Overseas doctors and the staffing structure of hospitals.

The introduction of the new immigration rules will considerably reduce the number of overseas doctors available for junior hospital appointments over the next five years. To offset this sponsorship schemes should be offered by universities and colleges comprising training courses, entry to examinations, and hospital appointments, and training programmes should be adapted to make objectives attainable in the four years available to overseas doctors. Employment of overseas doctors can ease the transition within the staffing structure to fewer juniors and more consultants, but planning is urgently required, and in particular the service and manpower needs of the National Health Service must be considered.     

Utilisation of hormone replacement therapy by women doctors.

OBJECTIVES--To ascertain the prevalence and duration of use of hormone replacement therapy by menopausal women doctors. DESIGN--Postal questionnaire. SETTING--General practices in the United Kingdom. SUBJECTS--Randomised stratified sample of women doctors who obtained full registration between 1952 and 1976, taken from the current principal list of the Medical Register. MAIN OUTCOME MEASURES--Prevalence and duration of use of hormone replacement therapy; menopausal status. RESULTS--Overall, 45.7% (436/954) of women doctors aged between 45 and 65 years had ever used hormone replacement therapy. When the results from women still menstruating regularly were excluded, 55.2% (428) were ever users and 41.2% (319) current users. The cumulative probability of remaining on hormone replacement therapy was 0.707 at five years and 0.576 at 10 years. CONCLUSIONS--Women doctors have a higher prevalence of use of hormone replacement therapy than has been reported for other women in the United Kingdom, and most users seem to be taking hormone replacement therapy for more than five years. The results may become generalisable to the wider population as information on the potential benefits of hormone replacement therapy is disseminated.     

Does the MRCGP examination discriminate against Asian doctors?

OBJECTIVE--To ascertain whether the membership examination for the Royal College of General Practitioners (MRCGP) discriminates against doctors of Indian subcontinent ethnic origin ("Asian doctors"). DESIGN--Retrospective analysis of data from five administrations of the MRCGP examination (December 1988-December 1990). SETTING--United Kingdom national examination body. SUBJECTS--3686 doctors taking the examination for the first time, 244 of whom were classified as Asian, the remainder as non-Asian. MAIN OUTCOME MEASURES--Comparison of performance in each of the written and oral components of the examination between Asian doctors, identified by their names and classified into subgroups by countries of birth and primary medical training from data provided at registration, and non-Asian doctors. RESULTS--On written components of the examination (multiple choice paper mean score Asians versus non-Asians 42.3 v 48.6, modified essay paper 40.9 v 48.9, practice topic/critical reading paper 41.5 v 48.7, all p less than 0.001 by t testing). But analysis by countries of birth and primary training showed that these differences were due largely to poor performance by certain groups of Asian doctors, especially those born and trained in the Indian subcontinent or elsewhere outside the United Kingdom. Asian doctors born and trained in the United Kingdom and those born in Africa or the West Indies and trained in the United Kingdom performed similarly to the non-Asian doctors. CONCLUSIONS--The examination does not systematically discriminate against Asian doctors, but the poor performance of the two subgroups of Asians is cause for serious concern and requires investigation.     

Generalized aphid population growth models with immigration and cumulative-size dependent dynamics

Mechanistic models in which the per-capita death rate of a population is proportional to cumulative past size have been shown to describe adequately the population size curves for a number of aphid species. Such previous cumulative-sized based models have not included immigration. The inclusion of immigration is suggested biologically as local aphid populations are initiated by migration of winged aphids and as reproduction is temperature-dependent. This paper investigates two models with constant immigration, one with continuous immigration and the other with restricted immigration. Cases of the latter are relatively simple to fit to data. The results from these two immigration models are compared for data sets on the mustard aphid in India.     

