Respect and reflexivity: international education partnerships in primary care.

The UK general practice model has been described as the 'jewel in the crown' of the National Health Service and is widely respected and emulated around the world. In recent years, there has been a particular interest in the UK approach to primary care medical education, including at undergraduate and postgraduate levels, leading to a number of international education partnerships designed to draw on the best of UK experience and expertise in this area. Drawing on the limited academic literature in this area, and the authors' personal experiences of working across many international partnership projects with countries around the world, this article reflects on the central importance of respect and reflexivity when engaging in such work. A respectful approach relies on a genuine and deep curiosity for the local context, and a desire to empower partners to build their own solutions that are contextually authentic. A reflexive approach, meanwhile, relies on those engaging in partnerships to understand themselves as 'invited guests' and to remain mindful of current and historical power differentials and inequities when framing their engagement, looking both inwardly and outwardly as they conduct themselves. As primary care education around the world develops and expands, there may be a greater role for international partnerships and it is critically important that those engaging in such partnerships bring a thoughtful and scholarly lens to this work.

Effect of PM2.5 chemical constituents on atmospheric visibility impairment.

PM2.5 sampling was conducted at a curbside location in Delhi city for summer and winter seasons, to evaluate the effect of PM2.5 and its chemical components on the visibility impairment. The PM2.5 concentrations were observed to be higher than the National Ambient Air Quality Standards (NAAQS), indicating poor air quality. The chemical constituents of PM2.5 (the water-soluble ionic species SO42-, NO3-, Cl-, and NH4+, and carbonaceous species: organic carbon, elemental carbon) were analyzed to study their impact on visibility impairment by reconstructing the light extinction coefficient, bext. The visibility was found to be negatively correlated with PM2.5 and its components. The reconstructed bext showed that organic matter was the largest contributor to bext in both the seasons which may be attributed to combustion sources. In summer season, it was followed by elemental carbon and ammonium sulfate; however, in winter, major contributions were from ammonium nitrate and elemental carbon. Higher elemental carbon in both seasons may be attributed to traffic sources, while lower concentrations of nitrate during summer, may be attributed to volatility because of higher atmospheric temperatures. IMPLICATIONS: The chemical constituents of PM2.5 that majorly effect the visibility impairment are organic matter and elemental carbon, both of which are products of combustion processes. Secondary formations that lead to ammonium sulfate and ammonium nitrate production also impair the visibility.

Collaborative care: models for treatment of patients with complex medical-psychiatric conditions.

Patients with co-morbidity and multi-morbidity have worse outcomes and greater healthcare needs. Co-morbid depression and other long-term conditions present health services with challenges in delivering effective care for patients. We provide some recent evidence from the literature to support the need for collaborative care, illustrated by practical examples of how to deliver a collaborative/integrated care continuum by presenting data collected between 2011 and 2012 from a London Borough clinical improvement programme that compared co-morbid diagnosis of depression and other long-term conditions and Accident and Emergency use. We have provided some practical steps for developing collaborative care within primary care and suggest that primary care family practices should adopt closer collaboration with other services in order to improve clinical outcomes and cost-effectiveness.

Sorption and transport modeling of hexavalent chromium on soil media.

Chromium-soil adsorption system exhibited both Langmuir and Freundlich isotherm models fit to the sorption data in the studied range of concentration. However the model fit was much better for Freundlich isotherm, this was primarily due to low adsorptive capacity of the soil, 1/n is equal to about 1.08 which is quite close to 1.0, indicating low adsorptive capacity of the soil for chromium(VI) system and the Q(max) was observed very low in range of 0.196-0.220 mg Cr(VI)/g of soil. The initial concentration of Cr(VI) in the solution remarkably influenced the equilibrium Cr(VI) uptake on soil sorption process. The model simulated results for the natural redemption of the soil show the periodic movement of the chromium concentration front ultimately reaching quite low concentration at the end of the cycles. In the case of inorganic chemicals, the absence of chemical decay makes the adsorption phenomena as the major contaminant removal mechanism where as for biodegradation the chemical depletion becomes a major factor in the transport of pollutant. Consequently, the concentration of contaminants reaching the ground water table becomes quite low.