Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review.

BACKGROUND: Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK. METHODS: A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework. RESULTS: 40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts. CONCLUSIONS: Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748

Proof of polar ejection fom the close-binary core of the planetary nebula Abell 63

We present the first detailed kinematical analysis of the planetary nebula Abell 63, which is known to contain the eclipsing close-binary nucleus UU Sge. Abell 63 provides an important test case in investigating the role of close-binary central stars on the evolution of planetary nebulae. Longslit observations were obtained using the Manchester echelle spectrometer combined with the 2.1-m San Pedro Martir Telescope. The spectra reveal that the central bright rim of Abell 63 has a tube-like structure. A deep image shows collimated lobes extending from the nebula, which are shown to be high-velocity outflows. The kinematic ages of the nebular rim and the extended lobes are calculated to be 8400+/-500 years and 12900+/-2800 years, respectively, which suggests that the lobes were formed at an earlier stage than the nebular rim. This is consistent with expectations that disk-generated jets form immediately after the common envelope phase. A morphological-kinematical model of the central nebula is presented and the best-fit model is found to have the same inclination as the orbital plane of the central binary system; this is the first proof that a close-binary system directly affects the shaping of its nebula. A Hubble-type flow is well-established in the morphological-kinematical modelling of the observed line profiles and imagery. Two possible formation models for the elongated lobes of Abell 63 are considered (1) a low-density, pressure-driven jet excavates a cavity in the remnant AGB envelope; (2) high-density bullets form the lobes in a single ballistic ejection event.Comment: 11 pages, 8 figures, accepted by MNRAS for publicatio

Preliminary observations on soluble programmed cell death protein-1 as a prognostic and predictive biomarker in patients with metastatic melanoma treated with patient-specific autologous vaccines.

Because of its role as an immune checkpoint, levels of soluble programmed cell death protein-1 (sPD-1) could be useful as a prognostic biomarker or predictive biomarker in cancer patients treated with vaccines. Very low levels of sPD-1 may indicate lack of an existing anti-cancer immune response; very high levels may indicate an active immune response that is suppressed. In between these extremes, a decrease in PD-1 following injections of an anti-cancer vaccine may indicate an enhanced immune response that has not been suppressed. Blood samples obtained during a randomized trial in patients with metastatic melanoma were tested from 22 patients treated with a tumor cell vaccine (TCV) and 17 treated with a dendritic cell vaccine (DCV). Survival was better in DCV-treated patients. sPD-1 was measured at week-0, one week before the first of three weekly subcutaneous injections, and at week-4, one week after the third injection. The combination of a very low baseline sPD-1, or absence of a very high PD-1 at baseline followed by a decline in sPD-1 at week-4, was predictive of surviving three or more years in DCV-treated patients, but not TCV-treated. Among DCV-treated patients, these sPD-1 criteria appropriately classified 8/10 (80%) of 3-year survivors, and 6/7 (86%) of patients who did not survive three years. These preliminary observations suggest that sPD-1 might be a useful biomarker for melanoma patients being considered for treatment with this DCV vaccine, and/or to predict efficacy after only three injections, but this would have to be confirmed in larger studies

Double radio peak and non-thermal collimated ejecta in RS Ophiuchi following the 2006 outburst

We report Multi-Element Radio-Linked Interferometer Network, Very Large Array, One-Centimetre Radio Array, Very Long Baseline Array (VLBA), Effelsberg and Giant Metrewave Radio Telescope observations beginning 4.5 days after the discovery of RS Ophiuchi undergoing its 2006 recurrent nova outburst. Observations over the first 9 weeks are included, enabling us to follow spectral development throughout the three phases of the remnant development. We see dramatic brightening on days 4 to 7 at 6 GHz and an accompanying increase in other bands, particularly 1.46 GHz, consistent with transition from the initial ‘free expansion’ phase to the adiabatic expansion phase. This is complete by day 13 when the flux density at 5 GHz is apparently declining from an unexpectedly early maximum (compared with expectations from observations of the 1985 outburst). The flux density recovered to a second peak by approximately day 40, consistent with behaviour observed in 1985. At all times the spectral index is consistent with mixed non-thermal and thermal emission. The spectral indices are consistent with a non-thermal component at lower frequencies on all dates, and the spectral index changes show that the two components are clearly variable. The estimated extent of the emission at 22 GHz on day 59 is consistent with the extended east and west features seen at 1.7 GHz with the VLBA on day 63 being entirely non-thermal. We suggest a two-component model, consisting of a decelerating shell seen in mixed thermal and non-thermal emission plus faster bipolar ejecta generating the non-thermal emission, as seen in contemporaneous VLBA observations. Our estimated ejecta mass of 4 ± 2 × 10−7 M⊙ is consistent with a white dwarf (WD) mass of 1.4 M⊙. It may be that this ejecta mass estimate is a lower limit, in which case a lower WD mass would be consistent with the data

Pathway to the PiezoElectronic Transduction Logic Device

The information age challenges computer technology to process an exponentially increasing computational load on a limited energy budget - a requirement that demands an exponential reduction in energy per operation. In digital logic circuits, the switching energy of present FET devices is intimately connected with the switching voltage, and can no longer be lowered sufficiently, limiting the ability of current technology to address the challenge. Quantum computing offers a leap forward in capability, but a clear advantage requires algorithms presently developed for only a small set of applications. Therefore, a new, general purpose, classical technology based on a different paradigm is needed to meet the ever increasing demand for data processing.Comment: in Nano Letters (2015

Addressing Inequity to Achieve the Maternal and Child Health Millennium Development Goals: Looking Beyond Averages.

