The identification of the general practice registrar needing assistance

BackgroundDoctors undertaking vocational training in general practicein Australia may require assistance, in addition to thenormal training offered as part of their training programme.Issues requiring assistance may go undetected for a periodof time. Delay in the identification of issues leads to delay inthe provision of the assistance. The aim of this study is todetermine the most common reasons registrars requireextra assistance, and how these issues are identified. Thefindings of this study will provide direction for 21 regionallybased training providers (RTPs) to develop improved toolsto ensure earlier detection of registrars requiring assistance.MethodThis study is based on qualitative research methods, usingsemi-structured interviews with senior medical educationstaff of four regional general practice training providers inVictoria, Australia.ResultsIssues identified included language and cultural issues,applied knowledge and skills, attitude and professionalism,and health and family issues.The principal method that training providers identifiedissues was via the GP supervisor. This was predominantly byinformal communication, rather than formal evaluationsheets. Other methods included the external clinicalteaching visit and other training formative assessments.These more formalised procedures were more likely toidentify issues later than desired. They were also used as away of clarifying suspected problems. The selection processwas not felt to be helpful, and the examinations providedinformation too late.ConclusionAn increased awareness of the potential issues leading to aregistrar to require assistance enables identification andsubsequent action to occur in a more timely and moreuseful fashion. Informal communication between practicesand training programme staff should be encouraged toenable these issues to be dealt with early in training

Are we teaching our students what they need to know about ageing? Results from the National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine

Introduction - Learning about ageing and the appropriate management of older patients is important for all doctors. This survey set out to evaluate what medical undergraduates in the UK are taught about ageing and geriatric medicine and how this teaching is delivered. Methods – An electronic questionnaire was developed and sent to the 28/31 UK medical schools which agreed to participate. Results – Full responses were received from 17 schools. 8/21 learning objectives were recorded as taught, and none were examined, across every school surveyed. Elder abuse and terminology and classification of health were taught in only 8/17 and 2/17 schools respectively. Pressure ulcers were taught about in 14/17 schools but taught formally in only 7 of these and examined in only 9. With regard to bio- and socio- gerontology, only 9/17 schools reported teaching in social ageing, 7/17 in cellular ageing and 9/17 in the physiology of ageing. Discussion – Even allowing for the suboptimal response rate, this study presents significant cause for concern with UK undergraduate education related to ageing. The failure to teach comprehensively on elder abuse and pressure sores, in particular, may be significantly to the detriment of older patients

Light curves and colours of the faint Uranian irregular satellites Sycorax, Prospero, Stephano, Setebos and Trinculo

After the work of Gladman et al. (1998), it is now assessed that many irregular satellites are orbiting around Uranus. Despite many studies have been performed in past years, very few is know for the light-curves of these objects and inconsistencies are present between colours derived by different authors. This situation motivated our effort to improve both the knowledge of colours and light curves. We present and discuss time series observations of Sycorax, Prospero, Stephano, Setebos and Trinculo, five faint irregular satellites of Uranus, carried out at VLT, ESO Paranal (Chile) in the nights between 29 and 30 July, 2005 and 25 and 30 November, 2005. We derive light curves for Sycorax and Prospero and colours for all of these these bodies. For Sycorax we obtain colours B-V =0.839 +/- 0.014, V-R = 0.531 +/- 0.005 and a light curve which is suggestive of a periodical variation with period about 3.6 hours and amplitude about 0.067 +/- 0.004 mag. The periods and colours we derive for Sycorax are in agreement with our previous determination in 1999 using NTT. We derive also a light-curve for Prospero which suggests an amplitude of about 0.2 mag and a periodicity of about 4 hours. However, the sparseness of our data, prevents a more precise characterization of the light-curves, and we can not determine wether they are one-peaked or two-peaked. Hence, these periods and amplitudes have to be considered preliminary estimates. As for Setebos, Stephano and Trinculo the present data do not allow to derive any unambiguous periodicity, despite Setebos displays a significant variability with amplitude about as large as that of Prospero. Colours for Prospero, Setebos, Stephano and Trinculo are in marginal agreement with the literature.Comment: Submitted to A&A 13 Dec 2006, Accepted 17 Apr 2007. 18 pages, 8 colours figures BW printable, 6 tables. LaTeX 2.09, with packages: natbib, graphicx, longtable, aa4babbage included in the submission file (tar gzipped of 349 KBytes

