The people living with HIV stigma survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay and heterosexual men.

We aim to understand the difference in stigma and discrimination, in particular sexual rejection, experienced between gay and heterosexual men living with HIV in the UK. The People Living with HIV StigmaSurvey UK 2015 recruited a convenience sample of persons with HIV through over 120 cross sector community organisations and 46 HIV clinics to complete an online survey. 1162 men completed the survey, 969 (83%) gay men and 193 (17%) heterosexual men, 92% were on antiretroviral therapy. Compared to heterosexual men, gay men were significantly more likely to report worrying about workplace treatment in relation to their HIV (21% vs. 11%), worrying about HIV-related sexual rejection (42% vs 21%), avoiding sex because of their HIV status (37% vs. 23%), and experiencing HIV-related sexual rejection (27% vs. 9%) in the past 12 months. In a multivariate logistic regression controlling for other sociodemographic factors, being gay was a predictor of reporting HIV-related sexual rejection in the past 12 months (aOR 2.17, CI 1.16, 4.02). Both gay and heterosexual men living with HIV experienced stigma and discrimination in the past 12 months, and this was higher for gay men in terms of HIV-related sexual rejection. Due to the high proportion of men reporting sexual rejection, greater awareness and education of the low risk of transmission of HIV among people on effective treatment is needed to reduce stigma and sexual prejudice towards people living with HIV.

Experiences of stigma and discrimination in social and healthcare settings among trans people living with HIV in the UK.

The People Living with HIV StigmaSurvey UK 2015 was a community led national survey investigating experiences of people living with HIV in the UK in the past 12 months. Participants aged 18 and over were recruited through over 120 cross-sector community organisations and 46 HIV clinics to complete an anonymous online survey. Trans is an umbrella term which refers to individuals whose current gender identity is different to the gender they were assigned at birth. Trans participants self-identified via gender identity and gender at birth questions. Descriptive analyses of reported experiences in social and health care settings were conducted and multivariate logistic regression analyses were used to identify sociodemographic predictors of reporting being treated differently to non-HIV patients, and being delayed or refused healthcare treatment in the past 12 months. 31 out of 1576 participants (2%) identified as trans (19 trans women, 5 trans men, 2 gender queer/non-binary, 5 other). High levels of social stigma were reported for all participants, with trans participants significantly more likely to report worrying about verbal harassment (39% vs. 23%), and exclusion from family gatherings (23% vs. 9%) in the last 12 months, compared to cisgender participants. Furthermore, 10% of trans participants reported physical assault in the last 12 months, compared to 4% of cisgender participants. Identifying as trans was a predictor of reporting being treated differently to non-HIV patients (48% vs. 30%; aOR 2.61, CI 1.06, 6.42) and being delayed or refused healthcare (41% vs. 16%; aOR 4.58, CI 1.83, 11.44). Trans people living with HIV in the UK experience high levels of stigma and discrimination, including within healthcare settings, which is likely to impact upon health outcomes. Trans-specific education and awareness within healthcare settings could help to improve service provision for this demographic.

New Measurement of the π0 radiative decay width.

High precision measurements of the differential cross sections for π0 photoproduction at forward angles for two nuclei, 12C and 208Pb, have been performed for incident photon energies of 4.9-5.5 GeV to extract the π0→γγ decay width. The experiment was done at Jefferson Lab using the Hall B photon tagger and a high-resolution multichannel calorimeter. The π0→γγ decay width was extracted by fitting the measured cross sections using recently updated theoretical models for the process. The resulting value for the decay width is Γ(π0→γγ)=7.82±0.14(stat)±0.17(syst) eV. With the 2.8% total uncertainty, this result is a factor of 2.5 more precise than the current Particle Data Group average of this fundamental quantity, and it is consistent with current theoretical predictions.

Examples of kinship analysis where Profiler Plus™ was not discriminatory enough for the identification of victims using DNA identification.

