Why don\u27t GPs go online?

A 2003 study of the adoption of online medical applications by Victorian GPs showed that not only are very few using them, but also very few have plans to do so. This paper asks why this is so. Three possible explanations are investigated: that their current IS/IT aligns with their strategy, rendering change unwarranted; that they do not have the requisite means; and that there are non-strategic, non-means reasons. After an analysis of the relevance of concepts of strategy and alignment to the medical profession, relevant concepts are applied to the data. The findings are not encouraging for government plans to improve access, equity and efficiency through online medical applications

The Wide Field Spectrograph (WiFeS): Performance and Data Reduction

This paper describes the on-telescope performance of the Wide Field Spectrograph (WiFeS). The design characteristics of this instrument, at the Research School of Astronomy and Astrophysics (RSAA) of the Australian National University (ANU) and mounted on the ANU 2.3m telescope at the Siding Spring Observatory has been already described in an earlier paper (Dopita et al. 2007). Here we describe the throughput, resolution and stability of the instrument, and describe some minor issues which have been encountered. We also give a description of the data reduction pipeline, and show some preliminary results.Comment: Accepted for publication in Astrophysics & Space Science, 15pp, 11 figure

A synthetic and spectroscopic investigation of the asymmetric α-lithiation-trapping of six-membered N-Boc heterocycles using Alexakis diamines

The asymmetric lithiation-trapping of six-membered N-Boc heterocycles using s-BuLi and two different Alexakis diamines is reported. These readily available ligands outperform the current ‘best-in-class’ sparteine-type diamines in the lithiation and benzophenone trapping of N-Boc piperazines and the lithiation-cyclisation-trapping of N-Boc-4-chloropiperidine. In situ IR spectroscopy has been used to optimise lithiation times and to discover previously unknown subtleties regarding the lithiation step

General Procedures for the Lithiation/Trapping of N-Boc Piperazines

In order to provide α-substituted piperazines for early-stage medicinal chemistry studies, a simple, general synthetic approach is required. Here, we report the development of two general and simple procedures for the racemic lithiation/trapping of N-Boc piperazines. Optimum lithiation times have been determined using in situ IR spectroscopy and the previous complicated and diverse literature procedures have been simplified. Subsequent trapping with electrophiles delivered a wide range of α-functionalised N-Boc piperazines. The scope and limitations of the distal N-group has been investigated. The selective α- and β- arylation of N-Boc piperazines via lithiation/Negishi coupling is reported

Fluconazole-Associated Birth Defects: A Comprehensive Review

Background: The August 2013 publication of a large historical cohort study in the New England Journal of Medicine has reignited interest in the potential teratogenic effects of fluconazole when used in pregnant females. Fluconazole is an effective and commonly-utilized antifungal medication. Thus, maternal and fetal exposure to fluconazole is expected in the general population, and pharmacists are expected to counsel patients regarding any risks to their prescribed treatment. Methods: A literature review of all published literature indexed to PubMed (January 1966 to October 2013) and International Pharmaceutical Abstracts (January 1975 to October 2013) including fluconazole and teratogenic effects and published in the English language was conducted. Results: Fourteen publications were included for analysis including case reports (n=7), cross-sectional research (n=2), and historical cohort studies (n=5). Conclusion: There appears to be little to no fetal risk resulting from a single dose or short duration antifungal therapy with fluconazole. However, prolonged high-dose fluconazole therapy has increased potential to confer teratogenic effects. In those cases, the risks of such therapy should be weighed against potential benefits

Detection of zoonotic pathogens and characterization of novel viruses carried by commensal Rattus norvegicus in New York City

Norway rats (Rattus norvegicus) are globally distributed and concentrate in urban environments, where they live and feed in closer proximity to human populations than most other mammals. Despite the potential role of rats as reservoirs of zoonotic diseases, the microbial diversity present in urban rat populations remains unexplored. In this study, we used targeted molecular assays to detect known bacterial, viral, and protozoan human pathogens and unbiased high-throughput sequencing to identify novel viruses related to agents of human disease in commensal Norway rats in New York City. We found that these rats are infected with bacterial pathogens known to cause acute or mild gastroenteritis in people, including atypical enteropathogenic Escherichia coli, Clostridium difficile, and Salmonella enterica, as well as infectious agents that have been associated with undifferentiated febrile illnesses, including Bartonella spp., Streptobacillus moniliformis, Leptospira interrogans, and Seoul hantavirus. We also identified a wide range of known and novel viruses from groups that contain important human pathogens, including sapoviruses, cardioviruses, kobuviruses, parechoviruses, rotaviruses, and hepaciviruses. The two novel hepaciviruses discovered in this study replicate in the liver of Norway rats and may have utility in establishing a small animal model of human hepatitis C virus infection. The results of this study demonstrate the diversity of microbes carried by commensal rodent species and highlight the need for improved pathogen surveillance and disease monitoring in urban environments. Importance: The observation that most emerging infectious diseases of humans originate in animal reservoirs has led to wide-scale microbial surveillance and discovery programs in wildlife, particularly in the developing world. Strikingly, less attention has been focused on commensal animals like rats, despite their abundance in urban centers and close proximity to human populations. To begin to explore the zoonotic disease risk posed by urban rat populations, we trapped and surveyed Norway rats collected in New York City over a 1-year period. This analysis revealed a striking diversity of known pathogens and novel viruses in our study population, including multiple agents associated with acute gastroenteritis or febrile illnesses in people. Our findings indicate that urban rats are reservoirs for a vast diversity of microbes that may affect human health and indicate a need for increased surveillance and awareness of the disease risks associated with urban rodent infestation

The Next Generation Virgo Cluster Survey. VI. The Kinematics of Ultra-compact Dwarfs and Globular Clusters in M87

The origin of ultra-compact dwarfs (UCDs)--objects larger and more massive than typical globular clusters (GCs), but more compact than typical dwarf galaxies--has been hotly debated in the 15 years since their discovery. Even whether UCDs should be considered galactic in origin, or simply the most extreme GCs, is not yet settled. We present the dynamical properties of 97 spectroscopically confirmed UCDs (rh >~10 pc) and 911 GCs associated with central cD galaxy of the Virgo cluster, M87. Our UCDs, of which 89% have M_star > ~2X10^6 M_sun and 92% are as blue as the classic blue GCs, nearly triple the sample of previous confirmed Virgo UCDs, providing by far the best opportunity for studying the global dynamics of a UCD system. We found that (1) UCDs have a surface number density profile that is shallower than that of the blue GCs in the inner ~ 70 kpc and as steep as that of the red GCs at larger radii; (2) UCDs exhibit a significantly stronger rotation than the GCs, and the blue GCs seem to have a velocity field that is more consistent with that of the surrounding dwarf ellipticals than with that of UCDs; (3) UCDs have a radially increasing orbital anisotropy profile, and are tangentially-biased at radii < ~ 40 kpc and radially-biased further out. In contrast, the blue GCs become more tangentially-biased at larger radii beyond ~ 40 kpc; (4) GCs with M_star > 2X10^6 M_sun have rotational properties indistinguishable from the less massive ones, suggesting that it is the size, instead of mass, that differentiates UCDs from GCs as kinematically distinct populations. We conclude that most UCDs in M87 are not consistent with being merely the most luminous and extended examples of otherwise normal GCs. The radially-biased orbital structure of UCDs at large radii is in general agreement with the "tidally threshed dwarf galaxy" scenario.Comment: 27 pages, 21 figures. To appear in The Astrophysical Journa