Chemsex and the city: an investigation into recreational drug use, poly drug use, chemsex and sexual behaviours among HIV negative men who have sex with men

Recreational drug use and the emerging phenomenon of chemsex (the use of mephedrone, crystal methamphetamine and γ -hydroxybutyrate/γ -butryolactone (GHB/GBL) to enable, enhance and prolong sexual interactions), are of significant concern in men who have sex with men (MSM), particularly in the context of HIV and STI transmission. Prevalence data from the UK and Europe are lacking and no studies have examined changes in chemsex over time within a cohort of MSM. In this thesis I use data from two studies that recruited HIV negative MSM from sexual health clinics in England; the cross-sectional AURAH study (Attitudes to and Understanding Risk of Acquisition of HIV), 2013-2014, (n=1484), and the prospective cohort study, AURAH2 study (Attitudes to and Understanding Risk of Acquisition of HIV over Time) (n=1167), which collected online questionnaire data from 2015 to 2018. I investigate the prevalence of recreational drug use including chemsex, and associations with sexual behaviours, and examine whether prevalence of chemsex and sexual behaviour changed over time. Over half (54.7% AURAH, 60.4% AURAH2) of HIV negative MSM attending sexual health clinics self-reported recreational drug use, and whilst the proportion engaged in chemsex was less (21.8% AURAH, 32.3% AURAH2), it is significant in terms of vulnerability to HIV and STI infections. Prevalence of chemsex significantly declined during online follow-up of AURAH2 participants (n=622) from 31.8% (198/622) at first online questionnaire, to 11.1% (8/72; p < 0.001) at the 9th. Most measures of sexual behaviour also declined over the follow-up period. MSM engaged in recreational drug use, and in particular chemsex, are at significant risk of both STI and HIV infection, as well as other harms, and should be a focus for targeted prevention interventions such as regular HIV and STI testing and treatment, PrEP initiation and chemsex support, which is potentially only necessary for select, and relatively short periods of time

Fecal Fingerprints of Enteric Pathogen Contamination in Public Environments of Kisumu, Kenya, Associated with Human Sanitation Conditions and Domestic Animals.

Young children are infected by a diverse range of enteric pathogens in high disease burden settings, suggesting pathogen contamination of the environment is equally diverse. This study aimed to characterize across- and within-neighborhood diversity in enteric pathogen contamination of public domains in urban informal settlements of Kisumu, Kenya, and to assess the relationship between pathogen detection patterns and human and domestic animal sanitation conditions. Microbial contamination of soil and surface water from 166 public sites in three Kisumu neighborhoods was measured by enterococcal assays and quantitative reverse transcription polymerase chain reaction (qRT-PCR) for 19 enteric pathogens. Regression was used to assess the association between observed sanitary indicators of contamination with enterococci and pathogen presence and concentration, and pathogen diversity. Seventeen types of pathogens were detected in Kisumu public domains. Enteric pathogens were codetected in 33% of soil and 65% of surface water samples. Greater pathogen diversity was associated with the presence of domestic animal feces but not with human open defecation, deteriorating latrines, flies, or disposal of human feces. Sanitary conditions were not associated with enterococcal bacteria, specific pathogen concentrations, or "any pathogen". Young children played at 40% of observed sites. Managing domestic animal feces may be required to reduce enteric pathogen environmental contamination in high-burden settings

The speaking vocabulary of grade two

Thesis (M.A.)--Boston Universit

The landscape of enteric pathogen exposure of young children in public domains of low-income, urban Kenya: The influence of exposure pathway and spatial range of play on multi-pathogen exposure risks.

