Understanding rural pharmacists' perspectives: lived experiences and insights associated with rural recruitment and retention.

INTRODUCTION: Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities. METHODS: The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention. RESULTS: The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns. DISCUSSION: The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities also require innovative approaches to address concerns among potential candidates. Lastly, efforts to enable and support social connections such as schooling and spousal employment, while building community connection and a sense of rural community belonging, remain essential to recruit and retain pharmacists. CONCLUSION: Rural pharmacist recruitment and retention is complex, requiring a multi-pronged approach to implement practical solutions. Given this complexity and the unique features of each rural community, solutions require whole-of-community ownership to create innovative solutions. Recognition of specific advantages and challenges can address key driving factors for pharmacist recruitment and retention in rural communities.

Utilizing Clinical and Non-clinical Patient Factors in Predicting Cardiovascular Events in Patients on JAK Inhibitor Therapy: A Retrospective Cohort Study.

BACKGROUND: Patients with autoimmune rheumatic diseases (ARDs) taking JAK inhibitors may have an increased risk of cardiovascular events, especially if they have other health conditions. Identifying high-risk patients can inform targeted preventive care. This study assessed the value of age and deprivation decile in predicting cardiovascular events in patients on JAK inhibitors for ARDs. OBJECTIVE: To assess the predictive value of age and deprivation decile in identifying patients at risk of cardiovascular events while on JAK inhibitor therapy for ARDs. METHODS: This cross-sectional cohort study enrolled 309 patients with ARDs (mean age 59.3 years, 77% female) treated with JAK inhibitors at a UK teaching hospital. Baseline characteristics, including age, gender, ethnicity, and comorbidities, were collected. Cardiovascular events (myocardial infarctions, strokes, and cardiovascular-related deaths) that occurred while on JAK inhibitor therapy were identified retrospectively. Deprivation indices were calculated using socioeconomic factors. RESULTS: Multivariate logistic regression analysis, adjusting for potential confounders, showed that a model combining age and deprivation decile was statistically significant (p = 0.031) in predicting cardiovascular events. Neither age nor deprivation decile alone was statistically significant. Older patients had an odds ratio of 1.06 (95% CI: 1.00-1.13) for increased risk of cardiovascular events. The logistic regression model as a whole was statistically significant (Chi2(14) = 24.04, p = 0.031, n = 309). The AUC of the ROC curve was 0.837. CONCLUSION: Age and deprivation decile can effectively predict cardiovascular events in patients on JAK inhibitor therapy for ARDs. Incorporating these predictive tools into routine clinical practice can help identify patients who warrant intensified cardiovascular risk management.

Chest X-ray Reporting: A Comparative Study of Specialist Nurses and Trainee Doctors' Knowledge in the Biologic Prescription Service.

With all the challenges facing the NHS at the current time, specialist nurses are fundamental and an important part of an ever-expanding NHS workforce. Furthermore, specialist nurses now possess more diversity and a wide range of advanced skills. In the field of rheumatology in most NHS hospitals, specialist nurses play a key role in biologic services to ensure that patients are promptly started on biological therapy to control their disease. An important element of this workup is the ability to comment on an unreported chest radiograph to facilitate a biological prescription. Some studies have shown that there is limited expertise among non-doctors with the required skills to review unreported chest X-rays confidently. The authors of this paper sought to explore whether this is the case among specialist nurses involved in the biologic prescription service among other clinicians in the same service. An online questionnaire was designed by the authors, which included seven questions and responses collected on a 5-point Likert scale. Trainee doctors, non-trainee grade doctors, and specialist nurses who were involved in the biologic prescribing team from Rheumatology, Dermatology, and Gastroenterology were invited. A total of 56 responses were obtained and analyzed. Descriptive and inferential statistics were obtained from the data. To determine if there was a statistical difference between the responses of trainee doctors and specialist nurses, the Kruskal-Wallis statistical test was used, and a post hoc test using the Dunn-Bonferroni test was used to analyze any statistically significant results. Regarding chest X-ray interpretation prior to starting biological treatment, only 8% of specialist nurses reported being confident, whereas 63% of trainees reported being confident. The Kruskal-Wallis test revealed a significant difference between specialist nurses' and doctors' confidence in interpreting unreported chest radiographs. The P-value is 0.001; thus, with available data, the null hypothesis is rejected. A Dunn-Bonferroni test (post hoc test) showed that, based on the available data, it can be assumed that the two groups had different levels of confidence between Specialist Nurses and trainee doctors. Chest X-ray interpretation skills are vital for specialist nurses in the context of biological therapy prescriptions. Therefore, we recommend access to resources, ongoing formal training, and educational sessions to help specialist nurses maintain their advanced skill sets and broaden their scope of practice to those without the required expertise.

