Determining the date of diagnosis – is it a simple matter? The impact of different approaches to dating diagnosis on estimates of delayed care for ovarian cancer in UK primary care

Background Studies of cancer incidence and early management will increasingly draw on routine electronic patient records. However, data may be incomplete or inaccurate. We developed a generalisable strategy for investigating presenting symptoms and delays in diagnosis using ovarian cancer as an example. Methods The General Practice Research Database was used to investigate the time between first report of symptom and diagnosis of 344 women diagnosed with ovarian cancer between 01/06/2002 and 31/05/2008. Effects of possible inaccuracies in dating of diagnosis on the frequencies and timing of the most commonly reported symptoms were investigated using four increasingly inclusive definitions of first diagnosis/suspicion: 1. "Definite diagnosis" 2. "Ambiguous diagnosis" 3. "First treatment or complication suggesting pre-existing diagnosis", 4 "First relevant test or referral". Results The most commonly coded symptoms before a definite diagnosis of ovarian cancer, were abdominal pain (41%), urogenital problems(25%), abdominal distension (24%), constipation/change in bowel habits (23%) with 70% of cases reporting at least one of these. The median time between first reporting each of these symptoms and diagnosis was 13, 21, 9.5 and 8.5 weeks respectively. 19% had a code for definitions 2 or 3 prior to definite diagnosis and 73% a code for 4. However, the proportion with symptoms and the delays were similar for all four definitions except 4, where the median delay was 8, 8, 3, 10 and 0 weeks respectively. Conclusion Symptoms recorded in the General Practice Research Database are similar to those reported in the literature, although their frequency is lower than in studies based on self-report. Generalisable strategies for exploring the impact of recording practice on date of diagnosis in electronic patient records are recommended, and studies which date diagnoses in GP records need to present sensitivity analyses based on investigation, referral and diagnosis data. Free text information may be essential in obtaining accurate estimates of incidence, and for accurate dating of diagnoses

Off-diagonal Interactions, Hund's Rules and Pair-binding in Hubbard Molecules

We have studied the effect of including nearest-neighbor, electron-electron interactions, in particular the off-diagonal (non density-density) terms, on the spectra of truncated tetrahedral and icosahedral ``Hubbard molecules,'' focusing on the relevance of these systems to the physics of doped C$_{60}$. Our perturbation theoretic and exact diagonalization results agree with previous work in that the density-density term suppresses pair-binding. However, we find that for the parameter values of interest for $C_{60}$ the off-diagonal terms {\em enhance} pair-binding, though not enough to offset the suppression due to the density-density term. We also find that the critical interaction strengths for the Hund's rules violating level crossings in C$_{60}^{-2}$, C$_{60}^{-3}$ and C$_{60}^{-4}$ are quite insensitive to the inclusion of these additional interactions.Comment: 20p + 5figs, Revtex 3.0, UIUC preprint P-94-10-08

Object Serialization and Deserialization Using XML

Interoperability of potentially heterogeneous databases has been an ongoing research issue for a number of years in the database community. With the trend towards globalization of data location and data access and the consequent requirement for the coexistence of new data stores with legacy systems, the cooperation and data interchange between data repositories has become increasingly important. The emergence of the eXtensible Markup Language (XML) as a database independent representation for data offers a suitable mechanism for transporting data between repositories. This paper describes a research activity within a group at CERN (called CMS) towards identifying and implementing database serialization and deserialization methods that can be used to replicate or migrate objects across the network between CERN and worldwide centres using XML to serialize the contents of multiple objects resident in object-oriented databases.Comment: 14 pages 7 figure

Surveying rip current survivors: Preliminary insights into the experiences of being caught in rip currents

This paper begins a process of addressing a significant gap in knowledge about people's responses to being caught in rip currents. While rip currents are the primary hazard facing recreational ocean swimmers in Australia, debate exists about the best advice to give swimmers caught in rip currents. Such surf rescue advice - on what to do and how to respond when caught in a rip - relies on empirical evidence. However, at present, knowledge about swimmers reactions and responses to rip currents is limited. This gap is a considerable barrier to providing effective advice to beach goers and to understanding how this advice is utilised (or not) when actually caught in the rip current. This paper reports the findings of a pilot study that focussed on garnering a better understanding of swimmers' experiences when caught in rip currents. A large scale questionnaire survey instrument generated data about rip current survivors' demographics, knowledge of beach safety and their reactions and responses when caught in a rip current. A mix of online and paper surveys produced a total of 671 completed surveys. Respondents were predominantly an informed group in terms of rip current knowledge, beach experience and had a high self-rated swimming ability. Preliminary insights from the survey show that most respondents recalled a "swim across the rip/parallel to the beach" message when caught in the rip and most escaped unassisted by acting on this message. However, while nearly a quarter of respondents recalled a message of "not to panic", short answer responses revealed that the onset of panic inhibited some respondents from recalling or enacting any other type of beach safety message when caught in the rip current. Results also showed that despite the research sample being younger, competent and frequent ocean swimmers, they were more likely to swim at unpatrolled beaches and outside of the red and yellow safety flags. Moreover, they were still caught in a rip current and they panicked. The findings of this study have significant implications for a range of demographic groups of differing beach safety knowledge and swimming ability who may be caught in rip currents behave, we know very little about how beach goers may respond to being caught in them. © 2012 Author(s)

