What do General Practitioners want from Specialist Alcohol and Other Drugs Services? A Qualitative Study of NSW Metropolitan GPs

Alcohol and other drug (AOD) use is common in Australia with significant health and community impacts. General practitioners (GP) often see people with AOD use; however, there is little research to understand how specialist AOD services could assist GPs in the management of patients with AOD issues. Methods. Thirty-five GPs working in general practice in a metropolitan area in Sydney in New South Wales, Australia, participated in one of three focus groups. The groups were recorded, transcribed and thematically analysed. Results. The five themes raised by participants were: GP personal agency and interest in AOD issues; GP education and training gaps; improving pathways between GP and specialist AOD services; easier access to AOD specialist advice; and improving access to collaborative care for patients with complex AOD presentations. Participants requested education on screening, assessing, managing AOD issues, focused on alcohol, stimulants and high-risk prescription medicines. They suggested better referral processes, discharge summaries and care planning for complex presentations. Participants wanted easy access to specialist advice and suggested collaborative care assisted by experienced AOD liaison nurses. Discussion and Conclusions. Australia has several existing programs; online referral pathways and specialist phone advice, that address some of the issues raised. Unfortunately, many participants were not aware of these. GP education must be supported by multiple processes, including durable referral pathways, ready access to local specialist advice, clear communication (including patient attendance and a treatment plan), care planning and written summaries

Diagnosing and managing prescription opioid use disorder in patients prescribed opioids for chronic pain in Australian general practice settings: a qualitative study using the theory of Planned Behaviour

Chronic pain is a debilitating and common health issue. General Practitioners (GPs) often prescribe opioids to treat chronic pain, despite limited evidence of benefit and increasing evidence of harms, including prescription Opioid Use Disorder (pOUD). Australian GPs are worried about the harms of long-term opioids, but few are involved in the treatment of pOUD. There is little research on GPs’ experiences diagnosing and managing pOUD in their chronic pain patients

Diagnosing and managing patients with chronic pain who develop prescription opioid use disorder: A scoping review of general practitioners’ experience

Prescription opioid use disorder is an important sequela of long-term prescribed opioids for chronic pain

The Crab Nebula at 1.3 mm: evidence for a new synchrotron component

We present the results of 1.3 mm observations of the Crab Nebula, performed with the MPIfR bolometer arrays at the IRAM 30-m telescope. The maps obtained, of unprecedented quality at these wavelengths, allow a direct comparison with high-resolution radio maps. Although the spatial structure of the Crab Nebula does not change much from radio to millimetre wavelengths, we have detected significant spatial variations of the spectral index between 20 cm and 1.3 mm. The main effect is a spectral flattening in the inner region, which can be hardly explained just in terms of the evolution of a single population of synchrotron emitting electrons. We propose instead that this is the result of the emergence of a second synchrotron component, that we have tried to extract from the data. Shape and size of this component resemble those of the Crab Nebula in X rays. However, while the more compact structure of the Crab Nebula in X rays is commonly regarded as an effect of synchrotron downgrading, it cannot be explained why a similar structure is present also at mm wavelengths, where the electron lifetimes far exceed the nebular age. Our data, combined with published upper limits on spatial variations of the radio spectral index, also imply a low-energy cutoff for the distribution of electrons responsible for this additional synchrotron component. Although no model has been developed so far to explain the details of this component, one may verify that the total number of the electrons responsible for it is in agreement with what predicted by the classical pulsar-wind models, which otherwise are known to fail in accounting for the number of radio emitting electrons. We have also detected a spectral steepening at mm wavelengths in some elongated regions, whose positions match those of radio synchrotron filaments.Comment: 10 pages, Latex, 8 figures, JPEG, given separately Submitted to Astronomy and Astrophysic