Clinicians' Interpretation of Unreported Chest Radiographs in Biologic Prescription Workup Service: A Comprehensive Analysis.

Clinicians without a radiology specialization face difficulties when they attempt to interpret chest X-rays (CXRs), a crucial and extensively utilized diagnostic tool that plays a fundamental role in the detection of pulmonary and cardiovascular disorders. This cross-sectional study assessed the confidence and competence of clinicians, including junior specialty trainees, higher specialty trainees, and specialist nurses, in interpreting CXRs before starting biological treatment. An online survey was used to collect data from clinicians in various healthcare settings, focusing on their experience, training, confidence levels, and CXR interpretation proficiency. The survey uncovered clinicians' insufficient confidence in interpreting the pre-biological screening CXRs despite their clinical expertise. This uncertainty raises concerns about potential misinterpretations, affecting timely treatment decisions. A Kruskal-Wallis test indicated a significant difference between training levels required with a p-value of 0.001, rejecting the null hypothesis. Subsequently, a Dunn-Bonferroni test revealed that the higher specialty trainee-specialist nurse pair differed significantly, with the specialist nurse group requiring more training. This study highlighted the need for enhanced radiology education for clinicians involved in chest radiograph interpretation for pre-biological screening. Implementing a structured training program is essential to improve skills and ensure accurate interpretation of non-formally reported chest radiographs, ultimately enhancing patient outcomes and healthcare practices.

Comparing Breast Cancer and Cardiovascular Disease Risk and Use of Chemoprevention and Statins among Women with High-risk Breast Lesions.

Breast cancer chemoprevention with selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) remains underutilized among high-risk women. A potential barrier to chemoprevention is competing comorbidities such as atherosclerotic cardiovascular disease (ASCVD), due to concern for additional medication side effects. We conducted a retrospective cohort study among women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), an important target population for chemoprevention. We compared risks for breast cancer and ASCVD, as well as use of SERMs/AIs versus statins among high-risk women (defined as a 5-year invasive breast cancer risk ≥1.67% and 10-year ASCVD risk ≥7.5%, respectively). We used clinical data extracted from the electronic health record to calculate breast cancer risk according to the Breast Cancer Surveillance Consortium model and ASCVD risk according to the 2013 American College of Cardiology/American Heart Association risk calculator. Among 298 evaluable women, mean age was 58.2 years (SD, 8.34), with 33% non-Hispanic White, 41% Hispanic, 9% non-Hispanic Black, 6% Asian, and 11% other/unknown race/ethnicity. About 98% of women met high-risk criteria for breast cancer, whereas 30% were high-risk for ASCVD. Mean 10-year risk of breast cancer was higher than mean 10-year risk of ASCVD (9.14% vs. 6.69%; P < 0.001). Among women who met high-risk criteria for both diseases, use of statins was higher compared with SERMs/AIs (58% vs. 21%; P < 0.001). Among women with AH or LCIS, statin use was higher compared with breast cancer chemoprevention among eligible women, despite having a higher mean risk of breast cancer than ASCVD. PREVENTION RELEVANCE: Among women with high-risk breast lesions, mean absolute risk of breast cancer was higher compared with cardiovascular disease; however, statin use was significantly higher than chemoprevention. To address underutilization of breast cancer chemoprevention, these drugs should be placed in the context of medications used to prevent other chronic diseases.

Genome sequence of Microbacterium foliorum bacteriophage DumpQuist isolated from soil in Clarksville, Tennessee.

Bacteriophage DumpQuist was isolated from soil collected in Clarksville, TN, using the bacterium Microbacterium foliorum. Electron microscopy revealed that DumpQuist has a podovirus morphology. DumpQuist has a 53,924-bp genome that contains 54 predicted protein-coding genes and is most similar to phages in actinobacteriophage cluster EK1.

Pericarditis of Polyarteritis Nodosa.

