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Sexually transmitted infection testing and key outcomes following implementation of online postal self-sampling into sexual health services in England: a retrospective observational study of routinely collected service-level healthcare data
No full textBackground
A shift to online postal self-sampling (OPSS) for sexually transmitted infections (STIs) in high-income settings has occurred. We evaluate whether introduction of OPSS in England is associated with changes in testing activity and if this differs by population characteristics.
Methods
A retrospective study of sexual health (online and clinic-based) service-level data, across three case study areas (CSAs) that implemented OPSS at different times, using different models, and whose populations have different socio-demographic profiles, between 01/01/2015 and 31/12/2022 (from 01/08/2014 in CSA1 to ensure 12 months pre-OPSS). The primary outcome was chlamydia/gonorrhoea and HIV testing activity. We evaluated change over time using selected calendar years, with total activity following introduction of OPSS (2019 and 2022) compared to pre-OPSS periods (CSA1, 2014–2015, CSA2 2017, CSA3 2019), and whether outcome changes differed by socio-demographic characteristics.
Findings
In all CSAs chlamydia/gonorrhoea and HIV testing activity increased following introduction of OPSS with incidence rate ratios (IRR) for chlamydia/gonorrhoea testing in 2022 compared to pre-OPSS baseline ranging from 2.1 (95% CI 2.1–2.2) in CSA1 to 2.5 (95% CI 2.4–2.5) in CSA3, and for HIV testing from 1.5 (95% CI 1.5–1.5) in CSA1 to 2.8 (95% CI 2.8–2.8) in CSA2. Differences existed across all demographic characteristics in the relative change in testing incidence (all P < 0.0001 for chlamydia/gonorrhoea). Higher testing activity via OPSS was seen among men who have sex with men (MSM), particularly in CSAs1-2 for chlamydia/gonorrhoea (IRR2.9 (95% CI 2.8–3.1) and 3.6 (95% CI 3.5–3.7) in MSM compared to 1.7 (95% CI 1.7–1.8)and 1.8 (95% CI 1.8–1.8) in men who have sex exclusively with women (MSEW) for 2022 vs pre-OPSS). In CSA3, the largest relative increase occurred in women (IRR 3.2 (95% CI 3.1–3.3), compared to IRR 1.9 (95% CI 1.8–1.9) in MSEW). The most deprived areas had the lowest relative increase in chlamydia/gonorrhoea testing uptake (1.9–2.1 for CSA1-3).
Interpretation
Despite a reduction in clinic-based testing linked to COVID-19, the introduction of OPSS has been associated with increases in overall testing activity. OPSS uptake was lower among populations with greater potential for unmet need, such as individuals living in more deprived areas. Although OPSS is available to all people living within the commissioned areas, in practice not all individuals with a need for STI testing are aware of it or have the confidence and ability to access it. Differences across all socio-demographic characteristics in the relative change in testing could inadvertently increase existing inequalities in access to care and it is important to offer choice of mode of testing for service users.
Funding
National Institute for Health and Care Research
A Self-Levelling railway sleeper concept and its large-scale testing
No full textRailway track transition zones present engineering challenges due to their abrupt change in stiffness between structural elements such as embankments, bridges and tunnels affecting track geometry parameters. Although a variety of stiffness-based remedial measures have been widely applied, their implementation can be constrained by high capital cost, operational disruption, and the complexities associated with modifying the substructure. As a result, interventions in practice commonly focus on controlling permanent deformations and differential settlement, particularly related to the development of hanging sleepers. Thus, this study investigates the use of modular self-levelling sleepers (SLS) as a solution. To do so, two concept SLS systems are designed and developed: one employing a granular mechanism (SLS-G), and the other based on a horizontally acting wedge mechanism (SLS-HW). Both variants use the polymeric sleepers and are designed for compatibility with conventional ballasted track systems. Experimental laboratory testing is undertaken, and it is found that the SLS prototypes were able to restore the sleeper-ballast contact for voids up to 40 mm depth, while stress measurements at the interface indicated improved load distribution under the rails. The findings support the proof-of-concept that self-levelling sleepers have the potential to be a modular, low-disruption solution for mitigating track geometry degradation and reducing maintenance requirements at transition zones
Valuing child and adolescent health states for use in economic evaluation: A good practices report of an ISPOR task force
No full textEconomic evaluations of interventions that target or include children require health state utilities (HSUs). Despite the availability of preference-weighted measures for children, methods for valuing child health states and estimating child utilities are not as well established as those for adult HSUs. The objective of this Task Force was to develop emerging good practice recommendations for valuing child and adolescent health to generate HSUs for use in economic evaluation.
This Task Force identified and described the interrelated methodological choices regarding valuation of child health to generate HSUs. The Task Force considered available evidence related to four key issues: (a) whose preferences should be sought; (b) whose health is imagined; (c) which method should be used; and (d) the comparability between adult and child utilities.
