Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care

Purpose

Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers.

Methods

This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales.

Results

Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health.

Conclusion

This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.

Sexually transmitted infections diagnosed in individuals presenting for forensic and medical care following sexual assault

BACKGROUND

People who report sexual assault express concerns regarding contracting sexually transmitted infection (STI); however, published literature regarding the risk of STI transmission in this context is sparse.

METHOD

We audited STI and blood-borne virus (BBV) testing at a forensic and medical sexual assault care service in the Australian Capital Territory between 2004 and 2022. Eligibility for testing among 1928 presentations was defined based on risk (eg, reported penetration). Testing at presentation included chlamydia and gonorrhoea 1850, syphilis and BBV 1472, and after 2-6 weeks, 890 out of 1928 (46.2%) and after 3 months 881 out of 1928 (45.7%), respectively.

RESULTS

At presentation, 100 out of 1928 (5.2%) individuals were diagnosed with chlamydia, of those, 95 out of 1799 (5.3%) were female, and 5 out of 121 (4.1%) were male. Gonorrhoea was diagnosed in 7 out of 1920 (0.4%), 5 out of 95 female and 2 out of 5 male. Hepatitis B, which was all pre-existing, was diagnosed in 5 out of 1799 (0.3%). Overall, chlamydia prophylaxis was given to 203 out of 1928 (10.5%) and HIV post-exposure prophylaxis to 141 out of 1928 (7.3%).At 2-6 weeks of follow-up, 10 out of 890 (1.1%) individuals were diagnosed with chlamydia, with no gonorrhoea diagnosed. There were no cases of syphilis, hepatitis B or HIV diagnosed at 3-month serology testing in 881 individuals. Chlamydia detection at follow-up was more common in the group aged 15-29 years. Of those provided with chlamydia prophylaxis, 203 out of 1928, only 16 out of 203 (7.9%) were diagnosed with chlamydia.

CONCLUSIONS

The offer of STI testing is almost universally accepted by individuals presenting for post-sexual assault care. There were no identifiable factors to justify the routine use of chlamydia prophylaxis. STI testing provided an opportunity for screening and should remain part of the clinical care of people who report sexual assault.

Cultivating intellectual community in academia: reflections from the Science and Technology Studies Food and Agriculture Network (STSFAN)

Scholarship flourishes in inclusive environments where open deliberations and generative feedback expand both individual and collective thinking. Many researchers, however, have limited access to such settings, and most conventional academic conferences fall short of promises to provide them. We have written this Field Report to share our methods for cultivating a vibrant intellectual community within the Science and Technology Studies Food and Agriculture Network (STSFAN). This is paired with insights from 21 network members on aspects that have allowed STSFAN to thrive, even amid a global pandemic. Our hope is that these insights will encourage others to cultivate their own intellectual communities, where they too can receive the support they need to deepen their scholarship and strengthen their intellectual relationships.

Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW)

BACKGROUND

Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia.

METHODS

Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week.

RESULTS

A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis.

CONCLUSIONS

Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness.

Is non-occupational HIV Post Exposure Prophylaxis (nPEP) still used? An exploration of nPEP use since widespread availability of HIV PrEP

BACKGROUND

Non-occupational Post-Exposure Prophylaxis (nPEP) is an effective HIV prevention strategy in gay and bisexual men (GBM) taken after possible exposure. HIV Pre-Exposure Prophylaxis (PrEP) is also a highly effective HIV prevention strategy.

METHODS

A retrospective audit of medical records of GBM presenting to a sexual health centre and provided with nPEP compared two periods to determine if nPEP usage changed following availability of PrEP. In the first period (P1) PrEP was available through extended trials. In the second period (P2) PrEP became more accessible through the Australian Pharmaceutical Benefits Scheme (PBS). Period comparisons were performed using a two-population test of proportions with one-tailed testing and significance set at P < .05 using SPSS Statistics Version 25.

RESULTS

There were 232 GBM provided with nPEP in P1, and 202 in P2. A two-population test of proportions demonstrated that GBM presentations for nPEP decreased significantly from 302/4779 (6.3%) of GBM visits in P1 to 221/7205 (3.1%) in P2 when PrEP was more accessible (Z=8.53, P < .001). PrEP uptake after presenting for nPEP increased from 30 (12.9%) of total GBM visits in P1 to 69 (34.2%) in P2 (Z=5.26, p < .001).

