Exploring the acceptability of two self-sampling devices for human papillomavirus testing in the cervical screening context: a qualitative study of Muslim women in London

Objectives We explored Muslim women's attitudes to self-sampling for human papillomavirus (HPV) in the context of cervical cancer screening and their responses to two self-sampling devices.Setting A Muslim community centre in north-east London.Methods Following a talk given on the subject of cervical cancer and HPV at the community centre, 28 women were recruited to take part in three focus group discussions. The discussion covered cervical screening, self-sampling and HPV testing. Women were also asked for their responses to a swab self-sampling kit and a cervico-vaginal lavage device. Discussions were recorded and transcribed verbatim and the qualitative data were analysed using Framework Analysis.Results Participants were generally positive about cervical screening but acknowledged that some women in their community were reluctant to offend because of embarrassment, language difficulties, fear or because they were unmarried and did not want to communicate implicit messages about being sexually active. Self-sampling met a mixed response - women were concerned about not doing the test correctly, but thought that it might overcome barriers to screening for some women. HPV testing itself was thought to raise potentially difficult issues relating to trust and fidelity within marriages. Although most women said they would prefer to continue to have screening by a health professional, if they were to perform self-sampling, there was overwhelming preference for the swab over the lavage kit.Conclusions There was limited enthusiasm for self-sampling in this group of Muslim women who had mostly attended for cervical screening, but a clear preference for a swab rather than a cervico-vaginal lavage

Interactive approaches to the solution of a class of combinatorial problems

PhD ThesisThis thesis considers the usefulness of interaction between a human and a powerful computer in attempting to solve a class of discrete optimization problems. Some typical problems are described in chapters 1 and 2 and the effectiveness of their exact solution by existing methods is assessed. Chapter 3 presents some heuristic techniques which produce good approximate solutions and the value of such methods is discussed. An alternative approach, that of providing a mechanism for manmachine interaction is proposed in chapter 4. A system for providing easy access to a range of algorithmic and heuristic techniques is described. The system, named IMPACT, was implemented by the author and its many features include the interruption, interrogation, adjustment and resumption of a process or algorithm. Some novel interactive tree-manipulation techniques and their usage are introduced in chapter 5. This chapter also describes extensions to certain other heuristics in order to improve their power when used interactively. Throughout the thesis a job-shop scheduling problem serves as a useful vehicle for illustrating ideas. This problem was investigated extensively and chapter 6 is devoted to the topic. The idea of a critical path of jobs through machines is introduced together with the slack time of a job upon a machine under a particular schedule. Branch-and-bound approaches to the problem have been proposed in the past. The performance of such an approach has been substantially improved, as is shown by new results. The improvement stems from two sources both of which were discovered interactively; i) a different branching procedure designed to exploit features of the job-shop scheduling problem, and ii) more realistic lower bounds than those originally proposed. The final chapter discusses the generality of the approach and illustrates the extendability of IMPACT. Other discrete optimization problems are discussed briefly and a branch-andbound formulation to one of them, an assignment problem~ is presented. An interactive approach by other authors to the travelling salesman problem is reviewed and features similar to those experienced in the job-shop scheduling investigation are remarked upon. To conclude, the advantages to be gained from an interactive approach are discussed

First report of Laternula elliptica in the Antarctic intertidal zone

Many Antarctic marine invertebrates are considered to be highly stenothermal, subjected to loss of functionality at increased temperatures and so at high risk of mortality in a rapidly warming environment. The bivalve Laternula elliptica is often used as a model taxon to test these theories. Here, we report the first instance L. elliptica from an intertidal site. Genetic analysis of the tissue confirms the species identity. A total of seven animals ranging in length from 6 to 85 mm were collected from 3 × 0.25 m2 quadrats of intertidal sediments at St Martha Cove on James Ross Island, Eastern Antarctic Peninsula. Ambient temperatures of 7.5 °C within the sediment and 10 °C (air) were recorded. This raises questions as to the current perception that “many Antarctic marine invertebrates cannot adapt to higher temperatures”

THE PRICING EFFICIENCY OF AGRICULTURAL FUTURES MARKETS: AN ANALYSIS OF PREVIOUS RESEARCH RESULTS

The analysis examines quantitatively the findings of previous studies of the pricing efficiency of various agricultural markets using a logit framework. The findings provide insight into the importance of commodity characteristics, uncertainty, and testing procedures used on the results of past research of pricing efficiency. The study also identifies several areas for further research.Demand and Price Analysis,

Life across the divide: Comparative Studies of the Ecology and Physiology of Species across the Antarctic Intertidal Zone

