What proportion of patients at the end of life contact out-of-hours primary care?: a data linkage study in Oxfordshire

Objectives: Out of hours (OOH) primary care services are a key element of community care at the end of life, yet there have been no previous attempts to describe the scope of this activity. We aimed to establish the proportion of Oxfordshire patients who were seen by the Out Of Hours service within the last 30 days of life, whether they were documented as in a palliative phase of care and the demographic and clinical features of these groups Design: Population based study linking a database of patient contacts with OOH primary care with the register of all deaths within Oxfordshire (600000 population) during 13 months. Setting: Oxfordshire Participants: Between 1/12/14 and 30/11/2015 there were 102,877 OOH contacts made by 67,943 patients with the OOH service. Main outcome measures: Proportion of patients dying in the Oxfordshire population who were seen by the Out Of Hours service within the last 30 days of life. Demographic and clinical features of these contacts. Results: 29.5% of all population deaths were seen by the OOH service in the last 30 days of life. Among the 1530 patients seen, patients whose palliative phase was documented (n=577, 36.4%) were slightly younger (median age = 83.5 vs 85.2 years, p&lt;0.001) and were seen closer to death (median days to death = 2 v 8, p&lt;0.001). More were assessed at home (59.8% vs 51.9%, p&lt;0.001) and less were admitted to hospital (2.7% vs 18.0%, p&lt;0.001). Conclusions: OOH services see around one third of all patients who die in a population. Most patients at the end of life are not documented as palliative by OOH services and are less likely to receive ongoing care at home.</p

“Not walled facts, their essence”: Derek Walcott’s Tiepolo’s Hound and Camille Pissarro

Life-writing — a genre which goes beyond traditional biography, includes both fact and fiction, and is concerned with either entire lives or days-in-the-lives of individuals, communities, objects, or institutions — has always played an important role in Derek Walcott’s work, from Another Life (1973),Walcott’s autobiography in verse, to his last play O Starry Starry Night (2014), where he re-imagines Paul Gauguin and Vincent Van Gogh’s (often tempestuous) cohabitation in the so-called “Yellow House” in 1888 Arles. In Tiepolo’s Hound (2000), Walcott’s life rhymes with that of the Impressionist painter Jacob Camille Pissarro, who was born in the Caribbean island of St Thomas in 1830. In this work, biographical and autobiographical impulses, fact and fiction, are productively combined, as “creation” (what “might have happened”) shapes Walcott’s life-writing as much as “recreation” (what “actually” happened). Walcott’s Pissarro is an individual immersed in a set of historical networks but also a figure at the centre of a web of imagined relations which illuminate the predicament of present and past artists in the Caribbean region and the ways in which they articulate their vision vis-à-vis the metropolitan centre, their relationship with their social and natural environment, and their individual and collective identity. Tiepolo’s Hound is enriched by the inclusion of twenty-six of Walcott’s own paintings which engage in conversation with the poet’s words and add complexity to his meditation on the nature and purpose of (re)writing and (re)creating lives. Extending the catholicity of life-writing to animals, in this case dogs and, in particular, mongrels, Tiepolo’s Hound also entails a careful, if counterintuitive, evaluation of anonymity

‘To the land or to the sea' : diet and mobility in early medieval Frisia

This study investigated palaeodiet and population mobility in early medieval Frisia through the stable isotope analysis of individuals buried in the fifth–eighth century AD cemetery of Oosterbeintum, a terp site on the northern coast of the Netherlands. The results cast new light on the role of the northern Netherlands in trade and migration in the early medieval period, and have significance for the study of interaction and movement throughout the wider North Sea region. Bone collagen and tooth enamel from humans and animals were analyzed using carbon, nitrogen, oxygen, and strontium isotopes. δ13C and δ15N results indicated that the population had a terrestrial, C3-based diet. High δ15N values were observed in humans and fauna, which are probably related to the terp's salt-marsh location. The δ18O and 87Sr/86Sr data revealed a high proportion of non-locals buried at Oosterbeintum, some of whom had probably migrated from regions as distant and varied as Scandinavia and southern England. It is suggested that this immigration may be associated with Frisian maritime trading activities. New data are also presented from a small number of contemporaneous European sites

Career mobility in a global era: advances in managing expatriation and repatriation

The surge of interest in expatriation and repatriation within the broader discourse on labor mobility of professionals and high-skilled labor, human capital development and the theory and practice of people management, serves as the backdrop to this paper. We propose that expatriation and repatriation be framed in the context of global careers and embedded in the wider social-economic environment of globalization through the lens of a career ecosystem theory. We chart the evolution of scholarly publications on career mobility over the past four decades and highlight current trends, in particular the emergence of self-initiated expatriation as a pivotal change in the direction of expatriation studies and derived practice. We assess the rigor of empirical findings, weigh theoretical underpinnings, offer a research agenda for future research and outline managerial implications

Cold case : the disappearance of Egypt bee virus, a fourth distinct master strain of deformed wing virus linked to honeybee mortality in 1970’s Egypt

