Defining the Urethritis Syndrome in Men Using Patient Reported Symptoms

To evaluate self-reported symptoms to guide urethritis diagnosis, symptomatic men being evaluated for urethritis were asked about seven symptoms captured during history-taking. Discharge and dysuria were significantly associated with urethritis and, when combined with genital irritation and itching, identified 95% of urethritis cases; odor and urinary frequency performed poorly

Meatal Swabs Contain Less Cellular Material and Are Associated with a Decrease in Gram Stain Smear Quality Compared to Urethral Swabs in Men

Urethral swabs are the samples of choice for point-of-care Gram stain testing to diagnose Neisseria gonorrhoeae infection and nongonococcal urethritis (NGU) in men. As an alternative to urethral swabs, meatal swabs have been recommended for the collection of urethral discharge to diagnose N. gonorrhoeae and Chlamydia trachomatis infection in certain populations by nucleic acid amplification testing (NAAT), as they involve a less invasive collection method. However, as meatal swabs could be sampling a reduced surface area and result in fewer collected epithelial cells compared to urethral swabs, the adequacy of meatal swab specimens to collect sufficient cellular material for Gram stain testing remains unknown. We enrolled 66 men who underwent either urethral or meatal swabbing and compared the cellular content and Gram stain failure rate. We measured the difference in swab cellular content using the Cepheid Xpert CT/NG sample adequacy control crossing threshold (SACCT) and determined the failure rate of Gram stain smears (GSS) due to insufficient cellular material. In the absence of discharge, meatal smears were associated with a significant reduction in cellular content (P = 0.0118), which corresponded with a GSS failure rate significantly higher than that for urethral swabs (45% versus 3%, respectively; P < 0.0001). When discharge was present, there was no difference among results from urethral and meatal swabs. Therefore, if GSS testing is being considered for point-of-care diagnosis of N. gonorrhoeae infection or NGU in men, meatal swabs should be avoided in the absence of a visible discharge

The Role of Resilience in Adolescents with Complex Trauma: A Look at Therapists’ Perspectives

The purpose of this research study was to look at what resilience factors therapists view to be important in their work with adolescents who have experienced complex trauma. This study used a qualitative research design, in the form of semi-structured interviews to collect data. The main findings of this study showed that 100% of the participants perceive healthy attachments to be a leading resilience factor in complex trauma. Additionally, according to the participants in this study, unhealthy coping skills (promiscuity, chemical use, self-harm and dissociation) were discussed as survival techniques. Finally, the use of resilience in therapy was addressed with incongruent findings. Participants differed in their view of client readiness to process their complex trauma. The findings of this study can be used to help therapists gain a better understanding of what resilience factors are common in clients who have experienced complex trauma, which will assist them in their work together

Interactions between Lactobacillus crispatus and bacterial vaginosis (BV)-Associated bacterial species in initial attachment and biofilm formation

Certain anaerobic bacterial species tend to predominate the vaginal flora during bacterial vaginosis (BV), with Gardnerella vaginalis being the most common. However, the exact role of G. vaginalis in BV has not yet been determined. The main goal of this study was to test the hypothesis that G. vaginalis is an early colonizer, paving the way for intermediate (e.g., Fusobacterium nucleatum) and late colonizers (e.g., Prevotella bivia). Theoretically, in order to function as an early colonizer, species would need to be able to adhere to vaginal epithelium, even in the presence of vaginal lactobacilli. Therefore, we quantified adherence of G. vaginalis and other BV-associated bacteria to an inert surface pre-coated with Lactobacillus crispatus using a new Peptide Nucleic Acid (PNA) Fluorescence In Situ Hybridization (FISH) methodology. We found that G. vaginalis had the greatest capacity to adhere in the presence of L. crispatus. Theoretically, an early colonizer would contribute to the adherence and/or growth of additional species, so we next quantified the effect of G. vaginalis biofilms on the adherence and growth of other BV-associated species by quantitative Polymerase Chain Reaction (qPCR) technique. Interestingly, G. vaginalis derived a growth benefit from the addition of a second species, regardless of the species. Conversely, G. vaginalis biofilms enhanced the growth of P. bivia, and to a minor extent of F. nucleatum. These results contribute to our understanding of BV biofilm formation and the progression of the disorder.This work was supported by European Union funds (FEDER/COMPETE) and by national funds (FCT) under the project with reference FCOMP-01-0124-FEDER-008991 (PTDC/BIA-MIC/098228/2008) and in part by funds from the National Institutes of Health (P60-MD002256). AM acknowledges the FCT individual fellowship SFRH/BD/62375/2009