Polyarteritis nodosa (PAN) is a rare systemic vasculitis characterised by necrotising inflammation of medium-sized arteries. PAN can affect patients of any age, gender, or ethnic background. Its highest incidence is in the fifth-sixth decade of life, with a slight male-to-female predilection. PAN can be idiopathic or secondary to a multitude of systemic conditions, such as infection, haematological malignancy, or autoinflammatory disorders. PAN has a broad spectrum of possible clinical manifestations the most common being constitutional symptoms, such as fever and myalgia. While cardiac involvement is well-described and is a common cause of mortality, it is exceedingly uncommon as the initial presentation. Below, we describe a case of a female in her 60s who presented with pericarditis as the first manifestation of PAN.

Impact of Lung Disease on COVID-19 Health Outcomes in People Living With HIV.

Introduction COVID-19 most commonly causes pulmonary/lung infection, and these pulmonary diseases can complicate HIV infection. Underlying pulmonary diseases in people living with HIV (PLWH) could affect health outcomes if infected with COVID-19. Therefore, this study was designed to determine the impact of pulmonary diseases on the health outcomes of PLWH that were infected with COVID-19. Materials and methods We conducted a retrospective study to assess the impact of superimposed COVID-19 infection on pre-existing lung pathologies in patients living with human immunodeficiency virus (HIV) infection using data from the Minnesota Fairview network from January 1, 2020 to December 31, 2022. Ordinal logistic regressions were used to determine the effect of lung comorbidities on COVID-19 severity, COVID-19-specific mortality, and all-cause mortality, adjusting for patient age and gender.  Results Two hundred sixteen PLWH tested positive for COVID-19. 24.54% of these patients had one or more pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other lung diseases (interstitial lung diseases and pulmonary hypertension). The severity of COVID-19 outcomes was evaluated by the ranking of patients' medical records of testing positive, admitted to the hospital, being admitted to the ICU, and death. COVID-19-specific and all-cause mortality were evaluated separately. PLWH with underlying asthma or COPD was not associated with increased all-cause or COVID-19-specific mortality. Interstitial lung disease or pulmonary hypertension was significantly associated with poor health outcomes for COVID-19-specific mortality and all-cause mortality (Fisher's Exact p-value <0.001), with ICU admissions accounting for the most impact. Using the multivariate models, interstitial lung disease and pulmonary hypertension was significantly associated with an increased risk of more severe COVID-19 outcomes and COVID-19-specific mortality (OR=6.6153, CI=2.5944, 17.0795, p-value < 0.001). Interstitial lung disease and pulmonary hypertension were also significantly associated with an increased risk of more severe COVID-19 outcomes and all-cause mortality (OR=​​5.0885, CI=2.0590, 12.5542, p-value < 0.001). Conclusions To mitigate the poor outcomes associated with interstitial lung diseases and pulmonary hypertension in PLWH due to COVID-19, healthcare providers must educate their patients about safety measures against the COVID-19 vaccine. They can also encourage the COVID-19 vaccine uptake among their eligible patients.

The Trend of Cefepime-Induced Neurotoxicity: A Systematic Review.

There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with neurotoxicity. We conducted a systematic review using online data to explore the trend of cefepime-induced neurotoxicity over the last 10 years. Forty-six articles met our inclusion criteria, including 73 cases of cefepime-induced neurotoxicity. We noticed a steady increase in the reports of cefepime-induced neurotoxicity, from one case in 2013 to 11 cases in 2022. Individuals aged 65 and older accounted for most cefepime-induced neurotoxicity cases (52%). The top three indications for cefepime administration included bone and joint infections (25%), urinary tract infections (22.7%), and pneumonia (22.7%). Most patients with renal impairment have never had a renal adjustment of their cefepime dosage (either 2 g 12 hours a day or 2 g eight hours a day). Most cases of cefepime-induced neurotoxicity occurred between days two and five (n=29, 71%), while most resolution occurred between days one and five (n=29, 85%). While cefepime continues to be a popularly used and effective antibiotic against gram-negative bacteria like Pseudomonas aeruginosa, its dosage needs to be adjusted in patients with renal impairment to avoid neurotoxicity.

Progressive Multifocal Leukoencephalopathy Mimicking a Cerebral Vasculitis Flare.