迁移对害虫抗性演化的影响

利用抗性群体遗传模型研究了迁移对害虫抗性演化的影响。模拟结果表明,迁入比例对害虫种群抗性演化的影响存在一定的阈值。若迁入个体全为敏感(SS)纯合子,而其比例又在阈值以下时,这种迁入对抗性演化无延缓作用;迁入比例在阈值以上时,随比例加大,对抗性延缓作用逐渐增强,加大到某一值时,抗性演化可完全被阻止;若迁入个体携有R基因,则迁入比例在阈值以下时,会促进迁入区害虫种群的抗性演化;在阈值以上时,可延缓或完全阻止害虫种群的抗性演化。处理区害虫种群原有个体的迁出,可加强SS个体迁入对害虫种群抗性演化的影响,而使携R基因的个体的迁入影响减弱。以小菜蛾Plutella xylostella为模型昆虫所作的试验结果表明,模型模拟与验证试验的结果具有较好的一致性,说明抗性模拟模型可用于害虫种群的抗性演化预测和分析。     

Time Making and Place Making: A Journey of Immigration from Ethiopia to Israel

ABSTRACT

Anthropological studies of immigration usually focus on the immigrants’ country of origin or their destination. The present ethnographic study is a claim that the immigration experience must be examined as part of a journey and movement. The study was designed to show how the immigration process of Zera Beita Israel (Feres Mura) from Ethiopia to Israel is constructed on a process of journey and dialogue among the various stations. The two main aspects of the journey are place making – constructing a place in the unique context of immigration, and time making – creating being-time and meta-time, both unique to immigration. Each of the places affects the immigration process and is affected by this dynamic, nonlinear process. The combined concepts of place making and immigration time help explain the complexity of immigration.     

The impact of migration from parasite-free patches on antagonistic host-parasite coevolution

Natural populations of hosts and parasites are often subdivided and patchily distributed such that some regions of a host species' range will be free from a given parasite. Host migration from parasite-free to parasite-containing patches is expected to alter coevolutionary dynamics by changing the evolutionary potential of antagonists. Specifically, host immigration can favor parasites by increasing transmission opportunities, or hosts by introducing genetic variation. We tested these predictions in coevolving populations of Pseudomonas fluorescens and phage Phi2 that received immigrants from phage-free populations. We observed a negative quadratic relationship between sympatric resistance to phage and host immigration rate (highest at intermediate immigration) but a positive quadratic relationship between coevolution rate and host immigration rate (lowest at intermediate immigration). These results indicate that for a wide range of rates, host immigration from parasite-free patches can increase the evolutionary potential of parasites, and increase the coevolutionary rate if parasite adaptation is limiting in the absence of immigration.     

Who undertakes the consultations in the outpatient department?

In a study of all 4275 outpatient consultations over one month in a district general hospital it was found that the clinics in surgical specialties had the largest numbers of patients. In general surgery less than half of new patients and only one third of all patients attending the clinic were seen by a consultant. (Nine months later about a third of all new patients had still not seen a consultant in the clinic.) In the medical clinics just over a quarter of patients were seen by doctors who had less than six months'' experience in their present specialty after registration. Overall, doctors had been on continuous duty for at least 24 hours before a third of consultations. Doctors in training had actually worked during the previous night before attending a quarter of the clinics.Much of the large volume of work is performed by tired, incompletely trained doctors. It is suggested that a greater proportion of the work should be performed by fully trained staff. The workload might be reduced by modifying the pattern of the consultation.     

VARIATION IN BENTHIC DIATOM (BACILLARIOPHYCEAE) IMMIGRATION WITH HABITAT CHARACTERISTICS AND CELL MORPHOLOGY1

We studied the hypothesis that diatom immigration abilities are related to their fitness for colonizing stream substrates. Diatom abundances on artificial substrates exposed for 24 h (the measure of immigration rate) and abundances of stream plankton were determined in six habitats. Diatom immigration varied among habitats from 50–2500 cells·cm^?2·d^?1. Immigration rates decreased 10-fold with increases in current from 10 to 30 cm·s^?1 but changed little during a 40-d summer period. Immigration abilities of diatom taxa were characterized as ratios of either their abundances or relative abundances in immigration assemblages versus in the plankton. Immigration abilities varied over 100-fold among different species. Immigration of some species could be characterized as slower than others in different streams; however, variation in immigration abilities of other species among streams indicated that environment also affected immigration. Diurnal variation in abundance and species composition of the immigration pool (stream plankton) can be important in assessing immigration abilities. Immigration ability may affect benthic diatom fitness. Monoraphid diatoms had a lower probability of immigrating from the plankton than araphid diatoms.     

