Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

d15N of trap WR2

Temporal changes in d15N values of sinking particles collected with sediment traps in the Benguela upwelling regime off southwest Africa mirrored variations in the input of inorganic nitrogen to the surface water. Reductions in d15N (to as low as 2.5 per mil) corresponded to low sea surface temperatures during austral spring and late austral autumn/early winter, indicating increased nitrate availability due to the presence of recently upwelled water. High particulate fluxes accompanied the low d15N values and sea surface temperatures, reflecting increased productivity, fueled by the upwelled nutrients. High d15N values (up to 13.1 per mil) coincided with high sea surface temperatures and low particle fluxes. In this area, the seaward extension of upwelling filaments, which usually occurs twice yearly, brings nutrient-rich water to the euphotic zone and leads to elevated productivity and relatively lower d15N values of the particulate nitrogen. Satellite images of ocean chlorophyll show that productivity variations coincide with d15N changes. The observed isotopic pattern does not appear to have been caused by variations in the species composition of the phytoplankton assemblage. Calculations based on d15N of the sinking particulate nitrogen show that the surface nitrate pool was more depleted during late austral summer/early fall and mid-winter and that supply exceeded demand during the intense spring bloom and in late austral fall. The main uncertainty associated with these estimates is the effect of diagenesis on d15N and possible variability in preservation of the isotope signal between periods of high and low particle flux.

Boston, Massachusetts and vicinity, showing Revolutionary War fortification sites, 1788 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Boston with its environs, [by] T. Conder, sculpt. The map was originally published in: William Gordon's The history of the rise, progress, and establishment, of the independence of the United States of America, 1788. Scale [ca. 1:53,360]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Massachusetts State Plane Coordinate System, Mainland Zone (in Feet) (Fipszone 2001). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows Revolutionary War features such as positions of troops, redoubts, batteries, and forts, etc. It also shows features such as roads, drainage, selected public buildings and residences, and more. Relief is shown by hachures. This layer is part of a selection of digitally scanned and georeferenced historic maps of Massachusetts from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of regions, originators, ground condition dates (1755-1922), scales, and purposes. The digitized selection includes maps of: the state, Massachusetts counties, town surveys, coastal features, real property, parks, cemeteries, railroads, roads, public works projects, etc.

A text-book of needlework, knitting, and cutting out : with methods of teaching /

Mode of access: Internet.

Lord Burghley and Queen Elizabeth

Sequel to Mr. Secretary Cecil and Queen Elizabeth

Archaelogic and historic fragments. Containing, inter alia, a facsimile of a rare ms. page dated 1638, having reference to two of Shakespeare's most famous plays, with notes thereon.

On a ms. list of plays of the year 1638. -- Sir Anthony Browne, standard bearer to king Henry VIII, and his descendants. -- On the source and nomenclature of the river Thames. -- On Sir Philip Sidney and his father, Sir Henry Sidney, in relation to Ludlow castle. -- Episodes in the career of Humphrey duke of Gloucester, and his first duchess, and their connection with the abbey of St. Albans. -- On the involuntary visit of Philip of Austria and Juana of Spain to Weymouth in 1506, and its consequences. -- Recuiver, the Regulbium of the Romans. -- Appendix.

Cases of divorce for several causes : viz. I. Memoirs of the life of Robert Feilding esq; containing an account of his amours ... and a true copy of his last will and testament. II. The case of Barbara late Dutchess of Cleaveland, with the whole proceedings between Her Grace, and Major-General Feilding in Doctors-Commons ... III. The case of John Dormer, esq. IV. The case of Sir George Downing, bart. and Mrs. Mary Forester. V. Depositions taken in the Lady Howard's case : also the judgment of the most eminent divines, &c. concerning the dissolution of marriage.

ESTC

Queen Elizabeth /

Mode of access: Internet.

A report on the problem of the substitution of woman for man power in industry; approved by the Board of directors, July 17th, 1918, made by the Committee on industrial welfare of the Cleveland Chamber of commerce.

"Appendix 'A': Industries and processes on which women are employed." Report on women employed in iron and steel industries in Cleveland, Ohio, by Elizabeth Arnold.

A company guide to effective stockholder relations, with sections on The role of the security analyst and The impact of Federal law.

Mode of access: Internet.

Athenian letters: or, The epistolary correspondence of an agent of the king of Persia, residing at Athens during the Peloponnesian war. A new edition; to which is prefixed a geographical index. In two volumes. Illustrated with engravings, and a map of ancient Greece ...

The work of a group of English writers each letter being signed by an initial indicating the author, as follows. P.-Philip Yorke; C.-Charles Yorke; R.-G.H. Rooke; G.-John Green; W.-Daniel Wray; H.-Henry Heaton; E.-Wm. Heberden; O.-Henry Coventry; L.-John Lawry; T.-Catherine Talbot; B.-Thomas Birch; S.-Samuel Salter. The work was edited by Thomas Birch, the brothers Yorke having the largest share in the composition of the letters.

Common birds of Louisiana /

Includes index.