Land, water and tourism in Aitutaki, Cook Islands

Most island governments in the South Pacific have placed a great deal of faith in a continued annual increase in numbers of tourists as a guarantee of national economic growth. This is particularly the case in the Cook Islands. The response by local, mostly small-scale entrepreneurs has been to invest in the building of tourist accommodation, not only on the main island of Rarotonga, but also on the island of Aitutaki. Until recently the piecemeal development of accommodation on that island has occurred with little reference to the impact on the environment

Motivations for contemporary Tongan migration

Migration can be seen as a process in which large numbers of individuals and families begin to write a new history for themselves. The initial act of leaving one's parents, family, neighbourhood, society and culture, and adopting a new life- and work-style is a crucial one. Only a small proportion of people who enter a migration process, or who have participated in major migration movements in the past, have had a clear perception of what they were going to encounter, or the extent to which their lives were going to change. While it is very likely that a large proportion of the individual migrants are the forerunners in a migration which will ultimately involve other members of their kin network, they are not usually able to foresee this at the time

The Hardy Uncertainty Principle Revisited

We give a real-variable proof of the Hardy uncertainty principle. The method is based on energy estimates for evolutions with positive viscosity, convexity properties of free waves with Gaussian decay at two different times, elliptic $L^2$-estimates and the invertibility of the Fourier transform on L^2(\Rn) and \mathcal S'(\Rn)

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data.

BACKGROUND: The UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England. METHODS: The study included 8124 general practices between 2011-2012 and 2013-2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0-100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification. RESULTS: Mean practice-level rates of A&E visits and emergency admissions increased from 2011-2012 to 2013-2014 (310.3-324.4 and 98.8-102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011-2012 and 76.6 in 2013-2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI -2.4% to -1.2%) in A&E visit rates and 1.4% (95% CI -1.9% to -0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses. CONCLUSIONS: Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

BACKGROUND: The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. OBJECTIVE: To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. METHODS: Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. RESULTS: The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. CONCLUSIONS: Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear

A Spherical Plasma Dynamo Experiment

We propose a plasma experiment to be used to investigate fundamental properties of astrophysical dynamos. The highly conducting, fast-flowing plasma will allow experimenters to explore systems with magnetic Reynolds numbers an order of magnitude larger than those accessible with liquid-metal experiments. The plasma is confined using a ring-cusp strategy and subject to a toroidal differentially rotating outer boundary condition. As proof of principle, we present magnetohydrodynamic simulations of the proposed experiment. When a von K\'arm\'an-type boundary condition is specified, and the magnetic Reynolds number is large enough, dynamo action is observed. At different values of the magnetic Prandtl and Reynolds numbers the simulations demonstrate either laminar or turbulent dynamo action

Swine influenza surveillance in East and Southeast Asia: a systematic review

East and Southeast Asia are important pig- and poultry-producing areas, where the majority of production takes place on small-scale farms with low biosecurity levels. This systematic review synthesizes data on swine influenza virology, serology and epidemiology in East and Southeast Asia. A total of 77 research articles, literature reviews and conference papers were selected and analyzed from 510 references retrieved from PubMed and ISI Web of KnowledgeSM. The number of published articles increased in the last 3 years, which may be attributed to improvement in monitoring and/or a better promotion of surveillance data. Nevertheless, large inequalities in surveillance and research among countries are underlined. Virological results represent the largest part of published data, while the serological and epidemiological features of swine influenza in East and Southeast Asia remain poorly described. The literature shows that there have been several emergences of swine influenza in the region, and also considerable evidence of multiple introductions of North American and avian-like European strains. Furthermore, several avian-origin strains are isolated from pigs, including H5 and H9 subtypes. However, their low seroprevalence in swine also shows that pigs remain poorly infected by these subtypes. We conclude that sero-epidemioligical investigations have been neglected, and that they may help to improve virological surveillance. Inter- and intra-continental surveillance of gene flows will benefit the region. Greater investment is needed in swine influenza surveillance, to improve our knowledge of circulating strains as well as the epidemiology and disease burden in the region.published_or_final_versio

Growth rate degeneracies in kinematic dynamos

We consider the classical problem of kinematic dynamo action in simple steady flows. Due to the adjointness of the induction operator, we show that the growth rate of the dynamo will be exactly the same for two types of magnetic boundary conditions: the magnetic field can be normal (infinite magnetic permeability, also called pseudovacuum) or tangent (perfect electrical conductor) to the boundaries of the domain. These boundary conditions correspond to well-defined physical limits often used in numerical models and relevant to laboratory experiments. The only constraint is for the velocity field u to be reversible, meaning there exists a transformation changing u into −u. We illustrate this surprising property using S2T2 type of flows in spherical geometry inspired by [Dudley and James, Proc. R. Soc. London A 425, 407 (1989)]. Using both types of boundary conditions, it is shown that the growth rates of the dynamos are identical, although the corresponding magnetic eigenmodes are drastically different