Immigration history of amphidromous species on a Greater Antillean island

Aim To use molecular data to test for dispersal structuring in the immigration history of an amphidromous community on an island. Location The Caribbean island of Puerto Rico. Methods Mitochondrial DNA sequences were obtained from 11 amphidromous species, including shrimps, fish and a gastropod, sampled from throughout the island. The timing of population expansion (T_E) in each species was calculated using nucleotide variation and molecular clock dating methods. The order of species accumulation was then reconstructed (oldest to most recent estimate for T_E), and groups of species with non‐overlapping estimates for T_E were identified. The temporal span and average immigration rate for each group were calculated and compared with expectations of two previously published models of island immigration [the ‘dispersal‐structured model of island recolonization’ ( Whittaker & Jones, Oikos, 1994 , 69 , 524–529), which predicts short phases of rapid immigration followed by extended phases with relatively slow immigration rates; and the ‘colonization window hypothesis’ ( Carine, Taxon, 2005 , 54 , 895–903), which suggests that opportunities for island colonization are temporally constrained to discrete waves of colonization]. Results The molecular data indicated the immigration history of Puerto Rican amphidromous fauna from the late Pleistocene through the Holocene and identified two groups of species with non‐overlapping estimates for T_E and one group that overlapped with the other two groups. The temporal span, average immigration rate and lack of discreteness between all three groups indicated a continuum of immigration rather than distinct phases of species arrivals. Main conclusions This study did not support the expectations of the immigration models and suggested that amphidromous species from Puerto Rico comprise a single class of marine‐based dispersers. The immigration sequence we report probably reflects a recolonization chronology in this community, in keeping with the notion of species turnover through time. Four areas of future research into the immigration history of amphidromous species on islands are identified, and indicated the possibility that equilibrium processes govern long‐term community change in amphidromous biota on islands.     

Effects of immigration on some stochastic logistic models: a cumulant truncation analysis.

This paper uses a new cumulant truncation methodology to investigate the stochastic power law logistic model with immigration, and illustrates the model with parameter values used to describe the growth of muskrat populations in the Netherlands. This model has a stable equilibrium distribution. The incorporation of immigration into the model, therefore, simplifies the qualitative nature of the stochastic solution. The (unconditional) cumulant functions for the transient and the equilibrium population size distributions are obtained, from which the distributions are shown to be near-normal at all times for the parameter values of interest. Approximating cumulant functions, which are relatively easy to find in practice, are derived and shown to be quite accurate, except for the case of massive immigration. As the level of immigration increases, the mean value rises more rapidly initially, as expected; however, the variance and the skewness of both the transient and the equilibrium distributions are reduced.     

北京市42所医院门诊预约挂号现状调查

目的 通过调查医院门诊预约挂号服务的内容、形式、管理模式等情况,为提高医院门诊预约挂号服务质量提供建议。方法 通过对2011—2013年北京市共计42所医院门诊预约挂号服务进行全面统计分析,了解其门诊预约挂号服务现状。 结果 目前北京市预约挂号工作呈现覆盖范围广泛、形式多样的特点;患者预约挂号使用率提高,就医习惯逐渐改变。结论医院应多部门协作,提供完善的配套制度、足够的人力资源等作为保障,推动预约挂号工作进一步发展。     

