Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background: Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. Methods: We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. Results: Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor’s time were also strong risk factors for delay, but were much less commonly reported (<6%). Interpretation: Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised

Increasing Dominance - the Role of Advertising, Pricing and Product Design

Despite the empirical relevance of advertising strategies in concentrated markets, the economics literature is largely silent on the effect of persuasive advertising strategies on pricing, market structure and increasing (or decreasing) dominance. In a simple model of persuasive advertising and pricing with differentiated goods, we analyze the interdependencies between ex-ante asymmetries in consumer appeal, advertising and prices. Products with larger initial appeal to consumers will be advertised more heavily but priced at a higher level - that is, advertising and price discounts are strategic substitutes for products with asymmetric initial appeal. We find that the escalating effect of advertising dominates the moderating effect of pricing so that post-competition market shares are more asymmetric than pre-competition differences in consumer appeal. We further find that collusive advertising (but competitive pricing) generates the same market outcomes, and that network effects lead to even more extreme market outcomes, both directly and via the effect on advertising

Differential information in large games with strategic complementarities

We study equilibrium in large games of strategic complementarities (GSC) with differential information. We define an appropriate notion of distributional Bayesian Nash equilibrium and prove its existence. Furthermore, we characterize order-theoretic properties of the equilibrium set, provide monotone comparative statics for ordered perturbations of the space of games, and provide explicit algorithms for computing extremal equilibria. We complement the paper with new results on the existence of Bayesian Nash equilibrium in the sense of Balder and Rustichini (J Econ Theory 62(2):385–393, 1994) or Kim and Yannelis (J Econ Theory 77(2):330–353, 1997) for large GSC and provide an analogous characterization of the equilibrium set as in the case of distributional Bayesian Nash equilibrium. Finally, we apply our results to riot games, beauty contests, and common value auctions. In all cases, standard existence and comparative statics tools in the theory of supermodular games for finite numbers of agents do not apply in general, and new constructions are required

The Type Ia Supernova 1999aw: a Probable 1999aa-like Event In a Low-Luminosity Host Galaxy

SN 1999aw was discovered during the first campaign of the Nearby Galaxies Supernova Search (NGSS) project. This luminous, slow-declining (Delta m_{15} (B) = 0.81 \pm 0.03) Type Ia supernova was noteworthy in at least two respects. First, it occurred in an extremely low luminosity host galaxy that was not visible in the template images, nor in initial subsequent deep imaging. Secondly, the photometric and spectral properties of this supernova indicate that it very likely was similar to the subclass of Type Ia supernovae whose prototype is SN 1999aa. This paper presents the BVRI and J_{s} HK_{s} lightcurves of SN 1999aw (through 100 days past maximum light), as well as several epochs of optical spectra. From these data we calculate the bolometric light curve, and give estimates of the luminosity at maximum light and the initial ^{56}Ni mass. In addition, we present deep BVI images obtained recently with the Baade 6.5-meter telescope at Las Campanas Observatory which reveal the remarkably low-luminosity host galaxy.Comment: 18 pages, 10 figures, 8 tables, accepted for publication in A

The Dozen Things Experimental Economists Should Do (More of)

What was once broadly viewed as an impossibility—learning from experimental data in economics—has now become commonplace. Governmental bodies, think tanks, and corporations around the world employ teams of experimental researchers to answer their most pressing questions. For their part, in the past two decades academics have begun to more actively partner with organizations to generate data via field experimentation. Although this revolution in evidence‐based approaches has served to deepen the economic science, recently a credibility crisis has caused even the most ardent experimental proponents to pause. This study takes a step back from the burgeoning experimental literature and introduces 12 actions that might help to alleviate this credibility crisis and raise experimental economics to an even higher level. In this way, we view our “12 action wish list” as discussion points to enrich the field