Best practices may vary depending on the modeling context, characteristics of the health states, and the health technology assessment setting in which the HSUs will be used. For any individual study, methods will be informed by empirical evidence, value judgments, and recommendations from healthcare decision-makers. Rather than recommending an approach that would apply to every study, this Task Force presents options to consider when determining the preference elicitation approach to generate utilities for child health states, along with strengths and limitations of each. Given that child HSUs can impact the outcomes of a cost-utility analysis and subsequent decisions about healthcare resource allocation, this Task Force recommends that researchers be transparent about methodological choices and their impact on HSUs
Balancing comfort and efficiency: Optimal deceleration rates at crosswalks and intersections in automated driving
No full textUnderstanding passenger comfort in automated vehicles (AVs) is critical for advancing highly automated driving systems. This test track study was conducted with 41 participants who are accustomed to European driving norms. It examined how deceleration rates and environmental factors influence passenger perceptions in two scenarios: crosswalks and blind intersections. The participants were driven by a real AV, which braked using deceleration rates of −1.5 m/s2, −2.5 m/s2, and −3.5 m/s2. Additionally, the visibility time of an approaching pedestrian was manipulated in the crosswalk scenario, while the presence or absence of an approaching vehicle was varied in the intersection scenario. The results show that passengers generally prefer lower to medium deceleration (−1.5 m/s2, −2.5 m/s2) rates but accept higher rates (−3.5 m/s2) when a pedestrian becomes visible more unexpectedly. In the intersection scenario, comfort ratings were less influenced by the presence of an approaching vehicle than by the deceleration rate, with lower and medium deceleration rates being favoured. These findings are valuable for the development of AVs. The study suggests that tailoring AV deceleration to specific traffic scenarios can improve passenger comfort. It can help AV developers to define driving styles that passengers perceive as comfortable and safe, without compromising efficiency
Integrating post-growth economics into transformative adaptation: Property relations, capital, and democratic planning
No full textTransformative adaptation (TA) is increasingly promoted as a way to drive systemic change beyond incremental adjustments. Yet many TA initiatives fall short of their transformative aims. This paper argues that this is not only due to implementation challenges, but also because of conceptual blind spots. We review TA litertaure and problematise three of its core assumptions regarding onto-epistemic and political shifts, root causes of vulnerability, and multi-level stakeholder engagement. Drawing on post-growth economics, we contend that TA tends to overlook some key dimensions of transformation. First, its focus on onto-epistemic and political shifts rarely challenges privatised property relations and sometimes reinforces scarcity narratives that justify exclusive control and management. Second, vulnerability is linked to a preoccupation with growth, efficiency, and commercialisation, yet these are not systematically tied to the structural dynamics of capital accumulation. Third, stakeholder engagement tends to foreground liberal notions of participation and governance, with little attention to democratic control over the economy. To address these gaps, we propose a set of reflective refinements based on post-growth principles: reorient development toward collective, decommodified ownership; link vulnerability to the structural tendencies of capital accumulation; and broaden participation and governance toward economic democratisation and planning. These dimensions are interdependent, with property relations and capital accumulation forming both structural arenas of transformation within, and obstacles to, democratic planning of the economy. We conclude by outlining key directions for future TA research
Spatial Chirp-based Joint Optimization for Analog Beamforming in Reconfigurable Intelligent Surface Assisted Terahertz Ultra-wideband Systems
No full textThis paper proposes a spatial chirp-based joint optimization method for analog beamforming in RIS-assisted THz ultra-wideband communication systems. The THz band (0.1-10 THz) offers significantly wider bandwidth, enabling Tbps data rates, which are crucial for 6G communications. However, traditional phase shifters are optimized for a single frequency. In ultra-wideband systems, the phase response deviates as frequency varies, leading to beam squinting problem, which significantly degrades system performance. Existing solutions, such as true-time-delay architectures, impose excessive complexity, making them impractical for THz systems. In this work, we propose leveraging polynomial expansion to optimize the spatially dependent phase functions of RIS, Tx, and Rx. We formulate the optimization problem as maximizing system throughput, and develop a gradient ascent-based iterative algorithm to solve it. Simulation results demonstrate that our method outperforms conventional and state-of-the-art approaches in metrics including phase response, throughput, and BER, providing a cost-effective solution for optimizing analog beamforming
Held out wings RNA binding activity in the cytoplasm during early spermatogenesis
No full textHeld out wings (HOW) is an RNA-binding protein essential for spermatogenesis in Drosophila melanogaster. HOW is a signal transduction and activation of RNA (STAR) protein, regulating post-transcriptional gene expression. The characteristics of RNA-binding by the conserved short cytoplasmic isoform, HOW(S), are unknown. In vivo RIP-seq identified 121 novel transcripts bound by HOW(S) in germ stem cells and spermatogonia, many with signal transduction functions. (A/G/U)CUAAC motifs were enriched in 3’-UTRs and GCG(A/U)G in 5’-UTRs. HOW binds with high affinity to sites containing CUAAC motifs from lola and hipk mRNAs. The binding of cytoplasmic HOW(S) specifically to CUAAC motifs in 3’-UTRs can result in stabilization or destabilization of mRNAs and translational regulation potentially depending on position of binding, number of sites and interacting partners. This study provides new insight into STAR protein-RNA interactions and functions in spermatogenesis
The effect of computer guided total hip replacement on risk of revision, Oxford Hip Score, and health related quality of life: an analysis of National Joint Registry data
No full textBackground
Total hip replacement (THR) can be performed conventionally or with the assistance of computer guidance systems. We aimed to compare the risk of revision for all-causes and dislocation, and differences in Oxford Hip Score (OHS) and health-related quality of life (EQ-5D-3L) following primary THR performed conventionally versus with the assistance of computer guidance systems.
