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Fine aerosol fraction (particulate matter with aerodynamic diameter <= 1.0 μm (PM) 1.0 ) over the Indian Institute of Technology Delhi campus was monitored day and night (10 h each) at 30 m height from November 2009 to March 2010. The samples were analyzed for 5 ions (NH 4 + , NO 3 − , SO 4 2− , F − , and Cl − ) and 12 trace elements (Na, K, Mg, Ca, Pb, Zn, Fe, Mn, Cu, Cd, Cr, and Ni). Importantly, secondary aerosol (sulfate and nitrate) formation was observed during dense foggy events, supporting the fog-smog-fog cycle. A total of 76 samples were used for source apportionment of PM mass. Six factors were resolved by PMF analyses and were identified as secondary aerosol, secondary chloride, biomass burning, soil dust, iron-rich source, and vehicular emission. The geographical location of the sources and/or preferred transport pathways was identified by conditional probability function (for local sources) and potential source contribution function (for regional sources) analyses. Medium- and small-scale metal processing (e.g. steel sheet rolling) industries in Haryana and National Capital Region (NCR) Delhi, coke and petroleum refining in Punjab, and thermal power plants in Pakistan, Punjab, and NCR Delhi were likely contributors to secondary sulfate, nitrate, and secondary chloride at the receptor site. The agricultural residue burning after harvesting season (Sept–Dec and Feb–Apr) in Punjab, and Haryana contributed to potassium at receptor site during November–December and March 2010. The soil dust from North and East Pakistan, and Rajasthan, North-East Punjab, and Haryana along with the local dust contributed to soil dust at the receptor site, during February and March 2010. A combination of temporal behavior and air parcel trajectory ensemble analyses indicated that the iron-rich source was most likely a local source attributed to emissions from metal processing facilities. Further, as expected, the vehicular emissions source did not show any seasonality and was local in origin.

Both Canada and Australia are facing severe shortages of primary health workers, and these shortages are exacerbated in rural and remote communities. This literature review highlights similarities and explores the factors that serve to attract and retain family practitioners in underserved regions of Canada and Australia. We used MEDLINE on OvidSP to review the literature between Jan. 1, 2000, and June 30, 2012. We excluded sources if the primary objective did not consider recruitment or retention of general practitioners. We found a total of 114 sources, 28 of which were excluded, leaving 86 sources for review. We organized results according to 5 life stages of family physicians in rural practice and graded the literature according to the strength of the methodology and the relevance of the findings. We chronologically categorized Canadian and Australian literature that discussed recruitment and retention of family practitioners into rural practice. Various factors that pertain to each life stage of a family physician have been shown to positively correlate with the eventual decision to commence and remain practising in rural areas. Training programs should be better structured to attract candidates who are more likely to enter rural practice. Policy-makers should be mindful of these findings, because improvements in retention will deliver large financial savings.

This study presents the concentration of submicron aerosol (PM 1.0 ) collected during November, 2009 to March, 2010 at two road sites near the Indian Institute of Technology Delhi campus. In winter, PM 1.0 composed 83% of PM 2.5 indicating the dominance of combustion activity-generated particles. Principal component analysis (PCA) proved secondary aerosol formation as a dominant process in enhancing aerosol concentration at a receptor site along with biomass burning, vehicle exhaust, road dust, engine and tire tear wear, and secondary ammonia. The non-carcinogenic and excess cancer risk for adults and children were estimated for trace element data set available for road site and at elevated site from another parallel work. The decrease in average hazard quotient (HQ) for children and adults was estimated in following order: Mn > Cr > Ni > Pb > Zn > Cu both at road and elevated site. For children, the mean HQs were observed in safe level for Cu, Ni, Zn, and Pb; however, values exceeded safe limit for Cr and Mn at road site. The average highest hazard index values for children and adults were estimated as 22 and 10, respectively, for road site and 7 and 3 for elevated site. The road site average excess cancer risk (ECR) risk of Cr and Ni was close to tolerable limit (10 −4 ) for adults and it was 13–16 times higher than the safe limit (10 −6 ) for children. The ECR of Ni for adults and children was 102 and 14 times higher at road site compared to elevated site. Overall, the observed ECR values far exceed the acceptable level.

