To investigate the association between student performance in undergraduate objective structured ... more To investigate the association between student performance in undergraduate objective structured clinical examinations (OSCEs) and the examination schedule to which they were assigned to undertake these examinations. Analysis of routinely collected data. One UK medical school. 2331 OSCEs of 3 different types (obstetrics OSCE, paediatrics OSCE and simulated clinical encounter examination OSCE) between 2009 and 2013. Students were not quarantined between examinations. (1) Pass rates by day examination started, (2) pass rates by day station undertaken and (3) mean scores by day examination started. We found no evidence that pass rates differed according to the day on which the examination was started by a candidate in any of the examinations considered (p>0.1 for all). There was evidence (p=0.013) that students were more likely to pass individual stations on the second day of the paediatrics OSCE (OR 1.27, 95% CI 1.05 to 1.54). In the cases of the simulated clinical encounter examin...
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 24, 2016
Longer consultations in primary care have been linked with better quality of care and improved he... more Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. There was no evidence that consultat...
Medical care research and review : MCRR, Apr 3, 2016
Patient evaluations of physician communication are widely used, but we know little about how thes... more Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluation...
The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux ... more The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated technique to derive estimates of the ionospheric projection of the OCB from the characteristics of latitudinal profiles of far ultraviolet (FUV) auroral intensity. For the typical auroral oval, these latitudinal intensity profiles can be well modelled
ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained s... more ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
To investigate if language spoken at home mediates the relationship between ethnicity and doctor-... more To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner-patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language. There was strong evidence of an association between doctor-patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0-100) than White British patients (95% CI -4.9 to -1.1, p=0.002). This difference reduced to 1.4 points (95% CI -3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-sp...
A number of recent studies have investigated temporal structuring within the magnetosphere ionosp... more A number of recent studies have investigated temporal structuring within the magnetosphere ionosphere system. Studies of ground magnetometer measurements, ionospheric velocity fluctuations, inter FTE intervals, and the AE index, have shown evidence of scale free behaviour. In contrast little work has been done to characterise the spatial structuring. With the large field of view of the SuperDARN radars we have
Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by... more Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by HF radars and of associated ground magnetic fluctuations measured by magnetometers reveals that convection fluctuations are primarily characterised by a scale-free property (no preferred frequency over the observed range), similar to that of the turbulent solar wind [5, 6]. We consider the implications of this on (a) the interpretation of finite-range and spatially-averaged observations, (b) forecasting space weather from solar wind observations, and (c) the Dungey reconnection model of magnetospheric convection.
Large-scale properties of reconnection structures on the magnetopause can be explained successful... more Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and ... more Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and lowest in the winter. Northern Irish data suggested seasonal variation for women only, especially those with thinner melanomas, sited on limbs. We interrogated two larger UK cancer registries for temporal differences in melanoma diagnosis and associated patient characteristics. Melanomas diagnosed from 2006 to 2010 in the Eastern England and Scottish cancer registries (n=11,611) were analysed by month of diagnosis, patient demographics and melanoma characteristics, using descriptive and multivariate modelling methods. More patients with melanoma were diagnosed in the summer months (June 9.9%, July 9.7%, August 9.8%) than the winter months (December 7.2%, January 7.2%, February 7.1%) and this pattern was consistent in both regions. There was evidence that the seasonal patterns varied by sex (p=0.015), melanoma thickness (p=0.002), body site (p=0.006), and type (superficial spreading melan...
To investigate the association between student performance in undergraduate objective structured ... more To investigate the association between student performance in undergraduate objective structured clinical examinations (OSCEs) and the examination schedule to which they were assigned to undertake these examinations. Analysis of routinely collected data. One UK medical school. 2331 OSCEs of 3 different types (obstetrics OSCE, paediatrics OSCE and simulated clinical encounter examination OSCE) between 2009 and 2013. Students were not quarantined between examinations. (1) Pass rates by day examination started, (2) pass rates by day station undertaken and (3) mean scores by day examination started. We found no evidence that pass rates differed according to the day on which the examination was started by a candidate in any of the examinations considered (p>0.1 for all). There was evidence (p=0.013) that students were more likely to pass individual stations on the second day of the paediatrics OSCE (OR 1.27, 95% CI 1.05 to 1.54). In the cases of the simulated clinical encounter examin...