CONCLUSIONS

GBM accessing nPEP decreased with statistical significance post introduction of PBS PrEP.

FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis

PURPOSE

Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making.

PARTICIPANTS

Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019.

FINDINGS TO DATE

The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up.

FUTURE PLANS

A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.

Do we DARE? Improving digital ano-rectal examination in men who have sex with men living with HIV: a quality improvement initiative

Men who have sex with men (MSM) living with HIV are at increased risk of anal cancer and annual screening via digital ano-rectal examination (DARE) is recommended. Baseline audit (Cycle 1) was undertaken of the medical records of MSM living with HIV aged ≥50years (n =85) from 1 January 2017 to 31 December 2018, in line with guidelines at the time. Data collection included whether DARE was discussed and offered, and whether DARE was accepted or declined. We provided staff training and altered clinic proformas aiming to increase DARE. Audit Cycle 2 (Cycle 2) was undertaken of eligible MSM (n =86) who attended between 1 January 2019 to 31 December 2020. DARE frequency increased from 4.7% in Cycle 1 to 41.8% in Cycle 2 (P <0.001) and discussion and offer of DARE increased from 8% to 64% in Cycle 2 (P <0.001).

PrEP your team! Clinician initiation of HIV pre-exposure prophylaxis discussion at sexually transmissible infection testing and diagnosis in gay and bisexual men

HIV pre-exposure prophylaxis (PrEP) is recommended for gay and bisexual men (GBM) with recent diagnosis of rectal chlamydia (CT), rectal gonorrhoea (NG) or infectious syphilis. A retrospective medical record audit was undertaken at Canberra Sexual Health Centre (CSHC) of all GBM who met this criterion in 2019 and were thus determined to be at higher risk of acquisition of human immunodeficiency virus (HIV). Pre-exposure prophylaxis was discussed and/or commenced in 85% of GBM at higher risk of HIV. Audit results and education were provided to the team with a post-interventional audit in 2020 showing significant improvement. This audit is easily replicated and may be applicable to other settings engaged in GBM care.

A national study of the clinical management of HIV-positive women in Australia: what are the successes and where are the gaps?

Background Women comprise ~10% of people living with HIV in Australia, so are often underrepresented in research.

METHODS

This study invited clinicians providing care to women living with HIV to complete an anonymous survey containing questions related to four key areas: HIV (including diagnosis, treatment and virological outcomes), reproductive health (including sexual activity, contraception, pregnancy and outcomes) and linkage and retention in care.

RESULTS

In total, 484 surveys were received, with responses from all states and territories. Most women living with HIV in Australia are on treatment (>90%) and virologically suppressed (>90% have a viral load <50 copies mL-1). Almost 75% of women have had at least one switch in treatment (with toxicity almost as common as simplification as the indication). Treatment interruption is also relatively common, but is more likely the longer a woman has been diagnosed, if she is on benefits (P = 0.007) and is the primary carer of children without a partner (P = 0.001). In Australia, women living with HIV are a diverse heterogeneous group, with over 70 different countries of birth and almost half speaking a language other than English at home. Mental health diagnosis was the most common co-morbid condition identified. A total of 21% of women were post-menopausal, with 42% reporting symptoms to their healthcare provider, but only 17% were receiving treatment for symptoms attributed to menopause.

CONCLUSIONS

As well as strategies to support women vulnerable to treatment interruption, important areas for future investment in research and clinical care include co-morbid mental health and menopause symptoms and treatment.

An observational study of the acceptability of patient-delivered partner therapy for management of chlamydia

Partners of heterosexual cases with chlamydia, who were identified as having difficulty in attending the clinic, were offered patient-delivered partner therapy (PDPT). Medication was delivered by the index case after telephone consultation with the partner to assess symptoms and medical history. The opportunity for testing of partners for chlamydia was provided. The PDPT process was evaluated by standardised phone interview with index patients and partners. Telephone consultation enables safe medication prescribing and an opportunity for further contact tracing. Partners were unlikely to seek testing when provided with PDPT. Delivery of medication resulted in a reported rate of treatment of 100%. PDPT was an acceptable treatment option to both index and partner and should be considered if legislation permits.