In 1977, a sample of diseased adult honeybees (Apis mellifera) from Egypt was found to contain large amounts of a previously unknown virus, Egypt bee virus, which was subsequently shown to be serologically related to deformed wing virus (DWV). By sequencing the original isolate, we demonstrate that Egypt bee virus is in fact a fourth unique, major variant of DWV (DWV-D): more closely related to DWV-C than to either DWV-A or DWV-B. DWV-A and DWV-B are the most common DWV variants worldwide due to their close relationship and transmission by Varroa destructor. However, we could not find any trace of DWV-D in several hundred RNA sequencing libraries from a worldwide selection of honeybee, varroa and bumblebee samples. This means that DWV-D has either become extinct, been replaced by other DWV variants better adapted to varroa-mediated transmission, or persists only in a narrow geographic or host range, isolated from common bee and beekeeping trade routes

Maternal exposure to polychlorinated biphenyls and the secondary sex ratio: an occupational cohort study

Though commercial production of polychlorinated biphenyls was banned in the United States in 1977, exposure continues due to their environmental persistence. Several studies have examined the association between environmental polychlorinated biphenyl exposure and modulations of the secondary sex ratio, with conflicting results. Our objective was to evaluate the association between maternal preconceptional occupational polychlorinated biphenyl exposure and the secondary sex ratio. We examined primipara singleton births of 2595 women, who worked in three capacitor plants at least one year during the period polychlorinated biphenyls were used. Cumulative estimated maternal occupational polychlorinated biphenyl exposure at the time of the infant's conception was calculated from plant-specific job-exposure matrices. A logistic regression analysis was used to evaluate the association between maternal polychlorinated biphenyl exposure and male sex at birth (yes/no). Maternal body mass index at age 20, smoking status, and race did not vary between those occupationally exposed and those unexposed before the child's conception. Polychlorinated biphenyl-exposed mothers were, however, more likely to have used oral contraceptives and to have been older at the birth of their first child than non-occupationally exposed women. Among 1506 infants liveborn to polychlorinated biphenyl-exposed primiparous women, 49.8% were male; compared to 49.9% among those not exposed (n = 1089). Multivariate analyses controlling for mother's age and year of birth found no significant association between the odds of a male birth and mother's cumulative estimated polychlorinated biphenyl exposure to time of conception. Based on these data, we find no evidence of altered sex ratio among children born to primiparous polychlorinated biphenyl-exposed female workers

Effect of angiotensin II-induced changes in perfusion flow rate on chlorothiazide transport in the isolated perfused rat kidney

Angiotensin II was used as a probe to study the effect of changes in perfusate flow rate on the renal clearance parameters of chlorothiazide in the isolated perfused rat kidney. Perfusion studies were performed in five rats with no angiotensin II present in the perfusate and in five rats with a 1–4 ng/min infusion of angiotensin II into the perfusate. Angiotensin II had a dramatic effect on the renal hemodynamics, resulting in a 43% decrease in perfusate flow, a 16% decrease in glomerular filtration rate (GFR), and a 45% increase in filtration fraction. Values for the fractional excretion of glucose were low and consistent, with or without angiotensin II. Although the unbound fraction (fu) of chlorothiazide was unchanged between treatments, the renal (CL r ) and the secretion clearances were reduced by about 50% in the presence of angiotensin II; the excretion ratio [ER=CL r /(fu·GFR)] was reduced by 38% with angiotensin II present in the perfusate. Analysis of the data was complicated by the presence of a capacity-limited transport for renal tubular secretion. Transport parameters (±SD) were obtained and the corrected intrinsic secretory clearance [(V max /GFR)/K m ] of chlorothiazide was 123 ± 18 without angiotensin II vs. 72.8 ± 30.0 with angiotensin II. These results demonstrate that alterations in organ perfusion can significantly reduce the clearance parameters of chlorothiazide in the rat IPK. These flow-induced changes in intrinsic secretory transport may reflect perturbations other than that of perfusion flow rate alone .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45047/1/10928_2005_Article_BF01071001.pd

Drivers of Change or Cut-Throat Competitors? Challenging Cultures of Innovation of Chinese and Nigerian Migrant Entrepreneurs in West Africa

L'afflux remarquable des entrepreneurs migrants chinois dans différents pays d'Afrique occidentale au cours des dernières années a été heurtée à une résistance de plus en plus farouche par des entrepreneurs locaux établis. Que le premiers ont un avantage concurrentiel sur ce dernier en raison de traits socio-culturels distinctifs, ou si l'efficacité supposée chinoise est juste une caractéristique de toutes les diasporas mercantiles, est ouvert à la question. Cette étude exploratoire des migrants entrepreneuriales chinois et nigérians au Ghana et au Bénin tente de répondre à cette question. Apparemment, les forces culturels des agents du changement migrants ne sont pas limités à des systèmes de valeurs héritées ou religions, comme une éthique protestante ou le confucianisme, mais ils sont adaptés en permanence et ont inventé de nouveau par des réseaux transnationaux de la migration dans un monde globalisé. Il n'y a aucune preuve d'une prétendue supériorité de la culture d’innovation chinois par rapport aux cultures d’innovation africains des migrants entrepreneuriales. Plutôt, il existe une capacité accrue d'innovation d'une diaspora mercantile en général vis à vis des entrepreneurs locaux, indépendamment de l'origine de la culture nationale dans lequel il est intégré. En outre, la rivalité des entrepreneurs migrants chinois et nigérians dans les marchés africains ne conduit pas nécessairement à la concurrence coupe-gorge souvent suspectée sous l'impact de la mondialisation. Souvent, les deux groupes agissent plutôt complémentaires. Cela contribue, sous certaines conditions, même à la réduction de la pauvreté dans le pays d'accueil