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 24, 2016
Longer consultations in primary care have been linked with better quality of care and improved he... more Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. There was no evidence that consultat...
Medical care research and review : MCRR, Apr 3, 2016
Patient evaluations of physician communication are widely used, but we know little about how thes... more Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluation...
The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux ... more The boundary between open and closed magnetic field lines (OCB) delimits the region of open flux in the Earth's magnetosphere. We present an automated technique to derive estimates of the ionospheric projection of the OCB from the characteristics of latitudinal profiles of far ultraviolet (FUV) auroral intensity. For the typical auroral oval, these latitudinal intensity profiles can be well modelled
ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained s... more ABSTRACT Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
To investigate if language spoken at home mediates the relationship between ethnicity and doctor-... more To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner-patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language. There was strong evidence of an association between doctor-patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0-100) than White British patients (95% CI -4.9 to -1.1, p=0.002). This difference reduced to 1.4 points (95% CI -3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-sp...
A number of recent studies have investigated temporal structuring within the magnetosphere ionosp... more A number of recent studies have investigated temporal structuring within the magnetosphere ionosphere system. Studies of ground magnetometer measurements, ionospheric velocity fluctuations, inter FTE intervals, and the AE index, have shown evidence of scale free behaviour. In contrast little work has been done to characterise the spatial structuring. With the large field of view of the SuperDARN radars we have
Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by... more Analysis of the spatio-temporal structure of ionospheric plasma velocity fluctuations measured by HF radars and of associated ground magnetic fluctuations measured by magnetometers reveals that convection fluctuations are primarily characterised by a scale-free property (no preferred frequency over the observed range), similar to that of the turbulent solar wind [5, 6]. We consider the implications of this on (a) the interpretation of finite-range and spatially-averaged observations, (b) forecasting space weather from solar wind observations, and (c) the Dungey reconnection model of magnetospheric convection.
Large-scale properties of reconnection structures on the magnetopause can be explained successful... more Large-scale properties of reconnection structures on the magnetopause can be explained successfully by simple models incorporating laminar magnetosheath flow with antiparallel reconnection. However, such models are inconsistent with the highly turbulent nature of the magnetosheath flow adjacent to the magnetopause. This presentation proposes a fractal reconnection model that resolves this contradiction by replacing the laminar magnetosheath flow with a turbulent flow which has realistic levels of fluctuation. The resultant fractal reconnection structures preserve the large-scale behaviour of simpler models, consistent with ground-based observations, but have small-scale fluctuations consistent with those observed in situ by spacecraft. We also present observations of evidence for scale-free fluctuations in ionospheric convection associated with dayside reconnection. This scale free behaviour may well arise as a consequence of the fractal reconnection model proposed.
Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and ... more Worldwide, the incidence of cutaneous melanoma has been reported to be highest in the summer and lowest in the winter. Northern Irish data suggested seasonal variation for women only, especially those with thinner melanomas, sited on limbs. We interrogated two larger UK cancer registries for temporal differences in melanoma diagnosis and associated patient characteristics. Melanomas diagnosed from 2006 to 2010 in the Eastern England and Scottish cancer registries (n=11,611) were analysed by month of diagnosis, patient demographics and melanoma characteristics, using descriptive and multivariate modelling methods. More patients with melanoma were diagnosed in the summer months (June 9.9%, July 9.7%, August 9.8%) than the winter months (December 7.2%, January 7.2%, February 7.1%) and this pattern was consistent in both regions. There was evidence that the seasonal patterns varied by sex (p=0.015), melanoma thickness (p=0.002), body site (p=0.006), and type (superficial spreading melan...
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