Young children are infected by a diverse variety of enteric pathogens in low-income, high-burden countries. Little is known about which conditions pose the greatest risk for enteric pathogen exposure and infection. Young children frequently play in residential public areas around their household, including areas contaminated by human and animal feces, suggesting these exposures are particularly hazardous. The objective of this study was to examine how the dose of six types of common enteric pathogens, and the probability of exposure to one or multiple enteric pathogens for young children playing at public play areas in Kisumu, Kenya is influenced by the type and frequency of child play behaviors that result in ingestion of soil or surface water. Additionally, we examine how pathogen doses and multi-pathogen exposure are modified by spatial variability in the number of public areas children are exposed to in their neighborhood. A Bayesian framework was employed to obtain the posterior distribution of pathogen doses for a certain number of contacts. First, a multivariate mixed effects tobit model was used to obtain the posterior distribution of pathogen concentrations, and their interdependencies, in soil and surface water, based upon empirical data of enteric pathogen contamination in three neighborhoods of Kisumu. Then, exposure doses were estimated using behavioral contact parameters from previous studies and contrasted under different exposure conditions. Pathogen presence and concentration in soil varied widely across local (< 25 meter radius area) and neighborhood-level scales, but pathogens were correlated among distinct surface water samples collected near to each other. Multi-pathogen exposure of children at public play areas was common. Pathogen doses and the probability of multi-pathogen ingestion increased with: higher frequency of environmental contact, especially for surface water; larger volume of soil or water ingested; and with play at multiple sites in the neighborhood versus single site play. Child contact with surface water and soil at public play areas in their neighborhood is an important cause of exposure to enteric pathogens in Kisumu, and behavioral, environmental, and spatial conditions are determinants of exposure

Milk Product Safety and Household Food Hygiene Influence Bacterial Contamination of Infant Food in Peri-Urban Kenya.

BACKGROUND: Milk is a common infant food in peri-urban Kenya that can transmit diarrhea-causing enteric pathogens. Little is known about how contamination of milk at point of purchase and household handling of milk-based infant foods contribute to infant exposure to enteric pathogens. OBJECTIVE: To compare the prevalence and concentrations of bacterial indicator organisms and enteric pathogens in unpackaged, fresh pasteurized, and ultra-high temperature (UHT) treated milk at purchase and assess the influence of the type of milk used to prepare infant food on contamination of this food. METHODS: Paired samples of purchased milk and infant food prepared with this milk were obtained from 188 households in low-income neighborhoods in Kisumu, Kenya. Samples were cultured on selective media to isolate Salmonella enterica, Shigella spp., Klebsiella aerogenes, Proteus spp., and Escherichia coli, with pathogens validated by PCR. Probability of detection of these bacteria was compared by milk product treatment and packaging method, and between milk at point of purchase vs. food at point of infant consumption. RESULTS: Unpackaged milk was most contaminated at point of purchase, but bacterial contamination was also present in pasteurized and UHT milk at purchase. Presence of bacteria in UHT and fresh pasteurized milk at purchase predicted presence of the same bacteria type in infant food. Prevalence of bacterial contamination and concentration level for bacterial indicators generally increased between point of purchase and consumption in UHT and fresh pasteurized milk-based food but decreased in unpackaged milk-based food. Prevalence of the four fecal bacteria were similar in infant foods prepared with each type of milk. CONCLUSION: Both pre-market contamination and post-purchase handling influence the likelihood of infants ingesting foods contaminated by diarrheal pathogens

Monocytes and γδ T cells control the acute phase response to intravenous zoledronate: insights from a phase IV safety trial

Aminobisphosphonates (NBPs) are used widely against excessive bone resorption in osteoporosis and Paget’s disease as well as in metastatic bone disease and multiple myeloma. Intravenous NBP administration often causes mild to severe acute phase responses (APRs) that may require intervention with analgesics and antipyretics and lead to treatment noncompliance and non-adherence. We here undertook a phase IV safety trial in patients with osteoporosis to investigate the APR of otherwise healthy individuals to first-time intravenous treatment with the NBP zoledronate. This study provides unique insight into sterile acute inflammatory responses in vivo, in the absence of confounding factors such as infection or cancer. Our data show that both periphera

Palliative radiotherapy after oesophageal cancer stenting (ROCS): a multicentre, open-label, phase 3 randomised controlled trial