The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group

Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care. This study analyzed 484 surveys received from clinicians collecting demographic, virological, and reproductive health data along with perceived barriers to linkage and retention in care. Most women (67%) were estimated to have been linked into care within 28 days of diagnosis. For women who were not linked into care for more than 28 days, the most commonly reason cited was fear of disclosure to others, followed by fear of disclosure to their partner. The main reasons given for non-retention in care were related to transport, carer responsibilities, financial pressure, health beliefs and concern about stigma or disclosure.

Origins of Vespa velutina hornets that recently invaded Iki Island, Japan and Jersey Island, UK

The native distribution of the yellow-legged hornet, Vespa velutina, is throughout East Asia. Around 15 years ago this species was accidentally introduced into South Korea and France, where it became established and then spread into neighbouring countries. Previous mitochondrial DNA studies showed that the South Korean, Japanese, and French populations all originated from Eastern China. Recently, the hornet has invaded Iki Island, Japan and Jersey Island, UK. In this study, we analyze the complete mitochondrial DNA sequence of V. velutina to trace the origin of these two populations. The mitochondrial DNA haplotypes (COI, Cytb, and 16S rRNA) of V. velutina in Iki Island matched the unique haplotype present in China, South Korea, and Japan, while the haplotype from Jersey Island matched that of V. velutina found in France and China. These findings were supported by data from the complete mitochondrial DNA sequence of V. velutina from Iki Island, which was consistent with the sequence from South Korea and Tsushima, whereas V. velutina in Jersey was most similar to the French population.

Ethambutol toxicity manifesting as acute onset psychosis

Ethambutol is commonly used for the treatment of tuberculous and atypical mycobacterial infection. Central nervous system (CNS) toxicity other than optic neuropathy is not widely reported. A 40-year-old man with advanced HIV infection and Mycobacterium avium complex infection experienced rapid cognitive decline after commencement of ethambutol, and symptoms fully resolved with cessation.

Lowering levels of bed occupancy is associated with decreased inhospital mortality and improved performance on the 4-hour target in a UK District General Hospital

OBJECTIVE

To evaluate whether there is an association between an intervention to reduce medical bed occupancy and performance on the 4-hour target and hospital mortality.

METHODS

This before-and-after study was undertaken in a large UK District General Hospital over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the 4-hour target and hospital mortality (hospital standardised mortality ratio (HSMR), summary hospital-level mortality indicator (SHMI) and crude mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the 4-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention.

RESULTS

Mean medical bed occupancy decreased significantly from 93.7% to 90.2% (p=0.02). The trend change in target performance, when comparing preintervention and postintervention, revealed a significant improvement (p=0.019). The intervention was associated with a mean reduction in all markers of mortality (range 4.5-4.8%). SHMI (p=0.02) and crude mortality (p=0.018) showed significant trend changes after intervention.

CONCLUSIONS

Lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% 4-hour target. Whole system transformation is required to create lower average medical bed occupancy.

Primary invasive aspergillosis with disseminated intravascular coagulation as a presenting feature of non-Hodgkin's lymphoma

Invasive aspergillosis (IA) is a life-threatening infection. IA is usually seen in severely immunocompromised patients. However, IA as a presenting feature of non-Hodgkin's lymphoma is rare. The patient we describe had no signs or symptoms of lymphoma prior to hospital admission. A. fumigatus was isolated from respiratory tract specimens on the day of admission and fungal elements were detected on autopsy. Isolation of Aspergillus in patients with severe sepsis should trigger a search haematological malignancy.

'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people

In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.

Hydrothermal carbonisation of sewage sludge: effect of process conditions on product characteristics and methane production

Hydrothermal carbonisation of primary sewage sludge was carried out using a batch reactor. The effect of temperature and reaction time on the characteristics of solid (hydrochar), liquid and gas products, and the conditions leading to optimal hydrochar characteristics were investigated. The amount of carbon retained in hydrochars decreased as temperature and time increased with carbon retentions of 64-77% at 140 and 160°C, and 50-62% at 180 and 200°C. Increasing temperature and treatment time increased the energy content of the hydrochar from 17 to 19 MJ/kg but reduced its energy yield from 88% to 68%. Maillard reaction products were identified in the liquid fractions following carbonisations at 180 and 200°C. Theoretical estimates of the methane yields resulting from the anaerobic digestion of the liquid by-products are also presented and optimal reaction conditions to maximise these identified.

