European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017): Design and Methods

AbstractMen-who-have-sex-with-men (MSM) carry a disproportionate burden of sexually transmitted infections across Europe. Health planners require sexual health needs assessment data to respond appropriately. In addition, surveillance of risk and precaution behaviours in this population enables evaluative judgements of policy responses. The European MSM Internet Survey (EMIS-2017) aimed to repeat the pan-European online survey on male homosexual behaviour conducted in 2010, both to update information required to plan and monitor health promotion interventions and consolidate harmonisation of existing behavioural surveillance approaches. Our study team collaborated with more than 200 partners from academia, public health and civil society across 50 countries. Starting from our previous EMIS-2010 questionnaire, partners engaged in three rounds of iterative survey development and piloting until the final content was agreed. Transfer to an online survey application was followed by further pre-testing before translation into 32 additional languages, final testing and sign-off. The survey was available to complete online in 33 languages simultaneously from 18 October 2017 to 31 January 2018. Ten international MSM dating mobile apps were paid to send short promotional messages, and national partners promoted the survey via at least another 272 websites and social media accounts. Real-time monitoring of responses facilitated targeted advertising by country and recruitment source. Ultimately 144,305 cases were submitted of which 137,358 (95.2%) were eligible for inclusion. EMIS-2017 demonstrated the feasibility of multi-country online MSM surveying with public funding. Meaningful involvement of a large number of collaborators in the survey design and its execution ensured successful recruitment. Careful design, piloting and presentation ensured the survey was acceptable and had authority and perceived community benefit. Partners in 38 countries have already been supplied with a national database of 100 or more respondents for national analysis, while the study team has focussed on international comparisons among 137,358 respondents in 50 countries.</jats:p

Are you a researcher as well as a medical illustrator?

When we list the areas of practice for medical illustrators we always include research, but how involved in research are we? The aim of this activity is to encourage your professional development not just as a medical illustrator but your involvement with research whether that is undertaking your own research, undertaking evidence based practice (1) , working as part of a research team, advising researchers on the value of medical illustration or supporting a student undertaking a research project for their degree or post-graduate qualification

Are X-ray properties of loose groups different from those of compact groups?

We compare the X-ray properties of loose and compact galaxy groups, using a combined sample of 42 groups. We find that we are unable to separate loose and compact groups on the luminosity-temperature relation, the luminosity-velocity dispersion relation or the velocity dispersion-temperature relation using equally weighted errors. This suggests that the distinction between compact and loose groups is not a fundamental one, and we argue that a more useful distinction is that between X-ray bright and X-ray faint systems. Given their similarity in X-ray properties, we combine the loose and compact subsamples to derive relations based on the full sample. This provides the highest statistical quality results to date on the way in which the correlations in X-ray properties of low mass systems depart from those seen in rich clusters.Comment: 6 pages, 6 figures. Accepted for publication in MNRA

Optimal Interruption of P. vivax Malaria Transmission Using Mass Drug Administration

Plasmodium vivax is the most geographically widespread malaria-causing parasite resulting in significant associated global morbidity and mortality. One of the factors driving this widespread phenomenon is the ability of the parasites to remain dormant in the liver. Known as ‘hypnozoites’, they reside in the liver following an initial exposure, before activating later to cause further infections, referred to as ‘relapses’. As around 79–96% of infections are attributed to relapses from activating hypnozoites, we expect it will be highly impactful to apply treatment to target the hypnozoite reservoir (i.e. the collection of dormant parasites) to eliminate P. vivax. Treatment with radical cure, for example tafenoquine or primaquine, to target the hypnozoite reservoir is a potential tool to control and/or eliminate P. vivax. We have developed a deterministic multiscale mathematical model as a system of integro-differential equations that captures the complex dynamics of P. vivax hypnozoites and the effect of hypnozoite relapse on disease transmission. Here, we use our multiscale model to study the anticipated effect of radical cure treatment administered via a mass drug administration (MDA) program. We implement multiple rounds of MDA with a fixed interval between rounds, starting from different steady-state disease prevalences. We then construct an optimisation model with three different objective functions motivated on a public health basis to obtain the optimal MDA interval. We also incorporate mosquito seasonality in our model to study its effect on the optimal treatment regime. We find that the effect of MDA interventions is temporary and depends on the pre-intervention disease prevalence (and choice of model parameters) as well as the number of MDA rounds under consideration. The optimal interval between MDA rounds also depends on the objective (combinations of expected intervention outcomes). We find radical cure alone may not be enough to lead to P. vivax elimination under our mathematical model (and choice of model parameters) since the prevalence of infection eventually returns to pre-MDA levels

