Capturing complexity in clinician case-mix: classification system development using GP and physician associate data.

Background: There are limited case-mix classification systems for primary care settings which are applicable when considering the optimal clinical skill mix to provide services. Aim: To develop a case-mix classification system (CMCS) and test its impact on analyses of patient outcomes by clinician type, using example data from physician associates' (PAs) and GPs' consultations with same-day appointment patients. Design & setting: Secondary analysis of controlled observational data from six general practices employing PAs and six matched practices not employing PAs in England. Method: Routinely-collected patient consultation records (PA n = 932, GP n = 1154) were used to design the CMCS (combining problem codes, disease register data, and free text); to describe the case-mix; and to assess impact of statistical adjustment for the CMCS on comparison of outcomes of consultations with PAs and with GPs. Results: A CMCS was developed by extending a system that only classified 18.6% (213/1147) of the presenting problems in this study's data. The CMCS differentiated the presenting patient's level of need or complexity as: acute, chronic, minor problem or symptom, prevention, or process of care, applied hierarchically. Combination of patient and consultation-level measures resulted in a higher classification of acuity and complexity for 639 (30.6%) of patient cases in this sample than if using consultation level alone. The CMCS was a key adjustment in modelling the study's main outcome measure, that is rate of repeat consultation. Conclusion: This CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation

Perceptions of the learning environment in higher specialist training of doctors: implications for recruitment and retention.

INTRODUCTION: Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention. METHODS: The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo software for qualitative data management. RESULTS: Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning. CONCLUSION: Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties

Surface study of the (100) and (010) faces of the quasicrystalapproximant Al4(Cr, Fe)

Low-energy electron diffraction (LEED) and scanning tunneling microscopy (STM) results are used to study the pseudo-6-fold nature of the (100) surface of the orthorhombic quasicrystal approximant Al4(Cr, Fe). LEED patterns are also presented from the pseudo-10-fold (010) surface of this material. In each case the results are compared with the known bulk structure of this complex metallic alloy

ANTI- OBSESSIVE COMPULSIVE ACTIVITY OF HONEY

Objective: The present study aim to investigate the anti-obsessive compulsive disorder potential of honey in mice.Methods: The honey was given orally in two concentrations of 17.5 ml/kg and 35 ml/kg to mice for 21 days. The anti-obsessive compulsive activity was assessed on 21th day by in-vitro methods viz flickering-light induced obsessive- compulsive behaviour model developed in our laboratory (Patent No. 3087/DEL/2012) and marble-burying behaviour model. The biochemical estimation was also done on 21 days.Results: When honey was administered chronically for 21 days significantly reduced gnawing behaviour and marble-burying behaviour of mice. Interestingly in our biochemical estimations, both, brain serotonin and GABA level were significantly increased by honey. The anti-Obsessive compulsive activity of honey may be due to the presence of Tryptophan, which is an important precursor of serotonin in the serotonergic neurons thereby enhancing the biosynthesis of serotonin to facilitate the anti- obsessive compulsive activity.Conclusion: The present study revealed that honey possessed significant anti-OCD activity.Â

Micro-organisms in the intestines of earthworms

RESP-480

A microbiological study of earthworm casts

RESP-480

Antiamnesic Activity of an Ayurvedic Formulation Chyawanprash in Mice

Chyawanprash (Chy) is an ayurvedic formulation commonly consumed in Indian households. Chy is a comprehensive herbal tonic, prepared from around 50 herbs employing anwala (Emblica officinalis) as the basic ingredient. The present study was undertaken to explore the beneficial effects of Chy (at the dose of 1 and 2% w/w of diet) administered daily for 15 successive days in mice with memory deficits. A total of 228 mice divided in 38 groups were employed in this study. Morris water maze, Hebb-Williams maze and elevated plus maze served as exteroceptive memory models, whereas scopolamine (Sco)-induced amnesia and alprazolam (Alp)-induced amnesia served as interoceptive memory models. The brain acetylcholinesterase activity, brain thiobarbituric acid reactive substances (TBARS) and reduced glutathione levels (GSH) were also estimated. The administration of Chy for 15 consecutive days significantly protected the animals from developing memory impairment. Furthermore, there was a significant decrease in brain TBARS and increase in GSH levels after administration of Chy (2% w/w), thereby indicating decreased free radical generation and increased scavenging of free radical, respectively. Thus, Chy may prove to be a useful remedy for the management of Alzheimer's disease owing to its antioxidant effect, pro-cholinergic action and/or antiamnesic potential

Teaching African history in South Africa: post-colonial realities between evolution and religion

This article describes arguments around and pertinent to a year-long foundation course presently taught at the University of Kwa Zulu-Natal in South Africa. The course, 'Africa in the World' (AITW), is first discussed in terms of objective and structure, followed by a critical evaluation of the circumstances of its development and coordination. A number of obstacles and challenges are examined, along with a contextualization of some of the more problematic aspects for the course's students

A SIMPLE LABORATORY MODEL FOR INDUCING AND MEASURING PAIN IN SMALL EXPERIMENTAL ANIMALS

Objective: Pain, an unpleasant sensation that we all experience in daily life, is an alert mechanism to prevent impending tissue injury. The animal models employed for screening of analgesic agents include pain-state models based on the use of thermal, mechanical electrical and chemical stimuli. This study was undertaken with an objective to design, develop and fabricate a new animal model for screening analgesics.Methods: In the present study, a humble attempt is made to develop a new animal model for screening analgesics overcoming the limitations of earlier models. The utility of the newly developed laboratory model (M-model) of pain was compared with already established models.Results: A simple laboratory model for screening of analgesics was developed in the present study. In this study, endurance time was defined as the time for which, the animals were able to endure the cold surface of ice-floor. The animals assumed a flinching posture and fled to M-Zone when they were unable to withstand the cold surface. Endurance time was significantly and consistently enhanced by different classes of analgesic agents such as pentazocine, butorphanol, tramadol, diclofenac, ketoprofen and meloxicam. The findings obtained using M-model was in line with those obtained using already established models.Conclusion: An effective animal model for screening analgesics overcoming the limitations of earlier models was developed in this study. This model showed excellent face and predictive validity.Keywords: Pain, Analgesics, Cold stimuli, M-model, Flinching posture, Endurance tim

SYNTHESIS, CHARACTERIZATION AND ANTIOXIDANT ACTIVITY OF 2-ARYL BENZOTHIAZOLE DERIVATIVES

Objective: To synthesize benzothiazole derivatives, characterize them by 1HNMR and ATIR techniques and evaluate for their antioxidant activity.Methods: In the present study 12 benzothiazole derivatives were synthesized by reacting 2-chloronitro benzene as the primary reactant with different aromatic aldehydes and benzoic acids. Reactions were monitored using thin layer chromatography technique, and the newly synthesized derivatives were characterized by ATIR and 1HNMR techniques. The antioxidant assay was performed using 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) or ABTS method and 2,2-diphenyl-1-picrylhydrazyl or DPPH method.Results: The antioxidant activity was found to be better in ABTS assay than DPPH assay. The compounds showed comparable activity to ascorbic acid at 100µg/ml.Conclusion: It was found that the synthesized benzothiazole derivatives showed significant radical scavenging potential