The Queensland Health Rural Generalist Pathway: providing a medical workforce for the bush

Introduction: Queensland Health's Rural Generalist Pathway is a supported career pathway for junior doctors to train in rural and remote medicine. The pathway joins evidence with policy to achieve professional recognition, credentialing, and industrial recognition. Methods: This article describes the principles underpinning the notion of rural generalism, the background to the establishment of the Rural Generalist Pathway in Queensland, Australia, how the pathway has been developed to meet the needs of Queensland's rural and remote communities, the implementation of the pathway, and the implications for other jurisdictions. Results: In 2007, 30 trainees commenced on the pathway, with total enrolment now of 182 in 2012. Trainees commence at the start of internship, completing their prevocational training component in postgraduate years 1 to 2. After prevocational certification they undertake advanced specialised training in a range of specialties, and then complete vocational training in a rural location, usually in their 4th to 5th postgraduate years. Trainees complete their general practice training through a Regional Training Provider, and achieve vocational registration by completion of appropriate fellowship assessment requirements. The pathway is managed by a geographically dispersed team of educators, clinicians and managers. The Rural Generalist team provide training and career advice, advocate for trainees and assist with negotiating posts. They map progress of trainees through the Vocational Indicative Planning process and arrange other educational activities including Rural Generalist workshops. Applications are often oversubscribed, with the intake growing to 41 in 2012, located at 10 intern training hospitals. In total 90 trainees have completed advanced specialised training as at the end of 2012. Conclusion: The Rural Generalist Pathway includes a challenging prevocational start to the career, the opportunity to specialise in a procedural skill or skills of interest and obtain general practice vocational training in a rural setting and appears to be proving an attractive choice for medical graduates seeking a challenging and varied career. Early evidence suggests that by recognizing and rewarding the worth of rural and remote practice, this strategy is creating its own supply line. From its initial roll-out in Queensland, rural generalist training continues to generate increased interest and enthusiasm across all Australian states and territories wishing to join this new wave of generalist practice. This new generation of health professionals for a new generation of services has the potential to provide the rural medical workforce the bush needs

Comment on: Rural Generalism and the Queensland Health pathway – implications for rural clinical supervisors, placements and rural medical education providers

[Extract] Professor Kitchener is to be congratulated on his recent article highlighting some practical issues involved in implementing Rural Generalist (RG) training. As members of the Queensland Health Rural Generalist Pathway (RGP) team we support his commitment to rural training and would like to emphasize and clarify some aspects of his informative paper which builds on our own description