Methods
We performed an observational study using National Joint Registry data. Adult patients who underwent primary THR for osteoarthritis between 2003 and 2020 were included. The co-primary analyses were revision for all-causes and dislocation. Secondary analyses were differences in OHS and EQ-5D-3L. Weights based on propensity scores were generated. Cox proportional hazards and generalised linear models were used to assess outcomes of revision, OHS, and EQ-5D-3L. Effective sample sizes (ESS) were computed.
Results
Risk of revision for all-causes comparing computer guided and conventional THR were similar (HR 0.947, 95% CI 0.698–1.283, p = 0.726, ESS 7235). However, sensitivity analysis restricting to the five most commonly used combination of prosthesis brands demonstrated reduced revision risk in favour of computer guidance (HR 0.446, 95% CI 0.231–0.858, p = 0.016, ESS 3993). There was no difference in revision for dislocation between groups (HR 0.929, 95% CI 0.512–1.688, p = 0.810, ESS 7235). Compared to conventional THR, the use of computer guidance increased OHS by 0.931 (95% CI 0.308–1.554, p = 0.003, ESS 2112) however there were no differences in EQ-5D-3L (0.007, 95% CI −0.008–0.023, p = 0.356, ESS 2929). Incidence of intra-operative complications was significantly fewer during computer guided THR (0.51% versus 0.96%, p = 0.006).
Conclusions
There were no differences in revision for all-causes and dislocation between computer guided and conventional THR. However, sensitivity analysis considering only the five most commonly used prosthesis brands demonstrated a reduced risk of revision for all-causes favouring computer guided THR. Furthermore, computer guidance was associated with a significant but minimal improvement in OHS and a lower risk of intra-operative complications, without differences in EQ-5D-3L. Although these findings suggest potential for computer guided THR to improve implant survivorship and reduce intra-operative complications, they require cautious interpretation given the limitations inherent to observational study designs and registry based analyses
Non-Steroidal Anti-Inflammatory Drugs After Abdominal Surgery: An Umbrella Review of Existing Evidence
No full textBackground: Multi-modal analgesia is recommended for enhanced recovery after colorectal and abdominal surgery. Previous
reviews have reported highly discordant observations around the benefits and risks of non-steroidal anti-inflammatory drugs
(NSAIDs). This umbrella review aimed to provide a recommendation based on the best available evidence.
Methods: A systematic search was performed for reviews exploring benefits and risks of NSAIDs after abdominal surgery.
The quality of reviews was assessed using the AMSTAR-2 tool. Outcomes of interest comprised clinical efficacy (pain, opioid
consumption, return of gut function) and safety (intestinal bleeding, anastomotic leak, acute kidney injury). The presence of discordant conclusions across reviews was investigated using the Jadad decision algorithm to determine the best available evidence.
Results: Twenty-seven reviews were included, reporting evidence for pain (n=10/27), opioid-consumption (n=11/27), gut function (n=4/27), bleeding (n=1/27), anastomotic leak (n=13/27), and acute kidney injury (n=2/27). The quality of all reviews
was ‘critically low’. The reviews were concordant in showing that NSAIDs reduce pain, opioid consumption, and time to gut
recovery. Studies reporting anastomotic leak after colorectal surgery were highly discordant. The best available evidence showed
an increased risk of anastomotic leak with non-selective NSAIDs, but not convincingly for COX-2 inhibitors.
Conclusion: NSAIDs after abdominal surgery reduce pain, opioid consumption, and the time to gut recovery. In the context of
colorectal surgery, non-selective NSAIDs may increase the risk of anastomotic leak, but this is based on low quality data. Their
use should be limited to selective NSAIDs until robust evidence is available to guide decision-making
