Utilization of health care services by migrants in Europe-a systematic literature review.

Introduction: Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. Sources of data: A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. Areas of agreement: Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. Areas of controversy: Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. Growing points: Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. Areas timely for developing research: A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants

Retrospective analysis and clinical evaluation of mandible reconstruction with free fibula flap

The objective of this investigation was to evaluate the indications for and the functional and cosmetic results of mandible reconstruction using free vascularized fibular flaps. It was also designed to assess the patients' quality of life, daily activities, and self-esteem, with special emphasis on patient satisfaction. We conducted a retrospective chart review of all patients who underwent osseus or osteocutaneous free flap reconstruction of the mandible over a 10-year period (1992-2002). Those in whom a vascularized fibular flap was used were included in the study and invited for a follow-up comprehensive physical examination and x-ray evaluation. A questionnaire was also administered to evaluate patient satisfaction. Twenty-six patients were included in the study. Fourteen patients died after an average of 2years and 9months postoperatively due to their prognosis despite surgical intervention and adjuvant therapy. Of the remaining 12 patients, 6 appeared for the follow-up evaluation, 2 were unavailable for follow-up, and 4 denied participating. Of these 6 patients, all experienced a decrease in pain and were satisfied with their results. At the time of the latest follow-up, they experienced some difficulties swallowing, and in 3 patients, their articulation was impaired. All 6 patients would undergo the procedure again. Reconstruction of the mandible using a vascularized fibular graft produces satisfactory functional and cosmetic results. In benign lesions, the procedure is highly indicated. However, in the case of malignancy, most patients do not survive their primary tumor. Given the patients limited life expectancy, the improvement in their quality of life as a result of the improved appearance and function of the reconstructed mandible needs to be weighed against the potential morbidity of the operative intervention on an individual basi

Thermochemistry of Alane Complexes for Hydrogen Storage: A Theoretical and Experimental Comparison

Knowledge of the relative stabilities of alane (AlH3) complexes with electron donors is essential for identifying hydrogen storage materials for vehicular applications that can be regenerated by off-board methods; however, almost no thermodynamic data are available to make this assessment. To fill this gap, we employed the G4(MP2) method to determine heats of formation, entropies, and Gibbs free energies of formation for thirty-eight alane complexes with NH3-nRn (R = Me, Et; n = 0-3), pyridine, pyrazine, triethylenediamine (TEDA), quinuclidine, OH2-nRn (R = Me, Et; n = 0-2), dioxane, and tetrahydrofuran (THF). Monomer, bis, and selected dimer complex geometries were considered. Using these data, we computed the thermodynamics of the key formation and dehydrogenation reactions that would occur during hydrogen delivery and alane regeneration, from which trends in complex stability were identified. These predictions were tested by synthesizing six amine-alane complexes involving trimethylamine, triethylamine, dimethylethylamine, TEDA, quinuclidine, and hexamine, and obtaining upper limits of delta G for their formation from metallic aluminum. Combining these computational and experimental results, we establish a criterion for complex stability relevant to hydrogen storage that can be used to assess potential ligands prior to attempting synthesis of the alane complex. Based on this, we conclude that only a subset of the tertiary amine complexes considered and none of the ether complexes can be successfully formed by direct reaction with aluminum and regenerated in an alane-based hydrogen storage system.Comment: Accepted by the Journal of Physical Chemistry

An environmental threshold for degree of phosphorus saturation in sandy soils.

ABSTRACT soil is completely saturated with P There is critical need for a practical indicator to assess the potential by local conditions and generally reflects local surface for phosphorus (P) movement from a given site to surface waters, water criteria for P. The Netherlands has established a either via surface runoff or subsurface drainage. The degree of phosphorus saturation (DPS), which relates a measure of P already adwater quality goal for ground water of 0.15 mg total P sorbed by a soil to its P adsorption capacity, could be a good indicator , and their studies have shown that leaching of P of that soil's P release capability. Our primary objective was to find could occur especially from manure-contaminated soils a suitable analytical protocol for determining DPS and to examine S andy soils in the Suwannee River basin of northern phorus (WSP) (assessed using either deionized water Florida have little ability to adsorb P, and yet many or 0.01 M CaCl 2 ) and each method of DPS calculation; dairies in the Suwannee River basin routinely apply and (iv) examine the possibility of defining a threshold P-rich lagoon effluent onto permanent sprayfields for DPS value for Florida's sandy soils. waste disposal and nutrient recycling. Increased P loading to these sites may lead to P loss through runoff and subsurface drainage, contributing to surface water MATERIALS AND METHODS quality degradation. Improved P management of these Study Site fields requires the evaluation of soil P concentrations The Suwannee River basin was selected for this study. Many relative to the soil's ability to adsorb P. of the dairies found in the middle Suwannee River basin, Recent studies suggest that the DPS, which relates proximal to the Suwannee and Santa Fe Rivers, are situated ammonium oxalate-extractable P to the sum of oxalateatop a geomorphic zone classified as the Chiefland Limestone extractable Fe and Al (DPS Ox ), is a good indicator of a Plain. The upper surface of the aquifer system is relatively soil's potential to release P (Hooda et al., 2000). This close to the surface and layers above it are thin and unconfined concept was first introduced in the Netherlands, where (Andrews, 1992). The surficial aquifer system is largely reit has been shown that P concentrations in the soil solucharged by rainfall that percolates downward through the tion can exceed a critical concentration well before the loose surficial clastic sediments. Water naturally discharges from the aquifer through evaporation, transpiration, spring flow, and downward seepage into the underlying Floridan aqui