Compact groups in theory and practice -- IV. The connection to large-scale structure

We investigate the properties of photometrically-selected compact groups (CGs) in the Sloan Digital Sky Survey. In this paper, the fourth in a series, we focus on understanding the characteristics of our observed CG sample with particular attention paid to quantifying and removing contamination from projected foreground or background galaxies. Based on a simple comparison of pairwise redshift likelihoods, we find that approximately half of compact groups in the parent sample contain one or more projected (interloping) members; our final clean sample contains 4566 galaxies in 1086 compact groups. We show that half of the remaining CGs are associated with rich groups (or clusters), i.e. they are embedded sub-structure. The other half have spatial distributions and number-density profiles consistent with the interpretation that they are either independently distributed structures within the field (i.e. they are isolated) or associated with relatively poor structures. Comparisons of late-type and red-sequence fractions in radial annuli show that galaxies around apparently isolated compact groups resemble the field population by 300 to 500 kpc from the group centre. In contrast, the galaxy population surrounding embedded compact groups appears to remain distinct from the field out beyond 1 to 2 Mpc, consistent with results for rich groups. We take this as additional evidence that the observed distinction between compact groups, i.e. isolated vs. embedded, is a separation between different host environments.Comment: 15 pages, 11 figures. Accepted for publication in MNRA

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

Sexual and Mental Health Inequalities across Gender Identity and Sex-Assigned-at-Birth among Men-Who-Have-Sex-with-Men in Europe: Findings from EMIS-2017.

Some men who have sex with men (MSM) were assigned female at birth (AFB) and/or identify as trans men. Little is known about how these men differ from other MSM. We compared sexual and mental health indicators from the European MSM Internet Survey (EMIS-2017), comparing men AFB and/or currently identifying as trans men with those assigned male at birth (AMB) who identified as men. EMIS-2017 was an opportunistic 33-language online sexual health survey for MSM recruiting throughout Europe. We used regression models adjusting for age, country of residence and employment status to examine differences across groups. An analytic sample of 125,720 men living in 45 countries was used, of which 674 (0.5%) were AFB and 871 (0.7%) identified as trans men. The two sub-groups were not coterminous, forming three minority groups: AFB men, AFB trans men and AMB trans men. Minority groups were younger and more likely unemployed. Anxiety, depression, alcohol dependence and sexual unhappiness were more prevalent in sex/gender minority men. Conversely HIV and STI diagnoses were less common. AMB trans men were most likely to have sexual risk behavior with steady partners and to have unmet health promotion needs, and were least likely to be reached by interventions. Sex assigned at birth and trans identification were associated with different sexual and mental health needs. To facilitate service planning and to foster inclusion, sex-assigned-at-birth and current gender identity should be routinely collected in health surveys

A model for malaria treatment evaluation in the presence of multiple species

Plasmodium (P.) falciparum and P. vivax are the two most common causes of malaria. While the majority of deaths and severe morbidity are due to P. falciparum, P. vivax poses a greater challenge to eliminating malaria outside of Africa due to its ability to form latent liver stage parasites (hypnozoites), which can cause relapsing episodes within an individual patient. In areas where P. falciparum and P. vivax are co-endemic, individuals can carry parasites of both species simultaneously. These mixed infections complicate dynamics in several ways; treatment of mixed infections will simultaneously affect both species, P. falciparum can mask the detection of P. vivax, and it has been hypothesised that clearing P. falciparum may trigger a relapse of dormant P. vivax. When mixed infections are treated for only blood-stage parasites, patients are at risk of relapse infections due to P. vivax hypnozoites. We present a stochastic mathematical model that captures interactions between P. falciparum and P. vivax, and incorporates both standard schizontocidal treatment (which targets blood-stage parasites) and radical treatment (which additionally targets liver-stage parasites). We apply this model to assess the implications of different treatment coverage of radical cure for mixed and P. vivax infections and a so-called "unified radical cure" treatment strategy for P. falciparum, P. vivax and mixed infections. We find that a unified radical cure strategy, with G6PD screening, leads to a substantially lower incidence of malaria cases and deaths overall. We perform a one-way sensitivity analysis to highlight important model parameters