Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants?

This study explores whether a partial explanation for high antidepressant prescription rates is the failure of prescribers to recommend alternatives. 1,829 New Zealand adults were asked which of six non-pharmacological treatment approaches were recommended when prescribed anti-depressants. The majority (82%) received at least one recommendation and 32% received three or more, most commonly ‘Counsellor/Psychologist/Psychotherapist’ (74%) and Exercise Schedule (43%). It cannot, therefore, be concluded that failing to consider non-pharmacological treatments is a major cause of high prescribing rates. Being younger and more severely depressed were both positively related to number of recommendations. Psychiatrists made significantly more recommendations than GPs.

North American Monsoon GPS Transect Experiment 2013

Ten GPS-Met stations were installed in northwest Mexico from June - September 2013. Each station included a Trimble NetR9 GPS receiver for PWV and a Vaisala WXT520 surface meteorological package measuring wind speed and direction, air temperature, humidity, pressure and precipitation. The geographic location, elevation and data period for each station are provided in Serra et al. (2016). The GPS receiver at Rayon failed on July 16, 21 days after installation, thus these data are not included in the archive but are available upon request (yserra@uw.edu). Data include 1-min surface meteorological variables, while the GPS PWV is calculated at 5-min intervals. A full description of the experiment can be found in Serra et al., 2016: Bull. Am. Meteor. Soc., doi: 10.1175/BAMS-D-14-00250.1.

Implementación del servicio de datos GPS de la Escuela de Topografía, Catastro y Geodesia

En la Escuela de Topografía, Catastro y Geodesia (ETCG) se ha implementado el Servicio de Datos GPS (SDG), el cual es un dominio en Internetque ofrece a los diferentes usuarios el acceso a información técnica y la posibilidad de descargar los archivos de datos generados diariamente por la estación GPS de operación continua de la ETCG. Los archivos disponibles en el SDG incluyen dos tratamientos previos a su publicación: un control de calidad al archivo rinex de observación con el programa Teqc y posteriormente la aplicación de la compresión de los tres archivos rinex (observación,navegación y meteorología) con el algoritmo de Hatanaka. Los dos procesos están totalmente automatizados y se ejecutan de forma diaria por medio de batch files. Con base en la puesta en operación del SDG, los archivos son procesados diariamente por uno de los centros de análisis de datos de SIRGAS y desde la semana 1501 GPS, los archivos de soluciones semanales generados por el DGFI de Alemania incorporan oficialmente los datos de la ETCG.

A comparison of the physiological demands of rugby union match-play when determined by absolute (ABS) or individual (IND) velocity bands in Global Positioning System (GPS) analysis

Since turning professional in 1995 there have been considerable advances in the research on the demands of rugby union, largely using Global Positioning System (GPS) analysis over the last 10 years. A systematic review on the use of GPS, particularly the setting of absolute (ABS) and individual (IND) velocity bands in field based, intermittent, high-intensity (HI) team sports was undertaken. From 3669 records identified, 38 studies were included for qualitative analysis. Little agreement on the definition of movement intensities within team sports was found, only three papers, all on rugby union, had used IND bands, with only one comparing ABS and IND methods. Thus, the aim of this study was to determine if there is a difference in the demands within positions when comparing ABS and IND methods for GPS analysis and if these differences are significantly different between the forward and back positional groups. A total of 214 data files were recorded from 26 players in 17 matches of the 2015/2016 Scottish BT Premiership. ABS velocity zones 1-7 were set at 1) 0-6, 2) 6.1-11, 3) 11.1-15, 4) 15.1-18, 5) 18.1-21, 6) 21.1-15 and 7) 25.1-40km.h-1 while IND zones 1-7 were 1) <20, 2) 20-40, 3) 40-50, 4) 50-70, 5) 70-80, 6) 80-95 and 7) 95-100% of player’s individually determined maximum velocity (Vmax). A 40m sprint test measured Vmax using OptaPro S4 10 Hz (catapult, Australia) GPS units to derive IND bands. The same GPS units were worn during matches. GPS outputs analysed were % distance, % time, high intensity efforts (HIEs) over 18.1 km.h-1 / 70% max velocity and repeated high intensity efforts (RHIEs) which consists of three HIEs in 21secs. General linear model (GLM) analysis identified a significant difference in the measurement of % total distance covered, between the ABS and IND methods in all zones for forwards (p<0.05) and backs (p<0.05). This difference was also significant between forwards and backs in zones 1, shown as mean difference ± standard deviation (3.7±0.7%), 6 (1.2±0.4%) and 7 (1.0±0.0%) respectively (p<0.05). Percentage time estimations were significantly different between ABS and IND analysis within forwards in zones 1 (1.7±1.7%), 2 (-2.9±1.3%), 3 (1.9±0.8%), 4 (-1.4±0.8%) and 5 (0.2±0.4%), and within backs in zones 1 (-10±1.5%), 2 (-1.2±1.1%), 3 (1.8±0.9%) and 5 (0.6±0.5%) (p<0.05). The difference between groups was significant in zones 1, 2, 4 and 5 (p<0.05). The number of HIEs was significantly different between forwards and backs in zones 6 (6±2) and 7 (3±2). RHIEs were significantly different between ABS and IND for forwards (1±2, p<0.05) although not between groups. Until more research on the differences in ABS and IND methods is carried out, then neither can be deemed a criterion method. In conclusion, there are significant differences between the ABS and IND methods of GPS analysis of the physical demands of rugby union, which must be considered when used to inform training load and recovery to improve performance and reduce injuries.

Glasgow Psychosis Screening tool for use in adults with Intellectual Disabilities (GPS-ID): development and psychometric properties

Background: Prevalence of psychosis is known to be higher in adults with intellectual disabilities (ID) than in the general adult population. However, there have been no attempts to develop a psychosis screening tool specifically for the adult ID population. The present study describes the development and preliminary evaluation of a new measure, the Glasgow Psychosis Screening tool for use in Adults with Intellectual Disabilities (GPS-ID). Method: An item pool was generated following: 1) focus groups with adults with ID and psychosis, and their carers and/or workers; 2) expert input from clinicians. A draft scale was compiled and refined following expert feedback. The new scale, along with the Psychotic Symptom Rating Scales was administered to 20 adults with ID (10 with and 10 without psychosis) and their relative or carers. Results: The GPS-ID total score, self-report subscale and informant rating-subscale differentiated psychosis and non-psychosis groups. The tool had good internal consistency (Cronbach’s α=0.91), and a cut-off score ≥4 yielded high sensitivity (90%) and specificity (100%). The method of tool development supports face and content validity. Criterion validity was not supported. Conclusions: Preliminary investigation of the tool’s psychometric properties is positive, although further investigation is required. The tool is accessible to adults with mild to moderate ID and can be completed in 15-30 minutes. The GPS-ID is not a diagnostic tool, therefore any adult exceeding the cut-off score of ≥4 should receive further assessment.

Evaluation of the GPS Accuracy of Tablets

Augmented Reality (AR) applications often require knowledge of the user’s position in some global coordinate system in order to draw the augmented content to its correct position on the screen. The most common method for coarse positioning is the Global Positioning System (GPS). One of the advantages of GPS is that GPS receivers can be found in almost every modern mobile device. This research was conducted in order to determine the accuracies of different GPS receivers. The tests included seven consumer-grade tablets, three external GPS modules and one professional-grade GPS receiver. All of the devices were tested with both static and mobile measurements. It was concluded that even the cheaper external GPS receivers were notably more accurate than the GPS receivers of the tested tablets. The absolute accuracy of the tablets is difficult to determine from the test results, since the results vary by a large margin between different measurements. The accuracy of the tested tablets in static measurements were between 0.30 meters and 13.75 meters.

Tackling health inequalities in primary care: an exploration of GPs’ experience at the frontline

In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally.

Evaluación de los patrones de movimiento en la competición para optimizar el proceso de entrenamiento en la élite del tenis de formación a partir de la tecnología GPS.

241 p.

Collar para la ubicación de semovientes mediante tecnología GSM - GPS en hatos lecheros

45 p.

Rapid directional change degrades GPS distance measurement validity during intermittent intensity running

Use of the Global Positioning System (GPS) for quantifying athletic performance is common in many team sports. The effect of running velocity on measurement validity is well established, but the influence of rapid directional change is not well understood in team sport applications. This effect was systematically evaluated using multidirectional and curvilinear adaptations of a validated soccer simulation protocol that maintained identical velocity profiles. Team sport athletes completed 90 min trials of the Loughborough Intermittent Shuttle-running Test movement pattern on curvilinear, and multidirectional shuttle running tracks while wearing a 5 Hz (with interpolated 15 Hz output) GPS device. Reference total distance (13 200 m) was systematically over- and underestimated during curvilinear (2.61±0.80%) and shuttle (-3.17±2.46%) trials, respectively. Within-epoch measurement uncertainty dispersion was widest during the shuttle trial, particularly during the jog and run phases. Relative measurement reliability was excellent during both trials (Curvilinear r = 1.00, slope = 1.03, ICC = 1.00; Shuttle r = 0.99, slope = 0.97, ICC = 0.99). Absolute measurement reliability was superior during the curvilinear trial (Curvilinear SEM = 0 m, CV = 2.16%, LOA ± 223 m; Shuttle SEM = 119 m, CV = 2.44%, LOA ± 453 m). Rapid directional change degrades the accuracy and absolute reliability of GPS distance measurement, and caution is recommended when using GPS to quantify rapid multidirectional movement patterns.