ObjectivesTo explore Aboriginal and Torres Strait Islander Australians’ perceptions of telehealth general practice consultations and elements required for a culturally safe telehealth consultation.DesignQualitative study.SettingPrimary care telehealth in three centres in regional and remote Australia.ParticipantsSeventeen Aboriginal or Torres Strait Islander individuals participated in semistructured interviews exploring the experiences of telehealth in general practice settings. Participants were eligible for inclusion if they were Aboriginal or Torres Strait Islander, over 18 years of age and had experienced at least one telehealth appointment with their general practitioner in the preceding 12 months. Data were collected in the form of short surveys and semistructured interviews. Data collection occurred between June 2022 and August 2023. Data were analysed using thematic and content analysis techniques.ResultsParticipants had experienced telephone (88%) and videoconference appointments (12%). Reasons for choosing telehealth included being unable to attend due to respiratory symptoms and/or COVID-19 restrictions on in-person consultations (reflecting the study period) and issues of access (eg, availability of doctor, convenience of hours). Participants described benefits of telehealth around reduced barriers to care but also described practical and communication challenges experienced during telehealth. Elements of culturally safe telehealth identified included: consultation skills, a pre-existing doctor-patient relationship and local knowledge (including knowledge of the local cultural and community context).ConclusionThis study demonstrates the benefits of telehealth and its ability to reduce barriers to care for Aboriginal and Torres Strait Islander Australians. However, the identified disadvantages demonstrate that this modality should be considered as an addition to, rather than a replacement for, face-to-face consultations. The elements identified interact as part of a complex interplay of factors contributing to cultural safety in the telehealth context. These elements provide useful recommendations for practice and policy.

Background Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. Methods A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. Results In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab ( p  < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS ( p  = 0.008) and Mayo ( p  = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab ( p  = 0.03). Conclusions CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.

Objective. To design and evaluate a professional identity program (PIP) based on self-determination theory (SDT) for entering Bachelor of Pharmacy (BPharm) students. Methods. The PIP, which featured autonomy-supportive teaching approaches, was delivered as 10 workshops that were integrated into existing pharmacy courses over the first four semesters (2 years) of the BPharm program. The program was evaluated using a student satisfaction survey and two previously validated tools for measuring professional identity (MCPIS-9) and motivation to study pharmacy (Pharm-S). Nonparametric statistical techniques were used to compare students’ scores before and after introducing the PIP. Results. Students responded positively to the introduction of the PIP in the pharmacy program. Based on survey responses, the students valued opportunities to engage in activities and discussions related to professional development and identity formation. Student scores on the motivation-based tool (Pharm-S) increased by the end of the first year of participation in the PIP, indicating an increase in student autonomy levels. There was no change in students’ scores on the professional identity measure (MCPIS-9) after the first year. Conclusion. The use of SDT-based instruction in professional identity education resulted in increased levels of autonomy in pharmacy students, indicating a transition to more intrinsic levels of motivation. This has the potential to positively impact student professional identity and future professional practice.

Biopharmaceuticals are complex therapeutic protein molecules produced in living cells and have been a major driving force for drug development in the pharmaceutical sector in recent years. Monoclonal antibodies (mAbs) are biological macromolecules used for treating life-threatening and rare illnesses. mAbs with post-translation alterations can be observed during the assessment of charge variants. Controlling the charge variant profile of therapeutic protein is a regulatory requirement to confirm that the macromolecule complies with the quality parameters to ensure patient safety. Unfortunately, manufacturing these biopharmaceuticals is very expensive. However, the emergence of biosimilars has reduced developmental cost across the biopharmaceutical industry. The advent of biosimilars has constrained the development of more efficient downstream bioprocesses that are mainly considered the bottleneck of the manufacturing process. This review focuses on the existing methods for charge variants separation and process optimization and indicates new approaches for future developments. It also provides a comprehensive summary for the biological community about the impact of charge variants.

Background Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine. Methods A scoping review was undertaken to answer the broad question ‘What is documented on rural generalist medicine?’ Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis. Results Included papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area. Important themes emerging from the review were: Definition Existing pathways and programmes Scope of practice and service models Enablers and barriers to recruitment and retention Reform recommendations There were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery. Conclusions Supported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine.

Background Assessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples. Methods This protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars. Discussion This study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Despite the release of the updated Australian Cardiovascular Disease (AusCVD) Risk calculator, many general practitioners (GPs) have raised concerns regarding the calculator's ability to be 'personalised' to the patient. As a result, inappropriate investigations are ordered in an attempt to individualise cardiovascular disease risk. The aim of this paper was to summarise the indications and pros and cons of different CVD screening tests to support GPs in managing a patient's CVD risk. We recommend that everyone above the age of 45 is screened with the AusCVD Risk calculator. If the patient's CVD risk is in doubt, a coronary artery calcium score may assist in sharpening the diagnosis. For those at high-risk, an exercise stress test, myocardial perfusion scan or computed tomography (CT) coronary angiography may be useful (provided they are conducted in safe environments) to determine the patients who require referral for specialist assessment.