We report a case of a 68-year-old woman with a background of primary cerebral vasculitis, which was diagnosed two years ago. She appeared to have had a recurrence of her symptoms with new onset history of expressive dysphasia, right-sided upper limb weakness, and right-sided facial weakness during a rheumatology clinic visit. The patient was on maintenance azathioprine for her cerebral vasculitis at the time of presentation. She had received a total of 2 g of rituximab through intravenous infusion, with a two-week interval between doses. Additionally, she had undergone intravenous cyclophosphamide treatment (15 mg/kg) following the standard vasculitis regimen for induction remission therapy, which was administered at the time of her diagnosis two years prior. Initial imaging on non-contrast computed tomography head after admission to the emergency department did not show any acute neurological findings. Further imaging studies revealed changes in the right parietotemporal white matter T2 hyperintensity with similar changes on the left frontal and left parietal lobes suggestive of progressive multifocal leukoencephalopathy (PML). A magnetic resonance imaging (MRI) of the brain conducted three months prior was found to be unremarkable. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing confirmed the presence of polyoma John Cunningham (JC) virus deoxyribonucleic acid (DNA). This case highlights that PML should be an important differential to consider in any immunocompromised patient who presents with new stroke-like features.

Correction: Linkages between men's wealth status and the ideal number of children: A trend and multilevel analysis of survey data in Nigeria.

[This corrects the article DOI: 10.1371/journal.pgph.0001036.].

Agitated ants: regulation and self-organization of incipient nest excavation via collisional cues.

Ants are millimetres in scale yet collectively create metre-scale nests in diverse substrates. To discover principles by which ant collectives self-organize to excavate crowded, narrow tunnels, we studied incipient excavation in small groups of fire ants in quasi-two-dimensional arenas. Excavation rates displayed three stages: initially excavation occurred at a constant rate, followed by a rapid decay, and finally a slower decay scaling in time as t-1/2. We used a cellular automata model to understand such scaling and motivate how rate modulation emerges without global control. In the model, ants estimated their collision frequency with other ants, but otherwise did not communicate. To capture early excavation rates, we introduced the concept of 'agitation'-a tendency of individuals to avoid rest if collisions are frequent. The model reproduced the observed multi-stage excavation dynamics; analysis revealed how parameters affected features of multi-stage progression. Moreover, a scaling argument without ant-ant interactions captures tunnel growth power-law at long times. Our study demonstrates how individual ants may use local collisional cues to achieve functional global self-organization. Such contact-based decisions could be leveraged by other living and non-living collectives to perform tasks in confined and crowded environments.

Effect of acidic pretreatment on the microstructural arrangement and anaerobic digestion of Arachis hypogea shells; and process parameters optimization using response surface methodology.

Enzymatic hydrolysis of lignocellulose feedstocks has been observed as the rate-limiting stage during anaerobic digestion. This necessitated the need for pretreatment before anaerobic digestion for an effective and efficient process. Therefore, this study investigated the impact of acidic pretreatment on Arachis hypogea shells, and different conditions of H2SO4 concentration, exposure time, and autoclave temperature were considered. The substrates were digested for 35 days at a mesophilic temperature to assess the impact of pretreatment on the microstructural organization of the substrate. For the purpose of examining the interactive correlations between the input parameters, response surface methodology (RSM) was used. The result reveals that acidic pretreatment has the strength to disrupt the recalcitrance features of Arachis hypogea shells and make them accessible for microorganisms' activities during anaerobic digestion. In this context, H2SO4 with 0.5% v. v-1 for 15 min at an autoclave temperature of 90 °C increases the cumulative biogas and methane released by 13 and 178%, respectively. The model's coefficient of determination (R2) demonstrated that RSM could model the process. Therefore, acidic pretreatment poses a novel means of total energy recovery from lignocellulose feedstock and can be investigated at the industrial scale.

Linkages between men's wealth status and the ideal number of children: A trend and multilevel analysis of survey data in Nigeria.

Most African societies practice a patriarchal family system that endows a man with authority and dominance in the family and society with a defined role of being the breadwinner of the home. A man is expected to have a great influence in determining the ideal number of children in the family and take a domineering role in decision-making, especially those related to household resource allocation. Therefore, this study examines the relationship between men's wealth status and an ideal number of children. The study used secondary data from the National Demographic Health Survey (NDHS) from 2003 to 2018. The objectives were achieved using descriptive and inferential statistics, including frequency, mean, ANOVA, and multilevel analysis techniques. Wealth status significantly influenced the ideal number of children considering the crude and adjusted regression analysis. After adjusting for individual-level and contextual factors, the odd ratio of ideal number of children was significantly lower among men in the richest categories of the wealth index. Moreover, men with two wives and above, uneducated men, Northern residents, men living in high community family norms, low community family planning, high community poverty, and low community level of education desired a high number of children. The analyses suggest the need for a consideration of community structures to provide lucrative employment for men and would experience an appreciable fertility decline in line with the objectives and targets stated in Nigeria's population policies and programmes.

