Primary Claims Research Articles

Estimating the prevalence of potential and actionable drug-gene interactions in Irish primary care: A cross-sectional study.

Pharmacogenetics (PGx) is increasingly recognized as a strategy for medicines optimisation and prevention of adverse drug reactions. According to guidelines produced by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetic Working Group (DPWG), most medicines with drug-gene interactions (DGIs) are prescribed in primary care. This study aimed to estimate the prevalence of potential and actionable DGIs involving all medicines dispensed in Irish primary care. Dispensings of 46 drugs to General Medical Services (GMS) patients in the Health Service Executive Primary Care Reimbursement Service Irish pharmacy claims database from 01 January 2021 to 31 December 2021 were analysed to estimate the national prevalence of total dispensings and incidence of first-time dispensings of drugs with potential DGIs according to the CPIC and/or DPWG guidelines. Phenotype frequency data from the UK Biobank and the CPIC were used to estimate the incidence of actionable DGIs. One in five dispensings (12 443 637 of 62 754 498, 19.8%) were medicines with potential DGIs, 1878 255 of these dispensed for the first time. On application of phenotype frequencies and linked guideline based therapeutic recommendations, 2349 055 potential DGIs (18.9%) required action, such as monitoring and guarding against maximum dose, drug or dose change. One in five (369 700, 19.7%) first-time dispensings required action, with 139 169 (7.4%) requiring a change in prescribing. Antidepressants, weak opioids and statins were most commonly identified as having actionable DGIs. This study estimated a high prevalence of DGIs in primary care in Ireland, identifying the need and opportunity to optimize drug therapy through PGx testing.

Calculating daily dose in the Observational Medical Outcomes Partnership Common Data Model.

We aimed to develop a standardized method to calculate daily dose (i.e., the amount of drug a patient was exposed to per day) of any drug on a global scale using only drug information of typical observational data in the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) and a single reference table from Observational Health Data Sciences And Informatics (OHDSI). The OMOP DRUG_STRENGTH reference table contains information on the strength or concentration of drugs, whereas the OMOP DRUG_EXPOSURE table contains information on patients' drug prescriptions or dispensations/claims. Based on DRUG_EXPOSURE data from the primary care databases Clinical Practice Research Datalink GOLD (United Kingdom) and Integrated Primary Care Information (IPCI, The Netherlands) and healthcare claims from PharMetrics® Plus for Academics (USA), we developed four formulas to calculate daily dose given different DRUG_STRENGTH reference table information. We tested the dose formulas by comparing the calculated median daily dose to the World Health Organization (WHO) Defined Daily Dose (DDD) for six different ingredients in those three databases and additional four international databases representing a variety of healthcare settings: MAITT (Estonia, healthcare claims and discharge summaries), IQVIA Disease Analyzer Germany (outpatient data), IQVIA Longitudinal Patient Database Belgium (outpatient data), and IMASIS Parc Salut (Spain, hospital data). Finally, in each database, we assessed the proportion of drug records for which daily dose calculations were possible using the suggested formulas. Applying the dose formulas, we obtained median daily doses that generally matched the WHO DDD definitions. Our dose formulas were applicable to >85% of drug records in all but one of the assessed databases. We have established and implemented a standardized daily dose calculation in OMOP CDM providing reliable and reproducible results.

Auditing standards and the persistence of the audit expectations gap: Evidencing the absence of French ‘exceptionalism’

Auditing standards have become a central feature in the world of auditing. One of the primary claims made for International Standards on Auditing (ISAs) is their capacity to reduce the audit expectations gap (AEG), but the gap persists despite the widespread adoption of ISAs. France is an intriguing case site for studying the development and impact of audit standard setting, especially given its reputation as a country for maintaining its own distinctive audit regulatory traditions. Its claimed resistance to Anglo‐American influences, however, is not what stands out in our archival analysis of French audit standard‐setting processes and an accompanying series of interviews with key participants. In contrast, the French audit standard setting emerges as a process that has largely aligned with the spirit of ISAs and adopted a narrow interpretation of the AEG. The presented analysis challenges the operational significance of a claimed French exceptionalism and adds to a growing questioning of the capacity of auditing standard setting to drive fundamental advancement in auditing practice and to meet public expectations.

Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland

ObjectivesCalcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are novel high-cost treatments for the prevention of migraine. This study presents data on utilization, expenditure, and treatment patterns with CGRP mAbs available under a managed access protocol in Ireland, to a cohort of treatment refractory patients (failed 3 or more previous treatments) with chronic migraine. MethodsData were extracted from the Primary Care Reimbursement Service High Tech claims database and special drug request online system and analyzed using Microsoft Excel and SAS. Treatment persistence was evaluated by refill patterns, and adherence was evaluated using the proportion of days covered method. Expenditure data were extracted directly from the database. ResultsBetween September 1, 2021 and April 30, 2023, 1517 applications for reimbursement approval for a CGRP mAb were received; 1458 (96.1%) were approved for reimbursement. Total expenditure on CGRP mAbs in year 1 (September 1, 2021 to August 31, 2022) was €3.2 million. The majority of patients initiated treatment with fremanezumab (60.8%) or erenumab (37.1%). Almost 90% of patients were considered adherent, and treatment persistence was high, with more than 75% of patients receiving more than 12 months of treatment in our 18-month study time frame. ConclusionsThis study demonstrates the importance of active health technology management, after reimbursement, in enabling cost-effective use of high-cost treatments while providing budget certainty for the healthcare payer. High levels of adherence and persistence suggest that treatment is successfully targeted in situations which unmet clinical need is greatest.

A Womanist’s Poetic, Theo-Ethical Response to Sexual Trauma: Ethics, Theology & Black Women’s Poetry

This paper gestures towards a womanist response to a recent conversation with a friend, indicative of many black women’s experiences of sexual trauma and struggle to reconcile their identity as black women, Christians, and survivors. I put in conversation black feminist writings, womanist ethics and theology, and black women’s poetry to gesture towards a womanist response to sexual trauma. This paper makes three primary claims. First, I assert that womanist theology and ethics provides a firm foundation for Christian responses to sexual trauma. Second, I argue for contemporary womanist ethics as a crucial dialogue partner for sexual trauma survivors. And finally, I posit the moral knowledge gleaned from three black women’s poems as guides for womanist responses to sexual trauma.

The Influence of Reasonableness in Determining Delictual or Tort Liability for Psychological or Psychiatric Harm in South African and English Law

Due to a lack of authority in Roman-Dutch law in respect of claims for psychological harm, our courts in South Africa relied on English law for guidance, in particular the tort of negligence where emphasis is placed on reasonable foreseeability of harm. The courts in both jurisdictions generally face challenges with who exactly is entitled to claim, the quantification of the damages that should be awarded and how to limit delictual or tort liability emanating from these types of claims. South African law also followed English law in making the distinction between primary and secondary victims and as will be shown in this contribution, limiting liability in respect of secondary victims is problematic. The courts generally tread with caution in awarding damages for pure psychological or psychiatric harm and several policy considerations are taken into account when deciding to award damages or not. Nevertheless, as will be shown in this contribution, the courts in South Africa and the United Kingdom acknowledge these claims and have been developing the law around the cases that have come before them. What is rather interesting and prevalent though with regard to primary and secondary victim claims for psychological or psychiatric harm in these jurisdictions, is the implicit and explicit influence of "reasonableness" in determining delictual or tort liability for these types of claims. This will be explored further in this contribution.

Making sense of L2 written argumentation with keystroke logging

This study examines associations between writing behaviors manifested by keystroke analytics and the formulation of argument elements in L2 undergraduate writers' writing processes. Ninety-nine persuasive essays written by L2 undergraduate writers were human annotated for Toulmin argument elements. The corresponding keystroke logs were segmented and analyzed to characterize the dynamics of writing processes for different categories of the elements. A multinomial mixed-effects logistic regression model was built to predict argument categories using the keystroke analytics. The study reported that L2 undergraduate writers' text production for final claims and primary claims featured P-bursts (execution processes delimited by pauses exceeding 2 seconds) of longer spans but lower production fluency compared to that for data. In addition, fewer revisions were observed when L2 writers were constructing final claims than when they were formulating data. These findings shed light on the varying cognitive loads and activities L2 undergraduate writers may experience when building different argument elements in written argumentation.

