Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany

Background: The integration of immigrating physicians has become a challenge for many societies and health care systems worldwide. Facilitating the integration process may benefit both the uptaking country and the immigrating physicians. Previous studies have approached this problem from a system integration perspective. The present study explores the degree of social integration of an exemplary group of Middle Eastern physicians following their migration to Germany from an individual perspective. Methods: Based on social constructivist epistemology, a series of fifteen interviews and two focus groups with immigrated Middle Eastern physicians (n = 23, purposively sampled) were conducted between 2017 and 2020 in Germany. The audio recordings were transcribed, translated into English and analysed deductively based on Esser's model of social integration, consisting of four dimensions: acculturation, positioning, interaction and identification. Results: The social integration of the participants showed a multifaceted picture. The early phase was characterized by disorientation and trial and error. Cultural differences were of major importance. Acculturation was facilitated by German language acquisition and increased over time, although some cultural difficulties remained. Professional positioning was facilitated by the need for physicians and a relatively low-hurdle relicensing procedure. Interaction and identification depended on the efforts of the individual physicians. Conclusions: This study provides a comprehensive picture of the individual social integration of Middle Eastern physicians in Germany. Language and cultural adaptation are identified as being of primary importance. Social integration can be facilitated through orientation programmes or cross-cultural training that benefits the uptaking countries as well as the immigrating physicians

First High-Convergence Cryogenic Implosion in a Near-Vacuum Hohlraum

Recent experiments on the National Ignition Facility [M. J. Edwards et al., Phys. Plasmas 20, 070501 (2013)] demonstrate that utilizing a near-vacuum hohlraum (low pressure gas-filled) is a viable option for high convergence cryogenic deuterium-tritium (DT) layered capsule implosions. This is made possible by using a dense ablator (high-density carbon), which shortens the drive duration needed to achieve high convergence: a measured 40% higher hohlraum efficiency than typical gas-filled hohlraums, which requires less laser energy going into the hohlraum, and an observed better symmetry control than anticipated by standard hydrodynamics simulations. The first series of near-vacuum hohlraum experiments culminated in a 6.8 ns, 1.2 MJ laser pulse driving a 2-shock, high adiabat (α ~ 3.5) cryogenic DT layered high density carbon capsule. This resulted in one of the best performances so far on the NIF relative to laser energy, with a measured primary neutron yield of 1.8×10[superscript 15] neutrons, with 20% calculated alpha heating at convergence ~27×

Coping with developmental tasks of young adults after paediatric heart transplantation

