Because these infections enhance both HIV transmission and susceptibility, clinical settings serving MSM should evaluate the prevalence of chlamydial and gonococcal infections by anatomic site using validated NAATs.

ObjectiveTo better understand the origins, manifestations and current policy responses to patient–physician mistrust in China.DesignQualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust.SettingGuangdong Province, China.ParticipantsOne hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships.ResultsOne of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust.ConclusionsThe blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.

This is the third and final part of a study of wrinkles in thin membrane structures. High-fidelity, geometrically nonlinear finite element models of membrane structures, based on thin-shell elements, are used to simulate the onset and growth of wrinkles. The simulations are carried out with the ABAQUS finite element package. The accuracy of the results is demonstrated by computing the characteristics of the wrinkles in two specific membrane structures that were investigated experimentally and analytically in the first two papers in this series.

This paper presents a detailed experimental study of the evolution and shape of reversible corrugations, or wrinkles, in initially flat, linear-elastic and isotropic thin foils subject to in-plane loads. Two sets of experiments were carried out, on a rectangular membrane under simple shear and on a square membrane subjected to two pairs of equal and opposite diagonal forces at the corners. Salient findings are that: the wrinkle profile is generally well approximated by a half sine wave in the longitudinal direction, with constant or linearly-varying transverse wavelength; sudden changes in the shape of the membrane, accompanied by changes in the number of wrinkles, occur in both cases; in the sheared membrane the wrinkle pattern remains essentially unchanged for increasing shear displacement, whereas in the square membrane a large diagonal wrinkle appears when the corner load ratio is around 3.