Clinical diagnosis and management of suspicious pigmented skin lesions: A survey of GPs

BACKGROUND The ability of general practitioners to make important clinical decisions about the diagnosis and management of skin lesions is poorly understood.METHODS A questionnaire on the diagnosis and management of eight photographed skin lesions was sent to 150 GPs in southeast Queensland.RESULTS The questionnaire was completed by 114 GPs (response rate 77%). General practitioners’ provisional diagnoses and management of photographed skin lesions were mostly or always correct, and there was general high consistency between diagnosis and intended management. Pigmented seborrhoeic keratoses were the most difficult lesions for GPs to diagnose correctly. Whether a lesion was different to usual moles appears to have the strongest association with clinical diagnosis.DISCUSSION The high ability of GPs as measured in this artificial study is encouraging. The strong association between identifying moles that appear different to usual and correct clinical diagnoses suggest that unless GPs can increase the number of skin lesions they see as part of their typical workload, their clinical ability may not increase further. Article in Australian family physician 34(1) · January 2005

Condução autónoma – localização de um veículo com base em odometria, IMU e GPS

A Condução de um veículo automóvel tem-se tornado cada vez mais automatizada ao longo dos anos. Este processo tem-se vindo a desenvolver com o intuito de facilitar cada vez mais a condução dos veículos, de prevenir acidentes rodoviários ou ainda de ser utilizado em operações militares. Este trabalho tem como principal foco o estudo da aplicação de dois dos principais métodos de cálculo da localização probabilística à localização de um veículo automóvel autónomo: o Filtro Estendido de Kalman e o Filtro de Partículas. Foram implementadas várias versões de ambos os filtros, quer em simulação, quer num veículo real, tendo por base, em termos de sensores, a odometria do robô, uma unidade inercial e um GPS. Este trabalho surge na continuação de vários projetos anteriores, com foco no desenvolvimento de um veículo autónomo de baixo custo, acrescentando-lhe a funcionalidade de se localizar. Neste sentido, o trabalho desenvolvido servirá de base para a navegação autónoma em trabalhos futuros.

Enhancing the trust of location acquisition systems for critical applications and location-based security services

This paper identifies a number of critical infrastructure applications that are reliant on location services from cooperative location technologies such as GPS and GSM. We show that these location technologies can be represented in a general location model, such that the model components can be used for vulnerability analysis. We perform a vulnerability analysis on these components of GSM and GPS location systems as well as a number of augmentations to these systems.

General practitioners’ experiences of the psychological aspects in the care of a dying patient

Objective: General practitioners (GPs) play an integral role in addressing the psychological needs of palliative care patients and their families. This qualitative study investigated psychosocial issues faced by GPs in the management of patients receiving palliative care and investigated the themes relevant to the psychosocial care of dying patients. Method: Fifteen general practitioners whose patient had been recently referred to the Mt. Olivet Palliative Home Care Services in Brisbane participated in an individual case review discussions guided by key questions within a semistructured format. These interviews focused on the psychosocial aspects of care and management of the referred patient, including aspects of the doctor/patient relationship, experience of delivering diagnosis and prognosis, addressing the psychological concerns of the patients' family, and the doctors' personal experiences, reactions, and responses. Qualitative analysis was conducted on the transcripts of these interviews. Results: The significant themes that emerged related to perceived barriers to exploration of emotional concerns, including spiritual issues, and the discussion of prognosis and dying, the perception of patients' responses/coping styles, and the GP's personal experience of the care (usually expressed in terms of identification with patient). Significance of results: The findings indicate the significant challenges facing clinicians in discussions with patients and families about death, to exploring the patient's emotional responses to terminal illness and spiritual concerns for the patient and family. These qualitative date indicate important tasks in the training and clinical support for doctors providing palliative care.

Older patients request more information : a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials.---------- Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of 50 GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years).----------- Results: All GPs reported using written materials with patients, although 28% had not given any to the Last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the Last six months and only hall of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials.---------- Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.