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

Perturbed myoepithelial cell differentiation in BRCA mutation carriers and in ductal carcinoma in situ.

Myoepithelial cells play key roles in normal mammary gland development and in limiting pre-invasive to invasive breast tumor progression, yet their differentiation and perturbation in ductal carcinoma in situ (DCIS) are poorly understood. Here, we investigated myoepithelial cells in normal breast tissues of BRCA1 and BRCA2 germline mutation carriers and in non-carrier controls, and in sporadic DCIS. We found that in the normal breast of non-carriers, myoepithelial cells frequently co-express the p63 and TCF7 transcription factors and that p63 and TCF7 show overlapping chromatin peaks associated with differentiated myoepithelium-specific genes. In contrast, in normal breast tissues of BRCA1 mutation carriers the frequency of p63+TCF7+ myoepithelial cells is significantly decreased and p63 and TCF7 chromatin peaks do not overlap. These myoepithelial perturbations in normal breast tissues of BRCA1 germline mutation carriers may play a role in their higher risk of breast cancer. The fraction of p63+TCF7+ myoepithelial cells is also significantly decreased in DCIS, which may be associated with invasive progression

Historic Preservation Law in a Nutshell

The purpose of this book is to provide a concise, coherent reference for the emerging field of historic preservation law for lawyers, policymakers, planners, architects, and students alike. We consider preservation law to be “emerging” because it began to fully develop in the United States only in the last fifty years. Two key transition points happened at the federal level: the 1966 passage of the National Historic Preservation Act and the 1978 Penn Central Supreme Court decision, which upheld a landmarks law against a constitutional challenge and consequently encouraged other localities to adopt similar ordinances. (Of course, this book covers laws and judicial decisions prior to and subsequent to those two key transition points.) Historic preservation law continues to evolve. Our book is intended to give a broad overview of the key issues as they stand today, supported by statutory references and caselaw. Some of the issues, particularly in the conservation/preservation restriction and the tax credit context, are very much “live,” and we strive to highlight areas of current controversy. We will address the way these legal controversies come to be settled, if at all, in future editions of this book. Most of the Chapters in this book focus on federal laws and jurisprudence implicating preservation, and we devote one Chapter to international preservation law. It is important to note, however, that the venue in which most people interact with historic preservation law is the local level. Hundreds of localities have stand-alone historic preservation ordinances, while others incorporate historic preservation considerations into their planning and zoning rules. While we could not survey every locality with a preservation ordinance, we present common legal strategies and areas of concern

Historic Preservation Law in a Nutshell

The purpose of this book is to provide a concise, coherent reference for the emerging field of historic preservation law for lawyers, policymakers, planners, architects, and students alike. We consider preservation law to be “emerging” because it began to fully develop in the United States only in the last fifty years. Two key transition points happened at the federal level: the 1966 passage of the National Historic Preservation Act and the 1978 Penn Central Supreme Court decision, which upheld a landmarks law against a constitutional challenge and consequently encouraged other localities to adopt similar ordinances. (Of course, this book covers laws and judicial decisions prior to and subsequent to those two key transition points.) Historic preservation law continues to evolve. Our book is intended to give a broad overview of the key issues as they stand today, supported by statutory references and caselaw. Some of the issues, particularly in the conservation/preservation restriction and the tax credit context, are very much “live,” and we strive to highlight areas of current controversy. We will address the way these legal controversies come to be settled, if at all, in future editions of this book. Most of the Chapters in this book focus on federal laws and jurisprudence implicating preservation, and we devote one Chapter to international preservation law. It is important to note, however, that the venue in which most people interact with historic preservation law is the local level. Hundreds of localities have stand-alone historic preservation ordinances, while others incorporate historic preservation considerations into their planning and zoning rules. While we could not survey every locality with a preservation ordinance, we present common legal strategies and areas of concern