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

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

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

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 (> 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

Emergency contraception in Australia: The desired source of information versus the actual source of information

Objective: To determine long-term trends in emergency contraception (EC) management by general practitioners in Australia. Design, setting and participants: Data from April 2000 to March 2012 were drawn from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous cross-sectional survey of GP activity. We analysed consultations involving EC management, unwanted pregnancy management and emergency contraceptive pill (ECP) prescribing per 1000 GP encounters with women aged 14-54 years. Summary statistics were calculated with 95% confidence intervals. Results: In 2000-2001, GPs managed EC problems at a rate of 5.50 per 1000 encounters (95% CI, 4.37-6.63). From 2004, after the ECP became available over the counter (OTC) in pharmacies, EC management, which includes ECP prescription, progressively declined. By 2011-2012, only 1.43 EC problems were managed per 1000 encounters (95% CI, 0.84-2.02) and only 0.48 ECP prescriptions were provided per 1000 encounters (95% CI, 0.14-0.82). Yet the management rate of unwanted pregnancy problems stayed relatively constant (rate in 2000-2001, 0.95 per 1000 encounters; 95% CI, 0.40-1.50; rate in 2011-2012, 0.88 per 1000 encounters; 95% CI, 0.41-1.36). Conclusion: Low rates of EC management by GPs since ECP became available OTC suggest that women may be obtaining information on EC elsewhere. Further investigation is needed to uncover the sources of this information and its acceptability and application by Australian women