Testing for sexually transmitted infections among students: a discrete choice experiment of service preferences

Objectives To assess preferences among students for sexually transmitted infection (STI) testing services, with a view to establishing strength of preference for different service attributes. Design Online discrete choice experiment (DCE) questionnaire. Setting South East of England. Participants A convenience sample of 233 students from two universities. Outcomes Adjusted ORs in relation to service characteristics. Results The study yielded 233 responses. Respondents’ ages ranged from 16 to 34 years with a mean age of 22 years. Among this sample, the respondents demonstrated strong preferences for a testing service which provided tests for all STIs including syphilis, herpes and HIV (OR 4.1; 95% CI 3.36 to 4.90) and centres staffed by a doctor or nurse with specialist knowledge of STIs (OR 2.1; 95% CI 1.78 to 2.37). Receiving all test results, whether positive or negative, was also significantly preferable to not being notified when tests were all negative (‘no news is good news’; OR 1.3; 95% CI 1.16 to 1.5). The length of time waiting for an appointment and the method by which results are received were not significant service characteristics in terms of preferences. Patient level characteristics such as age, sex and previous testing experience did not predict the likelihood of testing. Conclusions This study demonstrates that of the examined attributes, university students expressed the strongest preference for a comprehensive testing service. The next strongest preferences were for being tested by specialist STI staff and receiving negative as well as positive test results. However, it remains unclear how strong these preferences are in relation to characteristics which were not part of the study design and whether or not they are cost-effective

Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study

Objectives: To establish which aspects of sexually transmitted infection (STI) testing services are important to STI testing service users. Methods: 10 focus groups consisting of previous or existing users of STI testing services were conducted in community settings in the south east of England. Groups were quota sampled based on age, gender and sexual orientation. Data were analysed using Framework Analysis. Results: 65 respondents (58% men) participated. Perceived expertise of staff was the key reason for attendance at genitourinary medicine services rather than general practice. Although some respondents voiced a willingness to test for STIs within general practice, the apparent limited range of tests available in general practice and the perceived lack of expertise around sexual health appeared to discourage attendance at general practice. The decision of where to test for STIs was also influenced by past experience of testing, existing relationships with general practice, method of receiving test results and whether the patient had other medical conditions such as HIV. Conclusions: No one type of STI testing service is suitable for all patients. This is recognised by policymakers, and it now requires commissioners and providers to make services outside of genitourinary medicine clinics more acceptable and attractive to patients, in particular to address the perceived lack of expertise and limited range of STIs tests available at alternative testing sites

Assessing user preferences for sexually transmitted infection testing services: a discrete choice experiment

Objective: To assess user preferences for different aspects of sexually transmitted infection (STI) testing services. Design: A discrete choice experiment. Setting: 14 centres offering tests for STIs in East Sussex, England. Participants: People testing for STIs. Main outcome measure: (Adjusted) ORs in relation to preferred service characteristics. Results: 3358 questionnaires were returned; mean age 26 (SD 9.4) years. 70% (2366) were recruited from genitourinary medicine (GUM) clinics. The analysis suggested that the most important characteristics to users were whether 'staff had specialist STI knowledge' compared with 'staff without it' (OR 2.55; 95% CI 2.47 to 2.63) and whether 'tests for all STIs' were offered rather than 'some' (OR 2.19; 95% CI 2.12 to 2.25). They remained the most important two service characteristics despite stratifying the analysis by variables such as age and sex. Staff levels of expertise were viewed as particularly important by people attending CASH centres, women and non-men who have sex with men. A 'text or call to a mobile phone' and 'dropping in and waiting' were generally the preferred methods of results reporting and appointment system, respectively. Conclusions: This study suggests that people testing for STIs place particular importance on testing for all infections rather than some and staff with specialist STI knowledge. Thus, targets based purely on waiting up to 48 h for an appointment are misguided from a user perspectiv

An ultra-scale-down method to predict diafiltration performance during formulation of concentrated mAb solutions

