Imagining interventions for collective sex environments

Frank’s (2018) article provides an excellent summary of transdisciplinary research concerned with collective sex environments, synthesizing highly diverse studies spanning five decades. The contributing papers utilize a broad range of methods and reflect many key sexual health risks across several diverse and distinct populations. For many readers, such as ourselves, with a particular interest in a single population, Frank’s synthesis provides a much needed and entirely fascinating wider perspective. This overarching vantage point can teach us about similarities and differences across populations, while simultaneously illuminating the populations and research we know so well through a different lens. As such, the paper provides an essential contribution to the literature. However, rather than champion the paper’s many strengths, within this Commentary we wish to grapple with what could be seen as its potential shortcomings. Our aim here is not be critical for the sake of it, but to somewhat playfully push debates further about many issues addressed within the paper. In this way, we wish to initiate more dialogue concerning collective sex, concomitant risks, and imaginative ways to ameliorate such risks

Low levels of chemsex among men who have sex with men, but high levels of risk among men who engage in chemsex: analysis of a cross-sectional online survey across four countries

Background: This paper establishes the prevalence of chemsex drug use among men who have sex with men (MSM), the extent to which these drugs are used in a sexual context, as well as their associated behaviours and circumstances of use. Methods: Data from a cross-sectional, online survey of 2328 MSM recruited via gay sociosexual media in Scotland, Wales, Northern Ireland and the Republic of Ireland were analysed. Results: While almost half (48.8%) of participants had ever taken illicit drugs, lifetime chemsex drug use was less common (18.0%) and far fewer reported chemsex drug use in the last year (8.2%) or last 4 weeks (3.0%). Just over one-quarter (27.1%) of men who used chemsex drugs in the last year reported no sexualised drug use, but almost three-quarters (72.9%) did. Only 6.1% of the whole sample reported sexualised chemsex drug use in the last year. The odds of reporting chemsex in the last year were significantly higher for men aged 36–45 years (AOR = 1.96), single men (AOR = 1.83), men who were HIV positive (AOR = 4.01), men who report high-risk sex (AOR = 4.46), being fisted (AOR = 7.77) or had sex in exchange for goods other than money (AOR = 4.7) in the last year and men who reported an HIV test in the last 3 months (AOR = 1.53). Discussion: Only a small proportion of MSM in Scotland, Wales, Northern Ireland and the Republic of Ireland reported chemsex, and, for the first time, it is demonstrated that not all chemsex drug use was sexualised. Nevertheless, MSM who engage in chemsex (MWEC) reported substantial sexual risk inequalities. These novel findings highlight several opportunities for intervention, particularly around the multiple vulnerabilities of MWEC, opportunities for early identification of those most vulnerable to chemsex-related harm and the potential to develop a specialised responsive patient pathway

Young men who have sex with men's use of social and sexual media and sex-risk associations: cross-sectional, online survey across four countries

Objective There has been an increase in new HIV diagnoses among young men who have sex with men (YMSM) over the past decade in both UK and US contexts, with online sex-seeking implicated in driving this development. This study sought to examine YMSM's use of a variety of social and sexual networking websites and € apps', and assess sexual risk behaviours. Design YMSM were recruited from across four countries in Britain and Ireland, via an online survey using convenience sampling. Data were collected from 2668 men, of whom 702 were aged 18-25 €..years. Results Facebook use was almost ubiquitous and for largely social reasons; sexual media use was common with 52% using gay sexual networking (GSN) websites frequently and 44% using similar apps frequently. We found increased odds of high-risk condomless anal intercourse associated with the length of time users had been using GSN websites and lower levels of education. We found no significant differences across the four countries in sexual risk behaviours. Conclusions YMSM are a heterogeneous population with varied sexual health needs. For young men with digital literacy, individual-level online interventions, targeted and tailored, could be directed towards frequent users with lower levels of education. Variation in demographic characteristics of GSN websites and app users may affect who interventions are likely to reach, depending on where they are targeted. However, interventions, which may catch young men earlier, also provide a major opportunity for reducing sexual health inequalities

Location, safety and (non) strangers in gay men’s narratives on ‘hook-up’ apps

Hook-up websites and apps are said to be transforming the sexual lives of gay men and have been linked with the apparent erosion of gay publics as the basis for identity politics and social action. This article examines these dynamics in the interview and focus-group talk of gay men living on the economic and geographical margins of metropolitan gay culture. It offers perspectives on the importance of location – class, generation and space – for the experience of digital media, the negotiation of safety, and the new codifications and elaborations on sex with the (non) stranger; a figure who is not alien, yet not familiar, in sexual sociality. Reflecting on these situated perspectives in connection with debates on the erosion of gay publics, this article argues against monolithic framings of gay men’s sexual lives after digital media

Age related factors influence HIV testing within subpopulations: a cross sectional survey of MSM within the Celtic nations

Objectives: Despite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing. Methods: Cross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations—Scotland, Wales, Northern Ireland and Ireland (n=2436)—were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16–25 (n=447), 26–45 (n=1092) and ≥46 (n=897). Results: Multivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26–45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16–25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV. Conclusion: Key differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma

Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys

Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level

A rapid review of sexual wellbeing definitions and measures: should we now include sexual wellbeing freedom?

