Statistical complexity of reasons for encounter in high users of out of hours primary care:analysis of a national service

Background: Managing demand for urgent and unscheduled care is a major problem for health services globally. A particular issue is that some patients appear to make heavy use of services, including primary care out of hours. We hypothesised that greater variation (statistical complexity) in reasons for attending primary care out of hours services may be a useful marker of patients at high risk of ongoing heavy service use. Methods: We analysed an anonymised dataset of contacts with the primary care out of hours care for Scotland in 2011. This contained 120,395 contacts from 13,981 high-using patients who made 5 or more contacts during a calendar year. We allocated the stated reason for each encounter into one of 14 categories. For each patient we calculated measures of statistical complexity of reasons for encounter including the count of different categories, Herfindahl index and statistical entropy of either the categories themselves, or the category transitions. We examined the association of these measures of statistical complexity with patient and healthcare use characteristics. Results: The high users comprised 2.4% of adults using the service and accounted for 15% of all contacts. Statistical complexity (as entropy of categories) increased with number of contacts but was not substantially influenced by either patient age or sex. This lack of association with age was unexpected as with increasing multi-morbidity one would expect greater variability in reason for encounter. Between 5 and 10 consultations, higher entropy was associated with a reduced likelihood of further consultations. In contrast, the occurrence of one or more contacts for a mental health problem was associated with increased likelihood of further consultations. Conclusion: Complexity of reason for encounter can be estimated in an out of hours primary care setting. Similar levels of statistical complexity are seen in younger and older adults (suggesting that it is more to do with consultation behaviour than morbidity) but it is not a predictor of ongoing high use of urgent care.</p

The 'pay now argue later' principle in South African Tax Law: its development, operation, comparison to South African civil debt enforcement and consistency with the constitutional right of access to courts

Section 164 of the Tax Administration Act 28 of 2011 (the TAA), previously contained in section 88 of the Income Tax Act 58 of 1962 (the Income Tax Act) and section 36 of the Value-Added Tax (VAT) Act 89 of 1991 (the VAT Act), provides that the payment of tax will not be automatically suspended until the resolution of a dispute regarding the liability for the said tax debt. This is known as the 'pay now argue later' principle. The objectives of this research were to analyse the development of the 'pay now argue later' principle in South African tax law, to provide an overview of the content and operation of section 164 of the TAA, to compare the principle and its purpose with civil debt enforcement procedures and, lastly, to test the principle against the Constitution of the Republic of South Africa, 1996 (the Constitution), specifically the right of access to courts. The underlying theme of this research is the recognition of taxpayers' rights in South Africa, specifically the interplay between the powers of the fiscus and the rights of taxpayers. In order to achieve the abovementioned objectives, this research examined the development of the 'pay now argue later' principle from its first appearance in section 88 of the Income Tax Act and section 36 of the VAT Act to its subsequent incorporation into the Tax Administration Bill 11 of 2011 and, ultimately, into section 164 of the TAA. It was concluded that the development of the 'pay now argue later' principle, from its first appearance in the Income Tax Act in 1962 and the VAT Act in 1993 until their repeal in 2011, was relatively minor save for in 2009, during which year there was a marked change in the structure of this principle with the inclusion of the so-called 'suspension rule'. This research provided a practical overview and understanding of the operation of the 'pay now argue later' principle in terms of section 164 of the TAA, specifically focusing on the suspension rule. This research further compared the 'pay now argue later' principle with civil debt enforcement procedures, specifically provisional sentence and summary judgment. It was concluded that the 'pay now argue later' principle is an exception to the ordinary rules governing civil debt enforcement proceedings. Lastly, this research placed the 'pay now argue later' principle under constitutional scrutiny, specifically whether its application infringes on the right of access to courts of taxpayers. It was found that the 'pay now argue later' principle infringes a taxpayer's right of access to courts, but this limitation is justified in terms of section 36 of the Constitution

A Cross-Cultural Comparative Analysis of Print Advertisements: FIFA World Cup Sport Magazine Issues

This study analyzes advertisements in the top sports magazines in the United States and United Kingdom, Sports Illustrated and SPORT respectively, during the 2014 FIFA World Cup. Sports magazines see an increase in sales during the time of the FIFA World Cup, meaning companies will put more effort into the production of their advertisements as the audience is larger and more diverse. The study uses content analysis methods to gain insight into the informational content and gender representation in the advertisements. The results demonstrate both hard and soft-sell approaches to selling goods and services. The study uses predictive analysis to suggest the target market for each advertisement, specifically if the athletic female segment is being successfully targeted

Problematisation and regulation: bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome

Background Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. Methods Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach. Results Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole. Conclusion Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS

Choctaw Confederates: The American Civil War in Indian Country

Reviewer Sarah Elliott writes that Fay A. Yarbough’s Choctaw Confederates: The American Civil War in Indian Country, excels in demonstrating that Choctaws’ decision to align with the Confederacy was based on self-interests. Indeed, Yarbough shows that “increasingly close interaction with white Americans shifted Choctaw culture” in the antebellum era, so that by the eve of the Civil War, they were, in many ways, “’more ‘southern’” than many white southerners. Elliott finishes by praising Yarbough’s work as an “immensely valuable and illuminating” work

A New and Extensive Ethnoarchaeological Dung Reference Collection for Investigating Animal Occupation, Seasonality and Diet in the Past.

