Acceptability of digital vending machines to access STI and HIV tests in two UK cities.

OBJECTIVES: Prompt HIV and STI diagnosis and treatment is a public health priority and relies on accessible testing. Technology-based approaches to distribute test kits have the potential to increase access to testing. We evaluated the acceptability and uptake of vending machines in publicly available settings in Brighton and Hove (BH) and Bristol, North Somerset and South Gloucestershire (BNSSG), to distribute HIV rapid self-test and STI self-sample kits. METHODS: Seven machines were installed in BH and four in BNSSG. User characteristics, proportion of kits returned and test results, taken from the machine database and clinic records, combined with online questionnaires completed by self-recruited users and analysed using Stata and SPSS. RESULTS: 2536 kits were dispensed over 12 months (April 2022 to March 2023). The STI self-sample kits were most popular (74% of vends). 78% of kits dispensed were among users aged 16-35 years and 56% identified as male. 68% and 59% of users had either not tested in the last 12 months or never tested for HIV and STIs, respectively. 51% of STI kits were returned via post, lower than the local online service (65%). 208 users completed questionnaires. Convenience, desire for instant access and increased confidentiality were the most common reasons for using machines. 92% of respondents thought the machines were user-friendly and 97% would recommend the service. Concerns about safety and privacy while using the machine were reported by 42% and 66% of respondents. CONCLUSIONS: This study demonstrates that vending machines are an acceptable and effective means of accessing infrequent or never testers in the general population and can act as a horizontal intervention to tackle HIV and STIs. Research is needed to understand optimal machine locations to assure privacy and safety along with the long-term impact on sexual health services.

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana.

BACKGROUND: Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. CONCLUSION: The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.

Insomnia Medication Use by University Students: A Systematic Review.

Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected.

Strategies for reducing pain at dressing change in chronic wounds: protocol for a mapping review.

INTRODUCTION: Although pain experienced at dressing change has been reported as the worst aspect of living with chronic wounds, UK guidance for their management is primarily tailored to wound healing and only attends to pain as a secondary consideration. Consequently, there is little up-to-date guidance that specifically addresses how patients, carers and healthcare professionals should manage wound-related pain at dressing change. This mapping review will identify, describe and appraise the existing research evidence for strategies used to assess pain intensity and prevent or alleviate pain at dressing change in chronic wounds. In addition, it will highlight areas for future research and inform the development of up-to-date guidance for healthcare professionals. METHODS AND ANALYSIS: We will search MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (via Ovid SP), Embase (via Ovid SP), Cochrane Central Register of Controlled Trials (via Wiley Cochrane Library), Cumulative Index of Nursing and Allied Health Literature (via EBSCO) and the Web of Science Citation Index Expanded and Social Sciences Citation Index (via Clarivate Analytics). Screening will be undertaken independently by two reviewers, with any disagreements resolved through discussion. Included studies will be subject to coding, using a tested data extraction tool, by two reviewers working independently. The methodological quality of the studies included will be reviewed using quality assessment instruments appropriate for each study design (Cochrane Risk of Bias tool (RoB 2); Risk of Bias in Non-randomised Studies of interventions tool; Critical Appraisal Skills Programme tool). Data will be described narratively and also presented visually in an interactive web-based evidence and gap map. ETHICS AND DISSEMINATION: As this mapping review does not collect original data, ethical approval is not applicable. Findings will be disseminated via a written report, an interactive online mapping tool and in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021260130.

Greater male variability in daily energy expenditure develops through puberty.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

Assessing executive functions in free-roaming 2- to 3-year-olds.

Introduction: Core aspects of executive functions (EFs) are known to be related to academic skills such as literacy and numeracy. However, school outcomes may also be related to higher-level functions such as planning. Nevertheless, few studies have considered assessing natural manifestations of higher-level EFs in children who are on the cusp of entering formal schooling. One reason for this is the difficulty of obtaining ecologically valid measures of EFs in preschool-aged children. Method: We describe a novel task - building a striped Duplo tower subject to two constraints - designed to assess planning in real-world multi-action situation. Children were instructed to build a tower to a certain height by alternating between two different colors of blocks. Results: Performance on one of the constraints in this task was found to vary with age. Importantly, distinct components of multiple constraints planning performance predicted laboratory-based measures of inhibitory control and working memory efficacy. Discussion: Thus, this task provides a simple, cheap and effective way of assessing executive function in toddlers through the observation of natural behavior. It also opens up possibilities to investigate the neurodevelopment of EF in the real world.

Diversity and prevalence of nuisance arthropods detected by sticky traps in apartments in New Jersey.