Influential factors for natal dispersal in an avian island metapopulation

Dispersal is a key parameter in evolutionary, demographic and conservation theory, but the factors influencing dispersal between populations are rarely known, and the contribution of immigrants to population stability remains uncertain. Using dispersal data from nine island populations of song sparrows, we show that female and male immigrants responded differently to population structure: in females, immigration varied with adult sex ratio; whereas immigration by males was more influenced by population density. These patterns are consistent with the hypothesis that intra-sexual competition for breeding resources influenced recruitment patterns. Immigrants often constituted a substantial fraction of local population size, and in six cases immigration by females prevented the extirpation of that sex from the island. Breeding vacancies and extirpations may have been more likely in females because their apparent survival was lower than in males. Local recruitment and immigration varied markedly among islands, perhaps as consequence of island size and isolation. Overall, our results suggest that immigration varied with local demography in a sex-specific way, stabilized population numbers and reduced extinction rates in the smallest populations.     

北京市公立医院试点医事服务费调查

北京市在公立医院试点医药分开,取消药品加成、挂号费和诊疗费,收取医事服务费。对试点医院门诊调查发现,医院改变传统管理和经营模式,从关注创收转变为控制成本,从多开药转变为合理用药,门诊患者数量明显增多,多数患者对现行的医事服务费政策支持并感到满意。部分医院管理者认为采用医事服务费并取消药品加成没有真正切断医生和药品之间的利益关系,对医院和医护人员长期影响有待进一步观察。     

Immigration can destabilize tri-trophic interactions: implications for conservation of top predators

Top predators often have large home ranges and thus are especially vulnerable to habitat loss and fragmentation. Increasing connectance among habitat patches is therefore a common conservation strategy, based in part on models showing that increased migration between subpopulations can reduce vulnerability arising from population isolation. Although three-dimensional models are appropriate for exploring consequences to top predators, the effects of immigration on tri-trophic interactions have rarely been considered. To explore the effects of immigration on the equilibrium abundances of top predators, we studied the effects of immigration in the three-dimensional Rosenzweig-MacArthur model. To investigate the stability of the top predator equilibrium, we used MATCONT to perform a bifurcation analysis. For some combinations of model parameters with low rates of top predator immigration, population trajectories spiral towards a stable focus. Holding other parameters constant, as immigration rate is increased, a supercritical Hopf bifurcation results in a stable limit cycle and thus top predator populations that cycle between high and low abundances. Furthermore, bistability arises as immigration of the intermediate predator is increased. In this case, top predators may exist at relatively low abundances while prey become extinct, or for other initial conditions, the relatively higher top predator abundance controls intermediate predators allowing for non-zero prey population abundance and increased diversity. Thus, our results reveal one of two outcomes when immigration is added to the model. First, over some range of top predator immigration rates, population abundance cycles between high and low values, making extinction from the trough of such cycles more likely than otherwise. Second, for relatively higher intermediate predator migration rates, top predators may exist at low values in a truncated system with impoverished diversity, again with extinction more likely.     

Imported diseases: an assessment of trends

Increasing travel, migration and other forms of international exchange have given a new importance to imported diseases in Canada. This is reflected in the maintenance of an immigration medical screening program, the development of specialized clinics in major cities, increasing interest in tropical medicine and international health, and the designation of a national reference centre for parasitology.The introduction of a point system for immigration selection in 1967 gave rise to a burgeoning influx of people from developing countries that may have plateaued only within the past year. While tuberculosis is probably the single most important health problem in immigration, parasitic infections are of increasing concern. The popularity of overseas travel among Canadians is now also a major factor in the introduction of exotic diseases into Canada. Importation of disease by international trade is far less common than by travel and immigration.On a community health scale a system of monitoring trends of immigration to Canada and travel of Canadians to and from countries with a known risk would likely provide the best indicator of trends in disease importation. Thus, there was an increase of almost threefold (11.6% to 31.1%) between 1965 and 1975 in the proportion of immigration to Canada from countries with a malaria risk and a 2.78-fold increase between 1967 and 1974 in the overall amount of Canadian travel to such countries from which statistics were available.     

