Will I? won't I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures?

Background: Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure. Understanding why men who have sex with men (MSM) access PEPSE on some occasions and not others may lead to more effective health promotion and disease prevention strategies Methods: A qualitative study design using semi-structured interviews of 15 MSM within 6 months of them initiating PEPSE treatment at an HIV outpatient service in Brighton, UK. Results: PEPSE seeking was motivated by a number of factors: an episode that related to a particular sexual partner and their behaviour; the characteristics of the venue where the risk occurred; the respondent’s state of mind and influences of alcohol and recreational drug use; and their perceived beliefs on the effectiveness of PEPSE. Help was sought in the light of a “one-off” or “unusual” event. Many respondents felt they were less likely to behave in a risky manner following PEPSE. Conclusion: If PEPSE is to be effective as a public health measure, at risk individuals need to be empowered to make improved risk calculations from an increased perception that they could be exposed to HIV if they continue their current behaviour patterns. The concern is that PEPSE was sought by a low number of MSM implying that a greater number are not using the service based on failure to make accurate risk calculations or recognise high-risk scenario

Acute bronchitis in Australian general practice - a prescription too far?

OBJECTIVE: To quantify how frequently general practitioners in Australia prescribe antibiotics for acute bronchitis, which antibiotics are used, and whether there are subgroups of patients who might benefit from their use. DESIGN AND SETTING: A retrospective descriptive study using 3 sets of data: Australian Sentinel Practice Research Network, the Bettering the Evaluation and Care of Health (BEACH) Program, and the General Practice Research Network (GPRN). RESULTS: Over 50% of all patients with ‘acute bronchitis’ had either chest or one or more systemic signs on physical examination. The rate of antibiotic prescribing for acute bronchitis was 79.6% of acute bronchitis visits using BEACH data 2001–2002 and varied from 68.6 (95% CI: 62.8–74.5%) in 2001 to 78.7 (95% CI: 72.2–85.2%) in 1999 using GPRN data. Penicillins, followed by macrolides, were the most commonly prescribed antibiotics. DISCUSSION: Australian GPs frequently prescribe antibiotics for ‘acute bronchitis’ despite guidelines to the contrary. One reason may be that many patients present with chest or systemic signs.N.P. Stocks, H. McElroy, G.P. Sayer and K. Duszynsk

Priorities for International Forest Research

The world is moving towards knowledge-based societies. Economies are globalizing. The global public goods value of forests is being recognised at the same time that the traditional role of state forest agencies in production forestry is being taken over by multi-national corporations. At the same time emerging technologies are greatly enhancing our ability to assess and monitor forest attributes, process and disseminate information, and enhance forest production. All of these changes will have an impact on how forest research is organized, who does it, and who pays for it. It seems inevitable that much traditional forestry research concerned with sustainability and productivity enhancement at the stand level, will be taken over by the private sector. However, there is going to be a major challenge in finding resources for research in support of the public goods values of forests at both the local, national and global levels. There is a widely held view that we are in the midst of a world forest crisis. It is not a crisis of declining production but one of erosion of public goods, environmental values of forests. So far, we have not seen a concerted scientific response to this crisis. The Inter-Governmental Panel on Forests (IPF) has given us the mandate to orchestrate such a response and the World Forestry Congress is a valuable opportunity to provide impetus to a new vision of forest science for the 21st century

Integrating landscape ecology into landscape practice in Central African Rainforests

Context: We describe how large landscape-scale conservation initiatives involving local communities, NGOs and resource managers have engaged with landscape scientists with the goal of achieving landscape sustainability. We focus on two landscapes where local people, practitioners and landscape ecol-ogists have co-produced knowledge to design conservation interventions. Objective: We seek to understand how landscape ecology can engage with practical landscape management to contribute to managing landscapes sustainably. Methods: We focus on two large tropical landscapes: the Sangha Tri-National landscape (Cameroon, Republic of Congo and the Central African Republic) and the Batéké-Léfini Landscape (Gabon and Republic of Congo). We evaluate (1) a participatory method used in the Sangha Tri-National landscape that embeds interdisciplinary researchers and practitioners within a landscape to apply transdisciplinary learning to landscape conservation and (2) a participatory landscape zoning method where interdisciplinary teams of conservation practitioners analyse local land and resource use in the Batéké-Léfini landscape. Results: We find that landscape ecology's tradition of understanding the historical context of resource use can inform landscape conservation practice and natural resource mapping. We also find that the Sangha Group provides an example for landscape ecology on how to integrate local people and their knowledge to better understand and influence landscape processes. Conclusions: Place-based engagement as well as the uptake of co-produced knowledge by policy makers are key in enabling sustainable landscapes. Success occurs when researchers, local communities and resource managers engage directly with landscape processes

Purchase, use and adaptation: interpreting ‘patented’ aids to the deaf in Victorian Britain

