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

A miniature UV-VIS spectrometer for the surface of Mars

A miniature spectrometer is in the process of development for a future Mars mission, to measure the UV-VIS spectrum encountered at the martian surface. With an intended mass of ~100 g, the spectrometer is planned as part of the ESA ExoMars mission

Impact of symptom burden and health‐related quality of life (HRQOL) on esophageal motor diagnoses

BackgroundHigh‐resolution manometry (HRM) categorizes esophageal motor processes into specific Chicago Classification (CC) diagnoses, but the clinical impact of these motor diagnoses on symptom burden remain unclear.MethodsTwo hundred and eleven subjects (56.8±1.0 years, 66.8% F) completed symptom questionnaires (GERDQ, Mayo dysphagia questionnaire [MDQ], visceral sensitivity index, short‐form 36, dominant symptom index, and global symptom severity [GSS] on a 100‐mm visual analog scale) prior to HRM. Subjects were stratified according to CC v3.0 and by dominant presenting symptom; contraction wave abnormalities (CWA) were evaluated within “normal” CC. Symptom burden, impact of diagnoses, and HRQOL were compared within and between cohorts.Key ResultsMajor motor disorders had highest global symptom burden (P=.02), “normal” had lowest (P<.01). Dysphagia (MDQ) was highest with esophageal outflow obstruction (P=.02), but reflux symptoms (GERDQ) were similar in CC cohorts (P=ns). Absent contractility aligned best with minor motor disorders. Consequently, pathophysiologic categorization into outflow obstruction, hypermotility, and hypomotility resulted in a gradient of decreasing dysphagia and increasing reflux burden (P<.05 across groups); GSS (P=.05) was highest with hypomotility and lowest with “normal” (P=.002). Within the “normal” cohort, 33.3% had CWA; this subgroup had symptom burden similar to hypermotility. Upon stratification by symptoms, symptom burden (GSS, MDQ, HRQOL) was most profound with dysphagia.Conclusions and InferencesChicago Classification v3.0 diagnoses identify subjects with highest symptom burden, but pathophysiologic categorization may allow better stratification by symptom type and burden. Contraction wave abnormalities are clinically relevant and different from true normal motor function. Transit symptoms have highest yield for a motor diagnosis.The interrelationship between esophageal symptom characteristics, symptom burden, and motor diagnoses (Chicago Classification v 3.0) were further studied by obtaining validated self‐report questionnaires in 211 patients undergoing esophageal high‐resolution manometry (HRM). Chicago Classification diagnoses (outflow obstruction, major disorders) were associated with the highest symptom burden. Symptom characteristics were best characterized by pathophysiologic categorization of motor disorders into outflow obstruction, hypermotility disorders, and hypomotility disorders. Contraction wave abnormalities in patients without a motor disorder (according to Chicago Classification) had distinct symptom characteristics and symptom burden that aligned best with hypermotility disorders.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136428/1/nmo12970_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136428/2/nmo12970.pd

The Distribution of High Redshift Galaxy Colors: Line of Sight Variations in Neutral Hydrogen Absorption

We model, via Monte Carlo simulations, the distribution of observed U-B, B-V, V-I galaxy colors in the range 1.75<z<5 caused by variations in the line-of-sight opacity due to neutral hydrogen (HI). We also include HI internal to the source galaxies. Even without internal HI absorption, comparison of the distribution of simulated colors to the analytic approximations of Madau (1995) and Madau et al (1996) reveals systematically different mean colors and scatter. Differences arise in part because we use more realistic distributions of column densities and Doppler parameters. However, there are also mathematical problems of applying mean and standard deviation opacities, and such application yields unphysical results. These problems are corrected using our Monte Carlo approach. Including HI absorption internal to the galaxies generaly diminishes the scatter in the observed colors at a given redshift, but for redshifts of interest this diminution only occurs in the colors using the bluest band-pass. Internal column densities < 10^17 cm^2 do not effect the observed colors, while column densities > 10^18 cm^2 yield a limiting distribution of high redshift galaxy colors. As one application of our analysis, we consider the sample completeness as a function of redshift for a single spectral energy distribution (SED) given the multi-color selection boundaries for the Hubble Deep Field proposed by Madau et al (1996). We argue that the only correct procedure for estimating the z>3 galaxy luminosity function from color-selected samples is to measure the (observed) distribution of redshifts and intrinsic SED types, and then consider the variation in color for each SED and redshift. A similar argument applies to the estimation of the luminosity function of color-selected, high redshift QSOs.Comment: accepted for publication in ApJ; 25 pages text, 14 embedded figure

A brief review of low-dose rate (LDR) and high-dose rate (HDR) brachytherapy boost for high-risk prostate

For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LDR) or high-dose rate (HDR) brachytherapy to EBRT, although only ASCENDE-RT compared brachytherapy to dose-escalated EBRT but did report an over 50% improvement in biochemical failure with a LDR boost. Multiple single institution and comparative research series also support the use of a brachytherapy boost in the DE-EBRT era and demonstrate excellent prostate cancer specific outcomes. Despite improved oncologic outcomes with a brachytherapy boost in the high-risk setting, the utilization of both LDR, and HDR brachytherapy use is declining. The acute genitourinary toxicities when brachytherapy boost is combined with EBRT, particularly a LDR boost, are of concern in comparison to EBRT alone. HDR brachytherapy boost has many physical properties inherent to its rapid delivery of a large dose which may reduce acute toxicities and also appeal to the radiobiology of prostate cancer. We herein review the evidence for use of either LDR or HDR brachytherapy boost for high-risk prostate cancer and summarize comparisons between the two treatment modalities