This thesis describes the first detailed comparative study of Antarctic communities across the gradient of environmental conditions from terrestrial to marine zones. Sampling was undertaken at both sub-Antarctic (Scotia Arc) and Peninsula sites. This study is also the most detailed and comprehensive investigation of intertidal assemblages south of 60°S undertaken to date. Supralittoral, intertidal and, where possible, shallow sublittoral habitats were sampled along a latitudinal gradient from the Falkland Islands through the Scotia Arc (Bird Island, South Georgia and Signy Island (South Orkney Islands)) over one austral summer. Peninsula sites, in the vicinity of Rothera Research Station (Adelaide Island 67° 34.5’S), were studied in more detail over two austral summers, and one point sample was undertaken during the austral winter at Rothera Research Station. Contrary to the findings of previous studies, the Antarctic intertidal was found to support an unexpectedly rich and diverse community, with a total of 61 species being found at sites around Rothera Research Station, Adelaide Island. This is more than double the previous maximum richness reported in an Antarctic study. Intertidal assemblages at more northern Scotia Arc sites were less diverse and numerically abundant, the most depauperate sites being on Bird Island and South Georgia. Many of the taxa found are permanent residents in the intertidal near Rothera Research Station. Four-year-old colonies of the bryozoan Inversiula nutrix were found alive in summer samples, and a winter excavation of only 1 m2 of the intertidal icefoot revealed 17 species of both mobile and sessile taxa alive and present under the outer layer of rocks. The taxa present were predominantly marine species with only one possibly obligate intertidal animal being found, the halacarid mite Rhombognathus gressitti. The assemblages were virtually all located beneath the outer scoured surface of the intertidal rock matrix, in protected interstices. Both abundance and size of taxa increased with depth through the cobble boulder matrix suggesting that they are exploiting protected microhabitats in order to survive in this extreme environment. Preliminary ecophysiological studies suggest that the limpet Nacella concinna is capable of freeze tolerance and is able to survive all of the osmotically active water freezing, whilst the nemertean Antarctonemertes validum shows evidence of the presence of thermal hysteresis proteins (THPs). As such this is the first Antarctic and only the second marine invertebrate likely to possess THPs

Awareness of human papillomavirus among women attending a well woman clinic

Objectives: To assess the level and accuracy of public understanding of human papillomavirus (HPV) in the United Kingdom.Methods: Women attending a well woman clinic were asked to complete a questionnaire assessing HPV awareness and specific knowledge about the virus.Results: Questionnaires were completed by 1032 women, of whom 30% had heard of HPV. Older women, non-smokers, and those with a history of candida, genital warts, or an abnormal smear result were more likely to have heard of HPV. Even among those who had heard of HPV, knowledge was generally poor, and fewer than half were aware of the link with cervical cancer. There was also confusion about whether condoms or oral contraceptives could protect against HPV infection.Conclusions: In this relatively well educated sample, awareness and knowledge of HPV were poor. Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results, especially if HPV testing is soon to be introduced

Testing positive for human papillomavirus in routine cervical screening: examination of psychosocial impact

Objective To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.Design Cross sectional survey.Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.Setting Well women's clinic in London, UK.Population or Sample Four hundred and twenty-eight women aged 20-64 years.Methods Postal questionnaire survey.Main outcome measures Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.Results Women with normal cytology who tested positive for HPV (HPVdivided by) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267)=29, P<0.0001] and a screening specific measure of psychological distress [F(1,267)=69, P<0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV,. were significantly more distressed than HPV- women with the same smear result [F(1,267)=8.8, P=0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women.Conclusion The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety., distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening

Liquid polymorphism and density anomaly in a three-dimensional associating lattice gas

We investigate the phase diagram of a three-dimensional associating gas $(ALG)$ model. This model combines orientational ice-like interactions and ``van der Waals'' that might be repulsive, representing, in this case, a penalty for distortion of hydrogen bonds. These interactions can be interpreted as two competing distances making the connection between this model and continuous isotropic soft-core potentials. We present Monte Carlo studies of the $ALG$ model showing the presence of two liquid phase, two critical points and A density anomaly

Attitudes to self-sampling for HPV among Indian, Pakistani, African-Caribbean and white British women in Manchester, UK

Objective: To examine attitudes to self-sampling for human papillomavirus (HPV) testing among women from contrasting ethnic groups.Setting: Manchester, UK.Methods: Two hundred women of Indian, Pakistani, African-Caribbean and white British origin were recruited from social and community groups to participate in a questionnaire survey. The questionnaire included items on attitudes to self-sampling and intention to use the test.Results: Willingness to try to use the test was high, and women did not foresee religious or cultural barriers to self-sampling; however, a large proportion of women were concerned about doing the test properly. This concern was greatest in the Indian and African-Caribbean groups.Conclusions: Although women's willingness to try self-sampling for HPV is encouraging, worries about carrying out the procedure correctly must be addressed if women are to feel confident about the results of self-sampling methods and reassured by a negative result