Central circulatory hemodynamics as a function of gravitational stress

This study focuses on an evaluation of the central hemodynamics in a nonhuman primate model to variations in gravitational states. The baboon, phylogenectically close to man, was chosen as the human surrogate. The study environments selected are head-down and head-up tilt in the physiology laboratory, centrifugation to test hypergravic stress, and parabolic flights to test transient acute responses to microgravity

A Measurement of the Interference Structure Function, R_LT, for the 12C(e,e'p) reaction in the Quasielastic Region

The coincidence cross-section and the interference structure function, R_LT, were measured for the 12C(e,e'p) 11B reaction at quasielastic kinematics and central momentum transfer of q=400 MeV/c. The measurement was at an opening angle of theta_pq=11 degrees, covering a range in missing energy of E_m = 0 to 65 MeV. The R_LT structure function is found to be consistent with zero for E_m > 50 MeV, confirming an earlier study which indicated that R_L vanishes in this region. The integrated strengths of the p- and s-shell are compared with a Distorted Wave Impulse Approximation calculation. The s-shell strength and shape are compared with a Hartree Fock-Random Phase Approximation calculation. The DWIA calculation overestimates the cross sections for p- and s-shell proton knockout as expected, but surprisingly agrees with the extracted R_LT value for both shells. The HF-RPA calculation describes the data more consistently, which may be due to the inclusion of 2-body currents in this calculation.Comment: 8 Pages LaTex, 5 postscript figures. Submitted to Phys. Rev.

Nuclear structure studies with the 7Li(e,e'p) reaction

Experimental momentum distributions for the transitions to the ground state and first excited state of 6He have been measured via the reaction 7Li(e,e'p)6He, in the missing momentum range from -70 to 260 MeV/c. They are compared to theoretical distributions calculated with mean-field wave functions and with variational Monte Carlo (VMC) wave functions which include strong state-dependent correlations in both 7Li and 6He. These VMC calculations provide a parameter-free prediction of the momentum distribution that reproduces the measured data, including its normalization. The deduced summed spectroscopic factor for the two transitions is 0.58 +/- 0.05, in perfect agreement with the VMC value of 0.60. This is the first successful comparison of experiment and ab initio theory for spectroscopic factors in p-shell nuclei.Comment: 4 pages, 3 figure

Pan-European early switch/early discharge opportunities exist for hospitalised patients with methicillin-resistant <em>Staphylococcus</em> <em>aureus</em> complicated skin and soft-tissue infections

AbstractThe objective of this study was to document pan-European real-world treatment patterns and healthcare resource use and estimate opportunities for early switch (ES) from intravenous (IV) to oral antibiotics and early discharge (ED) in hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (cSSTIs). This retrospective observational medical chart review study enrolled 342 physicians across 12 European countries who collected data from 1542 patients with documented MRSA cSSTI who were hospitalized (July 2010 to June 2011) and discharged alive (by July 2011). Data included clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and oral antibiotic use, and ES and ED eligibility according to literature-based and expert-validated criteria. The most frequent initial MRSA-active antibiotics were vancomycin (50.2%), linezolid (15.1%), clindamycin (10.8%), and teicoplanin (10.4%). Patients discharged with MRSA-active antibiotics (n = 480) were most frequently prescribed linezolid (42.1%) and clindamycin (19.8%). IV treatment duration (9.3 ± 6.5 vs. 14.6 ± 9.9 days; p <0.001) and hospital LOS (19.1 ± 12.9 vs. 21.0 ± 18.2 days; p 0.162) tended to be shorter for patients switched from IV to oral treatment than for patients who received IV treatment only. Of the patients, 33.6% met ES criteria and could have discontinued IV treatment 6.0 ± 5.5 days earlier, and 37.9% met ED criteria and could have been discharged 6.2 ± 8.2 days earlier. More than one-third of European patients hospitalized for MRSA cSSTI could be eligible for ES and ED, resulting in substantial reductions in IV days and bed-days, with potential savings of €2000 per ED-eligible patient