Delay In Submission Research Articles

Effects of Automated Prompts for Logging Symptom and Exercise Data on Mobile Devices in Patients With Chronic Obstructive Pulmonary Disease

Traditional approaches to patient-reported outcomes diaries have been largely paper based. However, paper-based approaches have inherent inefficiencies such as an inability to communicate the entries in real time to the healthcare team, issues related to transport and mobility, and no tailored output related to what is entered. Traditional paper-based approaches also lack the ability to prompt users at regular intervals to record data. This lack of prompting may lead to delays in entering symptoms and exercises (diary hoarding). Electronic mobile devices have addressed some of these limitations. However, until recently these electronic devices have not been able to deliver the data in real time, thus limiting the ability of the care team to interact and respond. With the emergence of wireless mobile devices, which provide real-time linkages between the patient and the researchers, these limitations are largely eliminated. Yet, it is unclear (whether diary hoarding still occurs and) whether prompts are effective in reducing hoarding over the course of many months. The purpose of this analysis was to conduct a summative evaluation of 7474 automated prompts sent to participants with chronic obstructive pulmonary disease (n = 19). These participants were provided with mobile devices for logging exercise and symptom data over a 6-month period as part of a clinical trial. We found a marginal association between length in the study and delay in submission of exercise and symptom data in response to electronic prompts. Factors associated with delayed response to the prompts included older age, limited computer skills, and reports of no exercise. We recommend that future investigators who are using mobile devices in their research pay careful attention to usability issues as well as strategies that might keep patients engaged and motivated.

Effects of Automated Prompts for Logging Symptom and Exercise Data on Mobile Devices in Patients With Chronic Obstructive Pulmonary Disease

Traditional approaches to patient-reported outcomes diaries have been largely paper based. However, paper-based approaches have inherent inefficiencies such as an inability to communicate the entries in real time to the healthcare team, issues related to transport and mobility, and no tailored output related to what is entered. Traditional paper-based approaches also lack the ability to prompt users at regular intervals to record data. This lack of prompting may lead to delays in entering symptoms and exercises (diary hoarding). Electronic mobile devices have addressed some of these limitations. However, until recently these electronic devices have not been able to deliver the data in real time, thus limiting the ability of the care team to interact and respond. With the emergence of wireless mobile devices, which provide real-time linkages between the patient and the researchers, these limitations are largely eliminated. Yet, it is unclear (whether diary hoarding still occurs and) whether prompts are effective in reducing hoarding over the course of many months. The purpose of this analysis was to conduct a summative evaluation of 7474 automated prompts sent to participants with chronic obstructive pulmonary disease (n = 19). These participants were provided with mobile devices for logging exercise and symptom data over a 6-month period as part of a clinical trial. We found a marginal association between length in the study and delay in submission of exercise and symptom data in response to electronic prompts. Factors associated with delayed response to the prompts included older age, limited computer skills, and reports of no exercise. We recommend that future investigators who are using mobile devices in their research pay careful attention to usability issues as well as strategies that might keep patients engaged and motivated.

