The disappearance of the "revolving door" patient in Scottish general practice: successful policies

<b>Background</b> We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.<p></p> <b>Methods</b> A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.<p></p> <b>Results</b> A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.<p></p> <b>Conclusions</b> "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS

OFFICIAL STATISTICS: ABOVE AND BELOW THE PUBLIC DEBATE. THIRTIETH GEARY LECTURE, 1999

Roy Geary was a person of great distinction, recognised for a wide range of achievements. He was a first class mathematician who made significant contributions to statistical theory. He was an Official Statistician of distinction and he made great contributions to the development of economic statistics and to the use of statistics for policy purposes in fields as diverse as demography and economic statistics. He was the first Director of the Central Statistics Office when it was created in 1949 and I am delighted to be asked to present this lecture in the CSO’s 50th birthday year

Current practice and challenges towards handling uncertainty for effective outcomes in maintenance

The combination of viable heuristic attributes with statistical measurements presents significant challenges in industrial maintenance for complex assets under through-life service contracts. Techniques to obtain and process heuristic attributes raise numerous uncertainties which often go undefined and unmitigated. A holistic view of these uncertainties may improve decision-making capabilities and reduce maintenance costs and turnaround time. It is therefore necessary to identify and rank factors that influence uncertainties originating from challenges in the above context. This, along with an identification of who contributes to such challenges and current practice to handle them, sets the focus for this study. The influence of 32 categorised factors on uncertainty is assessed through a questionnaire completed by nine experienced maintenance managers from a leading defence company. The pedigree approach is applied to score validity of respondents’ answers according to their experience and job role to normalise scores. Results are discussed in interviews with respondents along with current practice in and ways to improve uncertainty assessment. Scores are weighted through the Analytical Hierarchy Process (AHP) in order to identify the most influential factors on uncertainty in maintenance. The analysis revealed that these include: intellectual property rights (IPR), maintainer performance, quality of information, resistance to change, stakeholder communication and technology integration. These are verified with 40 practitioners from various industrial backgrounds. From the interviews, it is deemed that a holistic view of heuristic and statistical attributes ultimately allows for more accomplished decision-making but requires trade-offs between quality and cost over the asset’s life cycle

The Influence of Managerial Forces and Users’ Judgements on Forecasting in International Manufacturers: a Grounded Study

Despite the improvements in mathematical forecasting techniques, the increase in forecasting accuracy is not yet significant. Previous research discussed various forecasting issues and techniques without paying attention to users’ forces and behaviours that influence the construction of forecasts. This research investigates this gap through examining the managerial forces that influence the judgements of different users and constructors of forecasts in international pharmaceutical companies. A qualitative research applying Grounded Theory methodology is used to explore the concealed forces in forecasting processes by interviewing different constructors and users of forecasts in international contexts. Using the Coding Matrices, the research identifies the forces which induce users’ judgements, and consequently lead to conflicts. The research adds value by providing assessment criteria of forecasting management in future research

The role of the individual in the coming era of process-based therapy

For decades the development of evidence-based therapy has been based on experimental tests of protocols designed to impact psychiatric syndromes. As this paradigm weakens, a more process-based therapy approach is rising in its place, focused on how to best target and change core biopsychosocial processes in specific situations for given goals with given clients. This is an inherently more idiographic question than has normally been at issue in evidence-based therapy over the last few decades. In this article we explore methods of assessment and analysis that can integrate idiographic and nomothetic approaches in a process-based era.Accepted manuscrip

Learning dispositif and emotional attachment:a preliminary international investigation