An increasing number of studies refer to sexual wellbeing and/or seek to measure it, and the term appears across various policy documents, including sexual health frameworks in the UK. We conducted a rapid review to determine how sexual wellbeing has been defined, qualitatively explored and quantitatively measured. Eligible studies selected for inclusion from OVID Medline, PsychInfo, PubMed, Embase, CINAHL were: in English language, published after 2007, were peer-reviewed full articles, focused on sexual wellbeing (or proxies for, e.g. satisfaction, function), and quantitatively or qualitatively assessed sexual wellbeing. We included studies with participants aged 16–65. Given study heterogeneity, our synthesis and findings are reported using a narrative approach. We identified 162 papers, of which 10 offered a definition of sexual wellbeing. Drawing upon a socio-ecological model, we categorised the 59 dimensions we identified from studies under three main domains: cognitive-affect (31 dimensions); inter-personal (22 dimensions); and socio-cultural (6 dimensions). Only 11 papers were categorised under the socio-cultural domain, commonly focusing on gender inequalities or stigma. We discuss the importance of conceptualising sexual wellbeing as individually experienced but socially and structurally influenced, including assessing sexual wellbeing freedom: a person’s freedom to achieve sexual wellbeing, or their real opportunities and liberties

Investigations into the well-controlled stereoselective ring-opening polymerisation of lactide

Polylactide (PLA) is a biodegradable and biocompatible alternative to traditional petrochemicalbased polymers. Synthesised by the ring-opening polymerisation of lactide (LA), the dehydrated form of lactic acid, PLA sits within a renewable cycle, and can be used in many commodity and biomedical applications. The intrinsic stereochemistry of LA can lead to a variety of polymer microstructures, and current industrially used initiators allow no control over this. Within this thesis a series of investigations into the use of amine tris(phenolate) metal complexes as stereoselective initiators for the ROP of LA are discussed. Chapter 1 introduces the field of ring-opening polymerisation (ROP) via a coordination insertion mechanism, presents previously reported initiators, and examines the influence of stereocomplexation on the physical properties of PLA chains. This introductory chapter also includes an in-depth review of recent developments in poly(phenolate) complexes of Group 4 and rare earth metals. Chapter 2 describes the synthesis of a series of isopropoxide and zwitterionic Group 4 complexes featuring the amine tris(phenolate) ligand motif, with emphasis on the effect of ligand variation on complex structure. The potential of the resulting complexes as initiators for the ROP of LA is also investigated, with in depth kinetic studies allowing for a proposed diastereoselective mechanism of stereocontrol. Chapter 3 details the synthesis of a series of borohydride and amide Group 4 amine tris(phenolate) complexes, and investigates their potential as initiators for the ROP of rac-LA. Chain-end analysis and kinetic studies are included, providing the basis for mechanistic discussions. Chapter 4 focuses on the synthesis of stereoblock PLA materials in a stereospecific manner, and co-block PLA-PEG materials by the reinitiation of short-chain macroinitiators. The effect of stereocomplexation on the thermal properties of these materials is investigated. Chapter 5 concerns the synthesis of a series of isopropanol and zwitterionic rare earth complexes featuring the amine tris(phenolate) ligand motif. The potential of these complexes as initiators for the ROP of rac-LA is also investigated, but only slight stereocontrol was observed in selected cases. Chapter 6 provides details of procedures employed in the synthesis of ligands, complexes and polymers within this thesis, as well as details of the analytical techniques used in their characterisation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Preliminary observations of muscle fibre cross sectional area of flexor digitorum brevis in cadaver feet with and without claw toes

<p>Abstract</p> <p>Background</p> <p>In order to facilitate normal gait, toes require to be in a rectus position during the propulsive phase. This requires a correct balance and sequence of activity of the intrinsic musculature of the feet. Alteration of this balance and sequence may lead to the development of claw toes. Atrophy of the lumbricals occurs in the development of claw toes, but it is not known if changes occur in any other intrinsic muscles, including flexor digitorum brevis. This study set out to investigate whether hypertrophic changes were evident in flexor digitorum brevis in feet with claw toes.</p> <p>Methods</p> <p>Four cadaver feet were investigated, two with rectus toes and two with claw toes. Flexor digitorum brevis was removed from each, and seven anatomically significant tissue sections from each muscle were routinely processed, cut and stained. One hundred and sixty muscle fibre cross sectional areas were measured from each section.</p> <p>Results</p> <p>The mean age of the donors was 81.5 years, and three of the four were female. Results showed that the cross sectional area of fibres from feet with claw toes was 417 μg²significantly greater (p < 0.01) than the cross sectional area of fibres from feet with rectus toes, which was 263 μg².</p> <p>Conclusions</p> <p>Although this study has several limitations, preliminary observations reveal that flexor digitorum brevis muscle fibre cross sectional area is significantly reduced in feet with claw toes. This would indicate a relationship between muscle fibre atrophy of flexor digitorum brevis and clawing of the lesser toes.</p

High-Q-factor Al [subscript 2]O[subscript 3] micro-trench cavities integrated with silicon nitride waveguides on silicon

We report on the design and performance of high-Q integrated optical micro-trench cavities on silicon. The microcavities are co-integrated with silicon nitride bus waveguides and fabricated using wafer-scale silicon-photonics-compatible processing steps. The amorphous aluminum oxide resonator material is deposited via sputtering in a single straightforward post-processing step. We examine the theoretical and experimental optical properties of the aluminum oxide micro-trench cavities for different bend radii, film thicknesses and near-infrared wavelengths and demonstrate experimental Q factors of > 10[superscript 6]. We propose that this high-Q micro-trench cavity design can be applied to incorporate a wide variety of novel microcavity materials, including rare-earth-doped films for microlasers, into wafer-scale silicon photonics platforms