Presentation and Management of Orbito-Ocular Malignancies in a Tertiary Institution in Southwest Nigeria.

Purpose: The aim of this study was to review the management of orbito-ocular malignancies in the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital, between January 1997 and December 2011 in comparison to previous and recent studies globally. Materials and Methods: This was a retrospective study of orbito-ocular malignancies seen at the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital from 1997 to 2011. Case files and treatment cards were retrieved through the Medical Records department and the information required was extracted with the aid of a data extraction form. Results: A total of 98 cases with histologically confirmed orbito-ocular malignancies seen during the 15-year study period were analysed. Retinoblastoma (51 [52.0%]) was the most common orbito-ocular malignancies seen in children, whereas squamous cell carcinoma of the conjunctiva (25 [25.5%]) was the most common in adults. Seventeen (17%) patients had a combination of radiotherapy, surgery, and chemotherapy. Thirty (33%) had enucleation, whereas 33 (36%) had exenteration. Thirty-six patients had chemotherapy, whereas 44 patients benefited from radiotherapy, and radical treatment was offered to 24 patients. Total radical treatment dose was 35-65 Gy in 20-35 fractions over 4-7 weeks. Most of the patients (84 [85.7%]) were lost to follow up. Five (5.1%) died from disease progression and four (4.1%) are still alive and on regular follow-up. Conclusion: This study showed that the use of multimodality treatment was implemented but did not improve survival because the majority of patients presented late. The need for a collaborative effort in early detection and prompt referral for treatment of cancer cases cannot be overemphasised.

Co-existence of extended-spectrum ß-lactamases blaCTX-M-9 and blaCTX-M-15 genes in Salmonella species isolated from febrile and diarrhoeagenic patients in Lagos, Nigeria: a cross-sectional study.

BACKGROUND: Resistance to different antimicrobial classes by Salmonella species has generated a global public health concern. The spread of extended-spectrum ß-lactamases (ESBLs) blaCTX gene variants is also increasing. This study aimed to investigate the antibiotic resistance and the carriage of blaCTX-M-9 and blaCTX-M-15 as well as the quinolone resistance gene (qnrB19) among Salmonella species from hospitalised patients in Lagos, Nigeria. METHODS: In this cross-sectional study from April 2021 to August 2021, a total of 508 samples were collected from hospitalised patients. The samples were subjected to standard microbiological investigation. All the isolates were identified using API 20E kits and real-time polymerase chain reaction (RT-PCR). The in vitro antibiotic susceptibility testing (AST) was investigated using the disk diffusion method. Detection of antibiotic resistance and virulence gene makers was conducted using RT-PCR. RESULTS: In total, 24 Salmonella species were identified. All the isolates were non-typhoidal Salmonella isolates. None of the isolates screened was S. Typhi and S. Paratyphi. Most of the isolates were susceptible to imipenem, ciprofloxacin, ofloxacin and gentamycin, while a high level of resistance to all cephalosporins, penicillin, and some carbapenems was observed. In total, 79.2% (19/24) of the Salmonella isolates harboured the blaCTX-M variant including 54.2% (13/24) blaCTX-M-9 and 12.5% (3/24) blaCTX-M-15, while co-habitation of blaCTX-M-9 and blaCTX-M-15 was observed in 12.5% (3/24) of the isolates, respectively. None of the isolates harboured quinolone-resistant qnrB19 gene and virulence gene stn. However, invA gene was present in 66.7% (16/24) of all isolates. CONCLUSIONS: This study is considered the first report of blaCTX-M-9 and blaCTX-M-15 variants in Salmonella species in Nigeria. The continued existence of cefotaximase (CTX-M)-producing Salmonella within our environment calls for the prudent use of cephalosporins.

Experimental evaluation of the influence of combined particle size pretreatment and Fe3O4 additive on fuel yields of Arachis Hypogea shells.