Colors of Inner Disk Classical Kuiper Belt Objects

We present new optical broadband colors, obtained with the Keck 1 and Vatican Advanced Technology telescopes, for six objects in the inner classical Kuiper Belt. Objects in the inner classical Kuiper Belt are of interest as they may represent the surviving members of the primordial Kuiper Belt that formed interior to the current position of the 3:2 resonance with Neptune, the current position of the plutinos, or, alternatively, they may be objects formed at a different heliocentric distance that were then moved to their present locations. The six new colors, combined with four previously published, show that the 10 inner belt objects with known colors form a neutral clump and a reddish clump in B-R color. Nonparametric statistical tests show no significant difference between the B-R color distribution of the inner disk objects compared to the color distributions of Centaurs, plutinos, or scattered disk objects. However, the B-R color distribution of the inner classical Kuiper belt objects does differ significantly from the distribution of colors in the cold (low inclination) main classical Kuiper belt. The cold main classical objects are predominately red, while the inner classical belt objects are a mixture of neutral and red. The color difference may reveal the existence of a gradient in the composition and /or surface processing history in the primordial Kuiper Belt, or indicate that the inner disk objects are not dynamically analogous to the cold main classical belt objects.Comment: Accepted for publication in A

A Motivating Exploration on Lunar Craters and Low-Energy Dynamics in the Earth -- Moon System

It is known that most of the craters on the surface of the Moon were created by the collision of minor bodies of the Solar System. Main Belt Asteroids, which can approach the terrestrial planets as a consequence of different types of resonance, are actually the main responsible for this phenomenon. Our aim is to investigate the impact distributions on the lunar surface that low-energy dynamics can provide. As a first approximation, we exploit the hyberbolic invariant manifolds associated with the central invariant manifold around the equilibrium point L_2 of the Earth - Moon system within the framework of the Circular Restricted Three - Body Problem. Taking transit trajectories at several energy levels, we look for orbits intersecting the surface of the Moon and we attempt to define a relationship between longitude and latitude of arrival and lunar craters density. Then, we add the gravitational effect of the Sun by considering the Bicircular Restricted Four - Body Problem. As further exploration, we assume an uniform density of impact on the lunar surface, looking for the regions in the Earth - Moon neighbourhood these colliding trajectories have to come from. It turns out that low-energy ejecta originated from high-energy impacts are also responsible of the phenomenon we are considering.Comment: The paper is being published in Celestial Mechanics and Dynamical Astronomy, vol. 107 (2010

The CFEPS Kuiper Belt Survey: Strategy and Pre-survey Results

We present the data acquisition strategy and characterization procedures for the Canada-France Ecliptic Plane Survey (CFEPS), a sub-component of the Canada-France-Hawaii Telescope Legacy Survey. The survey began in early 2003 and as of summer 2005 has covered 430 square degrees of sky within a few degrees of the ecliptic. Moving objects beyond the orbit of Uranus are detected to a magnitude limit of $m_R$=23 -- 24 (depending on the image quality). To track as large a sample as possible and avoid introducing followup bias, we have developed a multi-epoch observing strategy that is spread over several years. We present the evolution of the uncertainties in ephemeris position and orbital elements as the objects progress through the epochs. We then present a small 10-object sample that was tracked in this manner as part of a preliminary survey starting a year before the main CFEPS project. We describe the CFEPS survey simulator, to be released in 2006, which allows theoretical models of the Kuiper Belt to be compared with the survey discoveries since CFEPS has a well-documented pointing history with characterized detection efficiencies as a function of magnitude and rate of motion on the sky. Using the pre-survey objects we illustrate the usage of the simulator in modeling the classical Kuiper Belt.Comment: to be submitted to Icaru

The Canada-France Ecliptic Plane Survey - Full Data Release: The orbital structure of the Kuiper belt