Essential versus accessory aspects of cell death: recommendations of the NCCD 2015

Cells exposed to extreme physicochemical or mechanical stimuli die in an uncontrollable manner, as a result of their immediate structural breakdown. Such an unavoidable variant of cellular demise is generally referred to as ‘accidental cell death' (ACD). In most settings, however, cell death is initiated by a genetically encoded apparatus, correlating with the fact that its course can be altered by pharmacologic or genetic interventions. ‘Regulated cell death' (RCD) can occur as part of physiologic programs or can be activated once adaptive responses to perturbations of the extracellular or intracellular microenvironment fail. The biochemical phenomena that accompany RCD may be harnessed to classify it into a few subtypes, which often (but not always) exhibit stereotyped morphologic features. Nonetheless, efficiently inhibiting the processes that are commonly thought to cause RCD, such as the activation of executioner caspases in the course of apoptosis, does not exert true cytoprotective effects in the mammalian system, but simply alters the kinetics of cellular demise as it shifts its morphologic and biochemical correlates. Conversely, bona fide cytoprotection can be achieved by inhibiting the transduction of lethal signals in the early phases of the process, when adaptive responses are still operational. Thus, the mechanisms that truly execute RCD may be less understood, less inhibitable and perhaps more homogeneous than previously thought. Here, the Nomenclature Committee on Cell Death formulates a set of recommendations to help scientists and researchers to discriminate between essential and accessory aspects of cell death.

[1,2,4]triazolo[4,3-a]phthalazines: inhibitors of diverse bromodomains

Bromodomains are gaining increasing interest as drug targets. Commercially sourced and de novo synthesized substituted [1,2,4]triazolo[4,3-a]phthalazines are potent inhibitors of both the BET bromodomains such as BRD4 as well as bromodomains outside the BET family such as BRD9, CECR2, and CREBBP. This new series of compounds is the first example of submicromolar inhibitors of bromodomains outside the BET subfamily. Representative compounds are active in cells exhibiting potent cellular inhibition activity in a FRAP model of CREBBP and chromatin association. The compounds described are valuable starting points for discovery of selective bromodomain inhibitors and inhibitors with mixed bromodomain pharmacology.

N-methyl-d-aspartate receptors, learning and memory: chronic intraventricular infusion of the NMDA receptor antagonist d-AP5 interacts directly with the neural mechanisms of spatial learning

Three experiments were conducted to contrast the hypothesis that hippocampal N-methyl-d-aspartate (NMDA) receptors participate directly in the mechanisms of hippocampus-dependent learning with an alternative view that apparent impairments of learning induced by NMDA receptor antagonists arise because of drug-induced neuropathological and/or sensorimotor disturbances. In experiment 1, rats given a chronic i.c.v. infusion of d-AP5 (30 mm) at 0.5 μL/h were selectively impaired, relative to aCSF-infused animals, in place but not cued navigation learning when they were trained during the 14-day drug infusion period, but were unimpaired on both tasks if trained 11 days after the minipumps were exhausted. d-AP5 caused sensorimotor disturbances in the spatial task, but these gradually worsened as the animals failed to learn. Histological assessment of potential neuropathological changes revealed no abnormalities in d-AP5-treated rats whether killed during or after chronic drug infusion. In experiment 2, a deficit in spatial learning was also apparent in d-AP5-treated rats trained on a spatial reference memory task involving two identical but visible platforms, a task chosen and shown to minimise sensorimotor disturbances. HPLC was used to identify the presence of d-AP5 in selected brain areas. In Experiment 3, rats treated with d-AP5 showed a delay-dependent deficit in spatial memory in the delayed matching-to-place protocol for the water maze. These data are discussed with respect to the learning mechanism and sensorimotor accounts of the impact of NMDA receptor antagonists on brain function. We argue that NMDA receptor mechanisms participate directly in spatial learning.