On the origin of variable gamma-ray emission from the Crab Nebula

The oblique geometry of pulsar wind termination shock ensures that the Doppler beaming has a strong impact on the shock emission. We illustrate this using recent relativistic MHD simulations of the Crab Nebula and also show that the observed size, shape, and distance from the pulsar of the Crab Nebula inner knot are consistent with its interpretation as a Doppler-boosted emission from the termination shock. If the electrons responsible for the synchrotron gamma-rays are accelerated only at the termination shock then their short life-time ensures that these gamma-rays originate close to the shock and are also strongly effected by the Doppler beaming. As the result, bulk of the observed synchrotron gamma-rays of the Crab Nebula around 100 MeV may come from its inner knot. This hypothesis is consistent with the observed optical flux of the inner knot provided its optical-gamma spectral index is the same as the injection spectral index found in the Kennel & Coroniti model of the nebula spectrum. The observed variability of synchrotron gamma-ray emission can be caused by the instability of the termination shock discovered in recent numerical simulations. Given the small size of the knot, it is possible that the September 2010 gamma-ray flare of the Crab Nebula also came from the knot, though the actual mechanism remains unclear. The model predicts correlation of the temporal variability of the synchrotron gamma-ray flux in the Fermi and AGILE windows with the variability of the unpulsed optical flux from within 1 arcsec of the Crab pulsar.Comment: submitted to MNRAS, typos corrected, new references added, additional issues discusse

Molecular excitation in the Eagle nebula's fingers

Context: The M16 nebula is a relatively nearby Hii region, powered by O stars from the open cluster NGC 6611, which borders to a Giant Molecular Cloud. Radiation from these hot stars has sculpted columns of dense obscuring material on a few arcmin scales. The interface between these pillars and the hot ionised medium provides a textbook example of a Photodissociation Region (PDR). Aims: To constrain the physical conditions of the atomic and molecular material with submillimeter spectroscopic observations. Methods: We used the APEX submillimeter telescope to map a ~3'x3' region in the CO J=3-2, 4-3 and 7-6 rotational lines, and a subregion in atomic carbon lines. We also observed C18O(3-2) and CO(7-6) with longer integrations on five peaks found in the CO(3-2) map. The large scale structure of the pillars is derived from the molecular lines' emission distribution. We estimate the magnitude of the velocity gradient at the tips of the pillars and use LVG modelling to constrain their densities and temperatures. Excitation temperatures and carbon column densities are derived from the atomic carbon lines. Results: The atomic carbon lines are optically thin and excitation temperatures are of order 60 K to 100 K, well consistent with observations of other Hii region-molecular cloud interfaces. We derive somewhat lower temperatures from the CO line ratios, of order 40 K. The Ci/CO ratio is around 0.1 at the fingers tips.Comment: 4 pages, APEX A&A special issue, accepte

The Crab Nebula's Wisps in Radio and Optical

We present four new, high-resolution VLA radio images of the Crab nebula, taken between 2001 Feb. and Apr. The radio images show systematic variability in the Crab's radio emission throughout the region near the pulsar. The principal geometry of the variable features is that of elliptical ripples very similar to the optical wisps. The radio wisps are seen to move systematically outward with projected speeds of up to 0.3c. Comparing the new radio images to our earlier ones from 1998 and 2000, we show there are also more slowly moving features somewhat farther away from the pulsar. In particular, there is a prominent moving feature to the northwest of the pulsar which has a projected speed of order 10,000 km/s. Striation is seen throughout the nebula, suggesting the presence of wave-like disturbances propagating through the synchrotron bubble. The radio images were taken simultaneously with HST optical observations. Comparing the radio to the optical images, we find that the radio wisps are sometimes displaced from the optical ones or have no optical counterparts. We also find that some optical wisps in particular, the brightest optical wisps near the pulsar, do not seem to have radio counterparts. In the exterior of the nebula, by contrast, there is generally a good correspondence between the radio and optical features.Comment: LaTeX, 15 pages, 6 figures, Fig. 4 in colour. Supplementary material: mpeg animations accompanying Figs. 1 and 3 (download source from "other formats" to get mpegs). Accepted for publication in the Astrophysical Journal Typos fixed from previous versio

The Plerionic Supernova Remnant G21.5-0.9 Powered by PSR J1833-1034: New Spectroscopic and Imaging Results Revealed with the Chandra X-ray Observatory