The identification of the victims of the 2009 Victorian bushfires disaster, as in other mass disasters, relied on a number of scientific disciplines - including DNA analysis. As part of the DVI response, DNA analysis was performed to assist in the identification of victims through kinship (familial matching to relatives) or direct (self source of sample) matching of DNA profiles. The majority of the DNA identifications made (82%) were achieved through kinship matching of familial reference samples to post mortem (PM) samples obtained from the victims. Although each location affected by the bushfires could be treated as a mini-disaster (having a small closed-set of victims), with many such sites spread over vast areas, DNA analysis requires that the short tandem repeat (STR) system used be able to afford enough discrimination between all the DVI cases to assign a match. This publication highlights that although a 9-loci multiplex was sufficient for a DVI of this nature, there were instances that brought to light the short comings of using a 9-loci multiplex for kinship matching--particularly where multiple family members are victims. Moreso it serves to reinforce the recommendation that a minimum of 12 autosomal STR markers (plus Amelogenin) be used for DNA identification of victims which relies heavily on kinship matching.

The importance of Guthrie cards and other medical samples for the direct matching of disaster victims using DNA profiling.

The identification of disaster victims through the use of DNA analysis is an integral part of any Disaster Victim Identification (DVI) response, regardless of the scale and nature of the disaster. As part of the DVI response to the 2009 Victorian Bushfires Disaster, DNA analysis was performed to assist in the identification of victims through kinship (familial matching to relatives) or direct (self source sample) matching of DNA profiles. Although most of the DNA identifications achieved were to reference samples from relatives, there were a number of DNA identifications (12) made through direct matching. Guthrie cards, which have been collected in Australia over the past 30 years, were used to provide direct reference samples. Of the 236 ante-mortem (AM) samples received, 21 were Guthrie cards and one was a biopsy specimen; all yielding complete DNA profiles when genotyped. This publication describes the use of such Biobanks and medical specimens as a sample source for the recovery of good quality DNA for comparisons to post-mortem (PM) samples.

Taste does not determine daily intake of dilute sugar solutions in mice.

When a rodent licks a sweet-tasting solution, taste circuits in the central nervous system that facilitate stimulus identification, motivate intake, and prepare the body for digestion are activated. Here, we asked whether taste also determines daily intake of sugar solutions in C57BL/6 mice. We tested several dilute concentrations of glucose (167, 250, and 333 mM) and fructose (167, 250, and 333 mM). In addition, we tested saccharin (38 mM), alone and in binary mixture with each of the sugar concentrations, to manipulate sweet taste intensity while holding caloric value constant. In experiment 1, we measured taste responsiveness to the sweetener solutions in two ways: chorda tympani nerve responses and short-term lick tests. For both measures, the mice exhibited the following relative magnitude of responsiveness: binary mixtures > saccharin > individual sugars. In experiment 2, we asked whether the taste measures reliably predicted daily intake of the sweetener solutions. No such relationship was observed. The glucose solutions elicited weak taste responses but high daily intakes, whereas the fructose solutions elicited weak taste responses and low daily intakes. On the other hand, the saccharin + glucose solutions elicited strong taste responses and high daily intakes, while the saccharin + fructose solutions elicited strong taste responses but low daily intakes. Overall, we found that 1) daily intake of the sweetener solutions varied independently of the magnitude of the taste responses and 2) the solutions containing glucose stimulated substantially higher daily intakes than did the solutions containing isomolar concentrations of fructose. Given prior work demonstrating greater postoral stimulation of feeding by glucose than fructose, we propose that the magnitude of postoral nutritive stimulation plays a more important role than does taste in determining daily intake of dilute sugar solutions.

Early pregnancy termination with mifepristone and misoprostol in the United States.