This research investigated the significance of learning dispositif (LD) and emotional attachment (EA) on perceived learning success (LS) across a diaspora of Western, Russian, Asian, Middle Eastern and Chinese student cohorts. Foucault’s LD captures the disparate socio-cultural contexts, institutional milieus and more or less didactic teaching styles that moderate learning. EA is a multi-dimensional notion involving affective bonds that emerged in child psychology and spread to marketing and other fields. The sequential explanatory research reviewed the learning and EA literatures and generated an LD–EA framework to structure the quantitative phase of its mixed investigations. In 2017 and 2018, the research collected 150 responses and used a range of statistical techniques for quantitative analysis. It found that LS varied significantly across cohorts, intimating that dispositifs influence learning. Nonparametric analysis suggested that EA also influenced learning, but regressions were inconclusive. Exploratory techniques hint at a dynamic mix of emotional or cognitive motivations during the student learning journey, involving structural breaks in student/instructor relationships. Cluster analysis identified distinct student groupings, linked to years of learning. Separately, qualitative analysis of open-ended survey questions and expert interviews intimates that frequent teacher interactions can increase EA. The synthesis of quantitative with qualitative results and pedagogical reflection suggests that LD and EA both influence learning in a complex, dynamic system. The key constituents for EA are Affection, Connection, Social Presence (SP), Teaching Presence (TP) and Flow but student emotional engagement is conditioned by the socio-cultural milieu (LD) and associated factors like relationships and trust. Unlike in the Community of Learning framework, in the EA framework Cognitive Presence (CP) is an outcome of the interaction between these EA constituents, associated factors and the socio-cultural milieu. Finally, whilst awareness of culture and emotions is a useful pedagogical consideration, learning mainstays remain inclusive educational systems that identify student needs and support well-designed programmes. Within these, scaffolded modules should include a variety of engaging learning activities with non-threatening formative and trustworthy summative feedback. We acknowledge some statistical study limitations, but its tentative findings make a useful preliminary contribution

A System for Accessible Artificial Intelligence

While artificial intelligence (AI) has become widespread, many commercial AI systems are not yet accessible to individual researchers nor the general public due to the deep knowledge of the systems required to use them. We believe that AI has matured to the point where it should be an accessible technology for everyone. We present an ongoing project whose ultimate goal is to deliver an open source, user-friendly AI system that is specialized for machine learning analysis of complex data in the biomedical and health care domains. We discuss how genetic programming can aid in this endeavor, and highlight specific examples where genetic programming has automated machine learning analyses in previous projects.Comment: 14 pages, 5 figures, submitted to Genetic Programming Theory and Practice 2017 worksho

Evidence-Based Study of Medication Compliance Project in Hiv Prevention Using Pre-Exposure Prophylaxis (Prep) Antivirals for HIV-Negative Males

In 2012, emtricitabine/tenofovir was the only Food and Drug Administration-approved medication for pre-exposure prophylaxis (PrEP) used in human immunodeficiency virus (HIV) prevention. To date, there is little research on open-label and mixed-payer characteristics supporting medication compliance of men who have sex with men (MSM). The purpose of this research was to describe individual demographic variables associated with PrEP medication adherence and to examine the effect of a follow-up phone call from a nurse once a month for 3 months. A total of 30 MSM were recruited and data were collected using a demographic questionnaire, medication adherence tool and follow-up phone calls. Data were analyzed using a statistical package. Spearman’s rho correlations demonstrated high medication adherence in single men (rs (28) = −.375, p \u3c .05) with no mental health issues (rs (28) = .426, p \u3c .05) and a higher educational level (rs (28) = −.431, p \u3c .05). A between group Chi-square demonstrated men with high medication adherence and medium medication adherence did not statistically differ over 3 months (χ2 (2, N = 28) = .668, p = .71). Individuals who exhibited higher PrEP use in an open-label and mixed-payer structure appeared to be young, single, well educated, and employed Caucasian gay males with multiple partners. More information will be needed from ethnically diverse populations, especially non-Caucasians. Finally, clinical nurses, by supplying accountability by phone calls, could improve PrEP compliance by providing planned monthly reminders

Outline of a multilevel approach of the network society

Social and media networks, the Internet in particular, increasingly link interpersonal, organizational and mass communication. It is argued that this gives a cause for an interdisciplinary and multilevel approach of the network society. This will have to link traditional micro- and meso-level research of social and communication ties (Rogers, Granovetter a.o.) to the macro-level research of the network society at large (Castells a.o.).\ud Systems theory linked to a theory of communicative action establishes a potential basis for a multilevel theory. The systems theory described uses elements of a biologically inspired analysis of networks as complex adaptive systems and the mathematically inspired theory of random and scale-free networks recently elaborated by Barabási, Strogatz and Watts. The outline of the multilevel theory is summarized in ten statements about changing relationships in the network society: an information society with structures and modes of organization primarily shaped by social and media networks. \ud In the last section an inventory is made of the theoretical and methodological changes communication science will have to make to develop a general theory of the information and the network society in the perspective of communication