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Introduction: \ud International Medical Graduates (IMGs) represent a large portion of practicing doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK’s General Medical Council (GMC) recently set targets to ‘eliminate disproportionate complaints’ and ‘eradicate disadvantage and discrimination in medical education’. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs, to identify factors affecting IMGs’ professional practice (either directly or indirectly).\ud \ud Methods: \ud In September 2019 we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors’ themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts.\ud \ud Results: \ud Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practicing in all 6 continents in a range of settings, including primary and secondary care. We developed 5 key concepts: Migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the 4 main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented.\ud \ud Conclusions: \ud This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.

The integrity and function of catecholamine neurotransmitter systems can be assessed using neuromelanin-sensitive MRI (NM-MRI). The relevance of this method to neurodegenerative and psychiatric disorders is becoming increasingly evident, and it has potential as a clinical biomarker.To support future application of NM-MRI as a clinical biomarker by defining the normative range of NM-MRI signal and volume metrics in cognitively normal older adults.Prospective.A total of 152 cognitively normal older adults aged 53-86 years old, including 41 participants who had follow-up NM-MRI data collected 9-16 months later.A 3.0 T; NM-MRI turbo spin echo and T1-weighted magnetization-prepared rapid acquisition with gradient echo sequences.NM-MRI images were processed to yield summary measures of volume and signal (contrast-to-noise ratio, CNR) for the substantia nigra (SN) and locus coeruleus (LC) using a recently developed software employing a fully automated algorithm. Change in these metrics over time was also assessed.Mean and standard deviation of NM-MRI metrics were calculated; change over time was tested for significance using 1-sample t-tests. P values 0.05 were considered statistically significant.At baseline SN signal (CNR) was 10.02% (left) and 10.28% (right) and LC signal was 24.71% (left) and 20.42% (right). Baseline SN volume was 576 mmWe report normative values for NM-MRI signal and volume in the SN and LC of cognitively normal older adults and explore their change over time. These values may help future efforts to use NM-MRI as a clinical biomarker by facilitating identification of patients with extreme NM-MRI values.1.

Background ABO blood groups have been linked to susceptibility to infection with certain microorganisms, including coronaviruses. We examined the relationship between blood group and clinical outcomes in individuals infected with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and compared their blood group distribution with the general population. Methods At the inception of the pandemic, all individuals testing positive for SARS‐CoV‐2 in Kuwait were admitted to one designated coronavirus disease 2019 (COVID‐19) hospital and enrolled in a prospective registry. Patients admitted from February 24 to May 27, 2020, were stratified according to blood group. As a control, blood groups of 3,730,027 anonymized individuals representing almost Kuwait's entire population were obtained from a national database. Results Of 3305 SARS‐CoV‐2–positive patients, 37.1%, 25.5%, 28.9%, and 8.5% were groups O, A, B, and AB, respectively. Univariate analysis revealed no significant differences in severe clinical outcomes or death among the blood groups. However, multivariable analysis demonstrated that group A individuals had higher odds of developing pneumonia compared with non–group A (adjusted odds ratio 1.32, 95% confidence interval 1.02–1.72, p

Clinical presentation of coronavirus disease‐2019 (COVID‐19) ranges from asymptomatic to severe and life‐threatening. National‐level registries found that children, generally, have less severe disease when compared with adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID‐19 patients in Kuwait, and to estimate the potential duration of viral shedding. A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from February 29 to April 30, 2020. During the study period and as part of the public health measures, all severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients from 1 month to 18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed. We found that 67.9% (95% CI, 59.4%–75.3%) of 134 SARS‐CoV‐2‐infected children were asymptomatic. Median PCR positivity was 15 days and did not vary with symptoms. Among patients who had laboratory investigations and chest imaging, symptomatic infection was associated with elevated C‐reactive protein and procalcitonin, and radiographic pneumonia. Asymptomatic SARS‐CoV‐2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, regardless of symptoms.

This study is aimed at analyzing the effects of COVID-19 pandemic on the financial performance of Chinese listed companies. We applied pooled ordinary least square (OLS) regression as a baseline methodology to determine the effects of COVID pandemic on the financial performance of Chinese listed companies. We found that the small- and medium-sized companies are most affected by this pandemic, in addition to that our analysis has revealed that serious-impact areas and industries which were worst hit by the COVID-19 experienced a sharper decline in financial performance as compared to other industries. The findings of this study have broad implications for policymakers, as it is evident that governments, banks, regulatory bodies, and central banks must combine forces to tackle the financial and economic impacts of COVID-19 crises. They should come up with comprehensive policies to tackle the adverse impact of such crises in the future as well. Actions such as proving loans and rescheduling existing loans to worst-hit sectors such as tourism, airline industry, etc. are starting point. The disclosure of facts and figure by officials regarding the status of health care number of infections can reduce the chances of panic situations in the future.

Well-ordered CdTe/TiO2 heteronanostructure arrays are fabricated via a convenient anodic aluminum oxide template-directed approach and applied to photoelectrochemistry and solar energy devices. Both the CdTe and TiO2 present a decent crystalline quality. In comparison to the photoanode with only TiO2 nanotube array, the CdTe/TiO2 heteronanostructure electrodes possess a dramatic performance improvement.

Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

Noise reduction or denoising is required for visual improvement or as a preprocessing step for subsequent processing tasks, such as image compression and analysis. Therefore, denoising has become a highly desirable and essential process in multimedia applications. The aim of all denoising processes, especially in natural images, is to uncover the true image from the observed noisy image, ideally removing the additive white Gaussian noise (AWGN) while producing a sharp, useful image without losing finer details. Generally, most of the noise obtained during acquisition and transmission of the natural images is assumed to be AWGN. In this study, we propose a new adaptive denoising framework based on second-generation wavelet domain using hidden Markov models (SGWD-HMMs) with some new local structure, utilizing the fact that the images are nonstationary with singularities and some smooth areas that can be considered as stationary. The dependencies among wavelet coefficients can be efficiently captured by HMMs since the dependence between two wavelet coefficients dies down quickly as their distance becomes big. Quite remarkably, experimental results verify the effectiveness of SGWD-HMMs in benchmark images when compared with other state-of-the-art denoising algorithms. It gives competitive results in the subjective and objective assessments, but it is computationally more expensive. © 2016 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.