Background: patients with advanced oesophageal cancer have a median survival of 3-6 months, and most require intervention for dysphagia. Self-expanding metal stent (SEMS) insertion is the most typical form of palliation in these patients, but dysphagia deterioration and re-intervention are common. This study examined the efficacy of adjuvant external beam radiotherapy (EBRT) compared with usual care alone in preventing dysphagia deterioration and reducing service use after SEMS insertion.Methods: this was a multicentre, open-label, phase 3 randomised controlled trial based at cancer centres and acute care hospitals in England, Scotland, and Wales. Patients (aged ≥16 years) with incurable oesophageal carcinoma receiving stent insertion for primary management of dysphagia were randomly assigned (1:1) to receive usual care alone or EBRT (20 Gy in five fractions or 30 Gy in ten fractions) plus usual care after stent insertion. Usual care was implemented according to need as identified by the local multidisciplinary team (MDT). Randomisation was via the method of minimisation stratified by treating centre, stage at diagnosis (I-III vs IV), histology (squamous or non-squamous), and MDT intent to give chemotherapy (yes vs no). The primary outcome was difference in proportions of participants with dysphagia deterioration (&gt;11 point decrease on patient-reported European Organisation for Research and Treatment of Cancer quality of life questionnaire-oesophagogastric module [QLQ-OG25], or a dysphagia-related event consistent with such a deterioration) or death by 12 weeks in a modified intention-to-treat (ITT) population, which excluded patients who did not have a stent inserted and those without a baseline QLQ-OG25 assessment. Secondary outcomes included survival, quality of life (QoL), morbidities (including time to first bleeding event or hospital admission for bleeding event and first dysphagia-related stent complications or re-intervention), and cost-effectiveness. Safety analysis was undertaken in the modified ITT population. The study is registered with the International Standard Randomised Controlled Trial registry, ISRCTN12376468, and ClinicalTrials.gov, NCT01915693, and is completed.Findings: 220 patients were randomly assigned between Dec 16, 2013, and Aug 24, 2018, from 23 UK centres. The modified ITT population (n=199) comprised 102 patients in the usual care group and 97 patients in the EBRT group. Radiotherapy did not reduce dysphagia deterioration, which was reported in 36 (49%) of 74 patients receiving usual care versus 34 (45%) of 75 receiving EBRT (adjusted odds ratio 0·82 [95% CI 0·40-1·68], p=0·59) in those with complete data for the primary endpoint. No significant difference was observed in overall survival: median overall survival was 19·7 weeks (95% CI 14·4-27·7) with usual care and 18·9 weeks (14·7-25·6) with EBRT (adjusted hazard ratio 1·06 [95% CI 0·78-1·45], p=0·70; n=199). Median time to first bleeding event or hospital admission for a bleeding event was 49·0 weeks (95% CI 33·3-not reached) with EBRT versus 65·9 weeks (52·7-not reached) with usual care (adjusted subhazard ratio 0·52 [95% CI 0·28-0·97], p=0·038; n=199). No time versus treatment interaction was observed for prespecified QoL outcomes. We found no evidence of differences between trial group in time to first stent complication or re-intervention event. The most common (grade 3-4) adverse event was fatigue, reported in 19 (19%) of 102 patients receiving usual care alone and 22 (23%) of 97 receiving EBRT. On cost-utility analysis, EBRT was more expensive and less efficacious than usual care.Interpretation: patients with advanced oesophageal cancer having SEMS insertion for the primary management of their dysphagia did not gain additional benefit from concurrent palliative radiotherapy and it should not be routinely offered. For a minority of patients clinically considered to be at high risk of tumour bleeding, concurrent palliative radiotherapy might reduce bleeding risk and the need for associated interventions.Funding: National Institute for Health Research Health Technology Assessment Programme.</p

Concert recording 2019-03-26

[Track 1]. Amarilli mia bella / Guilio Caccini -- [Track 2]. Les Berceaux / Gabriel Fauré -- [Tracks 3-4]. O del mio dolce ardor / Christoph Willibald von Gluck -- [Track 5]. Song of the blackbird / Roger Quilter -- [Track 6]. Per Piera bell\u27idol mio / Vincenzo Bellini -- [Track 7]. Beau soir / Claude Debussy -- [Track 8]. Heart, we will forget him / Aaron Copland -- [Track 9]. Lascia ch\u27io pianga / George Frideric Handel -- [Track 10]. E amore un ladroncello from Cosí fan tutte / Wolfgang Amadeus Mozart -- [Track 11]. Tell me oh blue blue sky / Vittorio Giannini -- [Track 12]. O del mio amoto ben / Stefano Donuady -- [Track 13]. The roadside fire / Ralph Vaughan Williams -- [Track 14]. A blackbird singing / Michael Head -- [Track 15]. Saper Vorreste from Un ballo in maschera / Giuseppe Verdi -- [Track 16]. Mit Würd und Hoheit angetan from Die Schöpfung / Joseph Haydn -- [Track 17]. The one way / Charles Ives -- [Track 18]. From Sechs Lieder, op. 13. Ich stand in dunklen Träumen Liebeszauber Ich hab\u27 in Deinem Auge / Clara Schumann -- [Track 19]. From Though love be a day. Thy fingers make early flowers All the white horses are in bed / Gwenyth Walker -- [Track 20]. Der Rattenfänger / Hugo Wolf -- [Track 21]. Fin Ch\u27han dal vano from Don Giovanni / W.A. Mozart -- [Track 22]. From Brenntano Lieder. Ich wollte ein Straüßlein binden Saüsle, liebe Myrte / Richard Strauss