Über die Implementierung der verallgemeinerten Finite-Element-Methode

The Generalized Finite Element Method (GFEM) combines desirable features of the standard Finite Element Method and the meshless methods. The key difference of the GFEM compared to the traditional FEM is the construction of the ansatz space. Each node of the finite element mesh carries a number of ansatz functions, expressed in terms of the global coordinate system. Those ansatz functions are multiplied by a partition of unity and serve as element ansatz functions in the patch constituted by the elements incident at the node. Using this technique to create the ansatz space allows for arbitrary ansatz functions. C0-continuity is enforced by construction. The ansatz is enriched using analytical functions or numerical approximations derived from side calculations containing a-priori knowledge of the solution close to singularities. The performance of GFEM with a higher order of polynomial ansatz functions is compared to traditional h-, p- and hp-extensions of the FEM. Most of the efficient solvers, e.g. multi-grid or cg, cannot be applied to the semi-definite systems resulting from a GFEM discretization. Several solving strategies are evaluated for higher order GFEM. The work concludes with a description of the implementation of the GFEM with a flexible object-oriented framework using C++.Die verallgemeinerte Finite-Element-Methode (GFEM) kombiniert Vorteile der klassischen Finite-Element-Methode mit Vorteilen der netzfreien Methoden. Hauptunterschied beim Vergleich der GFEM mit der FEM ist die Konstruktions des Ansatzes. Jeder Knoten des FE-Netzes trägt eine Anzahl an Ansatzfunktionen, die in globalen Koordinaten ausgedrückt werden. Diese Ansatzfunktionen werden mit einer Partition of Unity multipliziert und dienen als Elementansatzfunktionen für den Patch, der aus den angrenzenden Elementen des Knotens gebildet wird. Durch diese Art des Ansatzes wird die C0-Stetikeit für beliebige Ansatzfunktionen gewährleistet. Der Ansatz wird mit analytischen Funktionen und numerischen Näherungsrechnungen angereichert und enthält somit a-priori Wissen der Lösung in der Nähe von Singularitäten. Die Performance der GFEM mit Ansätzen höhere Ordnung wird mit klassischen h-, p- und hp-Diskretisierungen der FEM verglichen. Die meisten effizienten Löser, z.B. Multi Grid Verfahren oder die CG-Methode, können nicht für das semi-definite Gleichungssystem verwendet werden, dass aus der GFEM-Diskretisierung resultiert. Verschiedene Lösungsstrategien für GFEM-Diskretisierungen höhere Ordnungen werden untersucht. Die Arbeit schließt mit einer Beschreibung der Implementierung der Methode in Form eines Objekt-orientierten Frameworks in C++ ab