BACKGROUND: Mifepristone and a prostaglandin have been used successfully to terminate pregnancy in Europe and China. We report the results of a large U.S. study of mifepristone and misoprostol in women with pregnancies of up to nine weeks' duration. METHODS: We administered 600 mg of mifepristone and then 400 microg of misoprostol two days later to 2121 women seeking termination of their pregnancies at 17 centers. The women were observed for four hours after the administration of misoprostol and returned on day 15 for final assessment. RESULTS: Two thousand fifteen women completed the final assessment. Among them, pregnancy was terminated in 762 of the 827 women pregnant for < or =49 days (92 percent), 563 of the 678 women pregnant for 50 to 56 days (83 percent), and 395 of the 510 women pregnant for 57 to 63 days (77 percent) (P<0.001). Termination occurred within 4 hours after the administration of misoprostol in 49 percent of the women and within 24 hours in 75 percent. Failures, defined as cases requiring surgical intervention for medical reasons or because the patient requested it, the abortion was incomplete, or the pregnancy was ongoing, increased with increasing duration of pregnancy. The largest increase was in failures representing ongoing pregnancy, which increased from 1 percent in the < or =49-days group to 9 percent in the 57-to-63-days group (P<0.001). Abdominal pain, nausea, vomiting, diarrhea, and vaginal bleeding also increased with advancing gestational age. Two percent of the women in the < or =49-days group, as compared with 4 percent in each of the other two groups, were hospitalized, underwent surgical interventions, and received intravenous fluids (P=0.008). CONCLUSIONS: This mifepristone-misoprostol regimen is effective in terminating pregnancies, especially in women with pregnancies of 49 days' duration or less.

PIP: The availability of medical abortion in the US and elsewhere could lead to greater access to safer abortion services. This study assessed the capability of mifepristone (600 mg) and misoprostol (400 mcg 2 days later) to terminate pregnancies of up to 63 days' duration. Enrolled were 2121 US women recruited from 17 Planned Parenthood, university hospital, and free-standing abortion clinics. Among the 2015 women who returned for the follow-up visit at day 15, the rates of pregnancy termination were 92% in women with pregnancies of durations of 49 days or under, 83% in the 50-56 days group, and 77% in the 57-63 days group (p 0.001). Abortion occurred within 4 hours of misoprostol administration in 49% of women and within 24 hours in 75%. Termination rates were higher for women with no previous induced abortions. Side effects such as abdominal pain, nausea, vomiting, diarrhea, and vaginal bleeding were frequent and increased with gestational age. 2% of women with pregnancies of 49 days' gestation or less, compared with 4% in both the 50-56 days and 57-63 days groups, were hospitalized, underwent surgical intervention, and received intravenous fluids. The success rate in this study was lower than that reported by other researchers. This may be related, in part, to the lack of experience with medical abortion in the US.

Operative outcomes of minimally invasive saphenous vein harvest.

BACKGROUND: The longest incision used in surgery is the standard incision for harvesting the greater saphenous vein for arterial grafting. This long incision is associated with significant pain and morbidity. We present a comparative study between two relatively less invasive techniques: the standard bridge technique (BT) and the endoscopic saphenous vein harvest (ESVH). PATIENTS AND METHODS: This is a prospective, nonrandomized, case-matched study of contemporaneous minimally invasive saphenous vein harvest in patients undergoing multiple vessel coronary artery bypass grafting (CABG). Data points include operative time, total wound length, length of vein harvested, intraoperative complications, conversions to open, injury to the graft, postoperative complications and hospital length of stay. Follow-up continued for 8 weeks postdischarge. RESULTS: Within a 10-month period (July 1996 to May 1997), 60 saphenous vein harvests were performed, with 29 by BT and 31 by ESVH. Patient demographics were well matched, except for a larger number of patients with peripheral vascular disease in the ESVH group. ESVH only required 2.3 incisions versus 5 for the BT (P = 0.000001), whereas ESVH produced on average longer veins of 53.9 cm versus 47.7 cm for BT (P = 0.05). Harvest times were comparable in the two groups. However, mean vein preparation times, incision closure times, and total vein operative times for the BT were, respectively, 18.5 minutes, 35.1 minutes, and 94 minutes versus significantly less times of 11.3 minutes (P = 0.009), 10.6 minutes (P = 0.000001), and 73 minutes (P = 0.0001), respectively, for ESVH. The early, minor wound complication rate was 32% for the ESVH group versus 3% for the BT group (P = 0.0048). However, excluding small wound hematomas, the wound complication rate in the ESVH group fell to 13%. Graft quality was acceptable in both groups. CONCLUSIONS: ESVH was demonstrated to be a useful procedure to harvest saphenous veins for CABG surgery. The ESVH technique allowed the harvesting of a longer vein, via shorter and fewer incisions and in less time. However, for maximum operating room efficiency with the new technology, staff education is essential. There was a greater incidence of minor wound complications in the ESVH group; however, the majority of these ESVH complications were small wound hematomas, which did not occur as surgeon experience with the technique increased.