The relationship between tetanus intensity and the magnitude of hippocampal long-term potentiation in vivo

In this study, we assessed the effects of varying tetanus and test-pulse intensity on the magnitude of long-term potentiation (LTP) in the perforant path–dentate gyrus projection of urethane-anaesthetized rats. We developed a novel within-subjects procedure in which test-pulse-stimulation intensity (60–1000 μA) was varied quasi-randomly under computer control throughout the recording period. After a baseline period, we applied a high-frequency tetanus, the intensity of which was varied over the same range as test-pulse intensity, but between subjects. The time-course of LTP was thus monitored continuously across a range of test-pulse intensities in each rat. Intense high-frequency tetanization at 1000 μA resulted in a paradoxical depression of the dentate field excitatory post-synaptic potential (fEPSP) slope at the lowest test intensity used (60 μA), but caused a potentiation at higher test intensities in the same animal. Moreover, intense tetanization induced less LTP than a moderate tetanus over most of the test-intensity range. Explanations for this pattern of data include a potentiation of feed-forward inhibition in conjunction with LTP of excitatory neurotransmission, or local tissue damage at the stimulation site. To address this issue, we conducted an additional experiment in which a second stimulating electrode was placed in the perforant path at a site closer to the dentate, in order to activate a common population of afferents at a location ‘downstream’ of the original stimulation site. After 1000-μA tetanization of the original (‘upstream’) site, fEPSPs were again depressed in response to test stimulation of the upstream site, but only potentiation was observed in response to stimulation of the downstream site. This is consistent with the idea that the depression induced by intense tetanization results from local changes at the stimulation site. In conclusion, while tetanus intensity must exceed the LTP induction threshold, intensities above 500 μA should be avoided; in the present study, tetanization at 250–500 μA yielded maximal levels of LTP.

Community pharmacy and cash reward: a winning combination for chlamydia screening?

OBJECTIVES

To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies.

METHODS

During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16-30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with $A10. Positive participants, and their nominated contacts, were offered treatment.

RESULTS

Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated-two for suspected pelvic inflammatory disease.

CONCLUSIONS

Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.

Modeling the Responses of Thickness-Shear Mode Resonators under Various Loading Conditions

We develop a general model that describes the electrical responses of thickness-shear mode resonators subject to a variety of surface conditions. The model incorporates a physically diverse set of single-component loadings, including rigid solids, viscoelastic media, and fluids (Newtonian or Maxwellian). The model allows any number of these components to be combined in any configuration. Such multiple loadings are representative of a variety of physical situations encountered in electrochemical and other liquid-phase applications, as well as gas-phase applications. In the general case, the response of the composite load is not a linear combination of the individual component responses. We discuss application of the model in a qualitative diagnostic fashion to gain insight into the nature of the interfacial structure, and in a quantitative fashion to extract appropriate physical parameters such as liquid viscosity and density and polymer shear moduli.

Resonator/Oscillator response to liquid loading

The resonant frequency of a thickness-shear mode resonator operated in contact with a fluid was measured with a network analyzer and with an oscillator circuit. The network analyzer measures changes in the device's intrinsic resonant frequency, which varies linearly with (ρη)(1/2), where ρ and η are liquid density and viscosity, respectively. The resonator/oscillator combination, however, responds differently to liquid loading than the resonator alone. By applying the operating constraints of the oscillator to an equivalent-circuit model for the liquid-loaded resonator, the response of the resonator/oscillator pair can be determined. By properly tuning the resonator/oscillator pair, the dynamic range of the response can be extended and made more linear, closely tracking the response of the resonator alone. This allows the system to measure higher viscosity and higher density liquids with greater accuracy.

Effect of time on colony odour stability in the ant Formica exsecta

Among social insects, maintaining a distinct colony profile allows individuals to distinguish easily between nest mates and non-nest mates. In ants, colony-specific profiles can be encoded within their cuticular hydrocarbons, and these are influenced by both environmental and genetic factors. Using nine monogynous Formica exsecta ant colonies, we studied the stability of their colony-specific profiles at eight time points over a 4-year period. We found no significant directional change in any colony profile, suggesting that genetic factors are maintaining this stability. However, there were significant short-term effects of season that affected all colony profiles in the same direction. Despite these temporal changes, no significant change in the profile variation within colonies was detected: each colony's profile responded in similar manner between seasons, with nest mates maintaining closely similar profiles, distinct from other colonies. These findings imply that genetic factors may help maintain the long-term stability of colony profile, but environmental factors can influence the profiles over shorter time periods. However, environmental factors do not contribute significantly to the maintenance of diversity among colonies, since all colonies were affected in a similar way.

