How does GP training impact rural and remote underserved communities? Exploring community and professional perceptions

Background: Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities. Method: A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis. Results: Participants reported they perceived GP training to improve communities' health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development. Conclusion: GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities

The Muster 2018: Global Community Engaged Medical Education Muster Conference

Many rural and remote communities are struggling to attract and retain GPs while experiencing poorer population health outcomes and burden of disease. Therefore, the provision of a reliable rural GP workforce is vital. Registered Training Organisations provide high quality training experiences for GP registrars. A collaborative project between JCU and Monash University aimed to identify aspects of GP training which impact registrars’ experience. Perspectives were obtained from GP registrars, supervisors, and practice managers. This presentation focuses on training and supervision aspects in rural and remote north-west Queensland. A mixed methods study was undertaken and both quantitative and qualitative data were collected. A modified survey based on the adapted Critical Access Hospital Community Apgar Questionnaire was used to collect data about perceptions of rural GP training and supervision with the highest rated factor being medical quality and the lowest rated being scope of practice. Semi-structured interviews were then used to gather additional information about training and supervision experiences. Interviews were thematically analysed and primary themes relating to attractors and barriers for workforce training and supervision, and impact of rural remote practice were elicited. Attractors included lifestyle, rural medicine, scope of practice, services and incentives while barriers included workforce factors, lifestyle, location, services and incentives. Rural remote GP training experiences contribute a variety of attractors and barriers which impact on a positive training experience for registrars. Identification of these factors make it possible to tailor training accordingly and foster a positive rural experience that may translate to a future reliable workforce

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

Optimization of an Optical Testbed for Characterization of EXCLAIM u-Spec Integrated Spectrometers

We describe a testbed to characterize the optical response of compact superconducting on-chip spectrometers in development for the Experiment for Cryogenic Large-Aperture Intensity Mapping (EXCLAIM) mission. EXCLAIM is a balloonborne far-infrared experiment to probe the CO and CII emission lines in galaxies from redshift 3.5 to the present. The spectrometer, called u-Spec, comprises a diffraction grating on a silicon chip coupled to kinetic inductance detectors (KIDs) read out via a single microwave feedline. We use a prototype spectrometer for EXCLAIM to demonstrate our ability to characterize the spectrometers spectral response using a photomixer source. We utilize an on-chip reference detector to normalize relative to spectral structure from the off-chip optics and a silicon etalon to calibrate the absolute frequency

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Incorporating New Technologies Into Toxicity Testing and Risk Assessment: Moving From 21st Century Vision to a Data-Driven Framework

Based on existing data and previous work, a series of studies is proposed as a basis toward a pragmatic early step in transforming toxicity testing. These studies were assembled into a data-driven framework that invokes successive tiers of testing with margin of exposure (MOE) as the primary metric. The first tier of the framework integrates data from high-throughput in vitro assays, in vitro-to-in vivo extrapolation (IVIVE) pharmacokinetic modeling, and exposure modeling. The in vitro assays are used to separate chemicals based on their relative selectivity in interacting with biological targets and identify the concentration at which these interactions occur. The IVIVE modeling converts in vitro concentrations into external dose for calculation of the point of departure (POD) and comparisons to human exposure estimates to yield a MOE. The second tier involves short-term in vivo studies, expanded pharmacokinetic evaluations, and refined human exposure estimates. The results from the second tier studies provide more accurate estimates of the POD and the MOE. The third tier contains the traditional animal studies currently used to assess chemical safety. In each tier, the POD for selective chemicals is based primarily on endpoints associated with a proposed mode of action, whereas the POD for nonselective chemicals is based on potential biological perturbation. Based on the MOE, a significant percentage of chemicals evaluated in the first 2 tiers could be eliminated from further testing. The framework provides a risk-based and animal-sparing approach to evaluate chemical safety, drawing broadly from previous experience but incorporating technological advances to increase efficiency

Overview and status of EXCLAIM, the experiment for cryogenic large-aperture intensity mapping

The EXperiment for Cryogenic Large-Aperture Intensity Mapping (EXCLAIM) is a balloon-borne far-infrared telescope that will survey star formation history over cosmological time scales to improve our understanding of why the star formation rate declined at redshift z < 2, despite continued clustering of dark matter. Specifically,EXCLAIM will map the emission of redshifted carbon monoxide and singly-ionized carbon lines in windows over a redshift range 0 < z < 3.5, following an innovative approach known as intensity mapping. Intensity mapping measures the statistics of brightness fluctuations of cumulative line emissions instead of detecting individual galaxies, thus enabling a blind, complete census of the emitting gas. To detect this emission unambiguously, EXCLAIM will cross-correlate with a spectroscopic galaxy catalog. The EXCLAIM mission uses a cryogenic design to cool the telescope optics to approximately 1.7 K. The telescope features a 90-cm primary mirror to probe spatial scales on the sky from the linear regime up to shot noise-dominated scales. The telescope optical elements couple to six {\mu}-Spec spectrometer modules, operating over a 420-540 GHz frequency band with a spectral resolution of 512 and featuring microwave kinetic inductance detectors. A Radio Frequency System-on-Chip (RFSoC) reads out the detectors in the baseline design. The cryogenic telescope and the sensitive detectors allow EXCLAIM to reach high sensitivity in spectral windows of low emission in the upper atmosphere. Here, an overview of the mission design and development status since the start of the EXCLAIM project in early 2019 is presented.Comment: SPIE Astronomical Telescopes + Instrumentation. arXiv admin note: substantial text overlap with arXiv:1912.0711

Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive as

A core outcome set for pre-eclampsia research : an international consensus development study

Objective: To develop a core outcome set for pre-eclampsia. Design: Consensus development study. Setting: International. Population: Two hundred and eight-one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods: Modified Delphi method and Modified Nominal Group Technique. Results: A long-list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre-eclampsia trials with those derived from thematic analysis of 30 in-depth interviews of women with lived experience of pre-eclampsia. Forty-seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small-for-gestational-age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusions: The core outcome set for pre-eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies. Tweetable abstract: 281 healthcare professionals, 41 researchers and 110 women have developed #preeclampsia core outcomes @HOPEoutcomes @jamesmnduffy. [Correction added on 29 June 2020, after first online publication: the order has been corrected.]