Impact of the introduction of new medical methods on therapeutic abortions at the Royal Infirmary of Edinburgh.

OBJECTIVE: To assess the impact of the introduction of new medical methods on the provision of therapeutic abortions at the Royal Infirmary Edinburgh. DESIGN: A review of the total number of abortions performed by medical and surgical means between 1989 and 1995 (inclusive); a prospective survey of the terminations of pregnancy (< or = 9 weeks of gestation) performed over the six-month period of January to June 1994; and a questionnaire of the reasons why women chosen a particular method. SETTING: Large teaching hospital in Scotland. SUBJECTS: One thousand and seven women seeking early pregnancy termination between January and June 1994. MAIN OUTCOME MEASURES: Proportion of pregnancies terminated by medical means; comparison of complete abortion rate, incidence of complications and morbidity following both medical and surgical methods (< or = 9 weeks of gestation); reasons for preference of the method of abortion. RESULTS: Since 1991 there has been a progressive increase in the number of medical abortions performed at the Royal Infirmary of Edinburgh, and by 1994 the majority of women (57%) seeking abortion at < or = 9 weeks chose a medical method. Women who chose medical abortion had more years at full-time education and were less likely to smoke (P < 0.04). Both medical and surgical methods were highly effective (> 96% complete abortion) with a low incidence of complications and morbidity. However, women who had chosen the medical method were less likely to receive antibiotics for suspected endometritis than their surgical counterparts (chi 2, P = 0.0001). CONCLUSIONS: If this trend towards medical methods in Edinburgh is repeated elsewhere, it will inevitably have an impact on gynaecological services by releasing staff and operating time for other purposes.

PIP: Data on 329 medical (drug-induced) abortions were compared with data on 215 vacuum aspiration abortions to determine the impact of new medical methods on therapeutic abortions. Medical abortions were performed at less than 9 weeks' gestation, while vacuum aspirations were performed at less than 12 weeks' gestation. All abortions were performed at the Royal Infirmary of Edinburgh, Scotland, during January-June 1994. The medical abortion method included 200 mg oral mifepristone and 0.5 mg gemeprost (vaginal pessary) or 600 mcg oral misoprostol 36-48 hours after administration of mifepristone. Since 1991, in terms of early pregnancy termination, the number of medical abortions has increased and the number of vacuum aspirations has decreased at the Royal Infirmary. Women who chose the medical method of pregnancy termination were more likely than those who chose vacuum aspiration not to smoke (60% vs. 51%), to have completed at least 19 years of formal education (18.5% vs. 13%), and to have had a previous induced abortion (32.5% vs. 24%) (p 0.04). Complete abortion rates were similar (96.4% for medical abortion and 97.9% for surgical abortion). Complications were rare for both methods. Women who had undergone vacuum aspiration were more likely to receive antibiotics for suspected endometritis than those who opted for medical abortion (9.6% vs. 1.2%; p = 0.0001). Postabortion bleeding was more likely to be perceived as heavier than normal menses in the medical abortion group than in the surgical abortion group (66% vs. 11%; p = 0.001). The two most important sources of information on abortion methods were medical staff (87%) and the information sheet (40%). The reduced demand for vacuum aspirations has released operating room time for other gynecological procedures. If the trend continues in Edinburgh and elsewhere, it will influence the provision of abortion services nationwide.

Combining medical and mechanical methods of cervical ripening. Does it increase the likelihood of successful induction of labor?

