No abstract

No abstract

Since the 1970s, policy-makers and the press have rendered young people, particularly those of black and minority ethnic backgrounds, synonymous with ‘inner-city crisis’. Focusing upon the high-density, multi-storey Hulme estate in Manchester, this article seeks to transcend stereotypical representations of these residents and illuminate their perspectives of the inner city. Conceptualizing the inner city as both a discursive and lived space, the article traces the intersections between its representation and residents’ testimonies to assess how far residents used prevalent understandings of Hulme as a space of crime and social breakdown respectively to shape their narratives of everyday life.

Due to the increasing prevalence of erectile dysfunction (ED) and pronounced distress for patients, a market for shockwave therapy (SWT) has emerged. The shockwave market segment has largely been dominated by GainsWave, a practitioner database and marketing platform that has promoted the efficacy of shockwave for ED despite limited evidence supporting its claim. We sought to evaluate trends in marketing and implementation of SWT as a restorative treatment for ED in large metropolitan areas by investigating cost to patients, provider credentials, and treatment protocols.METHODS: SWT providers in seven of the most populous metropolitan areas were identified using google search. Search queries included: "Shockwave therapy for erectile dysfunction in [city]"; "Shockwave therapy for ED in [city]"; "GainsWave in [city]". All clinics advertising SWT for ED within the boundaries of the selected metropolitan area were included; clinics were contacted by telephone, with the goal of identifying the pricing, duration, and provider administering the treatment.RESULTS: Across 7 of the most populous cities in the U.S., 60 clinics offered SWT as a treatment for ED. Comprehensive information was available for 60% of clinics. Only 10% of providers offering SWT were urologists, while 13% were not physicians. Table 1 highlights cost of SWT and provider credentials across each metropolitan area. Treatment duration was highly variable and ranged from one to indefinite courses based on individual patient circumstance.CONCLUSIONS: SWT, as a restorative therapy for ED, is performed primarily by non-urologists and is not standardized. More non-physician providers offer SWT for ED than providers who completed training in urology. Across all clinics, direct-to-consumer marketing is used to target distressed men, often with contradicting claims about the mechanism of therapy and the rates of cure. The AUA and SMSNA classify SWT as an experimental therapy, indicating that patients should not be charged for receiving it. This study highlights concerning trends in major metropolitan markets, given the substantial financial impact for patients and inconsistent credentials among providers. Further, these findings suggest that patients are frequently seeking care for ED from non-urologists.

Introduction Sleep apnea (SA) diagnosis requires multiple steps including an office visit and testing. People with serious mental illness (SMI) may require a longer time from referral to diagnosis and be less likely to complete the full diagnostic pathway because of functional limitations. Methods A retrospective cohort of VA Northeast Ohio Healthcare System Veterans referred for sleep medicine consultation (1/1/2010-12/31/2020). Dates of consultation, sleep clinic visits, and testing was collected in addition to demographics, past medical history, and medications at the time of initial consultation. SMI was defined as a composite of schizophrenia, schizoaffective disorder, and bipolar diagnosed disorder before the initial consultation. The outcome was defined as the time until fulfilling minimal SA diagnostic pathway defined as completing both a sleep clinic appointment and at last one sleep test. Relationships between SMI and pathway completion were tested using survival analyses. Analyses were adjusted for age, sex, race, insurance status, service connection percent, Medicare eligibility, marital status, alcohol use, and drug use to account for other potential sources of health disparities. Sensitivity analyses evaluated differences in time to pathway completion via the Wilcoxon-Mann-Whitney test. Results The cohort (n=11,030) was primarily male (91.1%), with mean age of 55.8 ±14.4 yrs, with mean body mass index of 32.9 ± 6.4 kg/m2, and a mean pathway completion in 71 days, interquartile range (IQR): [33, 135]. Those with SMI had similar pathway completion rates (89.9% in SMI vs. 90.2% without), but a longer time to completion (83 days, IQR = [35.5, 185.5] in SMI vs. 70 days IQR: [32, 132]). Pathway completion time was significantly higher in those with SMI (Wilcoxon rank sum test difference = 9.0 days, 95%CI: [4.0, 14.0]. ]SMI was associated with a lower hazard of time to pathway completion (HR = 0.87, 95% confidence interval (CI): [0.91, 0.94] in unadjusted and HR = 0.87, 95%CI:[0.81, 0.94]. Conclusion Although pathway completion rates were similar, Veterans with SMI were more likely to take longer before pathway completion. Additional investigation of factors that delay pathway completion may offer tailored avenues to improve the time to diagnosis. Support (if any) VA CSR&D IK2CX001882