Manuscript Rejection for the Schizophrenia Bulletin: Some Reasons

Since assuming editorial responsibilities for Schizophrenia Bulletin in 2005, there has been an increasing number of high-quality manuscripts submitted to the journal. This is very encouraging and gratifying but made the review process particularly challenging when saying “no” to good papers. Our page budget is especially small for regular articles and decisions are often made rapidly without external review so that there is little delay in submission elsewhere. Other manuscripts will receive a rejection decision after full review, and each category contains many good papers advancing knowledge and ideas that we hope will be published but will not make our tight space. Our acceptance rate is about 20% of ∼400 regular articles that we receive annually, and for these, it takes an average of 108 days from submission to production. Although we are able to publish accepted papers online in a timely manner, we face a large backlog of papers that have been published online but not in print. The Bulletin has developed a broad and diverse readership that we plan to continue to serve. We value our special features that cover several topics including the first person accounts, translational pieces for clinical and basic scientists, Cochrane Corner, and brief reviews on genetic and environmental factors relevant to schizophrenia. The emphasis of this section is on clarity and accessibility to a broader audience. Our theme issues provide timely, comprehensive, and multifaceted review of wide-ranging topics in schizophrenia and continue to be the centerpiece of Schizophrenia Bulletin. As a result, space is particularly tight for regular articles. Here, we seek to publish findings that are new, definitive, and which make substantial advances in schizophrenia research. Currently, we reject about 80% of these submissions, often papers reviewed as “good” or “very good.” The basis for our judgment of rejecting these manuscripts often involves one or more of the following considerations. Data support knowledge already established but extends it to a new geographic or cultural setting or the report is based on a larger sample. Longitudinal or follow-up studies where prognostic and outcome data are reported that generally support existing knowledge, albeit on a new and interesting cohort. Important correlations are reported but lack specificity. For instance, findings of decreased connectivity between 2 brain regions in imaging data in schizophrenia correlated with a specific cognitive function in itself is often not definitive. The data need to show that the disruption in connectivity is regionally specific, and the relationship with the specific cognitive function is unique and not part of the general cognitive/motivational deficit associated with schizophrenia. Important conclusions based on inadequate sample. If schizophrenia is the independent variable, interpretation of dependent measures as reflecting the disease process when other likely sources (eg, drug effects) are not addressed. Reporting similarities across heterogeneous syndromes without clarifying whether the similarities are decisive on diagnostic classification issues or merely expected across syndrome similarities (eg, if 2 psychosis syndromes have a substantial proportion of subjects with anxiety, anxiety-related measures will be observed in both without bearing on the question of separate illnesses or on a continuum). Reports on the negative symptom construct without addressing primary vs secondary causation of negative symptoms. Efficacy conclusions for nonpsychotic domains of pathology (eg, cognition) without addressing the pseudospecificity issue.1,2 Genetic association findings in the absence of replication sample or other converging lines of evidence. Review or meta-analysis papers on a topic covered in publications elsewhere in the past few years. Secondary analyses that may extend published findings without substantially advancing the field. These are some of the examples that guide our decisions. Ideally, we would like to accommodate many more of the high-quality papers that at present are rejected mostly because of limited space. We are now implementing a new set of guidelines for limiting manuscript size (see http://www.oxfordjournals.org/our_journals/schbul/for_authors/auth2.html). This would help us with the backlog of online papers ready for print publication and not reject high-quality regular articles.

Hindrance of Conservation Biology by Delays in the Submission of Manuscripts

Timely dissemination of scientific findings depends not only on rapid publication of submitted manuscripts, a topic which has received much discussion, but also on rapid submission of research after the research is completed. We measured submission delay (time from the last date of data collection to the submission of a manuscript) for every paper from 14 journals in 2007 and compared these submission delays among four fields of biology (conservation, taxonomy, behavior, and evolution). Manuscripts published in leading journals in the field of conservation biology have the longest delays in publication of accepted manuscripts and the longest intervals between completion of research and submission of the manuscript. Delay in manuscript submission accounts for more than half of the total time from last date of data collection to publication. Across fields, the number of authors was significantly negatively correlated with submission delay, but conservation journals had the second highest number of authors and the greatest submission delay, so submission of conservation manuscripts was not hindered by a shortage of collaboration relative to other fields. Rejection rates were greater in conservation journals than in behavior and evolution, but rejection times were faster; thus, there were no obvious net differences among fields in the time papers spent waiting to be rejected. Publication delay has been reduced significantly in the last 7 years, but was still greater in conservation journals than in any of the other three fields we studied. Thus, the urgent field of conservation biology is hindered in both preparation and publication of manuscripts.