Thermal stability of ribosomal ribonucleic acid from baby hamster kidney cells

1. RNA has been prepared from baby hamster kidney cells by extraction with a phenol-EDTA mixture and further purified by passing through a column of Sephadex G-25 that had been equilibrated with water. 2. Aging of the total RNA extracts at 4 degrees or heating at 95 degrees followed by rapid cooling caused a conversion of 28s RNA into material sedimenting in sucrose gradients at approx. 18s. 3. When heated RNA was re-extracted with phenol the sedimentation profile was not returned to that of the unheated RNA. 4. The 28s and 18s RNA fractions were collected separately from sucrose gradients by precipitation with 2vol. of ethanol and passed through a Sephadex G-25 column equilibrated with water. 5. Heat treatment of purified 28s RNA at 95 degrees caused the sedimentation coefficient to increase to approx. 40s, whereas similar treatment of 18s RNA caused no significant increase. If the RNA was heated before the Sephadex G-25 treatment the sedimentation coefficient of the 28s and 18s RNA decreased to approx. 12s and 8s. 6. Heating mixtures of purified 28s and 18s RNA at 95 degrees caused some aggregation of 18s material with the 28s fraction.

Effect of virus infection on the stability and synthesis of actinomycin-resistant ribonucleic acid in baby-hamster kidney cells

1. The sucrose-gradient pattern of (32)P-labelled RNA synthesized in actinomycintreated baby-hamster kidney cells infected with foot-and-mouth-disease virus depends greatly on the period of labelling. 2. Fractions are formed in infected cells that sediment at 12-20s and have the same base composition as similar fractions found in non-infected cells that have been treated with actinomycin. 3. In the presence of guanidine, which completely inhibits viral RNA synthesis, these fractions are labelled to a greater extent than in non-infected cells.

Synthesis of ribonucleic acid in baby-hamster kidney cells in the presence of actinomycin D

1. RNA molecules with sedimentation values in sucrose gradients of 12-20s are synthesized in baby-hamster kidney cells even after prolonged incubation in medium containing 1mug. of actinomycin D/ml. 2. The rate of formation of this RNA is dependent on the age of the cultures and is greatest during the exponential phase of growth. 3. Growth of cells on nutritionally poor medium causes degradation and inhibits the synthesis of these RNA fractions. 4. Replacement of the nutritionally poor medium with a rich medium stimulates the synthesis of actinomycin-resistant RNA. This stimulation is blocked by cycloheximide. 5. The base composition of this RNA is characterized by low cytidine and high guanosine values.

Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic

BACKGROUND

Anogenital warts are a common initial presentation to the Canberra Sexual Health Centre. It is anticipated that the introduction of human papillomavirus vaccination will reduce the incidence of anogenital warts. The present study determines the prevalence of other sexually transmissible infections in patients newly diagnosed with warts who may not have presented for screening without the impetus of a genital lump.

METHODS

The prevalence of other sexually transmissible infections in new patients presenting to the Canberra Sexual Health Centre diagnosed with anogenital warts was determined from a retrospective clinical audit from 2002 to 2007.

RESULTS

A total of 1015 new patients were diagnosed with anogenital warts. Of this total cohort, 53 (5.2%) were found to be co-infected with either chlamydia and/or gonorrhoea. Only 13.2% of co-infected patients reported symptoms other than genital lumps. Of co-infected patients 11.3% reported contact with a partner with chlamydia and/or gonorrhoea. Not all patients were screened for other sexually transmissible infections: 762 (75.1%) were screened for chlamydia and 576 (56.7%) were screened for gonorrhoea. Of those tested, 6.8% of men and 6.9% of women were positive for chlamydia highlighting the importance of offering full sexually transmissible infection screening in those newly diagnosed with anogenital warts. Chlamydia was more common in younger patients who reported a higher number of sexual partners.

CONCLUSIONS

It is anticipated that human papillomavirus vaccination will lead to a decline in anogenital wart incidence as well as other human papillomavirus associated disease. Although one opportunity for testing for other sexually transmissible infections may be lost in this population, the decrease in anogenital warts will leave clinicians with more time to pursue other screening programs. Education and screening campaigns should continue to focus on the asymptomatic nature of the majority of sexually transmissible infections.