The Neolithic (c 12,000-8000 BP) is a key period in human history when people for the first time domesticated plants and animals and began living in permanent villages. Understanding and pinpointing important transformations such as the domestication of animals in the Neolithic is challenging. Common methods to investigate animal domestication rely on interpretation of excavated archaeological remains. New dung studies demonstrate the potential to investigate important phenomena such as sedentarisation, animal domestication, secondary product use and animal diet. A new innovative multi-methodological research framework is currently being developed to integrate scientific analyses with ethnoarchaeological and archaeological datasets. Recent samples collected during a CBRL fellowship (2015-2016) will contribute to ethnoarchaeological research based on multimethod investigations into animal signatures using geochemistry, faecal spherulites, phytoliths and micromorphology. These reference collections will provide results which can be incorporated into future archaeological analysis and will be available for use as comparative data to understand archaeological sites in the Southern Levant. When this reference collection has been fully processed it will represent the biggest dung reference collection that exists worldwide

Effects of pituitary pars intermedia dysfunction (PPID), season, and pasture diet on blood adrenocorticotropic hormone and metabolite concentrations in horses.

Studies described in this thesis were performed to investigate associations among season, diet, pituitary pars intermedia dysfunction (PPID) and blood concentrations of adrenocorticotropic hormone (ACTH), insulin, glucose, and leptin in horses. In the first study, higher ACTH concentrations were detected in horses affected with PPID. A seasonal increase in plasma ACTH concentration was detected in the late summer and early fall, but PPID did not affect the timing or duration of this increase. Pasture grazing raised glucose and insulin concentrations with a peak in September, at the same time that horses had higher ACTH concentrations, and this convergence of risk factors may raise the risk of laminitis. All of the horses included in this study were from the same farm. The second study was performed to determine whether horses from different locations within the same region exhibited the same seasonal increase in ACTH concentrations. Results of this study indicate that the seasonal increase in plasma ACTH concentrations occurs in horses from different farms with varying management practices. The third study investigated the effects of season on plasma leptin concentrations in the horses from the first study. We hypothesized that higher leptin concentrations would be detected in advance of the seasonal increase in plasma ACTH concentrations. Results did not support our hypothesis because leptin concentrations increased after ACTH concentrations peaked in September. Our findings suggest that the seasonal increase in ACTH concentrations induced leptin resistance, which might facilitate weight gain in the autumn. Alternatively, leptin concentrations increased as a result of weight gain or change in body fat composition. In summary, season appears to signal upregulation of the hypothalamic-pituitary-adrenal axis in horses, in an effort to prepare for winter. This upregulation is retained in horses with PPID, a disorder associated with loss of dopaminergic inhibition to the pars intermedia of the pituitary. The seasonal rise in plasma ACTH concentrations is followed by an increase in leptin concentrations, which suggests the development of leptin resistance or an increase in adiposity

Distinct Patterns of Ccr5 Versus Alternative Coreceptor Dependence in Non-Natural Host Versus Natural Host Simmian Immunodeficiency Virus Infection

Natural host sooty mangabeys infected with simian immunodeficiency viruses (SIV) exhibit high plasma viral loads without widespread CD4+ T cell loss. By contrast, non-natural host rhesus macaques experimentally infected with related SIV exhibit high viral loads but display subsequent CD4+ T cell loss and progression to AIDS, analogous to the effects of HIV-1 infection in humans. Several mechanisms have been proposed to explain these discrepant outcomes, including infection of distinct target cells in vivo. Cell targeting is substantially determined at the level of viral entry. Prior work demonstrated that sooty mangabey infection occurs in the absence of functional coreceptor CCR5, implicating alternative SIV entry pathways in this natural host. In this thesis, I identified host-dependent patterns of SIV coreceptor use that distinguish viral entry in sooty mangabeys from viral entry in rhesus macaques. I cloned and characterized a panel of putative sooty mangabey coreceptors. Transfected target cells expressing species-specific CD4 and coreceptors identified sooty mangabey CCR5, CXCR6, and GPR15 as functional coreceptors of SIV in vitro. While rhesus macaque CCR5 and GPR15 also supported robust SIV infection in vitro, rhesus macaque CXCR6 was a remarkably poor coreceptor of SIV. Using CCR5 antagonist Maraviroc to block CCR5-mediated infection in primary peripheral blood mononuclear cells (PBMCs), I determined that SIV were highly CCR5-dependent in rhesus macaque PBMCs, whereas SIV were partially CCR5-independent in sooty mangabey PBMCs, implicating alternative coreceptors in infection of the natural host primary cells. A chemokine ligand of CXCR6, CXCL16, partially attenuated SIV infection of sooty mangabey PBMCs, indicating that sooty mangabey CXCR6 was indeed an alternative coreceptor of some SIV in primary sooty mangabey cells. Collectively, these data define coreceptor use as a host determinant distinguishing sooty mangabey SIV infection from rhesus macaque SIV infection in primary cells. Because CD4+ T cells from sooty mangabeys express exceedingly low levels of CCR5 relative to CD4+ T cells from rhesus macaques, the expression patterns of CXCR6 and other alterative coreceptor(s) in sooty mangabey CD4+ cell subsets may classify host target cells that maintain high levels of SIV replication without leading to loss of CD4+ T cell homeostasis