The multiple merger assembly of a hyperluminous obscured quasar at redshift 4.6.

Galaxy mergers and gas accretion from the cosmic web drove the growth of galaxies and their central black holes at early epochs. We report spectroscopic imaging of a multiple merger event in the most luminous known galaxy, WISE J224607.56-052634.9 (W2246-0526), a dust-obscured quasar at redshift 4.6, 1.3 billion years after the Big Bang. Far-infrared dust continuum observations show three galaxy companions around W2246-0526 with disturbed morphologies, connected by streams of dust likely produced by the dynamical interaction. The detection of tidal dusty bridges shows that W2246-0526 is accreting its neighbors, suggesting that merger activity may be a dominant mechanism through which the most luminous galaxies simultaneously obscure and feed their central supermassive black holes.

Chronic pain management: a qualitative study of elderly people's preferred coping strategies and barriers to management.

Although the majority of pain complaints, in Australia, are among the elderly population, the focus of treatment is not on this age group. In order to achieve effective management of elderly people's chronic pain, their perspective of pain and coping strategies used needs to be understood. This qualitative study explored the preferred strategies of elderly people and the barriers they encountered in trying to manage their pain. Elderly people (n = 72) with chronic pain, over 65 years of age and living in the community, were interviewed for the study. Data were collected using six focus group and 12 in-depth interviews and a biographical questionnaire. Preferred coping strategies were those that could be self-administered and included both physical and cognitive elements. Elderly people wished to be active in their treatment, make informed choices and were willing to try new methods. Least-preferred strategies were the conventional treatments of medications, exercise and physiotherapy. Many barriers have to be overcome to achieve relief for their pain such as cost, access to health care, related disorders, attitudes of health professionals, lack of communication and fear of losing independence. Health professionals need to be aware of elderly people's perspective of pain and their preferred strategies and reasons for these choices. Health services must meet their specific needs.

Development of long term use of psychotropic drugs by general practice patients.

From 1984 to 1986 a prospective study was conducted of 104 general practice patients who started treatment with a benzodiazepine or an antidepressant drug. The duration of reported use of the drugs was two months for 45% of patients, four months for 17% of patients, and six months for 15%. Type of drug, age, and level of education were found to be predictive of continuing use. General practitioners have a significant effect on their patients' use of drugs and, with careful selection and review when prescribing, may help to prevent dependence on psychotropic drugs.

A survey of new users of psychotropic drugs in Australian general practice.

During 1984 and 1985, a study was conducted of 104 new adult users of benzodiazepines or antidepressants prescribed by sixty-two general practitioners in Sydney, Australia. New users of antidepressants tended to be older than new users of benzodiazepines. Seventy per cent of new users of psychotropic drugs were women and 67% were suffering significant psychological distress according to the 12-item general health questionnaire administered in a home interview. It was estimated that the general practitioners initiated approximately one new episode of use per week, and that repeat prescriptions constituted the bulk of general practitioner prescribing of these drugs.

Trends in psychotropic drug prescribing in Australia.

In 1983-1984, 9.8 million prescriptions were written for the 12 most common psychotropic drugs that are available under the Pharmaceutical Benefits Scheme. Our analysis shows that, of these prescriptions, 59% (374 per 1000 persons) were for the four most commonly prescribed benzodiazepine agents; 34% (216 per 1000 persons) were for the five main antidepressant agents; and 7% (41 per 1000 persons) were for the three main phenothiazine agents. In the period from 1977-1978 to 1983-1984, prescription volumes were relatively stable for antidepressant and phenothiazine drugs. Fluctuations in the prescribing of individual benzodiazepine agents are discussed. Older patients and women of all ages receive the majority of the psychotropic drug prescriptions that are written by Australian general practitioners.

Is physiotherapy truly professional?

As the twentieth century draws to a close, there emerges a society which demands occupations to be clearly defined to ensure easy recognition, and hence a more efficiently organised labour force. This development has been assisted by the operation of professional bodies which lay down standards to be maintained by their members. Consequently, professional qualifications and capabilities are easily recognised by international bodies and mobility between countries is facilitated by clearly defined qualifications.