Factors affecting patients' trust and confidence in GPs: evidence from the English national GP patient survey.

OBJECTIVES: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. DESIGN: Secondary analysis of English national GP patient survey data (2009). SETTING: Primary Care, England, UK. PARTICIPANTS: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. OUTCOME MEASURES: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. RESULTS: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. CONCLUSIONS: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor

The effect of CO2-loaded amine solvents on the corrosion of a carbon steel stripper

The corrosive behaviour of loaded amine solvents was evaluated under stripper operating conditions, for post-combustion carbon capture, to determine the feasibility of using carbon steel in plant construction. In addition to monoethanolamine, three alternative amine solvents: methyldiethanolamine (MDEA), 2-amino-2-methyl-1-propanol (AMP), 1-(2-aminoethyl)piperazine (AEPZ), and the common additive K2CO3 were studied when in contact with carbon steel (C1018) over a 28-day period. Corrosive behaviour was evaluated using carbon steel coupons: gravimetric method for weight change, surface imaging (SEM) and analytical techniques (EDX and XRD), and Fe ion concentration in solution (ICP–OES). The results demonstrated that MDEA and AMP as well as K2CO3 develop a significant siderite (FeCO3) layer on the carbon steel surface. The presence of this layer is attributed to the preferred reaction pathway with CO2 for tertiary and sterically hindered amines. The FeCO3 layer formed in the case of MDEA provides superior protection from continued corrosion of the carbon steel. By contrast, MEA and AEPZ show significant corrosion to the carbon steel surface. In conclusion, MDEA, AMP, and K2CO3 can preferentially produce sufficient surface FeCO3 layers to reduce corrosion levels in carbon steels for use under stripper conditions in post-combustion carbon capture plants

Ocean acidification changes the male fitness landscape.

Sperm competition is extremely common in many ecologically important marine taxa. Ocean acidification (OA) is driving rapid changes to the marine environments in which freely spawned sperm operate, yet the consequences of OA on sperm performance are poorly understood in the context of sperm competition. Here, we investigated the impacts of OA (+1000 μatm pCO2) on sperm competitiveness for the sea urchin Paracentrotus lividus. Males with faster sperm had greater competitive fertilisation success in both seawater conditions. Similarly, males with more motile sperm had greater sperm competitiveness, but only under current pCO2 levels. Under OA the strength of this association was significantly reduced and there were male sperm performance rank changes under OA, such that the best males in current conditions are not necessarily best under OA. Therefore OA will likely change the male fitness landscape, providing a mechanism by which environmental change alters the genetic landscape of marine species.We acknowledge Catherina Artikis and Yueling Hao for their contributions to the molecular analysis. We thank the team at Exeter Biosciences for their help and support. A.L.C. was supported by a Natural Environment Research Council (NERC) PhD studentship to Exeter, and received additional funding from Exeter CLES PREF and a Santander Postgraduate Research Award (2014/2015). C.L. was supported by a UK-OARP NERC consortium grant NE/H017496/1 and a NERC UK Fellowship: NE/G014728/1. DRL was supported by funding from the United States, National Science Foundation (Grant DEB 1354272) which helped to fund the molecular analysis

On the continuity of learning, teaching, schooling: Mead’s educational proposal, from the perspective of decolonization and Land/place-based education

In her 1943 article “Our Educational Emphases,” Margaret Mead inquired: What constitutes education in “the broadest sense” of the term, as a continuing human process. More specifically she asked, how and from what basis can we understand the educational processes of long-standing/Indigenous societies as continuous with the forms of education practiced in modern industrialized society? In short, Mead proposes that we recognize the essential continuity of learning, teaching, and schooling across all human societies. In this article, I explore the controversies that Mead’s proposal raises for contemporary, intersecting discourses on decolonization, Indigenous pedagogy, and place- and Land-based education. I argue that Mead’s call alerts us to two major impediments to the widespread flourishment of decolonizing, place/Land-based education, both of which are deeply intertwined with the processes of colonization and forms of anti-Indigeneity implicit in mainstream notions and practices of schooling. The first impediment concerns the external demands for efficiency and productivity placed upon schools, teachers, and learners; the second concerns the interior (personal/spiritual/cognitive) manifestations of colonization that impact upon our ability to understand Land and place as educationally significant in the first place (Land/place as school). In conclusion, I outline the significance of this reconceptualization for the possibilities and controversies of decolonized, place- and Land-based education and the promises of settler-Indigenous reconciliation

Lavender Aromatherapy Compared to Midazolam For Quality Improvement Of Preoperative Anxiety In Elderly Surgical Patients: An Educational Module

Impact: Investigation into the anxiolytic effects of lavender aromatherapy across several patient populations, application types, and outcome measures establish that lavender oil relieves anxiety, reduces mental stress, provides sedation, and promotes good sleep. Background: Studies have investigated the link between age and the occurrence of undesired responses to premedication with agents of the benzodiazepine drug class. This link is explained by age-related pathophysiologic changes that occur as a function of aging. Despite numerous knowledge-based concerns, benzodiazepines prevail among the top psychotropic medications prescribed in elderly patients aged between 65 and 80 years. Objective: This quality improvement project aims to enhance anesthesia providers\u27 knowledge, beliefs, and attitude regarding the value of aromatherapy with lavender oil as an affordable, safe, and effective alternative to midazolam administration for preoperative anxiolysis in elderly surgical patients. Methods: An extensive literature search was conducted to synthesize studies relevant to the PICO question and create an evidence-based educational module for virtual presentation. An anonymous online platform was used to distribute the project’s intervention and survey components to a sample of anesthesia providers working at a South Florida level-1 trauma center and to record and statistically analyze data. Results: Collectively, the evidence-based literature presented by this project positively impacts the perioperative care of older adults, as it demonstrates lavender aromatherapy as a beneficial alternative to midazolam administration for improved management of preoperative anxiety in elderly surgical patients. Discussion: Analysis of the pre-and post-survey results reveals that this quality improvement project met the objective of expanding anesthesia providers’ knowledge and understanding of the use of lavender oil aromatherapy to optimize preoperative anxiety and care outcomes in elderly surgical patients. As a result, they will be more competent and effective in helping elderly patient populations achieve relief from anxiety before surgery and improved perioperative care outcomes. The small sample size, short project duration, and online delivery platform were limitations of this project

Carbonyl sulfide (OCS): Large-scale distributions over North America during INTEX-NA and relationship to CO2

An extensive set of carbonyl sulfide (OCS) observations were made as part of the NASA Intercontinental Chemical Transport Experiment-North America (INTEX-NA) study, flown from 1 July to 14 August 2004 mostly over the eastern United States and Canada. These data show that summertime OCS mixing ratios at low altitude were dominated by surface drawdown and were highly correlated with CO2. Although local plumes were observed on some low-altitude flight legs, anthropogenic OCS sources were small compared to this sink. These INTEX-NA observations were in marked contrast to the early springtime 2001 Transport and Chemical Evolution over the Pacific experiment, which sampled Asian outflow dominated by anthropogenic OCS emissions. To test the gridded OCS fluxes used in past models, the INTEX-NA observations were combined with the sulfur transport Eulerian model (STEM) regional atmospheric chemistry model for a top-down assessment of bottom-up OCS surface fluxes for North America. Initial STEM results suggest that the modeled fluxes underestimate the OCS plant sink by more than 200%. Copyright 2008 by the American Geophysical Union