Charles Peirce’s Philosophy and the Intersection Between Biosemiotics and the Philosophy of Biology

Charles S. Peirce’s philosophy of signs, generally construed as the foundation of current semiotic theory, offers a theory of general perception with significant implications for the notion of subjectivity in organisms. In this article, we will discuss Peirce’s primary claims in semiotic theory, particularly focusing on their relevance to biosemiotics. We argue that these claims align with certain areas of the philosophy of biology, specifically epistemological and ontological considerations, despite the limited formal interaction between disciplines. This article serves as a general introduction to Peircean biosemiotics as a philosophical perspective on biological subjectivity.

Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia®).

There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare.

Black gods: The major assertions of the black Jewish movement in America

The black Jewish movement in the United States is an African American new religious movement often linked to black gods. This religious thought raises concerns and questions. Firstly, if the assertions of black Jews are factual, what happens to biblical Israelites and their historicity? Secondly, what is the background of black Jews, and how does that relate to biblical Israel? Thirdly, what are the primary religious claims of black Jews? This article is a critical evaluation of the religious-historical, biblical and theological assertions of the black Jews in America. The article argues that the religious-historical antecedents, theological and biblical claims of the black Jews in America are untrue and cannot replace scriptural assertions about biblical Hebrews or Israelites. The claims of black Jews are eisegetical, not exegetical. The hermeneutics of the black Jews is incoherent with biblical tenets and theological integrity. Therefore, the black Jewish movement cannot substitute or reconstruct the biblical historicity of Israelites.Contribution: The article contributes to the subject of new religious movements in the US. It reveals the discourse of black gods within the African American communities, focusing on the ongoing discourse on the black Jewish movement. It explains and evaluates the claims of black Jews in America, refuting their religious-historical antecedents, theological and biblical claims.

The Beginning of Hegel'sLogic

AbstractThis article discusses two topics, both commonly referred to using the label “the beginning of Hegel'sLogic”: (1) Hegel's justification for the claim that a science of logic must begin by considering the concept of “pure being”. (2) Hegel's discussion of the concepts “being”, “nothing”, and “becoming” in the first chapter of hisLogic. Discussing recent work on both of these topics, two primary claims are defended: Regarding (1): the strongest interpretations of Hegel's case for beginning a science of logic with the concept of pure being are those which take him to argue that this concept must be necessarily both “immediate” and “mediated” at the same time. Regarding (2): The widespread tendency to take Hegel's treatment of the concepts of being, nothing, and becoming as an example with which to illustrate his “dialectical method” should be replaced with an interpretation of that chapter which understands it to rather make possible the kind of dialectical transitions which make up the rest of Hegel'sScience of Logic.

On being a lonely brain‐in‐a‐vat: Structuralism, solipsism, and the threat from external world skepticism

AbstractDavid Chalmers has recently developed a novel strategy of refuting external world skepticism, one he dubs the structuralist solution. In this paper, I make three primary claims: First, structuralism does not vindicate knowledge of other minds, even if it is combined with a functionalist approach to the metaphysics of minds. Second, because structuralism does not vindicate knowledge of other minds, the structuralist solution vindicates far less worldly knowledge than we would hope for from a solution to skepticism. For, solipsism threatens surprisingly vast swathes of worldly knowledge across multiple domains, including at least some knowledge about: political affairs, religious practices, artistic movements, historical events, and cultural trends. Third, the significance of these results exceeds their implications for the structuralist solution; these results suggest that no solution to external world skepticism which does not also solve the problem of other minds will ultimately yield the kind of solution we might have hoped for. Relatedly, these results suggest that the problem of external world skepticism should perhaps be construed as two different problems, since the problem might turn out to require two substantively different solutions, one for knowledge of the kind that is not dependent on other minds and one for knowledge that is.

Health service utilization by people experiencing homelessness and engaging with community paramedics: a pre-post study.