Formulation of monoclonal antibody (mAb) solutions using membrane filtration processing is a critical unit operation in the preparation of antibody therapies. A key constraint in formulation process development, particularly in the early stages of development and when using high protein concentration solutions, is the availability of material for experimental studies. Ultra-scale down (USD) technologies use a combination of critical flow regime analysis, bioprocess modelling and experimentation at the milliliter scale to enable a more effective process development approach significantly reducing process material, cost and time requirements (Rayat et al, 2016). The ability to predict the performance of large-scale (LS) operations, e.g. flux profile characteristics and changes in protein structure, will help maximize the value of eventual high cost pilot-scale runs during process development. In this study a USD membrane device, comprising a sheared cell unit with a rotating disc and with an effective membrane area of 0.00021 m2 developed at University College London, is used to predict the performance of a LS cross-flow membrane cassette of area 0.11 m2. The USD set up was designed to mimic the LS in terms of processing volumes, membrane area and process times. Computational Fluid Dynamics (CFD) is implemented to characterize average shear rates as a function of suspension viscosities and disc speed of the USD membrane device. A series of trials at USD scale established the effect of average shear rate on flux and the rate of flux decline during a diafiltration operation reaching 7 diafiltration volumes. A series of LS runs were carried out at different cross flow rates covering a similar range of average shear rates as the USD trials. Good correlation was obtained between USD and LS performance using constant average shear rate over the membrane surface as the basis for scale translation between the two scales of operation. The predicted effect of change in shear rate on flux in USD matched that found in LS. This scale correlation on performance was additionally verified by studying the effect of type and concentration of mAb. The comparable process performance was achieved at USD with 520-fold reduction in effective membrane area, required process material and diafiltration buffer for the trial. Future studies will include membrane concentration operations and evaluating sensitivity to stress-related effects and the impact of operation at higher protein concentrations. Rayat, A.CME; Chatel, A; Hoare, M; Lye, G.J (2016). Ultra scale-down approaches to enhance the creation of bioprocesses at scale: impacts of process shear stress and early recovery stages. Current Opinion in Chemical Engineering 14:150-15

Unconventional superconductivity in the nickel-chalcogenide superconductor, TlNi2_2Se2_2

We present the results of a study of the vortex lattice (VL) of the nickel chalcogenide superconductor TlNi2Se2, using small angle neutron scattering. This superconductor has the same crystal symmetry as the iron arsenide materials. Previous work points to it being a two-gap superconductor, with an unknown pairing mechanism. No structural transitions in the vortex lattice are seen in the phase diagram, arguing against d-wave gap symmetry. Empirical fits of the temperature-dependence of the form factor and penetration depth rule out a simple s-wave model, supporting the presence of nodes in the gap function. The variation of the VL opening angle with field is consistent with earlier reports of of multiple gaps

Reviewing art therapy research : a constructive critique

The literature search that informed our review initially yielded 12,122 papers of potential interest, derived from seven databases. After applying a series of filters we arrived at 92 papers on which we base our findings, thoughts and recommendations for future work. Our methodological approach was informed by the systematic review guidance published by the Centre for Reviews and Dissemination (2009), and the Arts Council definition of ‘arts activities’. Hence we considered papers reporting therapeutic arts interventions conducted on 'patients' which included some measurement of a health state. After excluding any research on people less than age 18, we selected studies where participants had active (as opposed to passive) engagement with the therapy/treatment/medium. Only study types which were quantitative were included in this review. Rather than simply criticise the execution of the research we applied our own expertise to the process. It was immediately evident that definitions and categories would pose some difficulties as there is much variety in the language used to describe the arts, therapies and treatment. This is a problem of indexing, causing the literature search and initial screening to be a laborious process. The most commonly reported art activities were: writing, music, art and dance. The most numerous health condition studied was mental health followed by cognitive function, stress and cancer. Most research was carried out in the US and the UK. As a discipline, psychology featured regularly. When arts therapists were involved in the research the descriptions and possible effects of the art medium tended to be better elucidated. Future research into the use of art therapy in healthcare will benefit from a synthesis of approaches that can retain the more robust aspects of, for example, RCTs with the insights that can be derived from qualitative methods

Fault and magmatic interaction within Iceland's western rift over the last 9kyr

We present high-resolution 'Chirp' sub-bottom profiler data from Thingvallavatn, a lake in Iceland's western rift zone. These data are combined with stratigraphic constraints from sediment cores to show that movement on normal faults since 9 ka are temporally correlated with magmatic events, indicating that movements were controlled by episodic dyke intrusion. Sediment depo-centres and the focus of subsidence migrated westwards over 3-4 kyr towards the locus of subsequent brittle failure. We interpret this subsidence as related to dyke intrusion a few km along strike, originating from the Hengill volcanic system, which occurred prior to major dyking, faulting and subsidence within the lake at 1.9 ka