We report the orbital distribution of the trans-neptunian objects (TNOs) discovered during the Canada-France Ecliptic Plane Survey, whose discovery phase ran from early 2003 until early 2007. The follow-up observations started just after the first discoveries and extended until late 2009. We obtained characterized observations of 321 sq.deg. of sky to depths in the range g ~ 23.5--24.4 AB mag. We provide a database of 169 TNOs with high-precision dynamical classification and known discovery efficiency. Using this database, we find that the classical belt is a complex region with sub-structures that go beyond the usual splitting of inner (interior to 3:2 mean-motion resonance [MMR]), outer (exterior to 2:1 MMR), and main (in between). The main classical belt (a=40--47 AU) needs to be modeled with at least three components: the `hot' component with a wide inclination distribution and two `cold' components (stirred and kernel) with much narrower inclination distributions. The hot component must have a significantly shallower absolute magnitude (Hg) distribution than the other two components. With 95% confidence, there are 8000+1800-1600 objects in the main belt with Hg <= 8.0, of which 50% are from the hot component, 40% from the stirred component and 10% from the kernel; the hot component's fraction drops rapidly with increasing Hg. Because of this, the apparent population fractions depend on the depth and ecliptic latitude of a trans-neptunian survey. The stirred and kernel components are limited to only a portion of the main belt, while we find that the hot component is consistent with a smooth extension throughout the inner, main and outer regions of the classical belt; the inner and outer belts are consistent with containing only hot-component objects. The Hg <= 8.0 TNO population estimates are 400 for the inner belt and 10,000 for the outer belt within a factor of two.Comment: 59 pages, 9 figures, 7 table

An educational leaflet improves response to invitation for screening for arthritis in patients with psoriasis in primary care, but only in practices in the most deprived areas

This study hypothesises that an educational leaflet about psoriatic arthritis (PsA) will improve psoriasis patients’ attendance for screening for PsA. A random sample of patients ≥18 years old with a coded diagnosis of psoriasis and no diagnosis of PsA, rheumatoid arthritis or ankylosing spondylitis were identified from five GP surgeries in Yorkshire, UK. Patients were randomised 1:1 to receive study information alone or with the educational leaflet, with an invitation to attend for a screening examination by a dermatologist and rheumatologist. Nine hundred thirty-two invitation packs were sent to recruit 191 (20.5%) participants. One hundred sixty-nine (88.5%) had current or previous psoriasis and 17 (10.1%) had previously undiagnosed PsA. The estimated prevalence of PsA was 18.1% (95% CI: 16.2, 20.1%). The response rate was lower than expected and was not significantly higher when patients received the educational leaflet (22.8 vs 18.3%, p = 0.08). Response rates varied by practice (14.7 to 30.6%). However, deprivation scores for each practice revealed a significant increase in response with the leaflet for deprivation decile of 3 (p < 0.001) but no significant differences in the other practices. An educational leaflet about PsA improves attendance for screening in primary care, but only in those practices with higher levels of socioeconomic deprivation

The psoriatic arthritis cost evaluation study: a cost-of-illness study on tumour necrosis factor inhibitors in psoriatic arthritis patients with inadequate response to conventional therapy

Objective. To evaluate costs, benefits and cost–effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment

Searching for Saturn's Dust Swarm: Limits on the size distribution of Irregular Satellites from km to micron sizes

We describe a search for dust created in collisions between the Saturnian irregular satellites using archival \emph{Spitzer} MIPS observations. Although we detected a degree scale Saturn-centric excess that might be attributed to an irregular satellite dust cloud, we attribute it to the far-field wings of the PSF due to nearby Saturn. The Spitzer PSF is poorly characterised at such radial distances, and we expect PSF characterisation to be the main issue for future observations that aim to detect such dust. The observations place an upper limit on the level of dust in the outer reaches of the Saturnian system, and constrain how the size distribution extrapolates from the smallest known (few km) size irregulars down to micron-size dust. Because the size distribution is indicative of the strength properties of irregulars, we show how our derived upper limit implies irregular satellite strengths more akin to comets than asteroids. This conclusion is consistent with their presumed capture from the outer regions of the Solar System.Comment: accepted to MNRA