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

Cosmological Adaptive Mesh Refinement

We describe a grid-based numerical method for 3D hydrodynamic cosmological simulations which is adaptive in space and time and combines the best features of higher order--accurate Godunov schemes for Eulerian hydrodynamics with adaptive particle--mesh methods for collisionless particles. The basis for our method is the structured adaptive mesh refinement (AMR) algorithm of Berger & Collela (1989), which we have extended to cosmological hydro + N-body simulations. The resulting multiscale hybrid method is a powerful alternative to particle-based methods in current use. The choices we have made in constructing this algorithm are discussed, and its performance on the Zeldovich pancake test problem is given. We present a sample application of our method to the problem of first structure formation. We have achieved a spatial dynamic range $L_{box}/\Delta x > 250,000$ in a 3D multispecies gas + dark matter calculation, which is sufficient to resolve the formation of primordial protostellar cloud cores starting from linear matter fluctuations in an expanding FRW universe.Comment: 14 pages, 3 figures (incl. one large color PS) to appear in "Numerical Astrophysics 1998", eds. S. Miyama & K. Tomisaka, Tokyo, March 10-13, 199

The impact of eliminating age inequalities in stage at diagnosis on breast cancer survival for older women.

BACKGROUND: Older women with breast cancer have poorer relative survival outcomes, but whether achieving earlier stage at diagnosis would translate to substantial reductions in mortality is uncertain. METHODS: We analysed data on East of England women with breast cancer (2006-2010) aged 70+ years. We estimated survival for different stage-deprivation-age group strata using both the observed and a hypothetical stage distribution (assuming that all women aged 75+ years acquired the stage distribution of those aged 70-74 years). We subsequently estimated deaths that could be postponed beyond 5 years from diagnosis if women aged 75+ years had the hypothetical stage distribution. We projected findings to the English population using appropriate age and socioeconomic group weights. RESULTS: For a typically sized annual cohort in the East of England, 27 deaths in women with breast cancer aged 75+ years can be postponed within 5 years from diagnosis if their stage distribution matched that of the women aged 70-74 years (4.8% of all 566 deaths within 5 years post diagnosis in this population). Under assumptions, we estimate that the respective number for England would be 280 deaths (5.0% of all deaths within 5 years post diagnosis in this population). CONCLUSIONS: The findings support ongoing development of targeted campaigns aimed at encouraging prompt presentation in older women.This article is an independent research supported by different funding bodies, beyond the authors’ own employing organisations. MJR was partially funded by a Cancer Research UK Postdoctoral Fellowship (CRUK_A13275). GL is supported by a Postdoctoral Fellowship award by the National Institute for Health Research (NIHR PDF-2011-04-047) to end of 2014 and a Cancer Research UK Clinician Scientist Fellowship award (A18180) from 2015. We thank all staff at the National Cancer Registration Service, Public Health England, Eastern Office who helped collect and code data used in this study. We particularly acknowledge the help of Dr Clement H Brown and Dr Brian A Rous who were responsible for staging.This is the final published version. It first appeared at http://www.nature.com/bjc/journal/v112/n1s/full/bjc201551a.html#ack

The impact of eliminating age inequalities in stage at diagnosis on breast cancer survival for older women

This is the final published version. Available from Springer Nature via the DOI in this record.BACKGROUND: Older women with breast cancer have poorer relative survival outcomes, but whether achieving earlier stage at diagnosis would translate to substantial reductions in mortality is uncertain.METHODS: We analysed data on East of England women with breast cancer (2006-2010) aged 70+ years. We estimated survival for different stage-deprivation-age group strata using both the observed and a hypothetical stage distribution (assuming that all women aged 75+ years acquired the stage distribution of those aged 70-74 years). We subsequently estimated deaths that could be postponed beyond 5 years from diagnosis if women aged 75+ years had the hypothetical stage distribution. We projected findings to the English population using appropriate age and socioeconomic group weights.RESULTS: For a typically sized annual cohort in the East of England, 27 deaths in women with breast cancer aged 75+ years can be postponed within 5 years from diagnosis if their stage distribution matched that of the women aged 70-74 years (4.8% of all 566 deaths within 5 years post diagnosis in this population). Under assumptions, we estimate that the respective number for England would be 280 deaths (5.0% of all deaths within 5 years post diagnosis in this population).CONCLUSIONS: The findings support ongoing development of targeted campaigns aimed at encouraging prompt presentation in older women.Cancer Research UKCancer Research UKNational Institute for Health Research (NIHR

Direct Mediation and Metastable Supersymmetry Breaking for SO(10)

We examine a metastable $\mathcal{N}=1$ Macroscopic SO(N) SQCD model of Intriligator, Seiberg and Shih (ISS). We introduce various baryon and meson deformations, including multitrace operators and explore embedding an SO(10) parent of the standard model into two weakly gauged flavour sectors. Direct fundamental messengers and the symmetric pseudo-modulus messenger mediate SUSY breaking to the MSSM. Gaugino and sfermion masses are computed and compared for each deformation type. We also explore reducing the rank of the magnetic quark matrix of the ISS model and find an additional fundamental messenger.Comment: 43 pages, Latex. Version to appear in JHEP