The evaluation of the Scottish Borders/Food Train Eat Well Age Well implementation of the Patients Association Nutrition Checklist

Background: The Patients Association Nutrition Checklist (Checklist) is a simple tool that can be used to identify older adults who may be at risk of malnutrition at an early stage and provide simple advice and signpost to additional support. The Scottish Borders Council, in partnership with the Eat Well Age Well Charity, have been implementing the Checklist across health and social care organisations since Autumn 2021. Aims: To see if it was possible to use the Checklist in 12 organisations that work with older adults in the community, and to understand what the impact of the Checklist is for older adults and the staff who use it. Methods: Information regarding how the Checklist was used and the experiences of staff who work in the organisations was collected using online surveys. Organisation staff and the Checklist trainer (Eat Well Age Well) were interviewed about their experiences of using the Checklist. Key Findings: Use of the Checklist varied across organisations, data show it was completed with 461 older adults and that 7.4% were considered at risk of malnutrition. The Checklist: was easy to use; helped with difficult conversations and referrals to additional services (dietetics, GP); and was quick to deliver, costing £4.17-£6.83 per older adult. Things that made using the Checklist more difficult included: short appointment times; older adult capacity/communication issues; and staffing levels. As a result of using the Checklist, organisation staff developed improved skills and confidence spotting and managing malnutrition and health improvements were seen in older adults. Patient and Public Involvement (PPI): PPI representatives, using lived experience, contributed to the study design and interpretation/dissemination of results. Conclusions: Using the Checklist could help to increase awareness of malnutrition, improve conversations and prevent older adult ill-health. Recommendations for future use include embedding Checklist use at strategic level in organisations to support intended use of the Checklist

Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study

OBJECTIVES: The aim of this study was to test whether household environmental hygiene and behavioural conditions moderated associations between diarrhoea and enteric pathogen detection in infants 5 months of age in Kenya and pathogen sources, including latrine access, domestic animal co-habitation and public food sources. DESIGN: Cross-sectional study utilising enrolment survey data of households participating in the Safe Start cluster-randomised controlled trial . SETTING: Kisumu, Kenya. PARTICIPANTS: A total of 898 caregivers with 5-month (22 week ± 1 week) aged infants were enrolled in the study and completed the enrolment survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes were (1) caregiver-reported 7-day diarrhoea prevalence and (2) count of types of enteric viruses, bacteria and parasites in infant stool. Exposures and effect modifiers included water access and treatment, cohabitation with domestic animals, sanitation access, handwashing practices, supplemental feeding, access to refrigeration and flooring. RESULTS: Reported handwashing after handling animals (adjusted odds ratio (aOR)=0.20; 95% CI=0.06 to 0.50) and before eating (aOR=0.44; 95% CI=0.26 to 0.73) were strongly associated with lower risk of caregiver-reported diarrhoea, while cohabitation with animals (aOR=1.54; 95% CI=1.01 to 2.34) living in a household with vinyl-covered dirt floors (aOR=0.60; 95% CI=0.45 to 0.87) were strongly associated with pathogen codetection in infants. Caregiver handwashing after child (p=0.02) or self-defecation (p=0.03) moderated the relationship between shared sanitation access and infant exposure to pathogens, specifically private latrine access was protective against pathogen exposure of infants in households, where caregivers washed hands after defecation. In the absence of handwashing, access to private sanitation posed no benefits over shared latrines for protecting infants from exposure. CONCLUSION: Our evidence highlights eliminating animal cohabitation and improving flooring, postdefecation and food-related handwashing, and safety and use of cow milk sources as interventions to prevent enteric pathogen exposure of young infants in Kenya. TRIAL REGISTRATION NUMBER: NCT03468114