OBJECTIVE: To determine if combining two commonly used methods or cervical ripening (intracervical prostaglandin E2 [Pge2] gel and Foley balloon catheter) would result in a higher number of successful inductions and fewer cesarean sections when compared to PGE2 gel alone. STUDY DESIGN: Seventy-eight patients with unfavorable cervixes eligible for induction of labor were prospectively randomized to receive either one dose (0.5 mg) of PGE2 gel followed by insertion of a 24-French Foley catheter (group 1, 41 patients) or two doses of 0.5 mg of intracervical gel (group 2, 37 patients). Outcome parameters included change in Bishop score, number of failed inductions, rate of cesarean section, rate of uterine hyperstimulation and postpartum infection. RESULTS: Patients in group 1 had a significant increase in posttreatment Bishop scores (7.26 +/- 2.0 SD vs. 4.82 +/- 1.8 P = .0001) and fewer failed inductions (0 vs. 6, P = .009) when compared to patients in group 2. Abdominal delivery rates, uterine hyperstimulation and infections complications were not different between the two groups. CONCLUSION: The combination of the Foley balloon and prostaglandin gel significantly improved the Bishop score and led to fewer failed inductions, although it did not increase the vaginal delivery rate.

The biologic role of B2 integrins in the host response to expanded polytetrafluoroethylene.

We hypothesized that the adherence of leukocytes to a vascular graft surface is mediated by B2 integrins. We studied integrin expression and monoclonal antibody inhibition of peripheral blood leukocyte (PBL) binding in vitro and CD11b expression in vivo. Human PBL were grown on ePTFE in culture and labeled with monoclonal antibodies to CD11a, -b, -c, and/or CD18. Percentage of monoclonal antibody binding and inhibition of leukocyte adherence was studied for up to 30 min using flow cytometry. ePTFE segments were implanted subcutaneously in SH-1 mice and PBL harvested 4 days later. PBL binding of monoclonal antibodies against CD11b was measured using flow cytometry. CD18 was constitutively expressed and CD11a decreased over time. CD11b increased from 41 to 62% and CD11c increased transiently (P < 0.003, P < 0.005). Inhibiton of PBL adherence was greatest by CD11b (34%) and CD11b + CD18 (57%) (P < 0.005, P < 0.0025). Implanted ePTFE caused a fourfold increase in PBL monoclonal antibody binding of CD11b (P < 0.001) compared to sham, Staphylococcus aureus alone, and combination of ePTFE and S. aureus. In conclusion, leukocyte integrins play a central role in the interaction between PBLs and ePTFE as measured by binding of monoclonal antibodies and inhibition of PBL adherence. This is also true in vivo since PBL increase CD11b expression four times when ePTFE is compared to sham. These observations indicate a potential role in vivo for B2 integrins in vascular prosthetic infections.

Endothelial cells adherent to expanded polytetrafluoroethylene express the intercellular adhesion molecule-1.

BACKGROUND: The foreign body reaction caused by implanted biomaterials is not fully characterized. To evaluate the effect of an expanded polytetrafluoroethylene (ePTFE) surface on the binding of monoclonal antibodies against the intercellular adhesion molecule (ICAM-1) by adherent endothelial cells, an in vitro bioassay was developed. STUDY DESIGN: Human saphenous vein endothelial cells (HSVEC) and human umbilical vein endothelial cells (HUVEC) were grown to confluency on fibronectin-pretreated ePTFE and on fibronectin-pretreated polystyrene culture flasks used as controls. Cells were assayed for size, density, viability, and binding of anti-ICAM-1 antibodies. Human peripheral blood leukocytes (PBLs) were then cocultured with HUVEC adherent to ePTFE and control polystyrene and HUVEC were assayed for the binding of anti-ICAM-1 antibodies. RESULTS: The adherence of HSVEC and HUVEC to ePTFE resulted in a twofold increase in the binding of monoclonal antibodies against ICAM-1 compared with controls at 48 hours (p < 0.005). The addition of PBLs to the adherent HUVEC resulted in a four- to eightfold increase in anti-ICAM-1 antibody binding on ePTFE and polystyrene, respectively, at 24 hours. CONCLUSIONS: Adherence of endothelial cells to ePTFE results in an increase in the binding of anti-ICAM-1 antibodies. Coculture of adherent HUVEC and PBLs results in a marked increase in the number of cells binding ICAM-1 antibodies. These data support the conclusion that ePTFE is associated with the activation of adherent cells, which is one aspect of a multicellular inflammatory response.