A solution concentration dependent transition from self-stratification to lateral phase separation in spin-cast PS:d-PMMA thin films

Thin films with a rich variety of different nano-scale morphologies have been produced by spin casting solutions of various concentrations of PS:d-PMMA blends from toluene solutions. During the spin casting process specular reflectivity and off-specular scattering data were recorded and ex situ optical and atomic force microscopy, neutron reflectivity and ellipsometry have all been used to characterise the film morphologies. We show that it is possible to selectively control the film morphology by altering the solution concentration used. Low polymer concentration solutions favour the formation of flat in-plane phase-separated bi-layers, with a d-PMMA-rich layer underneath a PS-rich layer. At intermediate concentrations the films formed consist of an in-plane phase-separated bi-layer with an undulating interface and also have some secondary phase-separated pockets rich in d-PMMA in the PS-rich layer and vice versa. Using high concentration solutions results in laterally phase-separated regions with sharp interfaces. As with the intermediate concentrations, secondary phase separation was also observed, especially at the top surface.

Granzymes in cancer and immunity

Cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells are indispensable factors in the body's ongoing defence against viral infection and tumor development. CTL/NK cells recognize and kill infected or aberrant target cells by two major pathways: either through introduction of a battery of proteases - called granzymes - to the target cell cytosol, or through TNF superfamily-dependent killing. During granzyme-dependent killing, target cell death is quick and efficient and is mediated by multiple granzymes, acting via redundant cell death pathways. Although granzyme-mediated cell death has been intensively studied, recent work has also hinted at an alternative, proinflammatory role for these enzymes. Thus, in addition to their well-established role as intracellular effectors of target cell death, recent data suggest that granzymes may have an extracellular role in the propagation of immune signals. In this study, we discuss the role of granzymes as central factors in antitumor immunity, as well possible roles for these proteases as instigators of inflammation.

'Show me the money': financial incentives increase chlamydia screening rates among tertiary students: a pilot study

Background: We hypothesise that text-messaging and financial incentives would increase tertiary student participation in chlamydia screening. Methods: A cross-sectional study was conducted over two phases on eight tertiary campuses during 2007. During Phase 1 (6 months) study activities were advertised through student organisations and media. Education and screening were offered during a range of student activities. During Phase 2 (4 days) education and screening were offered via text messages. Non-financial incentives were offered during Phase 1 and a $10 cash incentive was offered during Phase 2. Rates of specimens provided by students and the direct costs incurred during each phase were compared. Results: 2786 students attended the 31 activities conducted in Phase 1. Of these, 627 students (22.5%) provided urine specimens for chlamydia testing. During Phase 2, the dissemination of 866 text messages resulted in urine specimens from 392 students (45.3%). Costs per test were AUD $175.11 in Phase 1 and AUD $27.13 in Phase 2. Conclusions: Compared with more labour intensive (and therefore more expensive) screening activities conducted over a 6-month period, offering a small financial incentive to tertiary students through text messaging over a 4-day period significantly increased participation in on-campus chlamydia screening. This model could readily be applied to other populations to increase participation in chlamydia screening.

Multi-level selection for hygienic behaviour in honeybees

Disease is one of the main factors driving both natural and artificial selection. It is a particularly important and increasing threat to the managed honeybee colonies, which are vital in crop pollination. Artificial selection for disease-resistant honeybee genotypes has previously only been carried out at the colony-level, that is, by using queens or males reared from colonies that show resistance. However, honeybee queens mate with many males and so each colony consists of multiple patrilines that will vary in heritable traits, such as disease resistance. Here, we investigate whether response to artificial selection for a key resistance mechanism, hygienic behaviour, can be improved using multi-level selection, that is, by selecting not only among colonies as normal but also among patrilines within colonies. Highly hygienic colonies were identified (between-colony selection), and the specific patrilines within them responsible for most hygienic behaviour were determined using observation hives. Queens reared from these hygienic patrilines (within-colony selection) were identified using DNA microsatellite analysis of a wing-tip tissue sample and then mated to drones from a third highly hygienic colony. The resulting colonies headed by queens from hygienic patrilines showed approximately double the level of hygienic behaviour of colonies headed by sister queens from non-hygienic patrilines. The results show that multi-level selection can significantly improve the success of honeybee breeding programs.