Retrospective analysis and clinical evaluation of mandible reconstruction with free fibula flap

The objective of this investigation was to evaluate the indications for and the functional and cosmetic results of mandible reconstruction using free vascularized fibular flaps. It was also designed to assess the patients' quality of life, daily activities, and self-esteem, with special emphasis on patient satisfaction. We conducted a retrospective chart review of all patients who underwent osseus or osteocutaneous free flap reconstruction of the mandible over a 10-year period (1992-2002). Those in whom a vascularized fibular flap was used were included in the study and invited for a follow-up comprehensive physical examination and x-ray evaluation. A questionnaire was also administered to evaluate patient satisfaction. Twenty-six patients were included in the study. Fourteen patients died after an average of 2years and 9months postoperatively due to their prognosis despite surgical intervention and adjuvant therapy. Of the remaining 12 patients, 6 appeared for the follow-up evaluation, 2 were unavailable for follow-up, and 4 denied participating. Of these 6 patients, all experienced a decrease in pain and were satisfied with their results. At the time of the latest follow-up, they experienced some difficulties swallowing, and in 3 patients, their articulation was impaired. All 6 patients would undergo the procedure again. Reconstruction of the mandible using a vascularized fibular graft produces satisfactory functional and cosmetic results. In benign lesions, the procedure is highly indicated. However, in the case of malignancy, most patients do not survive their primary tumor. Given the patients limited life expectancy, the improvement in their quality of life as a result of the improved appearance and function of the reconstructed mandible needs to be weighed against the potential morbidity of the operative intervention on an individual basi

Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust

Purpose Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. Design/methodology/approach This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. Findings The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. Practical implications This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. Originality/value Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches

Novel multiple sclerosis susceptibility loci implicated in epigenetic regulation

We conducted a genome-wide association study (GWAS) on multiple sclerosis (MS) susceptibility in German cohorts with 4888 cases and 10,395 controls. In addition to associations within the major histocompatibility complex (MHC) region, 15 non-MHC loci reached genome-wide significance. Four of these loci are novel MS susceptibility loci. They map to the genes L3MBTL3, MAZ, ERG, and SHMT1. The lead variant at SHMT1 was replicated in an independent Sardinian cohort. Products of the genes L3MBTL3, MAZ, and ERG play important roles in immune cell regulation. SHMT1 encodes a serine hydroxymethyltransferase catalyzing the transfer of a carbon unit to the folate cycle. This reaction is required for regulation of methylation homeostasis, which is important for establishment and maintenance of epigenetic signatures. Our GWAS approach in a defined population with limited genetic substructure detected associations not found in larger, more heterogeneous cohorts, thus providing new clues regarding MS pathogenesis

Work done in the margins:A comparative study of mental health literacy in pre-service teacher education in Australia and in Scotland

Ensuring pre-service teachers have strong mental health literacy is vital for progress towards an inclusive, effective education system; yet little is known about how pre-service teachers are prepared for practice with school students who present with poor mental health. The original, internationally comparative small-scale (N = 24) qualitative study reported here compared current mental health literacy provision to pre-service teacher education students in Scotland and Australia. Semi-structured telephone interviews with teacher educators who delivered mental health content divulged highly variable, often ad-hoc mental health literacy provision; a concern, given the prevalence of poor mental health affecting children and young people in schools. Thematic data analysis revealed striking commonalities among issues raised by participants from both countries, highlighting the need for urgent improvement in the provision of mental health literacy to pre-service teachers. Results suggest the possibility of strategically developing a joint Australian-Scottish mental health component suitable for delivery in both countries