Augmenting the rural health workforce with physician assistants

Health workforce shortages are a global phenomenon and Australia is no exception. Deficiencies are particularly pronounced in general practice, dentistry, nursing and key allied health fields.1,2 Even with the Australian health workforce growing at close to double the rate of the population and despite an increase in medical schools and student numbers, the shortage continues to worsen due to factors such as reductions in work hours, increasing urbanisation and the ageing and feminisation of the workforce.2 A 2005 prediction by the Australian Medical Workforce Advisory Committee estimated a shortage of between 800 and 1300 general practitioner graduates alone by 2013.2 The ageing of the health workforce, increasing life expectancy and the mounting burden of chronic disease are major problems facing all developed nations. Compounding these issues in Australia are the difficulties of caring for significant rural, remote, and Indigenous populations. National and international trends suggest that the shortage and maldistribution of doctors in rural areas is very likely to worsen.2,3 As well, Australia has an increasing reliance on international medical graduates, which poses major moral questions among other dilemmas. Clearly there is a need for change in policy and service delivery models. Simply increasing the number of doctors will not necessarily improve recruitment or retention in general practice and geographically disadvantaged areas. According to Queensland Health there is considerable and ongoing difficulty in recruiting new doctors to rural and remote locations, resulting in a less than adequate rate of replacement for retiring doctors. Many health care advocates and organisations have suggested a variety of innovations to facilitate the needed transformation in the existing system. In 2007 The National Rural Health Alliance (NRHA) declared: We need to redesign the workforce so that services we currently see as ‘medical’ or ‘nursing’ are provided by a broader range of professionals than just doctors and nurses. We will get around the unavoidable shortage of doctors and nurses (given the excessive and escalating level of demand) by redesigning and redistributing the way doctoring and nursing are provided.4 This paper will outline how the introduction of physician assistants (PA) into Australia, may be one strategy to strengthen the health care team and address medical workforce shortages, especially in rural and remote areas

Do Children Who Experience Regret Make Better Decisions? A Developmental Study of the Behavioral Consequences of Regret

Although regret is assumed to facilitate good decision making, there is little research directly addressing this assumption. Four experiments (N = 326) examined the relation between children's ability to experience regret and the quality of their subsequent decision making. In Experiment 1 regret and adaptive decision making showed the same developmental profile, with both first appearing at about 7 years. In Experiments 2a and 2b, children aged 6–7 who experienced regret decided adaptively more often than children who did not experience regret, and this held even when controlling for age and verbal ability. Experiment 3 ruled out a memory-based interpretation of these findings. These findings suggest that the experience of regret facilitates children's ability to learn rapidly from bad outcomes

The development of regret

In two experiments, 4- to 9-year-olds played a game in which they selected one of two boxes to win a prize. On regret trials the unchosen box contained a better prize than the prize children actually won, and on baseline trials the other box contained a prize of the same value. Children rated their feelings about their prize before and after seeing what they could have won if they had chosen the other box and were asked to provide an explanation if their feelings had changed. Patterns of responding suggested that regret was experienced by 6 or 7 years of age; children of this age could also explain why they felt worse in regret trials by referring to the counterfactual situation in which the prize was better. No evidence of regret was found in 4- and 5-year-olds. Additional findings suggested that by 6 or 7 years, children’s emotions were determined by a consideration of two different counterfactual scenarios

Are we doing enough to help students manage their stress?

Introduction/background: High levels of stress in young people studying medicine is a problem that appears to be increasing in severity. Unfortunately it is not uncommon to see unhelpful or harmful coping strategies being employed by students to manage their study/life stress. The Australian Medical Students Association cite that medical students are three times more likely to commit suicide than the rest of the general population in their age range. Purpose/objectives: The purpose of the session is to discuss the widening issue of stress and self-harm amongst the student population, specifically medical students, and glean from each other what support strategies have been successful. Discussing responsibility, support, service and strategies with other expert healthcare educators will help illuminate and address the impact of student mental health and the serious impact this may have on their progression through the course. Issues/questions for exploration or ideas for discussion: •What level of responsibility should Universities have in managing young people's stress/anxiety issues? •Many Universities have reduced access to free counselling services for students – should these services be reinstated/increased? •Should colleges/healthcare facilities be doing more to support students, rather than relying on the University to offer services? •What support strategies have been the most effective at your College/School/University/Health facility? •Should mindfulness/meditation be compulsory components embedded in healthcare courses? If so, when should they be introduced and how often should they been revisited? •Should more or a different type of support be available for students who are on clinical placements

Quantifying Drug-Induced Bone Marrow Toxicity Using a Novel Haematopoiesis Systems Pharmacology Model.

Haematological toxicity associated with cancer therapeutics is monitored by changes in blood cell count, and their primary effect is on proliferative progenitors in the bone marrow. Using observations in rat bone marrow and blood, we characterize a mathematical model that comprises cell proliferation and differentiation of the full haematopoietic phylogeny, with interacting feedback loops between lineages in homeostasis as well as following carboplatin exposure. We accurately predicted the temporal dynamics of several mature cell types related to carboplatin-induced bone marrow toxicity and identified novel insights into haematopoiesis. Our model confirms a significant degree of plasticity within bone marrow cells, with the number and type of both early progenitors and circulating cells affecting cell balance, via feedback mechanisms, through fate decisions of the multipotent progenitors. We also demonstrated cross-species translation of our predictions to patients, applying the same core model structure and considering differences in drug-dependent and physiology-dependent parameters

Few-shot hypercolumn-based mitochondria segmentation in cardiac and outer hair cells in focused ion beam-scanning electron microscopy (FIB-SEM) data

We present a novel AI-based approach to the few-shot automated segmentation of mitochondria in large-scale electron microscopy images. Our framework leverages convolutional features from a pre-trained deep multilayer convolutional neural network, such as VGG-16. We then train a binary gradient boosting classifier on the resulting high-dimensional feature hypercolumns. We extract VGG-16 features from the first four convolutional blocks and apply bilinear upsampling to resize the obtained maps to the input image size. This procedure yields a 2688-dimensional feature hypercolumn for each pixel in a 224 x 224 input image. We then apply L1-regularized logistic regression for supervised active feature selection to reduce dependencies among the features, to reduce overfitting, as well as to speed-up gradient boosting-based training. During inference we block process 1728 x 2022 large microscopy images. Our experiments show that in such a formulation of transfer learning our processing pipeline is able to achieve high-accuracy results on very challenging datasets containing a large number of irregularly shaped mitochondria in cardiac and outer hair cells. Our proposed few-shot training approach gives competitive performance with the state-of-the-art using far less training data

Becoming-Bertha: virtual difference and repetition in postcolonial 'writing back', a Deleuzian reading of Jean Rhys’s Wide Sargasso Sea

Critical responses to Wide Sargasso Sea have seized upon Rhys’s novel as an exemplary model of writing back. Looking beyond the actual repetitions which recall Brontë’s text, I explore Rhys’s novel as an expression of virtual difference and becomings that exemplify Deleuze’s three syntheses of time. Elaborating the processes of becoming that Deleuze’s third synthesis depicts, Antoinette’s fate emerges not as a violence against an original identity. Rather, what the reader witnesses is a series of becomings or masks, some of which are validated, some of which are not, and it is in the rejection of certain masks, forcing Antoinette to become-Bertha, that the greatest violence lies