Regulation of caspase activation in apoptosis: implications for transformation and drug resistance

Recent developments in the apoptosis field have uncovered a family of cysteine proteases, the Caspases, that act as signalling components as well as effectors of the cell death machinery. Caspases are constitutively present as inactive precursors within most cells and undergo proteolytic processing in response to diverse death-inducing stimuli to initiate the death programme. Active caspases can process other caspases of the same type as well as process caspases further downstream in the pathway that ultimately leads to collapse of the cell. This cellular collapse is thought to occur as a consequence of caspase-mediated cleavage of a diverse array of cellular substrates. Regulation of entry into the death programme is controlled at a number of levels by members of the Bcl-2 family, as well as by other cell death regulatory proteins. Recent data has shed light upon the mechanism of action of these regulatory molecules and suggests that the point of caspase activation is a major checkpoint in the cell death programme. Because many transformed cell populations possess derangements in cell death-regulatory genes, such as bcl-2, such cells frequently exhibit elevated resistance to cytotoxic chemotherapy. Thus, a deeper understanding of how apoptosis is normally regulated has therapeutic implications for disease states where the normal controls on the cell death machinery have been subverted.

Screening for hepatitis C in sexual health clinic attendees

Introduction: Hepatitis C virus (HCV) prevalence has been shown to be higher in some sexual health clinic attendees than the general population. Screening for HCV in sexual health clinics may be based on risk assessment or universal screening. The aim of this audit was to explore the value of routine HCV screening in a sexual health centre population. Methods: Medical records and pathology data concerning all patients tested for HCV between 2000 and 2002 at Canberra Sexual Health Centre were audited to determine whether the diagnosis of HCV was already known and which, if any, risk factors were identified at the time of testing. Results: A total of 3845 tests were conducted on 3156 individuals over the 3-year period. HCV seropositivity was confirmed in 95 patients (3.0%; 95% CI 2.4–3.7), of which 29 (30.5%) were new diagnoses. A total of 85.3% of all patients with confirmed HCV infection reported a history of injecting drug use. Tattoos and body piercings were the most common risk factor in those who denied ever injecting. Risk factor assessment correctly identified all but one positive patient. Conclusions: HCV testing based on clinician-led risk assessment is an effective approach to HCV screening.

The rodent hippocampus and spatial memory: from synapses to systems

Although its operations are not limited to the spatial domain, there is a near consensus that the hippocampus plays a critical role in memory for place. This review aims to explore this role, with a particular emphasis on the functions performed by distinct hippocampal subregions. The use of innovative lesioning techniques, localized pharmacological treatments, and molecular genetic interventions is offering increasingly precise brain-regional specificity and temporal control. Together with the electrophysiological recording of neuronal activity, these techniques are beginning to shed light on the functioning of specific components of the hippocampal circuitry in the different phases of memory - encoding, storage, consolidation, and retrieval. In view of these developments, we examine the involvement of the hippocampus in the encoding versus retrieval of spatial memory, before turning to the issue of long-term information storage and the role of 'cellular' and 'systems' consolidation processes in the formation of lasting memories.

The CASBAH: a searchable database of caspase substrates

Apoptosis is coordinated by members of the caspase family of aspartic acid-specific proteases. Other members of this protease family also play essential roles in inflammation where they participate in the maturation of pro-inflammatory cytokines. To date, almost 400 substrates for the apoptosis-associated caspases have been reported and there are likely to be hundreds more yet to be discovered. Thus, the fraction of the proteome that is degraded (the degradome) by caspases during the demolition phase of apoptosis appears to be quite substantial. Despite this, we still know surprisingly little concerning how caspases provoke some of the signature events in apoptosis, such as membrane phosphatidylserine externalization, cellular retraction, chromatin condensation and apoptotic body production. The inflammatory caspases appear to be much more specific proteases than those involved in apoptosis and only two confirmed substrates for these proteases have been described to date. Here, we have compiled a comprehensive list of caspase substrates and describe a searchable web resource (The Casbah; www.casbah.ie) which contains information pertaining to all currently known caspase substrates. We also discuss some of the unresolved issues relating to caspase-dependent events in apoptosis and inflammation.