. PCDD/Fs from the sediments were also taken up by mussels which, during one month, accumulated them to levels above the EU maximum advised concentration for human consumption.

Exploring visuomotor priming following biological and non-biological stimuli

Observation of human actions influences the observer's own motor system, termed visuomotor priming, and is believed to be caused by automatic activation of mirror neurons. Evidence suggests that priming effects are larger for biological (human) as opposed to non-biological (object) stimuli and enhanced when viewing stimuli in mirror compared to anatomical orientation. However, there is conflicting evidence concerning the extent of differences between biological and non-biological stimuli, which may be due to stimulus related confounds. Over three experiments, we compared how visuomotor priming for biological and non-biological stimuli was affected over views, over time and when attention to the moving stimulus was manipulated. The results indicated that the strength of priming for the two stimulus types was dependent on attentional location and load. This highlights that visuomotor priming is not an automatic process and provides a possible explanation for conflicting evidence regarding the differential effects of biological and non-biological stimuli.

How men with non-chlamydial, non-gonococcal urethritis are managed in Australasia

Summary:

The aim of this study was to ascertain how sexual health physicians in Australia and New Zealand manage men with chlamydia-negative non-gonococcal urethritis (NGU), particularly in relation to the notification of their female sexual partners. In July 2006, a cross-section survey was sent out to all the members of the Australasian Chapter of Sexual Health Medicine. Seventy-three percent of sexual health physicians believed that female partners of men who present with chlamydia-negative NGU were at risk of adverse reproductive health outcomes. At least 62% usually initiated some form of partner notification of female partners of men with chlamydia-negative NGU. However, only 19% (21/111) of sexual health physicians routinely tested for, and only 65% sometimes tested for, pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in men presenting with NGU. These included Mycoplasma genitalium, herpes simplex virus, ureaplasma species, Trichomonas vaginalis and adenoviruses.

More than just anal sex: the potential for sexually transmitted infection transmission among men visiting sex-on-premises venues

OBJECTIVES

This study aimed to obtain detailed data on the frequency of sexual practices among men who had sex with men (MSM) at sex-on-premises venues (SOPV) and to compare this with their sexual practices outside SOPV.

METHODS

A cross-sectional survey was undertaken of MSM at six SOPV between December 2006 and March 2007.

RESULTS

Of 604 men approached, 200 (33%) participated. Men reported sexual contact with a median of two other men (range 0-28). Receptive and insertive anal intercourse was reported by 19.5% and 34.0%, respectively, and was unprotected in 2.5% and 6.0%. The frequency of other practices included: unprotected insertive and receptive penile-anal touching or rubbing without penetration, or "nudging" (26.5% and 20.0%); unprotected, transient insertive and receptive anal intercourse, or "dipping" (6.0% and 5.0%) and insertive and receptive anal fingering (38.5% and 32.5%). Approximately 40% of men who reported "nudging" reported that they had not engaged in any "anal sex". Compared with their practices with casual male partners outside SOPV, men having sex at SOPV were less likely to have receptive oral intercourse with ejaculation (odds ratio (OR) 0.4; 95% CI 0.2 to 1.0, p = 0.04) and unprotected receptive anal intercourse (OR 0.3; 95% CI 0.1 to 0.8, p = 0.01), but were more likely to have group sex (OR 2.0; 95% CI 1.1 to 3.6, p = 0.03).

CONCLUSIONS

Substantial penile-anal contact not involving anal intercourse occurred at SOPV and may explain anal infections in the absence of reported anal sex. Some higher risk practices were reported more frequently with male partners outside of these venues than with partners within SOPV.

31. WHY HAS TRICHOMONAS VAGINALIS DECLINED DRAMATICALLY AMONG VICTORIAN WOMEN (1947-2005)?

Trichomonas vaginalis (TV) diagnosis rates have decreased considerably in some countries during the last two decades. It is unclear why TV has decreased only in some countries. This study investigated the relationships between: 1) TV diagnosis rates among women attending the Melbourne Sexual Health Centre (MSHC), and among Pap smears screened by Victorian Cytology Services (VCS); 2) the use of nitroimidazoles in Australia and; 3) gonorrhoea notification data for Victoria to assess changes in sexual behaviour. TV diagnosis rates among women attending MSHC rose from under 5% in the 1940's, to 20% to 30% in the 1960's and then declined 5% to 10% during the 1970's. From 1980 onwards, TV diagnosis rates fell progressively to below 1% by 1991, with 0.1% in 2004. A similar pattern was seen in TV at VCS, but with lower absolute percentages. Metronidazole was introduced into Australia in 1961 and tinidazole in 1976 and by 1987 there were 400 000 nitroimidazole prescriptions per year. Pap smear screening in Victoria began in 1965, only including 20% of women per year (aged 15 to 69) by the mid 1980's. Post 1980's, screening rose until 2000, stabilising at 35% of women per year. Gonorrhoea notification rates peaked during times TV was experiencing its greatest falls. The initial decline of TV seen in Victoria was associated with the introduction of effective antibiotics. The further decline to less than 1% was seen when Pap smear screening participation increased during the 1990's.