(Abridged) In 1999, Chandra revealed a 150"-radius X-ray halo surrounding the 40"-radius PWN G21.5-0.9. A 2005 imaging study showed that the halo is limb-brightened, and suggested this feature is a candidate for the long-sought SNR shell. We present a spectral analysis of G21.5-0.9, using the longest effective observation to date (578.6 ks with ACIS, 278.4 ks with HRC) to study unresolved questions about the spectral nature of remnant features, such as the limb-brightening of the X-ray halo and the bright knot in the northern part of the halo. The Chandra analysis favours the non-thermal interpretation of the limb. Its spectrum is well fit with a power-law model with a photon index $\Gamma$ = 2.13 (1.94-2.33) and a luminosity of L_x (0.5-8 keV) = (2.3 +/- 0.6) x 10^33 erg/s (at an assumed distance of 5.0 kpc). An srcut model was also used to fit the spectrum between radio and X-ray energies. We find that the maximum energy to which electrons are accelerated at the shock ranges from ~60-130 TeV (B/10$\mu$G)^(-1/2), where B is the magnetic field in units of $\mu$G. For the northern knot, we constrain previous models and find that a two-component power-law (or srcut) + pshock model provides an adequate fit, with the pshock model requiring a very low ionization timescale and solar abundances for Mg and Si. Our spectroscopic study of J1833-1034, the highly energetic pulsar powering G21.5-0.9, shows that its spectrum is dominated by hard non-thermal X-ray emission with some evidence of a thermal component that represents ~9% of the observed non-thermal emission and that suggests non-standard rapid cooling of the neutron star. Finally, the ACIS and HRC-I images provide the first evidence for variability in the PWN, a property observed in other PWNe such as the Crab and Vela.Comment: Accepted by ApJ. 38 pages using aastex.cls - including 4 tables and 14 figures (figures 1, 2, and 10-13 are in colour). Resolution of figures 1, 10, 11, and 13 have been reduced for astro-ph submission only. The original full-resolution version can be downloaded from: http://www.physics.umanitoba.ca/~samar/ms-G21.pd

A multifrequency study of the active star forming complex NGC6357. I. Interstellar structures linked to the open cluster Pis24

We investigate the distribution of the gas (ionized, neutral atomic and molecular), and interstellar dust in the complex star forming region NGC6357 with the goal of studying the interplay between the massive stars in the open cluster Pis24 and the surrounding interstellar matter. Our study of the distribution of the ionized gas is based on narrow-band Hhalfa, [SII], and [OIII] images obtained with the Curtis-Schmidt Camera at CTIO, Chile, and on radio continuum observations at 1465 MHz taken with the VLA with a synthesized beam of 40 arcsec. The distribution of the molecular gas is analyzed using 12CO(1-0) data obtained with the Nanten radiotelescope, Chile (angular resolution = 2.7 arcmin). The interstellar dust distribution was studied using mid-infrared data from the GLIMPSE survey and far-infrared observations from IRAS. NGC6357 consists of a large ionized shell and a number of smaller optical nebulosities. The optical, radio continuum, and near- and mid-IR images delineate the distributions of the ionized gas and interstellar dust in the HII regions and in previously unknown wind blown bubbles linked to the massive stars in Pis24 revealing surrounding photodissociation regions. The CO line observations allowed us to identify the molecular counterparts of the ionized structures in the complex and to confirm the presence of photodissociation regions. The action of the WR star HD157504 on the surrounding gas was also investigated. The molecular mass in the complex is estimated to be (4+/-2)X10^5 Mo. Mean electron densities derived from the radio data suggest electron densities > 200 cm^-3, indicating that NGC6357 is a complex formed in a region of high ambient density. The known massive stars in Pis24 and a number of newly inferred massive stars are mainly responsible for the excitation and photodissociation of the parental molecular cloud.Comment: 16 pages, 9 figures. Accepted for publication in MNRA

Simulated synchrotron emission from Pulsar Wind Nebulae

A complete set of diagnostic tools aimed at producing synthetic synchrotron emissivity, polarization, and spectral index maps from relativistic MHD simulations is presented. As a first application we consider here the case of the emission from Pulsar Wind Nebulae (PWNe). The proposed method is based on the addition, on top of the basic set of MHD equations, of an extra equation describing the evolution of the maximum energy of the emitting particles. This equation takes into account adiabatic and synchrotron losses along streamlines for the distribution of emitting particles and its formulation is such that it is easily implemented in any numerical scheme for relativistic MHD. Application to the axisymmetric simulations of PWNe, analogous to those described by Del Zanna et al. (2004, A&A, 421, 1063), allows direct comparison between the numerical results and observations of the inner structure of the Crab Nebula, and similar objects, in the optical and X-ray bands. We are able to match most of the observed features typical of PWNe, like the equatorial torus and the polar jets, with velocities in the correct range, as well as finer emission details, like arcs, rings and the bright knot, that turn out to arise mainly from Doppler boosting effects. Spectral properties appear to be well reproduced too: detailed spectral index maps are produced for the first time and show softening towards the PWN outer borders, whereas spectral breaks appear in integrated spectra. The emission details are found to strongly depend on both the average wind magnetization (here approximately 2%), and on the magnetic field shape.Comment: 14 pages, submitted to A&