Differentiation of adult Leydig cells.

Adult Leydig cells originate within the testis postnatally. Their formation is a continuous process involving gradual transformation of progenitors into the mature cell type. Despite the gradual nature of these changes, studies of proliferation, differentiation and steroidogenic function in the rat Leydig cell led to the recognition of three distinct developmental stages in the adult Leydig cell lineage: Leydig cell progenitors, immature Leydig cells and adult Leydig cells. In the first stage, Leydig cell progenitors arise from active proliferation of mesenchymal-like stem cells in the testicular interstitium during the third week of postnatal life and are recognizable by the presence of Leydig cell markers such as histochemical staining for 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) and the present of luteinizing hormone (LH) receptors. They proliferate actively and by day 28 postpartum differentiate into immature Leydig cells. In the second stage, immature Leydig cells are morphologically recognizable as Leydig cells. They have an abundant smooth endoplasmic reticulum and are steroidogenically active, but primarily produce 5 alpha-reduced androgens rather than testosterone. Immature Leydig cells divide only once, giving rise to the total adult Leydig cell population. In the third and final stage, adult Leydig cells are fully differentiated, primarily produce testosterone and rarely divide. LH and androgen act together to stimulate differentiation of Leydig cell progenitors into immature Leydig cells. Preliminary data indicate that insulin like growth factor-1 (IGF-1) acts subsequently in the transformation of immature Leydig cells into adult Leydig cells.

Role of adhesion molecules in leukocyte binding to endothelial cells adherent to vascular grafts.

BACKGROUND: The localization of leukocytes to vascular grafts is an essential part of healing and infection resistance. The mechanisms involved in this process are only partly understood. STUDY DESIGN: Human saphenous vein endothelial cells (HSVEC) were grown on control polystyrene culture ware and expanded polytetrafluoroethylene (ePTFE). The binding of monoclonal antibodies against the intercellular adhesion molecule (ICAM-1) and the E-selectin by adherent HSVEC was determined by flow cytometry. Peripheral blood leukocytes (PBL) were cocultured with HSVEC adherent to ePTFE and leukocyte binding was determined with and without the addition of a protein kinase C inhibitor. RESULTS: HSVEC adherent to ePTFE constitutively bound anti-ICAM-1 antibodies, which were attenuated by the protein kinase C inhibitor, H-7. HSVEC adherent to ePTFE bound significantly greater numbers of leukocytes than those on control (58 versus 41 percent, p < 0.05). Incubation with H-7 decreased leukocyte binding to HSVEC significantly (p < 0.005). Coculture of PBL with HSVEC adherent to ePTFE caused a tenfold increase in binding of anti-E-selectin antibodies (p < 0.0005). CONCLUSIONS: These data indicate that PBL binding to HSVEC adherent to ePTFE is, at least in part, ICAM-1 to HSVEC adherent to ePTFE is, at least in part, ICAM-1 and E-selection dependent.

Functional profiles of healthy older persons.

To learn whether the percentage of time spent at different functional levels varies as a function of age, we studied 44 older (mean age 70 years) and 46 younger (mean age 27 years) urban, community-dwelling volunteers who participated in a study of normative ageing of the cardiovascular system. Each subject completed one 24-hour activity diary which was coded using a standardized scoring system for functional activity levels and energy levels. Compared with younger persons, older persons spent larger percentage of their day performing basic (BADLs) and intermediate activities of daily living (IADLs) and less time in physical advanced activities of daily living and sleeping. Older women spent more time than younger women performing BADLs and more time than younger women or older men performing IADLs. These findings support the concept of functional changes associated with healthy ageing which may be more pronounced in women. Our results may also reflect a cohort effect that may disappear with the change of traditional sex roles.