Obstetric violence as immigration injustice: A view from the United States and Colombia

In September 2020, Project South, along with numerous other organizations, released a report detailing abuses in a Georgia Detention Center – including forced hysterectomies. Whatever other factors are at play, one of them is an intrinsic connection between obstetric violence against pregnant migrants and immigration injustice. It is not incidental that these acts – in US detention centers, along the US-Mexico border, in Colombian hospitals and clinics – are being perpetrated on immigrant bodies. And it is not accidental or random which immigrant bodies are vulnerable to these violations. Understanding and confronting obstetric violence directed at pregnant migrants, though, requires reconceptualizing the nature of obstetric violence itself. In particular, we must recognize that obstetric violence against pregnant Latin American migrants in the United States and Colombia is a type of immigration injustice, a means to perpetrate immigration injustice, and a product of immigration injustice. As such, bioethicists need to collaborate with immigration scholars to resist it. After providing some background on the nature of obstetric violence and some ways it is perpetuated against pregnant migrants in the United States and Colombia, I will give a brief overview of how I conceptualize immigration justice. From there, I explain how this type of obstetric violence constitutes a type of immigration injustice, a means to perpetrate immigration injustice, and a product of immigration injustice. My hope is that this analysis motivates bioethicists throughout the Americas to engage with immigration scholars and activists to confront the issue more forcefully.     

Teleconnection between the early immigration of brown planthopper (Nilaparvata lugens Stål) and ENSO indices: implication for its medium- and long-term forecast

Teleconnection between the early immigration of brown planthopper (BPH) and El Nino/Southern Oscillation (ENSO) indices from January of two years previously to the current June was investigated to make long-term forecast. The teleconnection results were as follows: ENSO indices which were significantly correlated with the early immigration of BPH were primarily sea surface temperature anomalies (SSTA) in N3, N4 and N3.4 regions, accounting for 71.8% of the total. Significant ENSO indices from two years and one year before the immigration events had a proportion of about 84%, while those in the current year only accounted for 16.7%. There was significantly negative correlation between the early immigration of BPH and SSTA in each Nino region from two years before to the previous spring, whereas there was significantly positive correlation between these two factors during the period from the previous winter to the current spring. The significant correlation between the early immigration of BPH and SSTA in each Nino region in the last summer and autumn did not show any obvious tendencies. The relationship between the southern oscillation index (SOI) and the early immigration of BPH was opposite to that between the immigration and SSTA in each Nino region. The above mentioned significant ENSO indices were used as key factors to build forecasting models for the early immigration of BPH by step-wise multiple linear regression analysis. Finally, 12 integrated forecasting models were obtained, which could make predictions 3–27 months ahead and had a predictive accuracy of 88.9%.     

Living on the good soil: relationships between soils,vegetation and human settlement during the late Allerød period in Denmark

The immigration of woody plants, especially Betula (tree birch), is examined in relation to geomorphological regions in a compilation of Late-glacial plant macrofossil records from Denmark. The immigration of trees led to a large ecological transformation of the landscape and had a major effect on the flora and fauna available to Palaeolithic people. We show that soil type was a controlling factor in the development of vegetation during the Allerød and Younger Dryas periods. Following the first immigration of trees during the Allerød period, woods became established in the eastern part of Denmark, where ice advances from the Baltic had deposited calcareous and clayey sediments. The western and northern parts of Denmark that are characterised by more sandy and non-calcareous sediments remained treeless throughout the whole Late-glacial period. Finds from the Bromme Culture are concentrated in the region which was wooded, suggesting that the regional variable environment allowed local adaptations using the diverse resources available.     

Biodiversity and the Lotka-Volterra theory of species interactions: open systems and the distribution of logarithmic densities

Theoretical interest in the distributions of species abundances observed in ecological communities has focused recently on the results of models that assume all species are identical in their interactions with one another, and rely upon immigration and speciation to promote coexistence. Here we examine a one-trophic level system with generalized species interactions, including species-specific intraspecific and interspecific interaction strengths, and density-independent immigration from a regional species pool. Comparisons between results from numerical integrations and an approximate analytic calculation for random communities demonstrate good agreement, and both approaches yield abundance distributions of nearly arbitrary shape, including bimodality for intermediate immigration rates.