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The “Brain Drain”: Factors influencing physician migration to Canada

Health 2013年第1期5卷 125-137页

作者： Aisha Lofters morgan slater Naomi Thulien Department of Family and Community Medicine St. Michael’s Hospital Toronto Cnada Department of Family and Community Medicine University of Toronto Toronto Canada Lawrence s. Bloomberg Faculty of Nursing University of Toronto Toronto Canada

Context: Higher income countries have an average physician density of 300 physicians per 100,000 people. In stark contrast, lower income countries have an average physician density of 17 physicians per 100,000 people. A major cause of this discrepancy is the migration of healthcare professionals from lower income to higher income countries, a phenomenon colloquially known as the “brain drain”. Objective: To explore factors that led International Medical Graduate (IMG) physicians to leave their home countries and migrate to Canada. Methods: An anonymous questionnaire with a mix of open- and close-ended questions was sent to 500 randomly selected IMG physicians practicing in Ontario, Canada. Results were analyzed using a mixed-method design utilizing both descriptive statistics and a thematic analysis approach. Results: 39 physicians met inclusion criteria and completed the survey. The majority were 50 years or older, and over 60% were male. The most common reason for emigration from their home country was the socioeconomic and/or political situation, and the most common reason for selecting Canada was family issues. suggestions for how brain drain could be stemmed fell into three broad categories: 1) more accurate information about lack of opportunities in Canada, 2) more continuing medical education opportunities in home countries, and 3) address issues such as safety and quality of life in home countries. Conclusions: This survey provides insights into the reasons for emigration and immigration for international medical graduates. The results of this survey can assist stakeholders in working toward appropriate and acceptable solutions to the brain drain.

关键词： Brain Drain International Medical Graduates Migration

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predictors of Low Colorectal Cancer screening in an Urban Academic Family practice

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Open Journal of preventive Medicine 2014年第6期4卷 438-445页

作者： shaelyn Culleton morgan slater Aisha Lofters Centre for Research on Inner City Health The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Canada Department of Family & Community Medicine St. Michael’s Hospital Toronto Canada Department of Family & Community Medicine University of Toronto Toronto Canada

purpose: The primary objective was to describe the specific socio-demographic variables that are associated with colorectal cancer (CRC) under-screening in an urban, inner city population. The secondary objective was to determine the overall proportion of eligible patients who are not appropriately screened. Methods: A retrospective chart review of patients eligible for average-risk CRC screening as per Ontario’s ColonCancerCheck program guidelines was conducted at an academic, inner city family health practice associated with st. Michael’s Hospital in Toronto, Ontario. simple measures of association, including t-tests and chi-square tests, were used to determine the relationships between screening and demographic characteristics. Based on a type I error rate of 0.05 and an appropriate sample size, the calculated power for this study was 0.82. Results: A total of 200 patients were randomly selected;54% were male;the majority were non-immigrants (77.5%) and were employed or retired (76.5%). Fifty-five percent of screened patients were up to date as per guidelines;29.5% and 31% were up to date with a fecal occult blood test or a colonoscopy respectively. Individuals with psychiatric illness (p = 0.0005), with no history of prior cancer screening for other cancers (p = 0.0001), on disability or unemployed (p = 0.0010), or who were younger (p = 0.0062) were significantly less likely to undergo CRC screening. Conclusion: Colorectal cancer screening rates at this academic, urban family practice were very similar to province wide screening rates. Future studies should focus on group specific interventions to increase CRC screening uptake in low CRC screened populations.

关键词： Colorectal Neoplasms Early Detection of Cancer Vulnerable population secondary prevention

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Critical Evaluation for Alternative Causes of Drug Induced and Herbal Induced (DILI/HILI) Hepatotoxicity

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Health 2016年第9期8卷 800-804页

作者： Vasilios Frankos Raushanah Najeeullah Joel morgan Global Regulatory Compliance and product safety Herbalife International of America Inc. Torrance CA USA post Market Medical surveillance Global Post-Market Safety Surveillance Herbalife International of America Inc. Torrance CA USA Global post-Market safety surveillance Herbalife International of America Inc. Torrance CA USA

The objective of this review is to highlight the continued exclusion of discussion in the literature regarding alternative causes and proper causality assessment of cases of hepatotoxicity when use of dietary supplements is reported. Though independent experts are working diligently to advance the discussion related to alternative causes of hepatotoxicity resulting in idiosyncratic drug-induced liver injury/herb-induced liver injury (DILI/HILI), the literature continues to recite the same cases, such as those presented here, to reiterate potentially biased positions and ignore current, standardized and valid evaluations utilizing the Roussel Uclaf Causality Assessment Method (RUCAM). several historical cases purporting hepatotoxicity induced by use of dietary supplements are presented in this review to demonstrate how such cases may be improperly assessed due to bias, inconsistent use of causality assessment methods, as well as use of causality assessment methods deemed obsolete. This in essence, delays any true progress in establishing sound criteria to determine and address the actual cause(s) of DILI/HILI.