Many nuisance arthropods occur in homes. In this study, nuisance arthropods are defined as any arthropod other than cockroaches and bed bugs. We examined nuisance arthropods found on sticky traps in 1,581 low-income apartments in four cities in New Jersey during 2018-2019 as part of a study for monitoring cockroach infestations. Four sticky traps (three in the kitchen, one in the bathroom) were placed in each apartment for approximately two weeks. Forty two percent of the apartments had nuisance arthropods on sticky traps. The relative abundance of different groups of arthropods were flies-36%, beetles-23%, spiders-14%, ants-10%, booklice-5%, and others-12%. The flies were further grouped into the following subgroups and their relative abundance were fungus gnats-42%, phorid flies-18%, moth flies-17%, fruit flies-10%, midges-8%, and others-5%. Among the beetles, 82% were stored product beetles (including spider beetles). Summer months (May-July) had a much higher frequency of nuisance arthropods occurrence than winter months (November-January). In addition to installing sticky traps, we also conducted interviews with 1,020 residents. Only 13% of the interviewed residents indicated sightings of nuisance arthropods. Resident interviews revealed a much higher relative frequency of sightings for flies (58%), much lower frequency for beetles (4%), and much higher frequency for mosquitoes compared to those captured on sticky traps. We conclude that sticky traps provide much more accurate information on indoor nuisance arthropod abundance and diversity than resident interviews and are a valuable tool for monitoring indoor nuisance arthropods.

British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023.

This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.

Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Two decades of the EU Water Framework Directive: Evidence of success and failure from a lowland arable catchment (River Wensum, UK).

The EU Water Framework Directive (WFD) is widely regarded as a seminal piece of environmental legislation. However, two decades since its inception, many European waterbodies are failing to meet its ambitious goal to ensure 'good' quantitative and qualitative status. Here, we investigate the impact of the WFD upon the environmentally sensitive yet heavily impacted River Wensum, a lowland arable catchment in eastern England. Compiling a dataset of 10,950 water quality samples collected from 57 sites across the catchment at approximately monthly intervals during 2000-2022, we assess the spatio-temporal dynamics of 12 priority pollutants, identify the major drivers of water quality change, and evaluate current and future compliance with WFD goals. Our analysis reveals improvements in wastewater treatment initiated significant declines (11-50 %) in the concentration of key sewage pollution indicators (phosphorus, ammonium, biological oxygen demand (BOD)) during the early 2000s. Conversely, agricultural pollution indicators (nitrogen, suspended solids, pesticides) displayed either limited change or a deterioration in water quality, with oxidised nitrogen concentrations in particular having increased 23 % during 2015-2022. Concentration spikes of organic chemical contaminants in recent years (propyzamide, tetrachloroethylene) raise concerns about increased riverine pollution from hazardous substances. Similarly, changes in winter (+13 %) and summer (-7 %) discharge over the past two decades have increased the risk of diffuse pollution mobilisation and reduced the dilution of point source pollutants, respectively. By 2022, 'good' or 'high' water quality status for organic matter pollution indicators (dissolved oxygen, BOD, ammonium) was achieved for >98 % of samples, however WFD compliance fell to just 46 % for phosphorus and 1.8 % for nitrogen. Projections to the end of the third River Basin Management Plan cycle (2027) reveal that whilst phosphorus compliance is likely to improve, nitrogen compliance failure will persist due to the existence of catchment legacy stores and climate change induced impacts on nitrogen mobilisation.

Comparative Efficacy of Superheated Dry Steam Application and Insecticide Spray Against Common Bed Bugs Under Simulated Field Conditions.

The common bed bug, Cimex lectularius L., is a difficult urban pest to control. A simulated field study was conducted to compare the efficacy of steam application and an insecticide mixture spray (0.05% acetamiprid and 0.06% bifenthrin mixture) against C. lectularius. Three types of furniture (desk chair, upholstered armchair, and wooden table) were treated in the laboratory. The efficacy of the treatments was evaluated by visual inspection and placement of interceptor traps under the legs of the furniture. One hundred mixed stages of an insecticide-resistant population of C. lectularius were released onto each furniture item. After a 10-day acclimation period, each furniture item received steam treatment, insecticide spray, or no treatment. The second application of treatment was conducted 14 d later. Bed bug counts from interceptors and visual inspections were recorded at 13 d and 28 d after the initial treatment. At 28 d, the mean (± SE) live bed bug count in the steam, spray, and control group was 1 ± 0, 2 ± 1, and 83 ± 10, respectively. Both treatment methods were highly effective in controlling bed bugs on furniture. The mean bed bug count from interceptors in the steam, spray, and control groups were 0.3 ± 0.2, 11 ± 7, and 47 ± 9, respectively. There was no significant difference in the efficacy between steam and spray treatments based on either visual inspection or bed bug counts from interceptors. However, based on interceptor counts, the steam treatment caused faster bed bug population reduction than insecticide sprays.

Evaluating contralateral neck failure in patients with lateralized OPSCC treated with transoral robotic surgery and neck management based on pre-operative SPECT-CT lymphatic mapping.