50. THE MANAGEMENT OF MEN WITH ACUTE CHLAMYDIA-NEGATIVE NON-GONOCOCCAL URETHRITIS: A LACK OF CONSENSUS AMONG AUSTRALIAN SEXUAL HEALTH PHYSICIANS

Objective: In clinical practice, chlamydia-negative non-gonococcal urethritis (NGU) is a common but poorly understood condition. The purpose of this study was to determine how Australian sexual health physicians manage men with this condition. Methods: In July 2006, a survey was mailed to all members of the Australasian Chapter of Sexual Health Medicine. Results: Of 166 surveys mailed out, 111 (67%) were returned completed. The majority of sexual health physicians (73%, n�=�81) indicated that they believed that female partners of men with acute chlamydia-negative NGU were at risk of adverse reproductive health outcomes. However, only 19% (n�=�21) routinely tested men with acute NGU for pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis. Most commonly, this was for M. genitalium (n�=�16). While 68% of respondents believed that M. genitalium was a cause of acute NGU, only 27% had access to testing for this organism. Other pathogens that were sometimes tested for included herpes simplex virus, Trichomonas vaginalis and adenovirus. Over half of sexual health physicians indicated that they would usually initiate notification of female sexual partners of men presenting with acute NGU, even before confirmatory test results were available. Conclusion: There are substantial differences in how acute, chlamydia-negative NGU is managed by Australian sexual health physicians. In part, these may relate to differences in beliefs around which pathogens are responsible for this condition and the availability of testing for particular pathogens. Notification of female partners is commonplace, even though the underlying cause of urethritis in affected men appears to be poorly defined.

26. MORE THAN JUST ANAL SEX: THE POTENTIAL FOR STI TRANSMISSION AMONG MEN VISITING SEX ON PREMISES VENUES IN MELBOURNE

Objective: Sex On Premises Venues (SOPVs), where men have sex with other men, provide an environment where the transmission of sexually transmitted infections (STIs) is potentially enhanced. However, the extent to which SOPVs contribute to STI transmission is unknown. This study aimed to obtain detailed data on the types of sexual practices and frequency of these practices among men who have sex with men (MSM) visiting SOPVs in Melbourne, Australia. Methods: In a cross-sectional study, MSM visiting 6 Melbourne SOPVs between December 2006 and February 2007 were asked to complete an exit survey on the types of sexual practices and frequency of such practices they had engaged in at that visit. Of 447 men approached, 150 (34%) participated in the study. Results: The median age of participants was 42.5 years (range 20-79). Among participants who engaged in receptive oral sex (66%) and insertive oral sex (75%), the median number of such acts reported by each man during the visit was 2 (range 1-10) and 2 (range 1-10) respectively. Eleven men (7%) reported receptive oral sex with ejaculation into their mouth with a median of 1 act (range 1-3) per man. Among participants who engaged in receptive anal sex (19%) and insertive anal sex (38%), the median number of such acts per man during the visit was 1 (range 1-4) and 1 (range 1-8) respectively. Eleven men (7%) reported unprotected insertive anal sex with a median of 1 act (range 1-4) per man; 4 (3%) reported unprotected receptive sex. A substantial number of men who did not report any anal sex engaged in practices potentially capable of transmitting infections. Notably, 44 men (29%) reported unprotected rubbing or touching of their penis ('nudging') onto another man's anus without actual anal penetration with a total of 71 other men (median 1 act per man, range 1-10). When specifically asked, 17 (39%) of these men reported that they had not engaged in 'anal sex'. In addition, 32 men (21%) reported being the recipients of 'nudging' with 40 other men. Fourteen (44%) of these men reported not having had any 'anal sex'. Oro-anal sex, whether 'active' or 'passive', was reported by 57 (38%) of men, while 84 (56%) men reported anal penetration using fingers, whether receptive or insertive. A significant minority (11%) of men reported that their ability to have safe sex was compromised by the use of drugs or alcohol. Of note, 58 (39%) men reported having a regular male partner, with whom 23 (40%) had unprotected anal sex. And 13 (9%) reported having a regular female partner, with whom 10 (77%) reportedly had unprotected vaginal or anal sex. Conclusions: The potential for STI transmission between men visiting Melbourne SOPVs and to their partners outside these venues is high. The contribution of what might be perceived as 'safer' sex practices to the transmission of STIs among MSM may have been underrecognised.

Pituitary tumor transforming gene: an important gene in normal cellular functions and tumorigenesis

Pituitary tumor transforming gene (PTTG) is an oncogene which is found to be highly expressed in proliferating cells and in most of the tumors analyzed to date. Overexpression of PTTG induces cellular transformation and promotes tumor development in nude mice. PTTG is regulated by various growth factors including insulin and IGF-1. PTTG is a multifunctional and multidomain protein. Some of the functions of PTTG include inhibition of separation of sister chromatids, expression and secretion of angiogenic and metastatic factors. In this review we focus on expression of PTTG in normal and tumor tissues, define its biological function, its role in tumorigenesis, and its interaction with other proteins that may play important role in mediating tumorigenic function of PTTG.