How the weather affects the pain of citizen scientists using a smartphone app.

Patients with chronic pain commonly believe their pain is related to the weather. Scientific evidence to support their beliefs is inconclusive, in part due to difficulties in getting a large dataset of patients frequently recording their pain symptoms during a variety of weather conditions. Smartphones allow the opportunity to collect data to overcome these difficulties. Our study Cloudy with a Chance of Pain analysed daily data from 2658 patients collected over a 15-month period. The analysis demonstrated significant yet modest relationships between pain and relative humidity, pressure and wind speed, with correlations remaining even when accounting for mood and physical activity. This research highlights how citizen-science experiments can collect large datasets on real-world populations to address long-standing health questions. These results will act as a starting point for a future system for patients to better manage their health through pain forecasts.

Development and piloting of a survey to estimate the frequency and nature of potentially harmful preventable problems in primary care from a UK patient's perspective.

OBJECTIVES: To design and pilot a survey to be used at the population level to estimate the frequency of patient-perceived potentially harmful preventable problems occurring in UK primary care. To explore the nature of the problems, patient-suggested strategies for prevention and opinions of clinicians and the public regarding the potential for harm. DESIGN: A survey was codesigned by three members of the public and one researcher and piloted through public and patient involvement and engagement networks. SETTING: Self-selected sample of the UK population. PARTICIPANTS: 977 members of the public accessed the online survey during October and November 2015. PRIMARY OUTCOME MEASURES: Respondent feedback about the ease of completion of the survey, quality of responses in terms of review by clinicians and members of the public, preliminary estimates of the frequency and nature of patient-perceived potentially harmful problems occurring in the last 12 months. RESULTS: 638 (65%) members of the public completed the survey and few respondents reported any difficulty in understanding or completing the survey. 132 (21%) respondents reported experiencing a potentially harmful preventable problem during the past 12 months and 108 (82%) of these respondents provided a description that was adequate for at least one clinician to form an opinion about the potentially harmful problem. Respondents were older than the UK generally, more likely to work or volunteer in the healthcare sector and tended to use primary care more frequently but their confidence and trust in their own general practitioner (GP) was similar to that of the UK population as measured by the annual English GP patient survey. CONCLUSIONS: The survey was acceptable to patients and mostly provided data of sufficient quality for review by clinicians and members of the public. It is now ready to use at a population level to estimate the frequency and nature of potentially harmful preventable problems in primary care from a patient's perspective.

Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain.

OBJECTIVES: To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful. DESIGN: Population-level survey. SETTING: Great Britain. PARTICIPANTS: A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016. MAIN OUTCOME MEASURES: Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public. RESULTS: 3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful. CONCLUSIONS: This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care.

Estrogen-receptor independent effects of two ubiquitous environmental estrogens on Melosira varians Agardh, a common component of the aquatic primary production community.

Estrogenic compounds have been discovered in many surface water samples in many anthropogenically altered surface waters. Wastewater effluent has been identified as a major pathway of contamination and found to revert much of the metabolic products of these biologically active compounds back to their original form. This presentation explains methodology for determining exposure effects through a newly developed bioassay, examining the physiological response of a diatom to these compounds. Diatoms represent an important aspect of the primary production community. They are a desirable food source over other members of the primary production community through storage of photosynthetically produced sugars in the form of lipids rather than starch. Therefore, many members of higher trophic levels selectively feed on diatoms when present with other members of the primary production community. This study examines the effects of 17beta-estradiol and 4-nonylphenol on the physiological development of the diatom species Melosira varians. Clearly, unicellular protists such as diatoms are not susceptible to these contaminants in a manner directly analogous to that expressed in vertebrates. However, estradiol and nonylphenol are lipophilic making them particularly effective in entering the diatom cell membrane. Melosira varians was selected because it commonly occurs in most freshwater environments and has been the subject of other toxicological studies. An adequate literature base also exists for evaluating results of this experiment. The species grows rapidly and is easy to maintain in culture. Comparing cell density, chl-a, and lipid content in control and exposed cultures allowed interpretation of how the species responded to varying compound concentrations. Results of this study revealed differences in responses to each compound. 17beta-estradiol appears to have no detrimental effect on M. varians, while 4-nonylphenol results in cell mortality with sufficient dosage. Similar results with 17beta-estradiol are reported for other autotrophic organism, but the 4-nonylphenol response is not as uniform in other photosynthetic groups. The use of a phytoplankton species as a test organism complements other investigations involving vertebrate models at or near the apex of the trophic hierarchy by considering effects at the base of the food web.