A Pilot Study to Improve Workflow in an Academic Radiation Oncology Department

The delivery of timely, effective and accurate therapy is requisite to maximizing tumor control in patients whose treatments include radiation therapy. Given the complex process associated with radiation treatment planning, systems-based approaches are needed to minimize delays in the initiation of radiation treatment. From December 2007 to September 2008, all patients treated at the Johns Hopkins Department of Radiation Oncology were prospectively coded to indicate whether radiation was initiated on a planned start date assigned at the time of simulation. Additionally, delayed patients were coded to categorize the reason for the delay. An intervention program was then piloted with three provider teams between December 2008 and March 2009 to reduce the incidence of physician-associated factors in treatment delays. The intervention plan included: (1) the initiation of a requisite weekly provider team scheduling conference, (2) reserved slots per provider for simulation, and (3) provider team accountability. Intervention data was prospectively gathered and statistical comparisons were performed using chi-square analysis. Over a 10-month period, 1,652 patients were treated with radiation and the initiation of radiation therapy was delayed in 491 patients (29.7%). Reasons for delays in the initiation of therapy were attributed to: (1) physician delay in the submission of treatment contours to dosimetry, 9.9% (or 33.3% of delayed patients), (2) physician request for patient delay, 7.8%, and (3) non-physician associated delays (i.e., physics/dosimetry initiated delays, patient requests for delay), 12.0%. After the initiation of a pilot intervention program with three provider teams over a 3-month period (n = 113 patients), the average number of patient delays in the intervention group decreased significantly from 29.7% to 15.1% (p = .00086). Patient delays in the intervention period attributable to physician-associated factors were significantly reduced (contour submission delays, 1.8% vs. 9.9%; p = 0.0042; physician request, 0% vs. 7.8%; p = 0.002), but delays associated with other causes were not significantly changed (13.3% vs. 12.0%; p = 0.699). Our data demonstrate that several factors contribute to delays in the initiation of radiation therapy at a major academic radiation department. Furthermore, a pilot program focused on decreasing physician associated delays helped to significantly improve the timeliness of radiation therapy initiation. Taken together, these results show that systems-based approaches can help solve a vexing problem in oncologic care by facilitating team-centered solutions that empower the physician provider. Further goals include the implementation of the interventions to all provider teams in the department.

An Internet-based external quality assessment in cytogenetics that audits a laboratory's analytical and interpretative performance

A novel approach to external quality assessment (EQA) using the Internet mimics the diagnostic situation so that multiple tests can be requested and EQA cases can be 'tailor made' to address a specific chromosome syndrome, disease, or clinical dilemma. The web-based EQA system was trialled on a large UK EQA scheme, UK NEQAS for Clinical Cytogenetics. It has also been used to implement a new Cytogenetics European Quality Assessment scheme, CEQA, set up with the intention of providing laboratories in countries without access to a local EQA scheme the opportunity of participation in EQA. Overall, Internet-based EQA allows for a varied EQA programme. Poor performance was detected in both CEQA and UK NEQAS constitutional EQA schemes and also in the UK NEQAS oncology EQA scheme. The Internet-based EQA overcomes submission delays due to international surface mail. There is also a reduction in administration and assessors' time compared to a retrospective EQA involving the submission of unique cases for EQA assessment, as participants analyse the same three Internet-based EQA cases simultaneously. Many EU27 (EU member states) laboratories still do not participate in their national EQA schemes, so until EQA participation becomes mandatory as a component of compulsory laboratory accreditation, the quality of laboratory diagnostic service is unpredictable.

Presentation in relation to publication of results from clinical trials

Background Results from clinical trials are typically disseminated first by presentation at scientific meetings. An important question has to do with the role of presentation in improving the quality of manuscripts submitted to the journals as well as the effect of presentation in speeding, or delaying subsequent publication. The aim of this research is focused on presentation practices of trialists to examine their effect on the timing of publications of clinical trial results. Methods Six hundred and one (601) trials published in 1996 and 1997 were identified via MEDLINE using medical subject heading “clinical trials” or the occurrence of the term in the text and by limiting to publication type “clinical trial”. Authors of those trials were surveyed to determine prior presentation history for the identified trials. Results Among the 601 trials identified, complete responses to questionnaires were obtained for 379 (63%) trials. The median time from completion to first submission of the primary results manuscript was 11 months and the median time from completion to publication was 25 months for the 220 trials involving presentation prior to submission for publication. The corresponding median times from completion to first submission and publication for the subset of trials not involving presentation prior to the submission were 8 and 19 months (159 trials), respectively. The adjusted relative hazard for publication for trials involving presentation prior to first submission was 0.55 versus trials not involving presentation prior to first submission (95% confidence interval, 0.44 to 0.69). Conclusion Despite the importance of dissemination of results prior to publication, investigators should carefully weigh a potential gain in quality against a potential for delay in submission of the primary results manuscript by presentation at scientific meetings. The findings of our study suggest that presentation prior to submission may increase time to publication. Inclusion of presentation dates in clinical trial registers should be considered to allow future studies investigating presentation and publication practices.