To compare health service utilization of patients interacting with a mobile integrated health care program consisting of advanced care paramedics delivering community paramedic care to people experiencing homelessness before and after their initial visit. ED visits, physician claims, and pharmaceutical dispensations were compared in the year prior to and in the year following the initial community paramedic visit. Administrative databases were linked and utilization rates were calculated and analyzed between periods in this pre-post cohort study. The 1360 community paramedic patients included in this study had no significant change in ED visits (IRR: 1.02) following their initial visit. There were 17,699 ED visits in the pre-period and 18,398 visits in the post-period. There was an observed increase in rates of primary care physician claims (IRR 1.22) and pharmaceutical dispensations from community pharmacies (IRR 1.04). Patients who did not have pharmaceutical dispensations and those without physician claims in the pre-period were significantly less likely to not access these services in the post-period. In the year following the initial community paramedic visit there were small but significant increases in community-based care utilization of people experiencing homelessness. These data suggest that the continued development and implementation of paramedics as part of an interdisciplinary care team can increase access to care for a traditionally underserved population with complex health needs. Patients would likely benefit from the integration of community paramedics in community-based management that aim to improve access to care following ED visits.

Feasibility and acceptability of a paeārahi (Indigenous Whānau Ora navigator) intervention for unintentional injury prevention for older Māori: non-randomised, non-comparator trial study protocol

BackgroundMāori (the Indigenous population of Aotearoa New Zealand) experience increased burden of unintentional injury and reduced access to publicly funded injury prevention and rehabilitation services, compared with non-Māori. Māori-led models...

OZANTÜRK’ÜN “TURNALAR” DESTANI ÜZERİNE MİLLİYETÇİLİK KURAMLARI BAKIMINDAN BİR İNCELEME

There are different researches and studies that have appeared regarding nationalism. There are 3 major theories of these studies, these studies are: primary, modernist, and ethno-symbolic hypotheses. Primary hypothesis claims that all nations came from the same race, and they share the same religion, language, culture and history. The modernist hypothesis claims that nationalism is a communal necessity. In this theory, nationalism explains the modernist process that was affected by social, political, and economic parameters. Finally, the ethno-symbolism theory posits that nationalism is mainly based on ethnic origin and culture. The Epic of “Turnalar” by Ozanturk has pushed the Turkish culture forward. There are three sections connected to each other that talk about the Turkish communities in the “Turnalar” Epic. The first section talks about the Turkish people in Azerbaijan, Kazakhstan, Kyrgyzstan, North Cyprus, Uzbekistan, Turkmenistan, and Turkey.Second section talks about Turkish tribes who live in Iraq, Iran, East Turkistan, Kirim, Tataristan, Main Kurdistan, Yakutsk, Chuvashia, The Republic of Altai, The Republic of Tuva, etc…The third section details the Turkish people who are struggling to live in eastern European countries such as Greece, Bulgaria, Romania, Moldova, Serbia, Bosnia, Kosovo, Albania, Hungary and Macedonia. “Turnalar” is the first work of Bayram Durbilmez who used Ozanturk as a nickname. Bayram Durbilmez used Ozanturk as a nickname for the first time in “Turnalar”. Durbilmez is known by literature studies about love, religious literature, and Turkish national folklore. This scholar defended Turkish nationalism in non-governmental organizations, some foundations, and associations. He used the Ozanturk nickname in his work which shows us how much of a nationalist he is in the literature world. This thesis aims to study “Turnalar” by Ozanturk from the nationalist aspect. By doing this, this thesis will reference his nationalist academic studies. Keywords: Nationalism, Nationalist Theories, Turkish Communities, Ozanturk, Turnalar, Saga, Love Literature

Sensible individuation

AbstractThere is a straightforward view of perception that has not received adequate consideration because it requires us to rethink basic assumptions about the objects of perception. In this paper, I develop a novel account of these objects—the sensible qualities—which makes room for the straightforward view. I defend two primary claims. First, I argue that qualities like color and shape are “ontologically flexible” kinds. That is, their real definitions allow for both physical objects and mental entities to be colored or shaped. Second, a single instance of these qualities can be attributed to more than one entity. Just as we attribute the same instance of a material property to a statue and to the clay that constitutes it, single instances of sensible qualities should be attributed both to the physical objects perceived and to the perceptual states that have those instances as their objects.