Rush to Judgment: The STI-Treatment Trials and HIV in Sub-Saharan Africa

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence. Discussion: Examination of the trials reveals critical methodological problems sufficient to account for statistically insignificant outcomes in nine of the ten trials. Shortcomings of the trials include weak exposure contrast, confounding, non-differential misclassification, contamination and effect modification, all of which consistently bias the results toward the null. In any future STI-HIV trial, ethical considerations will again require weak exposure contrast. The complexity posed by HIV transmission in the genital microbial environment means that any future STI-HIV trial will face confounding, non-differential misclassification and effect modification. As a result, it is unlikely that additional trials would be able to answer the question of whether STI control reduces HIV incidence. Conclusions: Shortcomings in published RCTs render invalid the conclusion that treating STIs and other cofactor infections is ineffective in HIV prevention. Meta-analyses of observational studies conclude that STIs can raise HIV transmission efficiency two- to fourfold. Health policy is always implemented under uncertainty. Given the known benefits of STI control, the irreparable harm from not treating STIs and the likely decline in HIV incidence resulting from STI control, it is appropriate to expand STI control programmes and to use funds earmarked for HIV prevention to finance those programmes

The Role of Resilience in Adolescents with Complex Trauma: A Look at Therapists’ Perspectives

The purpose of this research study was to look at what resilience factors therapists view to be important in their work with adolescents who have experienced complex trauma. This study used a qualitative research design, in the form of semi-structured interviews to collect data. The main findings of this study showed that 100% of the participants perceive healthy attachments to be a leading resilience factor in complex trauma. Additionally, according to the participants in this study, unhealthy coping skills (promiscuity, chemical use, self-harm and dissociation) were discussed as survival techniques. Finally, the use of resilience in therapy was addressed with incongruent findings. Participants differed in their view of client readiness to process their complex trauma. The findings of this study can be used to help therapists gain a better understanding of what resilience factors are common in clients who have experienced complex trauma, which will assist them in their work together

Prevalence of bacterial vaginosis in Portuguese pregnant women and vaginal colonization by Gardnerella vaginalis

Supplemental information for this article can be found online at: http://dx.doi.org/10.7717/ peerj.3750#supplemental-information.Background We aimed to determine the prevalence of vaginal colonization by Gardnerella vaginalis and of bacterial vaginosis (BV) in Portuguese pregnant women, and to identify risk factors for BV and G. vaginalis colonization in pregnancy. Methods A cross-sectional study was conducted among pregnant women aged 18 years who were attending in two public hospitals of the Northwest region of Portugal. Epidemiological data was collected by anonymous questionnaire. BV was diagnosed by Nugent criteria and G. vaginalis presence was identified by polymerase chain reaction. Crude associations between the study variables and BV or G. vaginalis colonization were quantified by odds ratios (ORs) and their 95% confidence intervals (CIs). Results The prevalences of BV and of G. vaginalis colonization among Portuguese pregnant women were 3.88% and 67.48%, respectively. Previous preterm delivery and colonization by G. vaginalis were factors with very high OR, but only statistically significant for a 90% CI. Conversely, higher rates of G. vaginalis colonization were found in women with basic educational level (OR = 2.77, 95% CI [1.335.78]), during the second trimester of pregnancy (OR = 6.12, 95% CI [1.8020.85]) and with BV flora (OR = 8.73, 95% CI [0.50153.60]). Discussion Despite the lower number of women with BV, prevalence ratios and association with risk factors were similar to recent European studies. However, the percentage of healthy women colonized by G. vaginalis was significantly higher than many previous studies, confirming that G. vaginalis colonization does not always lead to BV development.This work was supported by the FCT Strategic Project of UID/BIO/04469/2013 unit. DM was funded by the FCT individual fellowship SFRH/BD/87569/2012. NC is an investigator FCT. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio

Some Remarks on Generalized Finite Element Methods (GFEM) in Solid Mechanics

International audienceAfter a short introduction to Generalized Finite Element Methods (GFEM) for two-dimensional triangular elements, a technique is presented to impose Dirichlet-type boundary conditions to global higher order GFEM ansatz spaces. The convergence rates of $h$-, $p$-, $hp$- and enriched $p$-versions of the GFEM are discussed with respect to singularities. The method is applied to a two dimensional Poisson model problem and the global errors measured in energy norm are compared

Sexually transmitted infections: challenges ahead.

: WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.<br/