A smart energy recovery process can achieve maximum energy recovery from organic wastes. Pretreatment of feedstock is essential to biogas and methane yields during the anaerobic digestion process. This work combined particle size reduction with Fe3O4 nanoparticles to investigate their influence on biogas and methane yields from anaerobic digestion of Arachis hypogea shells. Twenty milligrams per litre of Fe3O4 nanoparticles was implemented with 2, 4, 6 and 8 mm particle sizes and a single treatment of Fe3O4 for 35 days. The treatments were compared with each other and were discovered to significantly (p < 0.05) enhance biogas yield by 37.40%, 50.10%, 54.40%, 51.40% and 35.50% compared with control, respectively. Specific biogas yield recorded was 966.2, 1406, 1552.7, 1317.4, 766.2 and 413 mL g-1 volatile solid. This study showed the combination of Fe3O4 with 6 mm particle size of Arachis hypogea shells produced the optimum biogas and methane yields. The addition of Fe3O4 to particle sizes below 6 mm resulted in over-accumulation of volatile fatty acids and lowered the gas yield. This can be applied on an industrial scale.

The Pharmacy Community Apgar Questionnaire: a modified Delphi technique to develop a rural pharmacist recruitment and retention tool.

INTRODUCTION: An adequate healthcare workforce remains essential for the health of rural communities. Strategies to address rural health workforce challenges have often centred on the medical and nursing workforce; however, addressing the rural pharmacist workforce also remains critical as they are often the first point of contact for health advice. Initiatives have increased pharmacist supply; however, key issues such as poor attraction, recruitment, and retention to rural areas remain. The aim of this study was to support the recruitment and retention of pharmacists in rural areas of Australia through the development of the Pharmacy Community Apgar Questionnaire (PharmCAQ). METHODS: A modified Delphi technique was employed to develop the PharmCAQ. A panel of experts were purposively selected. Eight representatives were from organisations with rural experience relevant to the study including the Society of Hospital Pharmacists of Australia, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Pharmacy Board of Australia, and a representative of a government health agency, who also leads a hospital pharmacy. Three additional participants included local and international academics with health policy and rural health workforce expertise. All participants participated in three separate focus groups of 45-60 minutes duration, where the review and refinement of factors that drive recruitment and retention of pharmacist were discussed. Face and content validity was achieved through the representatives, while internal consistency was achieved when the tool was piloted among 10 rural pharmacists in rural Victoria. RESULTS: Fifty key factors that impact the recruitment and retention of pharmacists were identified, developed and succinctly described. All factors were grouped into five classifications: (1) geographic, (2) economic and resources, (3) practice and scope of practice, (4) practice environment and (5) community practice support. After final consensus, the factors and their definitions formed the final questionnaire. Lastly, the reliability of PharmCAQ was determined, with a Cronbach's alpha coefficient of 0.852. CONCLUSION: While the development and use of the Apgar questionnaire for the recruitment and retention of health professionals is not a novel idea, seeking to specifically focus on pharmacists is unique. However, 10 factors were similar to factors associated with rural recruitment and retention of both physicians and nurses; they encompassed geographic, community support, and economic and resource factors. Regardless of similarities or differences between health professions in terms of recruitment and retention, as a mechanism for addressing the worsening health professional shortage currently experienced in rural areas, the PharmCAQ was developed to support the recruitment and retention of the pharmacist workforce in rural areas.

Low-cost adaptation options to support green growth in agriculture, water resources, and coastal zones.

The regional climate as it is now and in the future will put pressure on investments in sub-Saharan Africa in water resource management, fisheries, and other crop and livestock production systems. Changes in oceanic characteristics across the Atlantic Ocean will result in remarkable vulnerability of coastal ecology, littorals, and mangroves in the middle of the twenty-first century and beyond. In line with the countries' objectives of creating a green economy that allows reduced greenhouse gas emissions, improved resource efficiency, and prevention of biodiversity loss, we identify the most pressing needs for adaptation and the best adaptation choices that are also clean and affordable. According to empirical data from the field and customized model simulation designs, the cost of these adaptation measures will likely decrease and benefit sustainable green growth in agriculture, water resource management, and coastal ecosystems, as hydroclimatic hazards such as pluviometric and thermal extremes become more common in West Africa. Most of these adaptation options are local and need to be scaled up and operationalized for sustainable development. Governmental sovereign wealth funds, investments from the private sector, and funding from global climate funds can be used to operationalize these adaptation measures. Effective legislation, knowledge transfer, and pertinent collaborations are necessary for their success.