"TO‘LOVGА QOBILIYATSIZLIK VUJUDGА KELISHIGА АSOS BO‘LАDIGАN TАLАBLАR: PUL MАJBURIYATLАRI VА MАJBURIY TO‘LOVLАR"

This article systematizes all the claims imposed by creditors in order to determine the occurrence of an insolvency situation. These claims are divided into two categories: monetary obligations and mandatory payments, and the debts included in them are described in detail. In highlighting the essence of the category “monetary obligations”, the norms of civil law and labor law are mutually compared, and the content of the concept of “mandatory payments” in accordance with the norms of tax legislation is also revealed. As a result of the analysis, a list of clear and simple creditors’ claims has been formed, which is acceptable at the bankruptcy legislation. Also the requirements that should be taken into account when initiating a bankruptcy case and the experience of a foreign state was studied in this regard, as well as problematic conditions that need to be eliminated. It was concluded that the initiation of a bankruptcy case should be based only on primary claims; secondary claims (non-payment, fines, amounts of compensation and incentives) should not be the basis for the initiation of the case. In addition, in the course of the study the question of the role of requirements arising from personal relationships and requirements related to intellectual activity, which will become the basis for initiating a rehabilitation case, which is used in the legislation of some states was also considered.

Kierkegaard’s Strong Anti-Rationalism: Offense as a Propaedeutic to Faith

Abstract In a now classic paper, Karen Carr argues that Kierkegaard is a religious “anti-rationalist”: He holds that reason and religious truth exist in necessary tension with one another. Carr maintains that this antagonism is not a matter of the logical incoherence of Christianity, but rather the fact that genuine submission to Christ precludes approaching him through demonstration. In this essay, we argue that while Kierkegaard is in fact an anti-rationalist, the literature has failed to appreciate the full strength of his position. It is not just that reason and obedience are in tension; rather, Kierkegaard holds the stronger view that reason is actively offended by Christianity’s primary claims. Not only is reason incapable of generating any positive evidence for the truth of Christianity, more radically, it provides evidence against it. In order to make this case, we offer a close reading of Practice in Christianity, developing a typology of Kierkegaard’s account of Christ’s “offense.” Finally, having motivated Kierkegaard’s strong anti-rationalism, we consider why, on his account, anyone would want to be a Christian.

Legitimacy, resistance and the stakes of politics

This essay argues for the conceptual connection of legitimacy, resistance and ‘the people’ within liberal theories of public justification by making two primary claims: that legitimacy and resistance are mutually constitutive of one another and that together legitimacy and resistance are constitutive of an aspirational conception of ‘the people’. These claims revolve around the idea that the legitimacy of democratic regimes necessarily entails the questioning of that legitimacy through resistance, which concerns demands that say something about the makeup of ‘the people’. The concern is conceptual, examples of resistance showing how the conceptual connection manifests itself.

Physician- versus practice-level primary care continuity and association with outcomes in Medicare beneficiaries.

To compare physician-level versus practice-level primary care continuity and their association with expenditure and acute care utilization among Medicare beneficiaries and evaluate whether continuity of outpatient primary care at either/both physician or/and practice level could be useful quality measures. Medicare Fee-For-Service claims data for community dwelling beneficiaries without end-stage renal disease who were attributed to a national random sample of primary care practices billing Medicare (2011-2017). Retrospective secondary data analysis at per Medicare beneficiary per year level. We used multivariable linear regression with practice-level fixed effects to estimate continuity of care score at physician versus practice level and their associations with outcomes. We calculated clinician- and practice-level Bice-Boxerman continuity of care index scores, ranging from 0 to 1, using primary care outpatient claims. Medicare expenditures, hospital admissions, emergency department (ED) visits, and readmissions were obtained from the Medicare Beneficiary Summary File: Cost and Utilization Segment. Ambulatory care sensitive conditions (ACSC) were defined using diagnosis codes on inpatient claims. We studied 2,359,400 beneficiaries who sought care from 13,926 physicians. Every 0.1 increase in physician continuity score was associated with a $151 reduction in expenditure per beneficiary per year (p < 0.01), and every 0.1 increase in practice continuity score was associated with $282 decrease (p < 0.01) per beneficiary per year. Both physician- and practice-level continuity were associated with lower Medicare expenditures among small, medium, and large practices. Both physician- and practice-level continuity were associated with lower probabilities of hospitalization, ED visit, admissions for ACSC, and readmission. Primary care continuity of care could serve as a potent value-based care quality metric. Physician-level continuity is a unique value center that cannot be supplanted by practice-level continuity.