AN EVALUATION OF REACTOR CONCEPTS FOR USE AS SEPARATE STEAM SUPER-HEATERS

Various reactor concepts were compared for use as a separate superheater which could be added on to an advanced 300-Mwe reactor producing saturated steam. Fossil steam plant superheat temperatures were used as a criterion for selecting nuclear superheat temperatures. Therefore, the performance specified for the superheater was a minimum exit steam temperature of 566 deg C (1050 deg F) when supplied with saturated steam at either 7l atm (l050 psia) or l67 atm (2450 psia). A preliminary screening of ten different reactor concepts resulted in the selection of two for a detailed evaluation. These are a direct-cycle, watermoderated reactor, and an indirect-cycle, sodium-cooled reactor. The steam- cooled, water-moderated system is judged to have the best chance for initially reaching 566 deg C (l050 deg F), whereas, the indirect-cycle, sodiumcooled system is considered best for subsequent advances to exploit the more efficient, high- pressure steam reheat cycles. A design concept was selected for each of the reactors to establish a basis for the detailed evaluations and comparisons. The technical evaluation of the two concepts shows that the sodium-cooled, indirect- cycle superheater can realize a significant reductlon in the gross plant heat rate STA0.6097 to 0.5404cal/watt-sec (87l0 to 7720 Btu/kwh)! by use of the l64- atm (2400 psig) reheat steam cycle. This is not feasible with the water- moderated superheater, because of an assumed limitation of 71 atm (l050 psia) on large-size pressure vessels for reactors. This restricts the direct-cycle superheater to the use of 69-atm (l000psig) turbines without reheat. On the other hand, to reach the specified steam exit temperature of 566 deg C (l050 deg F), the direct-cycle concept requires less extrapolation of current technology. Oxide fuel is suitable for the direct-cycle reactor but carbides are necessary to reach sufficiently high sodium temperatures with the indirect-cycle reactor. Both concepts need fuel cladding of high creep strength; however, the problems of corrosion and erosion are alleviated in a sodium-cooled system. Cost estimates give an advantage to the water-moderated, direct-cycle system although both show a net reduction in power costs when added as separate superheaters to a boiling water reactor. The significance of a size factor for plants in the 500-Mwe range is illustrated by comparisons made in this study. Power costs for the direct- cycle superheater, boiling water reactor combination were almost identical with those of an integraltype water-moderated direct-cycle system. This is because two of the integral-type units are required to match the power (575 Mwe) of the separate superheater-boiler combination. Conversely, with the sodium system, a separate sodium-cooled superheater, sodium-graphite boiler combination gives higher power costs than an integral-type sodium system because only one reactor is required for the latter in the 500-Mwe range. This study was centered on an approach to cheaper nuclear power through higher over-all thermal efficiency. To reach the ceiling now imposed by steam turbine technology, higher temperatures are indicated for the sodium-cooled superheater, since it is already amenable to the use of a high-pressure, reheat steam cycle. Alternatively, the direct-cycle, steam-cooled superheater (in the light of current development programs) is closer to the current limit to turbine temperature so that the major degree of freedom remaining is increased pressure for improved cycle efficiency. (auth

Caltech Faint Galaxy Redshift Survey. XI. The Merger Rate to Redshift 1 from Kinematic Pairs

The rate of mass accumulation due to galaxy merging depends on the mass, density, and velocity distribution of galaxies in the near neighborhood of a host galaxy. The fractional luminosity in kinematic pairs combines all of these effects in a single estimator which is relatively insensitive to population evolution. Here we use a k-corrected and evolution compensated volume-limited sample drawing about 300 redshifts from CFGRS and 3000 from CNOC2 to measure the rate and redshift evolution of merging. We identify kinematic pairs with projected separations less than either 50 or 100 \hkpc and rest-frame velocity differences of less than 1000\kms. The fractional luminosity in pairs is modeled as f_L(Delta v,r_p,M_r^{ke})(1+z)^{m_L} where [f_L,m_L] are [0.14+/-0.07,0+/-1.4] and [0.37+/-0.7,0.1+/-0.5] for r_p<= 50 and 100\hkpc, respectively (Omega_M=0.2, Omega_Lambda=0.8). The value of m_L is about 0.6 larger if Lambda=0. To convert these redshift space statistics to a merger rate we use the data to derive a conversion factor to physical space pair density, a merger probability and a mean in-spiral time. The resulting mass accretion rate per galaxy (M_1,M_2>= 0.2 M*) is 0.02+/-0.01(1+z)^{0.1+/-0.5} M*~Gyr^{-1}. Present day high-luminosity galaxies therefore have accreted approximately 0.15M* of their mass over the approximately 7 Gyr to redshift one. (abridged)Comment: accepted for publication in ApJ Letter

Adaptive self-regulation: A process view of managerial effectiveness

This article describes a set of processes involved in attaining managerial effectiveness. These processes are components of an adaptive self-regulation framework. They involve the active management of constituencies' role expectations and performance opinions through standard-setting, discrepancy-detection, and discrepancy-reduction. These processes serve to enhance constitutents' opinions of the manager's effectiveness. Several social and contextual factors that either facilitate or inhibit managers' self-regulation efforts are identified and hypotheses to guide future empirical research are offered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31730/1/0000669.pd