Two years maternal mortality in Matebeleland North Province, Zimbabwe

To describe timeliness and completeness of maternal mortality notifications after the introduction of a revised national notification form in 1998, as well as socio-demographic and obstetric variables and causes of maternal deaths. Retrospective descriptive study. Seven districts in Matebeleland North province. 95 maternal death notifications from 1 August 1998 to 31 July 2000. Delay in submission and completeness of reports, age, marital status, religion, reproductive history, booking and referral status, duration and outcome of pregnancy, place of death, cause of death. 92/95 notifications were true maternal deaths, 86% were notified within 48 hours and 79% were complete, 74% of the deaths took place in a health facility. Mean age of the women was 27.8 years, mean parity 3.0. Sixty percent had booked. The five main causes of death were obstetric haemorrhage (26%), malaria (24%), immune deficiency syndrome (13%), abortion (11%) and eclampsia (8%). The maternal mortality ratio per 100,000 reported home and institutional live births ranged from 155 to 532 per district. There is under reporting of maternal mortality in some districts, although from 1997 to 2000 a 200% increase in reporting was seen. Timeliness and completeness of reporting was satisfactory. With the exception of a high contribution from malaria the causes of maternal mortality in Matebeleland North province are similar to those reported elsewhere in Zimbabwe.

AFTA In the Light of New Economic Developments

Introduction It was at the 1992 Association of Southeast Asian Nations (ASEAN) Summit that the six states made a stronger commitment to a liberal trade regime through the instrument of the Common Effective Preferential Tariff (CEPT). They decided to establish an ASEAN Free Trade Area (AFTA). Coming on the heels of the North American Free Trade Agreement (NAFTA) and Europe 1992, AFTA did not evolve from a comprehensive and detailed programme of liberalization complete with rules and procedures. In fact the agreement incorporating AFTA was less than 10 pages. Compare this with the NAFTA document exceeding 2,000 pages. Yet AFTA stands out among all attempts in ASEAN at economic co-operation in several ways. First, this was the first time that ASEAN described free trade as its eventual goal, a break from its previous mind-set of cautious liberalization. Second, the Heads of Governments in ASEAN identified 15 product groups for accelerated liberalization, thus avoiding a lengthy process of negotiations among bureaucrats to identify product groups, Third, there was a definite timetable within which free trade would be achieved, that is in 15 years. Finally, the CEPT was a vast improvement over an earlier (1987) programme for enhanced Preferential Trading Arrangements (PTA), which allowed for more automatic liberalization of items, deeper margins of preferences, and more product coverage than under PTA. This latter programme did not really progress substantially, suffered from delays in submission of items for liberalization, and some members were behind schedule for as much as two years. As shown in Figure 1, the CEPT has two tracks: fast and normal. In the fast track, according to the 1992 agreements, the achievement of free trade was to take place in 10 years, that is by 2003. For items with base tariff rates exceeding 20 per cent, reductions were to be spread over 10 years till 2003. For items with rates below 20 per cent, reductions were to be completed by the year 2000. In the normal track, tariffs of more than 20 per cent were to be reduced in three stages: to 20 per cent by 2001, 15 per cent by 2003, 10 per cent by 2005 and free trade (0–5 per cent) in 2008. For items with tariff rates less than 20 per cent, reductions were to be completed by 2003.

Delay in State Appellate Courts of Last Resort

Delays in appeals occur first in filing them, sec ond in preparing and submitting them for decision, third in the courts' consideration and disposition of them. The first may be met by court rule requiring filing within specified num ber of days after decision in trial court. Delays in submission, due to procrastination of lawyers, decrease upon adoption of a rule providing for dismissal of appeals, automatically or on a court's own motion, when not submitted promptly. Some delays in hearing appeals are due, as are delays in deciding them, to the courts' inability or failure to keep up with work- loads. Suggested means of increasing productiveness of judges include change in methods of judicial selection and improved compensation and facilities to attract the ablest lawyers to the bench. Among proposals for meeting today's increased case-loads are elimination of requirement that highest courts write opinions in every case decided, enlarging court member ship, divisional sittings of the courts, placing restrictions on right of appeal, furnishing courts with legally trained clerks or commissioners, or establishment of intermediate courts of appeal. Advantages and disadvantages are found in each. The object of proposals is not only to expedite appellate opera tion but to improve the quality of the product.