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs

Sex and Socioeconomic Differentials in Child Health in Rural Bangladesh: Findings from a Baseline Survey for Evaluating Integrated Management of Childhood Illness

This paper reports on a population-based sample survey of 2,289 children aged less than five years (under-five children) conducted in 2000 as a baseline for the Bangladesh component of the Multi-country Evaluation (MCE) of the Integrated Management of Childhood Illness strategy. Of interest were rates and differentials by sex and socioeconomic status for three aspects of child health in rural Bangladesh: morbidity and hospitalizations, including severity of illness; care-seeking for childhood illness; and home-care for illness. The survey was carried out among a population of about 380,000 in Matlab upazila (subdistrict). Generic MCE Household Survey tools were adapted, translated, and pretested. Trained interviewers conducted the survey in the study areas. In total, 2,289 under-five children were included in the survey. Results showed a very high prevalence of illness among Bangladeshi children, with over two-thirds reported to have had at least one illness during the two weeks preceding the survey. Most sick children in this population had multiple symptoms, suggesting that the use of the IMCI clinical guidelines will lead to improved quality of care. Contrary to expectations, there were no significant differences in the prevalence of illness either by sex or by socioeconomic status. About one-third of the children with a reported illness did not receive any care outside the home. Of those for whom outside care was sought, 42% were taken to a village doctor. Only 8% were taken to an appropriate provider, i.e. a health facility, a hospital, a doctor, a paramedic, or a community-based health worker. Poorer children than less-poor children were less likely to be taken to an appropriate healthcare provider. The findings indicated that children with severe illness in the least poor households were three times more likely to seek care from a trained provider than children in the poorest households. Any evidence of gender inequities in child healthcare, either in terms of prevalence of illness or care-seeking patterns, was not found. Care-seeking patterns were associated with the perceived severity of illness, the presence of danger signs, and the duration and number of symptoms. The results highlight the challenges that will need to be addressed as IMCI is implemented in health facilities and extended to address key family and community practices, including extremely low rates of use of the formal health sector for the management of sick children. Child health planners and researchers must find ways to address the apparent population preference for untrained and traditional providers which is determined by various factors, including the actual and perceived quality of care, and the differentials in care-seeking practices that discriminate against the poorest households

Major and Minor Group Rhinoviruses Elicit Differential Signaling and Cytokine Responses as a Function of Receptor-Mediated Signal Transduction

Major- and minor-group human rhinoviruses (HRV) enter their host by binding to the cell surface molecules ICAM-1 and LDL-R, respectively, which are present on both macrophages and epithelial cells. Although epithelial cells are the primary site of productive HRV infection, previous studies have implicated macrophages in establishing the cytokine dysregulation that occurs during rhinovirus-induced asthma exacerbations. Analysis of the transcriptome of primary human macrophages exposed to major- and minor-group HRV demonstrated differential gene expression. Alterations in gene expression were traced to differential mitochondrial activity and signaling pathway activation between two rhinovirus serotypes, HRV16 (major-group) and HRV1A (minor-group), upon initial HRV binding. Variances in phosphorylation of kinases (p38, JNK, ERK5) and transcription factors (ATF-2, CREB, CEBP-alpha) were observed between the major- and minor-group HRV treatments. Differential activation of signaling pathways led to changes in the production of the asthma-relevant cytokines CCL20, CCL2, and IL-10. This is the first report of genetically similar viruses eliciting dissimilar cytokine release, transcription factor phosphorylation, and MAPK activation from macrophages, suggesting that receptor use is a mechanism for establishing the inflammatory microenvironment in the human airway upon exposure to rhinovirus

Abell 41: shaping of a planetary nebula by a binary central star?

We present the first detailed spatio-kinematical analysis and modelling of the planetary nebula Abell 41, which is known to contain the well-studied close-binary system MT Ser. This object represents an important test case in the study of the evolution of planetary nebulae with binary central stars as current evolutionary theories predict that the binary plane should be aligned perpendicular to the symmetry axis of the nebula. Deep narrowband imaging in the light of [NII], [OIII] and [SII], obtained using ACAM on the William Herschel Telescope, has been used to investigate the ionisation structure of Abell 41. Longslit observations of the H-alpha and [NII] emission were obtained using the Manchester Echelle Spectrometer on the 2.1-m San Pedro M\'artir Telescope. These spectra, combined with the narrowband imagery, were used to develop a spatio-kinematical model of [NII] emission from Abell 41. The best fitting model reveals Abell 41 to have a waisted, bipolar structure with an expansion velocity of ~40km\s at the waist. The symmetry axis of the model nebula is within 5\degr of perpendicular to the orbital plane of the central binary system. This provides strong evidence that the close-binary system, MT Ser, has directly affected the shaping of its nebula, Abell 41. Although the theoretical link between bipolar planetary nebulae and binary central stars is long established, this nebula is only the second to have this link, between nebular symmetry axis and binary plane, proved observationally.Comment: 7 pages, 6 figures, Accepted for publication in MNRA