Despite the enormous number and variety of hearing devices sold in the nineteenth century, and currently displayed in a variety of museums across the UK and the United States, there has hitherto been no commercially focused study of the business of selling and making them. While this might be because remaining company records are very sparse, another key issue is that such technologies, unlike artificial limbs, do not fall obviously in the domain of disability, nor medicine or communications. Hence they have until recently been under-represented in the historical studies of the Victorian period. We focus on the diverse lived experiences of hard-of-hearing people who did not necessarily identify as (partially) ‘deaf’ but who were nevertheless treated normatively by hearing contemporaries as if relatively deaf. By engaging with their experience of hearing aids to either pass as ‘hearing’ or at least be visibly ‘hard-of-hearing’, our study complements the recent work of Jaipreet Virdi-Dhesi on medical encounters with deaf subjects; of Jennifer Esmail on Deaf sign-language culture, and of Mara Mills on USA hearing technologies in the twentieth century

Zirconia phase transformation in retrieved, wear simulated and artificially aged ceramic femoral heads

Zirconia in Zirconia toughened alumina ceramic hip replacements exists in an unstable state and can transform in response to stress giving the material improved fracture toughness. Phase transformation also occurs under hydrothermal conditions such as exist in vivo. To predict the hydrothermal aging that will occur in vivo accelerated aging procedures have been used, but validation of these models requires the study of retrieved hip joints. Here 26 retrievals are analysed to determine the degree of phase transformation in vivo. These were compared with virgin heads, heads that had undergone the accelerated aging process and heads wear tested to 5 million cycles in a hip simulator. Monoclinic content and surface roughness were measured using Raman spectroscopy and white light interferometry respectively. The monoclinic content for retrieved heads was 28.5% ± 7.8, greater than twice that in virgin, aged or wear tested heads and did not have a significant correlation with time, contrary to the predictions of the hydrothermal aging model. The surface roughness for retrieved heads in the unworn area was not significantly different to that in virgin, aged or unworn areas of wear tested heads. However in worn areas of the retrieved heads, the surface roughness was higher than observed in wear simulator testing. These results indicate that current testing methodologies do not fully capture the operational conditions of the material and the real performance of future new materials may not be adequately predicted by current pre-clinical testing methods. This article is protected by copyright. All rights reserve

Pinnipeds, people and photo identification: the implications of grey seal movements for effective management of the species

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this record.Grey seals (Halichoerus grypus) of the North-east Atlantic are protected at designated European Marine Sites (Special Areas of Conservation, SACs) typically during their reproductive periods and in the UK at Sites of Special Scientific Interest (SSSI). As a mobile marine species, grey seals spend other parts of their annual life cycle in non-designated habitat. There is limited information on individual grey seal movements in south-west England. Citizen science photo identification (PID) revealed the movements of 477 grey seals at a regional scale (54 haul-outs up to 230 km apart) for over a decade. Reconstructed movements showed considerable individual variability. Four SACs were linked to up to 18 non-designated sites and two SSSIs in Cornwall were linked to a maximum of 41 non-designated sites. Observations support the value of existing SSSIs at both the well-connected West and North Cornwall sites. Thirteen Marine Protected Areas (MPAs) were visited by grey seals from four SACs and two SSSIs in Cornwall. As a mobile species, grey seals could be included in English MPA management plans. The application of functional linkage from SACs and SSSIs, informed by the movements evidenced in this research, could aid management efforts. This analysis reveals grey seal movements occur across a complex network of interconnected designated and non-designated sites that need to be managed holistically for this species for which the UK has a special responsibility

The recent secular trend in grip strength among older adults: findings from the English Longitudinal Study of Ageing

Purpose: Weaker grip strength in older adults is associated with adverse health outcomes and is a key component of sarcopenia. The secular trend of grip strength is, therefore, relevant in the setting of ageing populations. A recent study suggested differences in this trend among countries in mainland Europe. We used data from the English Longitudinal Study of Ageing (ELSA) to investigate the recent secular trend of older English adults. Methods: We used data on participants aged 50–89 having their first measurement of grip strength in waves 2 (2002/2003), 4 (2008/2009) or 6 (2012/2013) of ELSA. Grip was measured using a Smedley dynamometer. We expressed grip values as Z-scores (number of standard deviations above the age and gender mean from normative data) for use in linear regression analyses examining the annual secular trend after adjustment for potential confounders. Results: We included a total of 11,476 participants from the three waves of ELSA. Grip strength declined across the three waves, with mean (SD) Z-scores of 0.01 (0.94), − 0.06 (0.97) and − 0.20 (0.98) in waves 2, 4 and 6, respectively. The annual Z-score decline after adjustments was 0.03 SDs (95% CI 0.02, 0.03) per year. Conclusion: We saw evidence of a recent slight decline in the grip strength of older English adults. Over the 9-year period of this study, the decline seen is equivalent to 65-year-olds’ mean strength declining to that previously seen in individuals at age 69. Further monitoring of secular trends in grip strength and investigation of possible causes are warranted

P324 RADIOGRAPHIC KNEE OSTEOARTHRITIS IS ASSOCIATED WITH AN INCREASE IN TRABECULAR BUT NOT CORTICAL BONE MINERAL DENSITY USING PERIPHERAL QUANTITATIVE CT

Digitalitzat per Artypla