Von allen durchgeführten Herztransplantationen weltweit sind etwa 12% pädiatrische Herztransplantation (PHTX). Ein Großteil der Kinder überlebt heute bis ins Erwachsenenalter. Nur wenige Studien beschäftigten sich bislang mit dem psychosozialen Wohlbefinden junger Erwachsener nach PHTX; keine Studie hat Entwicklungsaufgaben des aufkommenden Erwachsenwerdens der verschiedenen Bereiche (Familie, soziales Umfeld, Bildung und Beruf, Partnerschaft) untersucht, weshalb sich diese Studie der explorativen Analyse genannter Themenfelder im Vergleich mit gesunden jungen Erwachsenen widmet. Der Frage nach einem möglichen prädiktiven Zusammenhang der psychosozialen Ressourcen und psychosomatischen Beschwerden zur gesundheitsbezogenen Lebensqualität soll nachgegangen werden. Achtunddreißig junge Erwachsene im mittleren Alter von 22,11 Jahren (SD=4,7) nach einer PHTX und eine Kontrollgruppe von 46 jungen Erwachsenen ohne bekannte chronische Erkrankung im mittleren Alter von 22,91 Jahren (SD=1,8) nahmen an der Studie teil. Alle Teilnehmer*innen beantworteten neben dem soziodemographischen Fragebogen, den Fragebogen zur sozialen Unterstützung (F-SozU K-14), den Gießener Beschwerdebogen (GBB-24) zur Messung subjektiver Beschwerden von Patient*innen, den KIDSCREEN-27 zur Messung des Wohlbefindens und die deutsche Version der Shortform-36 (SF-36) zur Messung der Lebensqualität. Entwicklungsaufgaben des jungen Erwachsenenalters sind für Patient*innen nach PHTX sowie Gesunde gleich; deren Bewältigung unterscheidet sich sequentiell in allen Bereichen. Im Themenbereich Familie ergab: Die Qualität der Beziehung zu den Eltern war in beiden Gruppen gleich, während PHTX-Patient*innen näher bei ihren Eltern wohnen blieben (F(1,26.0) = 45.57, p < 0.001). Der Themenbereich Bildung und Beruf ergab: Die berufliche Situation unterschied sich zwischen den Gruppen (χ 2 (1, N=79) = 26,36, p < 0.001), während die PHTX-Patient*innenen am häufigsten entweder Vollzeit arbeiteten (23%) oder keinen Job hatten (21%), befanden sich die meisten der gesunden jungen Erwachsenen in einer Ausbildung (40%) und/oder arbeiteten in Teilzeit (32%). Der Themenbereich Partnerschaft ergab: Die PHTX-Patient*innen hatten seltener eine/n Partner*in als die Kontrollgruppe (χ (1, N=84) =9,42, p = 0,002), wobei sich die Dauer der längsten Beziehung zwischen den Gruppen nicht unterschied (F(1,75) = 1,52, p = 0.222). Der Themenbereich Soziales Umfeld ergab: PHTX-Patient*innen berichteten von einer geringeren sozialen Unterstützung durch Freunde als die gesunde Kontrollgruppe (F(1,44.92) = 23,39, p < 0.001). In explorativen Regressionsanalysen erwies sich die soziale Unterstützung durch Gleichaltrige als Prädiktor für die physische Lebensqualität, während physische Beschwerden und die physische Rolle die psychische Lebensqualität bei PHTX-Patient*innen vorhersagten. Die explorativen Analysen zeigen wichtige Ähnlichkeiten und Differenzen in spezifischen Entwicklungsaufgaben zwischen PHTX-Patient*innen und gesunden Kontrollpersonen auf. Zukünftige Studien sollten sich tiefergehend auf die Entwicklungsaufgaben von PHTX-Patient*innen in dieser Altersgruppe konzentrieren und die Rolle einzelner Themenbereich für das körperliche und geistige Wohlbefinden bestätigen. (Deutsch)Background Of all heart transplants performed worldwide, approximately 12% are pediatric heart transplants (PHTX). The majority of children now survive into adulthood. Only a few studies have investigated the long-term psychosocial well-being of young adult patients after PHTX; no studies have examined developmental tasks of emerging adulthood in different domains (family, social environment, education and profession, partnership), which is why this study is devoted to the explorative analysis of the above-mentioned domains in comparison with healthy young adults. The question of a possible predictive relationship between psychosocial resources and psychosomatic complaints and healthrelated quality of life will be investigated. Methods Thirty-eight young adults aged 22.11 years (SD=4.7) who underwent PHTX and a control group of 46 participants with no known chronic diseases, aged 22.91 years (SD=1.8), participated in the study. All participants completed the following questionnaires: Sociodemographic, the F-SozU, to measure perceived social support, the GBB-24 to measure subjective complaints experienced by patients, the KIDSCREEN-27 to measure well-being, and the SF-36 to measure health-related quality of life. Results ‘Family’: The quality of the relationship with the parents was found to be equal in both groups, while PHTX patients stayed in closer spatial proximity to their parents (F(1,26.0) = 45.57, p < 0.001). ‘Education and profession’: The career situation differed between groups (χ 2 (1, N=79) = 26.36, p < 0.001), while PHTX patients most often either worked full-time (23%) or had no job (21%), most of the healthy young adults were in education (40%) and/or worked part-time (32%). ‘Partnership’: Fewer of the PHTX patients had a partner than the control group while relationship duration did not differ (χ (1, N=84) =9,42, p = 0,002). ‘Social environment’: PHTX patients reported lower social support by peers than the control group (F(1,44.92) = 23,39, p < 0.001). In exploratory regression analyses, social support by peers predicted physical quality of life, whereas physical complaints and the physical role predicted mental quality of life in PHTX patients. Conclusion Our exploratory findings highlight important similarities and differences in specific developmental tasks between PHTX patients and healthy controls. Future studies should focus on developmental tasks of PHTX patients in this age group more systematically, investigating their role in physical and mental well-being in a confirmatory manner

In-flight observations of low-mode ρR asymmetries in NIF implosions

Charged-particle spectroscopy is used to assess implosion symmetry in ignition-scale indirect-drive implosions for the first time. Surrogate D³He gas-filled implosions at the National Ignition Facility produce energetic protons via D+³He fusion that are used to measure the implosion areal density (ρR) at the shock-bang time. By using protons produced several hundred ps before the main compression bang, the implosion is diagnosed in-flight at a convergence ratio of 3–5 just prior to peak velocity. This isolates acceleration-phase asymmetry growth. For many surrogate implosions, proton spectrometers placed at the north pole and equator reveal significant asymmetries with amplitudes routinely ≳10%, which are interpreted as ℓ=2 Legendre modes. With significant expected growth by stagnation, it is likely that these asymmetries would degrade the final implosion performance. X-ray self-emission images at stagnation show asymmetries that are positively correlated with the observed in-flight asymmetries and comparable in magnitude, contradicting growth models; this suggests that the hot-spot shape does not reflect the stagnated shell shape or that significant residual kinetic energy exists at stagnation. More prolate implosions are observed when the laser drive is sustained (“no-coast”), implying a significant time-dependent asymmetry in peak drive.United States. Department of Energy (Grant DE-NA0001857)United States. Department of Energy (Grant DE-FC52-08NA28752