Optimizing the Access to Healthcare Services in Dense Refugee Hosting Urban Areas: A Case for Istanbul

With over 3.5 million refugees, Turkey continues to host the world's largest refugee population. This introduced several challenges in many areas including access to healthcare system. Refugees have legal rights to free healthcare services in Turkey's public hospitals. With the aim of increasing healthcare access for refugees, we looked at where the lack of infrastructure is felt the most. Our study attempts to address these problems by assessing whether Migrant Health Centers' locations are optimal. The aim of this study is to improve refugees' access to healthcare services in Istanbul by improving the locations of health facilities available to them. We used call data records provided by Turk Telekom.Comment: version to submit for D4R competitio

Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases.

OBJECTIVE: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This article is based on a meeting report authored by 12 scientists studying atrial fibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials. METHODS: An advisory board panel was convened to confer on management strategies for challenging AF cases. The article is derived from a summary of case presentations and the collaborative discussions at the meeting. CONCLUSION: This expert consensus of cardiologists aimed to define management strategies for challenging cases with patients who underrepresented in pivotal trials using case examples from their routine practice. Although strong evidence is lacking, exploratory subgroup analysis of phase III pivotal trials partially informs the management of these patients. Clinical trials with higher external validity are needed to clarify areas of uncertainty. The lack of clear evidence about complex AF cases has pushed clinicians to manage patients based on clinical experience, including rare situations of off-label prescriptions

Structure, Deformations and Gravitational Wave Emission of Magnetars

Neutron stars can have, in some phases of their life, extremely strong magnetic fields, up to 10^15-10^16 G. These objects, named magnetars, could be powerful sources of gravitational waves, since their magnetic field could determine large deformations. We discuss the structure of the magnetic field of magnetars, and the deformation induced by this field. Finally, we discuss the perspective of detection of the gravitational waves emitted by these stars.Comment: 11 pages, 2 figures, prepared for 19th International Conference on General Relativity and Gravitation (GR19), Mexico City, Mexico, July 5-9, 201

CP and related phenomena in the context of Stellar Evolution

We review the interaction in intermediate and high mass stars between their evolution and magnetic and chemical properties. We describe the theory of Ap-star `fossil' fields, before touching on the expected secular diffusive processes which give rise to evolution of the field. We then present recent results from a spectropolarimetric survey of Herbig Ae/Be stars, showing that magnetic fields of the kind seen on the main-sequence already exist during the pre-main sequence phase, in agreement with fossil field theory, and that the origin of the slow rotation of Ap/Bp stars also lies early in the pre-main sequence evolution; we also present results confirming a lack of stars with fields below a few hundred gauss. We then seek which macroscopic motions compete with atomic diffusion in determining the surface abundances of AmFm stars. While turbulent transport and mass loss, in competition with atomic diffusion, are both able to explain observed surface abundances, the interior abundance distribution is different enough to potentially lead to a test using asterosismology. Finally we review progress on the turbulence-driving and mixing processes in stellar radiative zones.Comment: Proceedings of IAU GA in Rio, JD4 on Ap stars; 10 pages, 7 figure

Tkachenko waves, glitches and precession in neutron star

Here I discuss possible relations between free precession of neutron stars, Tkachenko waves inside them and glitches. I note that the proposed precession period of the isolated neutron star RX J0720.4-3125 (Haberl et al. 2006) is consistent with the period of Tkachenko waves for the spin period 8.4s. Based on a possible observation of a glitch in RX J0720.4-3125 (van Kerkwijk et al. 2007), I propose a simple model, in which long period precession is powered by Tkachenko waves generated by a glitch. The period of free precession, determined by a NS oblateness, should be equal to the standing Tkachenko wave period for effective energy transfer from the standing wave to the precession motion. A similar scenario can be applicable also in the case of the PSR B1828-11.Comment: 6 pages, no figures, accepted to Ap&S

Cardiac tamponade from a giant thymoma: case report

Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses. These tumors are routinely asymptomatic for prolonged periods of time. Pericardial tamponade is a very rare initial manifestation of a thymoma. This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature

Lattice dynamics and structural stability of ordered Fe3Ni, Fe3Pd and Fe3Pt alloys

We investigate the binding surface along the Bain path and phonon dispersion relations for the cubic phase of the ferromagnetic binary alloys Fe3X (X = Ni, Pd, Pt) for L12 and DO22 ordered phases from first principles by means of density functional theory. The phonon dispersion relations exhibit a softening of the transverse acoustic mode at the M-point in the L12-phase in accordance with experiments for ordered Fe3Pt. This instability can be associated with a rotational movement of the Fe-atoms around the Ni-group element in the neighboring layers and is accompanied by an extensive reconstruction of the Fermi surface. In addition, we find an incomplete softening in [111] direction which is strongest for Fe3 Ni. We conclude that besides the valence electron density also the specific Fe-content and the masses of the alloying partners should be considered as parameters for the design of Fe-based functional magnetic materials.Comment: Revised version, accepted for publication in Physical Review

The Magnificent Seven: Magnetic fields and surface temperature distributions

Presently seven nearby radio-quiet isolated neutron stars discovered in ROSAT data and characterized by thermal X-ray spectra are known. They exhibit very similar properties and despite intensive searches their number remained constant since 2001 which led to their name ``The Magnificent Seven''. Five of the stars exhibit pulsations in their X-ray flux with periods in the range of 3.4 s to 11.4 s. XMM-Newton observations revealed broad absorption lines in the X-ray spectra which are interpreted as cyclotron resonance absorption lines by protons or heavy ions and / or atomic transitions shifted to X-ray energies by strong magnetic fields of the order of 10^13 G. New XMM-Newton observations indicate more complex X-ray spectra with multiple absorption lines. Pulse-phase spectroscopy of the best studied pulsars RX J0720.4-3125 and RBS 1223 reveals variations in derived emission temperature and absorption line depth with pulse phase. Moreover, RX J0720.4-3125 shows long-term spectral changes which are interpreted as due to free precession of the neutron star. Modeling of the pulse profiles of RX J0720.4-3125 and RBS 1223 provides information about the surface temperature distribution of the neutron stars indicating hot polar caps which have different temperatures, different sizes and are probably not located in antipodal positions.Comment: 10 pages, 8 figures, to appear in Astrophysics and Space Science, in the proceedings of "Isolated Neutron Stars: from the Interior to the Surface", edited by D. Page, R. Turolla and S. Zan

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians