Video Consultation Use by Australian General Practitioners: Video Vignette Study

Background: There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy. Objective: The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems. Methods: Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.Results: A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations. Conclusions: Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools

HD 145263: Spectral Observations of Silica Debris Disk Formation via Extreme Space Weathering?

We report here time domain infrared spectroscopy and optical photometry of the HD145263 silica-rich circumstellar disk system taken from 2003 through 2014. We find an F4V host star surrounded by a stable, massive 1e22 - 1e23 kg (M_Moon to M_Mars) dust disk. No disk gas was detected, and the primary star was seen rotating with a rapid ~1.75 day period. After resolving a problem with previously reported observations, we find the silica, Mg-olivine, and Fe-pyroxene mineralogy of the dust disk to be stable throughout, and very unusual compared to the ferromagnesian silicates typically found in primordial and debris disks. By comparison with mid-infrared spectral features of primitive solar system dust, we explore the possibility that HD 145263's circumstellar dust mineralogy occurred with preferential destruction of Fe-bearing olivines, metal sulfides, and water ice in an initially comet-like mineral mix and their replacement by Fe-bearing pyroxenes, amorphous pyroxene, and silica. We reject models based on vaporizing optical stellar megaflares, aqueous alteration, or giant hypervelocity impacts as unable to produce the observed mineralogy. Scenarios involving unusually high Si abundances are at odds with the normal stellar absorption near-infrared feature strengths for Mg, Fe, and Si. Models involving intense space weathering of a thin surface patina via moderate (T < 1300 K) heating and energetic ion sputtering due to a stellar superflare from the F4V primary are consistent with the observations. The space weathered patina should be reddened, contain copious amounts of nanophase Fe, and should be transient on timescales of decades unless replenished.Comment: 41 Pages, 5 Figures, 5 Tables, Accepted for publication in the Astrophysical Journa

Systematics of Fission Barriers in Superheavy Elements

We investigate the systematics of fission barriers in superheavy elements in the range Z = 108-120 and N = 166-182. Results from two self-consistent models for nuclear structure, the relativistic mean-field (RMF) model as well as the non-relativistic Skyrme-Hartree-Fock approach are compared and discussed. We restrict ourselves to axially symmetric shapes, which provides an upper bound on static fission barriers. We benchmark the predictive power of the models examining the barriers and fission isomers of selected heavy actinide nuclei for which data are available. For both actinides and superheavy nuclei, the RMF model systematically predicts lower barriers than most Skyrme interactions. In particular the fission isomers are predicted too low by the RMF, which casts some doubt on recent predictions about superdeformed ground states of some superheavy nuclei. For the superheavy nuclei under investigation, fission barriers drop to small values around Z = 110, N = 180 and increase again for heavier systems. For most of the forces, there is no fission isomer for superheavy nuclei, as superdeformed states are in most cases found to be unstable with respect to octupole distortions.Comment: 17 pages REVTEX, 12 embedded eps figures. corrected abstrac

Physical linkages between an offshore canyon and surf zone morphologic change

Author Posting. © American Geophysical Union, 2017. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Oceans 122 (2017): 3451–3460, doi:10.1002/2016JC012319.The causes of surf zone morphologic changes observed along a sandy beach onshore of a submarine canyon were investigated using field observations and a numerical model (Delft3D/SWAN). Numerically simulated morphologic changes using four different sediment transport formulae reproduce the temporal and spatial patterns of net cross-shore integrated (between 0 and 6.5 m water depths) accretion and erosion observed in a ∼300 m alongshore region, a few hundred meters from the canyon head. The observations and simulations indicate that the accretion or erosion results from converging or diverging alongshore currents driven primarily by breaking waves and alongshore pressure gradients. The location of convergence or divergence depends on the direction of the offshore waves that refract over the canyon, suggesting that bathymetric features on the inner shelf can have first-order effects on short-term nearshore morphologic change.WHOI-USGS postdoctoral scholarship, NSF, ONR2017-10-2

Respiratory tract infections among children younger than 5 years: Current management in Australian general practice