Tree Level Metastability and Gauge Mediation in Baryon Deformed SQCD

We investigate supersymmetric QCD with gauge group SU(2) and a baryon deformation to the superpotential. The existence of an uplifted vacuum at the origin with tree level metastability is demonstrated. When this model is implemented in a direct gauge mediation scenario we therefore find gaugino masses which are comparable to sfermion masses and parameterised by an effective number of messengers 1/8. All deformations are well motivated by appealing to the electric theory and an R-symmetry. This R-symmetry is explicitly broken by the same term responsible for supersymmetry breaking. Moreover, the model does not suffer from the Landau pole problem and we find that it can be described in terms of just two scales: the weak scale and a high scale like the Planck or GUT scale. The model can be tested by searching for new particles at the TeV scale charged under the visible sector gauge group.Comment: 17 pages, 7 figures, updated reference

A smoother end to the dark ages

Independent lines of evidence suggest that the first stars, which ended the cosmic dark ages, came in pairs, rather than singly. This could change the prevailing view that the early Universe had a Swiss-cheese-like appearance.Comment: Nature News and Views, April 7, 201

Estimating the potential survival gains by eliminating socioeconomic and sex inequalities in stage at diagnosis of melanoma

This is the final published version. Available from Springer Nature via the DOI in this record.BACKGROUND: Although inequalities in cancer survival are thought to reflect inequalities in stage at diagnosis, little evidence exists about the size of potential survival gains from eliminating inequalities in stage at diagnosis.METHODS: We used data on patients diagnosed with malignant melanoma in the East of England (2006-2010) to estimate the number of deaths that could be postponed by completely eliminating socioeconomic and sex differences in stage at diagnosis after fitting a flexible parametric excess mortality model.RESULTS: Stage was a strong predictor of survival. There were pronounced socioeconomic and sex inequalities in the proportion of patients diagnosed at stages III-IV (12 and 8% for least deprived men and women and 25 and 18% for most deprived men and women, respectively). For an annual cohort of 1025 incident cases in the East of England, eliminating sex and deprivation differences in stage at diagnosis would postpone approximately 24 deaths to beyond 5 years from diagnosis. Using appropriate weighting, the equivalent estimate for England would be around 215 deaths, representing 11% of all deaths observed within 5 years from diagnosis in this population.CONCLUSIONS: Reducing socioeconomic and sex inequalities in stage at diagnosis would result in substantial reductions in deaths within 5 years of a melanoma diagnosis.Cancer Research UKCancer Research UKNational Institute for Health Research (NIHR

Thermal Evolution of the Non Supersymmetric Metastable Vacua in N=2 SU(2) SYM Softly Broken to N=1

It has been shown that four dimensional N=2 gauge theories, softly broken to N=1 by a superpotential term, can accommodate metastable non-supersymmetric vacua in their moduli space. We study the SU(2) theory at high temperatures in order to determine whether a cooling universe settles in the metastable vacuum at zero temperature. We show that the corrections to the free energy because of the BPS dyons are such that may destroy the existence of the metastable vacuum at high temperatures. Nevertheless we demonstrate the universe can settle in the metastable vacuum, provided that the following two conditions are hold: first the superpotential term is not arbitrarily small in comparison to the strong coupling scale of the gauge theory, and second the metastable vacuum lies in the strongly coupled region of the moduli space.Comment: 32 pages, 30 figure

Revealing the footprints of squark gluino production through Higgs search experiments at the Large Hadron Collider at 7 TeV and 14 TeV

The invariant mass distribution of the di-photons from the decay of the lighter scalar Higgs boson(h) to be carefully measured by dedicated h search experiments at the LHC may be distorted by the di-photons associated with the squark-gluino events with much larger cross sections in Gauge Mediated Supersymmetry Breaking (GMSB) models. This distortion if observed by the experiments at the Large Hadron Collider at 7 TeV or 14 TeV, would disfavour not only the standard model but various two Higgs doublet models with comparable h - masses and couplings but without a sector consisting of new heavy particles decaying into photons. The minimal GMSB (mGMSB) model constrained by the mass bound on h from LEP and that on the lightest neutralino from the Tevatron, produce negligible effects. But in the currently popular general GMSB(GGMSB) models the tail of the above distribution may show statistically significant excess of events even in the early stages of the LHC experiments with integrated luminosity insufficient for the discovery of h. We illustrate the above points by introducing several benchmark points in various GMSB models - minimal as well as non-minimal. The same conclusion follows from a detailed parameter scan in a simplified GGMSB model recently employed by the CMS collaboration to interpret their searches in the di-photon + \etslash channel. Other observables like the effective mass distribution of the di-photon + X events may also reveal the presence of new heavy particles beyond the Higgs sector. The contamination of the h mass peak and simple remedies are also discussed.Comment: 23 pages, 7 figures, title and organization of the paper is changed, detailed parameter scan in a simplified GGMSB model is added, conclusions and old numerical results remain unchange