BACKGROUND: Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is relatively low, however, many OPSCC patients receive bilateral neck treatment. This study evaluates the oncological outcomes with management of the contralateral cN0 neck based on lymphatic mapping with single photon emission computed tomography (SPECT-CT). METHODS: Retrospective evaluation of patients with lateralized cT1-2 and contralateral cN0 OPSCC treated with primary surgery between December 2017 and October 2019. All patients underwent pre-operative lymphatic mapping using SPECT-CT. Clinical parameters including demographics, tumor characteristics and oncological outcomes were recorded. RESULTS: Thirteen patients underwent primary site resection with transoral robotic surgery (TORS) and ipsilateral neck dissection with or without adjuvant therapy. Twelve patients (92.3%) had ipsilateral drainage on SPECT-CT, whereas 1 (7.7%) patient had bilateral neck lymphatic drainage. Four patients (30.8%) underwent post-operative radiation therapy (PORT). Three patients with unilateral drainage on SPECT-CT underwent PORT with unilateral neck irradiation, and 1 patient with bilateral drainage underwent PORT with bilateral neck irradiation. Seven (53.8%) patients were staged as pT1, 6 (46.2%) patients as pT2, 6 (46.2%) patients were pN0, 3 (23.1%) patients were pN1, 1 (7.7%) patient was pN2a for and 3 (23.1%) patients were N2b. The median distance of the tumor from midline was 1.05 cm (0.0-1.58). Primary sites included tonsil (n = 10, 76.9%) and tongue base (n = 3, 23.1%). The median follow-up time was 15.4 months. All patients were disease free at the latest follow-up with no contralateral neck failures. CONCLUSIONS: Pre-operative mapping of lymphatic drainage in early stage OPSCC with SPECT-CT is a promising tool which can reduce treatment to the contralateral neck potentially without compromising oncological outcomes.

The Evaluation of a Clinical Decision Support Tool Using Natural Language Processing to Screen Hospitalized Adults for Unhealthy Substance Use: Protocol for a Quasi-Experimental Design.

BACKGROUND: Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in the usual care of patients hospitalized with conditions related to unhealthy substance use. The rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. An NLP tool to use routinely collected data in the electronic health record was previously validated for diagnostic accuracy in a retrospective study for screening unhealthy substance use. Our next step is a noninferiority design incorporated into a research protocol for clinical implementation with prospective evaluation of clinical effectiveness in a large health system. OBJECTIVE: This study aims to provide a study protocol to evaluate health outcomes and the costs and benefits of an AI-driven automated screener compared to manual human screening for unhealthy substance use. METHODS: A pre-post design is proposed to evaluate 12 months of manual screening followed by 12 months of automated screening across surgical and medical wards at a single medical center. The preintervention period consists of usual care with manual screening by nurses and social workers and referrals to a multidisciplinary Substance Use Intervention Team (SUIT). Facilitated by a NLP pipeline in the postintervention period, clinical notes from the first 24 hours of hospitalization will be processed and scored by a machine learning model, and the SUIT will be similarly alerted to patients who flagged positive for substance misuse. Flowsheets within the electronic health record have been updated to capture rates of interventions for the primary outcome (brief intervention/motivational interviewing, medication-assisted treatment, naloxone dispensing, and referral to outpatient care). Effectiveness in terms of patient outcomes will be determined by noninferior rates of interventions (primary outcome), as well as rates of readmission within 6 months, average time to consult, and discharge rates against medical advice (secondary outcomes) in the postintervention period by a SUIT compared to the preintervention period. A separate analysis will be performed to assess the costs and benefits to the health system by using automated screening. Changes from the pre- to postintervention period will be assessed in covariate-adjusted generalized linear mixed-effects models. RESULTS: The study will begin in September 2022. Monthly data monitoring and Data Safety Monitoring Board reporting are scheduled every 6 months throughout the study period. We anticipate reporting final results by June 2025. CONCLUSIONS: The use of augmented intelligence for clinical decision support is growing with an increasing number of AI tools. We provide a research protocol for prospective evaluation of an automated NLP system for screening unhealthy substance use using a noninferiority design to demonstrate comprehensive screening that may be as effective as manual screening but less costly via automated solutions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03833804; https://clinicaltrials.gov/ct2/show/NCT03833804. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42971.

Variation in human water turnover associated with environmental and lifestyle factors.

Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

What influences cancer treatment service access in Ghana? A critical interpretive synthesis.

OBJECTIVES: Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. The aim of this research was to assess existing literature on how these factors interplay and could be susceptible to local and national policy changes. DESIGN: This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. RESULTS: Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organisational and policy levels), which are dynamic and interacting, for example, community level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking in relation to determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. CONCLUSIONS: Future policy should prioritise multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.

The Continuum Between Hexagonal Planar and Trigonal Planar Geometries.

New heterometallic hydride complexes that involve the addition of {Mg-H} and {Zn-H} bonds to group 10 transition metals (Pd, Pt) are reported. The side-on coordination of a single {Mg-H} to Pd forms a well-defined σ-complex. In contrast, addition of three {Mg-H} or {Zn-H} bonds to Pd or Pt results in the formation of planar complexes with subtly different geometries. We compare their structures through experiment (X-ray diffraction, neutron diffraction, multinuclear NMR), computational methods (DFT, QTAIM, NCIPlot), and theoretical analysis (MO diagram, Walsh diagram). These species can be described as snapshots along a continuum of bonding between ideal trigonal planar and hexagonal planar geometries.