Objective: To explore the current management in Australian general practice of common respiratory tract infections (RTIs) in children younger than 5 years. Design, setting and participants: Analysis of data from a sample of 4522 general practitioners who participated in the Bettering the Evaluation and Care of Health (BEACH) cross-sectional survey, April 2007 to March 2012. Consultations with children younger than 5 years were analysed. Main outcome measures: GPs’ management of four common RTIs (acute upper RTI [URTI], acute bronchitis/bronchiolitis, acute tonsillitis, and pneumonia) in association with six management options: antibiotic medications; prescribed or supplied non-antibiotic medications; medications advised for over-the-counter purchase; referrals; pathology testing; and counselling. Results: Of 31 295 encounters recorded, at least one of the four selected paediatric RTIs was managed at 8157 encounters. URTI was managed 18.6 times per 100 GP patient encounters, bronchitis/bronchiolitis 4.2 times, acute tonsillitis 2.7 times, and pneumonia 0.6 times per 100 encounters. Antibiotics were prescribed most frequently for tonsillitis and least frequently for URTI. Male GPs prescribed antibiotics for URTI significantly more often than female GPs, while older GPs prescribed antibiotics for URTI more often than younger GPs. Conclusion: GP management of paediatric RTIs in Australia varied according to the clinical problem and with age and sex of the GP. Further research into parents’ and health professionals’ attitudes and practices regarding the role of antibiotics, over-the-counter medications, and hygiene will help maintain favourable management practices

Constraining the nature of the accreting binary in CXOGBS J174623.5-310550

We report optical and infrared observations of the X-ray source CXOGBS J174623.5-310550. This Galactic object was identified as a potential quiescent low-mass X-ray binary accreting from an M-type donor on the basis of optical spectroscopy and the broad Halpha emission line. The analysis of X-shooter spectroscopy covering 3 consecutive nights supports an M2/3-type spectral classification. Neither radial velocity variations nor rotational broadening is detected in the photospheric lines. No periodic variability is found in I- and r'-band light curves. We derive r' = 20.8, I = 19.2 and Ks = 16.6 for the optical and infrared counterparts with the M-type star contributing 90% to the I-band light. We estimate its distance to be 1.3-1.8 kpc. The lack of radial velocity variations implies that the M-type star is not the donor star in the X-ray binary. This could be an interloper or the outer body in a hierarchical triple. We constrain the accreting binary to be a < 2.2 hr orbital period eclipsing cataclysmic variable or a low-mass X-ray binary lying in the foreground of the Galactic Bulge.Comment: (9 pages, 5 figures, accepted for publication in MNRAS

Near-Earth asteroid sample return missions

The rate of discovery of new NEAs and the success of D-S 1 and NEAR-Shoemaker, suggest that sample return from NEAs is now technically feasible. Here we present a summary of a recent workshop on the topic

The Multifragmentation Freeze--Out Volume in Heavy Ion Collisions

The reduced velocity correlation function for fragments from the reaction Fe + Au at 100 A~MeV bombarding energy is investigated using the dynamical--statistical approach QMD+SMM and compared to experimental data to extract the Freeze--Out volume assuming simultaneous multifragmentation.Comment: 8 pages; 3 uuencoded figures available with figures command, LateX, UCRL-J-1157

A dynamical model of surrogate reactions

A new dynamical model is developed to describe the whole process of surrogate reactions; transfer of several nucleons at an initial stage, thermal equilibration of residues leading to washing out of shell effects and decay of populated compound nuclei are treated in a unified framework. Multi-dimensional Langevin equations are employed to describe time-evolution of collective coordinates with a time-dependent potential energy surface corresponding to different stages of surrogate reactions. The new model is capable of calculating spin distributions of the compound nuclei, one of the most important quantity in the surrogate technique. Furthermore, various observables of surrogate reactions can be calculated, e.g., energy and angular distribution of ejectile, and mass distributions of fission fragments. These features are important to assess validity of the proposed model itself, to understand mechanisms of the surrogate reactions and to determine unknown parameters of the model. It is found that spin distributions of compound nuclei produced in $^{18}$O+$^{238}$U $\rightarrow ^{16}$O+$^{240*}$U and $^{18}$O+$^{236}$U $\rightarrow ^{16}$O+$^{238*}$U reactions are equivalent and much less than 10$\hbar$, therefore satisfy conditions proposed by Chiba and Iwamoto (PRC 81, 044604(2010)) if they are used as a pair in the surrogate ratio method.Comment: 17 pages, 5 figure

Current contraceptive management in Australian general practice: An analysis of BEACH data

Objective: To determine current contraceptive management by general practitioners in Australia. Design, setting and participants: Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed. Main outcome measures: GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception. Results: Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (&gt; 20%). Conclusion: A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use