Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

State of Montana v. Ronald Dwight Tipton: On Petition for a Writ of Certiorari to the Supreme Court of the State of Montana

Montana’s pending certiorari petition in Montana v. Tipton provides the Supreme Court with an opportunity to review the important issue of when States are permitted to revive criminal cases based on newly discovered DNA evidence. Until recently, many states have had child sex abuse statutes of limitation that have made it difficult for prosecution to occur. In Stogner v. California, 539 U.S. 607 (2003), the Supreme Court addressed California’s attempt to address the injustice by reviving expired criminal statutes of limitations in all cases of child sex abuse. In a 5-4 decision, the Court held that the California law violated the Ex Post Facto Clause. For a narrow majority of the Court, the blanket revival of criminal claims went too far. Since Stogner, the science of DNA evidence in sex assault cases has become increasingly sophisticated and reliable and states have begun to enact laws to permit prosecution of child rape where conclusive DNA evidence becomes available. This deeply reliable evidence justifies the reopening of a child sexual abuse case even when the statute of limitations previously expired, because it does not raise the risk of unfairness to the perpetrator. It is also necessary to prevent further abuse by the now-identified perpetrator. In this case, eight-year-old L.T. was raped in her home in the middle of the night. Evidence was gathered immediately. The wrong man served a decade in prison due to a false conviction. It is now possible, due to a later-discovered DNA match with the actual perpetrator, to hold the right man accountable. This case is a proper vehicle for the Supreme Court to consider the appropriate interpretation and limits of Stogner v. California. By permitting prosecution of child abuse perpetrators, this Court would not only be providing particular victims access to much-needed justice but would also be aiding in the incarceration of dangerous sexual predators before they could abuse more children. Nothing in the Constitution forbids these laudable conclusions

Cost Effectiveness of Bio-Gas Systems for Dairy Farms

Considerable attention has recently been focused on the development of farm management practices that utilize the total resource potential of animal wastes. In addition to the fertilizer value of manure, energy in the form of bio-gas can be generated from manure wastes by an anaerobic digestion process. The purpose of this economic analysis was to evaluate the feasibility of producing energy from the anaerobic digestion of dairy-cow manure. Anaerobic digestion systems were rationally designed for several farm management practices on Vermont dairy farms. These designs were sized to accommodate dairy herds of 20, 50, 100, and 200 cows for both free- and tie-stall arrangements. The realistic evaluation of the potential of any energy source must include a cost effectiveness analysis. This 1974 economic analysis, with selected 1977 cost updatings, included considerations of both the total annual financial investment and the unit cost of net energy production. Minimum unit costs of net energy production for 1977 prices are approximately $0.19 per kwh for the 20-cow operation, but these values decrease with increasing herd size to$0.05 per kwh for the 200-cow dairy farm. At the present time, the generation of bio-gas from the anaerobic digestion of dairy farm manures becomes economically feasible as an alternate source of energy for dairy farms in excess of 200 cows

Being an Early-Career CMS Academic in the Context of Insecurity and ‘Excellence’: The Dialectics of Resistance and Compliance

Drawing on a dialectical approach to resistance, we conceptualise the latter as a multifaceted, pervasive and contradictory phenomenon. This enables us to examine the predicament in which early-career Critical Management Studies academics find themselves in the current times of academic insecurity and ‘excellence’, as gleaned through this group’s understandings of themselves as resisters and participants in the complex and contradictory forces constituting their field. We draw on 24 semi-structured interviews to map our participants’ accounts of themselves as resisters in terms of different approaches to tensions and contradictions between, on the one hand, the interviewees’ Critical Management Studies alignment and, on the other, the ethos of business school neoliberalism. Emerging from this analysis are three contingent and interlinked narratives of resistance and identity – diplomatic, combative and idealistic – each of which encapsulates a particular mode (negotiation, struggle, and laying one’s own path) of engaging with the relationship between Critical Management Studies and the business school ethos. The three narratives show how early-career Critical Management Studies academics not only use existing tensions, contradictions, overlaps and alliances between these positions to resist and comply with selected forces within each, but also contribute to the (re-)making of such overlaps, alliances, tensions and contradictions. Through this reworking of what it means to be both Critical Management Studies scholars and business school academics, we argue, early-career Critical Management Studies academics can be seen as active resisters and re-constituters of their complex field

Fiber Optic Tactical Local Network (FOTLAN)

A 100 Mbit/s FDDI (fiber distributed data interface) network interface unit is described that supports real-time data, voice and video. Its high-speed interrupt-driven hardware architecture efficiently manages stream and packet data transfer to the FDDI network. Other enhancements include modular single-mode laser-diode fiber optic links to maximize node spacing, optic bypass switches for increased fault tolerance, and a hardware performance monitor to gather real-time network diagnostics

The impact of flooding on aquatic ecosystem services

Flooding is a major disturbance that impacts aquatic ecosystems and the ecosystem services that they provide. Predicted increases in global flood risk due to land use change and water cycle intensification will likely only increase the frequency and severity of these impacts. Extreme flooding events can cause loss of life and significant destruction to property and infrastructure, effects that are easily recognized and frequently reported in the media. However, flooding also has many other effects on people through freshwater aquatic ecosystem services, which often go unrecognized because they are less evident and can be difficult to evaluate. Here, we identify the effects that small magnitude frequently occurring floods (\u3c 10-year recurrence interval) and extreme floods (\u3e 100-year recurrence interval) have on ten aquatic ecosystem services through a systematic literature review. We focused on ecosystem services considered by the Millennium Ecosystem Assessment including: (1) supporting services (primary production, soil formation), (2) regulating services (water regulation, water quality, disease regulation, climate regulation), (3) provisioning services (drinking water, food supply), and (4) cultural services (aesthetic value, recreation and tourism). The literature search resulted in 117 studies and each of the ten ecosystem services was represented by an average of 12 ± 4 studies. Extreme floods resulted in losses in almost every ecosystem service considered in this study. However, small floods had neutral or positive effects on half of the ecosystem services we considered. For example, small floods led to increases in primary production, water regulation, and recreation and tourism. Decision-making that preserves small floods while reducing the impacts of extreme floods can increase ecosystem service provision and minimize losses

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people

Primary care consultations and costs among HIV-positive individulas in UK primary care 1995-2005: a cohort study

Objectives: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence. Methods: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record. Results: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications. Conclusion: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways