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

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

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated

Enabling Entry Technologies for Ice Giant Missions

The highest priority science goals for Ice Giant missions are: 1) Interior structure of the Planet, and 2) Bulk composition that includes isotopes and noble gases. The interaction between the planetary interior and the atmosphere requires sustained global measurements. Noble gas and Isotope measurements require in situ measurement. Drag modulated aerocapture utilizing ADEPT offers more mass delivered to the Ice Giants than with propulsive orbit insertion. The Galileo Probe entered at a hot spot which created interpretation challenges. Juno is providing valuable orbital measurements, but without in situ measurements the story is incomplete. Planetary scientists interested in Ice Giant missions should perform mission design studies with these new Entry System technologies to assess the feasibility within the context of the international collaboration framework. A mission architecture that includes probe(s) along with an orbiting spacecraft can deploy the probes at the desired location while taking simultaneous measurements from orbit to provide invaluable data that can correlate both global and local measurements. Entry System Technologies currently being developed by NASA are poised to enable missions that position the Orbiter & Probes through drag modulated aerocapture (ADEPT), and HEEET enables the Probes to survive the extreme environments encountered for entry into the atmospheric interior

Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

Generating socially appropriate tutorial dialog

Analysis of student-tutor coaching dialogs suggest that good human tutors attend to and attempt to influence the motivational state of learners. Moreover, they are sensitive to the social face of the learner, and seek to mitigate the potential face threat of their comments. This paper describes a dialog generator for pedagogical agents that takes motivation and face threat factors into account. This enables the agent to interact with learners in a socially appropriate fashion, and foster intrinsic motivation on the part of the learner, which in turn may lead to more positive learner affective states

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

The SPORTSMART study: a pilot randomised controlled trial of sexually transmitted infection screening interventions targeting men in football club settings

Background: Uptake of chlamydia screening by men in England has been substantially lower than by women. Non-traditional settings such as sports clubs offer opportunities to widen access. Involving people who are not medically trained to promote screening could optimise acceptability. Methods: We developed two interventions to explore the acceptability and feasibility of urine-based sexually transmitted infection (STI) screening interventions targeting men in football clubs. We tested these interventions in a pilot cluster randomised control trial. Six clubs were randomly allocated, two to each of three trial arms: team captain-led and poster STI screening promotion; sexual health adviser-led and poster STI screening promotion; and poster-only STI screening promotion (control/comparator). Primary outcome was test uptake. Results: Across the three arms, 153 men participated in the trial and 90 accepted the offer of screening (59%, 95% CI 35% to 79%). Acceptance rates were broadly comparable across the arms: captain-led: 28/56 (50%); health professional-led: 31/46 (67%); and control: 31/51 (61%). However, rates varied appreciably by club, precluding formal comparison of arms. No infections were identified. Process evaluation confirmed that interventions were delivered in a standardised way but the control arm was unintentionally ‘enhanced’ by some team captains actively publicising screening events. Conclusions: Compared with other UK-based community screening models, uptake was high but gaining access to clubs was not always easy. Use of sexual health advisers and team captains to promote screening did not appear to confer additional benefit over a poster-promoted approach. Although the interventions show potential, the broader implications of this strategy for UK male STI screening policy require further investigation

#Bieber + #Blast = #BieberBlast: Early Prediction of Popular Hashtag Compounds

Compounding of natural language units is a very common phenomena. In this paper, we show, for the first time, that Twitter hashtags which, could be considered as correlates of such linguistic units, undergo compounding. We identify reasons for this compounding and propose a prediction model that can identify with 77.07% accuracy if a pair of hashtags compounding in the near future (i.e., 2 months after compounding) shall become popular. At longer times T = 6, 10 months the accuracies are 77.52% and 79.13% respectively. This technique has strong implications to trending hashtag recommendation since newly formed hashtag compounds can be recommended early, even before the compounding has taken place. Further, humans can predict compounds with an overall accuracy of only 48.7% (treated as baseline). Notably, while humans can discriminate the relatively easier cases, the automatic framework is successful in classifying the relatively harder cases.Comment: 14 pages, 4 figures, 9 tables, published in CSCW (Computer-Supported Cooperative Work and Social Computing) 2016. in Proceedings of 19th ACM conference on Computer-Supported Cooperative Work and Social Computing (CSCW 2016