关键词： Drug-Induced Liver Injury RUCAM Herb-Induced Liver Injury Causality Dietary supplement

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Transepithelial leak in Barrett's esophagus patients: The role of proton pump inhibitors

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World Journal of Gastroenterology 2012年第22期18卷 2793-2797页

作者： Christopher Farrell Melissa morgan Owen Tully Kevin Wolov Keith Kearney Benjamin Ngo Giancarlo Mercogliano James J Thornton Mary Carmen Valenzano James M Mullin Division of Gastroenterology Lankenau Hospital Wynnewood PA 19096 United States Lankenau Institute for Medical Research Wynnewood PA 19096 United States

AIM： To determine if the observed paracellular sucrose leak in Barrett＇s esophagus patients is due to their pro- ton pump inhibitor （ppI） use. METHODs： The in vivo sucrose permeability test was administered to healthy controls, to Barrett＇s patients and to non-Barrett＇s patients on continuous ppI thera- py. Degree of leak was tested for correlation with pres- ence of Barrett＇s, use of ppIs, and length of Barrett＇s segment and duration of ppI use. REsULTs： Barrett＇s patients manifested a near 3-fold greater, upper gastrointestinal sucrose leak than healthy controls. A decrease of sucrose leak was ob- served in Barrett＇s patients who ceased ppI use for 7 *** initial introduction of ppI use （in a ppI-na＇ive population） results in dramatic increase in sucrose leak, long-term, continuous ppI use manifested a slow spon- taneous decline in leak. The sucrose leak observed in Barrett＇s patients showed no correlation to the amount of Barrett＇s tissue present in the esophagus. CONCLUsION： Although future research is needed to determine the degree of paracellular leak in actual Barrett＇s mucosa, the relatively high degree of leak ob- served with in vivo sucrose permeability measurement of Barrett＇s patients reflects their ppI use and not their Barrett＇s tissue perse.

关键词： Barrett's esophagus sucrose Tight junc-tion paracellular, Omeprazole proton pump inhibitor Transepithelial

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The Impact of Cooperative Leaming and Empowerment on the performance of First-Year Accounting students

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Journal of Modern Accounting and Auditing 2013年第3期9卷 348-355页

作者： Wahida Zraa Marie Kavanagh Melissa Johnson morgan University of southem Queensland Queensland Australia

Empowerment in learning has been a topic of discussion for the last two decades. Empowered learners are not only believed to achieve greater content learning but are also thought to better demonstrate competencies such as communication, teamwork, and problem solving. These competencies are becoming increasingly important as the role of professional accountants evolves and diversifies. This paper examines first-year accounting students＇ perceptions of empowerment based on two different learning styles： cooperative learning and traditional classroom instruction. A quantitative research design was used to survey 279 first-year business degree students studying at institutions in Libya. The results indicated that students who attended cooperative learning classes were more empowered in terms of the impact they believed they could have on class discussions and the meaningfulness they attributed to the tasks being discussed. In addition, students taught by cooperative learning methods recorded significantly higher end of term exam results than those students who received traditional classroom instruction. In conclusion, this research indicates that the teaching method used in classroom instruction may impact an accounting student＇s levels of empowerment and subsequently their critical thinking, problem solving, writing skills, and technical accounting competencies.

关键词： student empowerment cooperative learning accounting education

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Extreme hyperbilirubinemia: An indicator of morbidity and mortality in sickle cell disease

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World Journal of Hepatology 2019年第3期11卷 287-293页

作者： John paul Haydek Cesar Taborda Rushikesh shah preeti A Reshamwala morgan L McLemore Fuad El Rassi saurabh Chawla Department of Medicine Emory University School of Medicine Division of Digestive Diseases Department of Medicine Emory University School of Medicine Department of Hematology and Medical Oncology Emory University School of Medicine

BACKGROUND sickle cell disease(sCD) is a disorder that results in increased hospitalizations and higher mortality. Advances in management have resulted in increases in life expectancy and led to increasing awareness of sickle cell hepatopathy(sCH).However, its impact in patients on the natural history and outcomes of sCD is not known. Our study aims to describe the prevalence of extreme hyperbilirubinemia(EH), one form of sCH, its effect on morbidity and mortality,and correlations between sickle cell genotype and sCH type. We hypothesize that EH is associated with higher morbidity and *** To investigate the effects of EH on morbidity and mortality among patients with *** This retrospective cohort study was performed using a database of patients with sCD treated at Grady Memorial Hospital between May 2004 and January *** with EH(defined as total bilirubin above 13.0 mg/dL) were identified. A control group was identified from the same database with patients with total serum bilirubin ≤ 5.0 mg/dL. Electronic medical records were used to extract demographic information, laboratory values, radiology results, current medications, need for transfusions and mortality data. Two samples T-test, chi-squared test and Fisher's exact test were then used to compare the parameters between the two *** Out of the database, fifty-seven charts were found of patients with bilirubin > 13 mg/dL. prevalence of severe sCH as defined by EH was 4.8%(57/1172). There were no demographic differences between patients with and without *** genotypic differences existed between the two groups, with hemoglobin ss sCD being much higher in the EH group(p patients with severe EH had a significant elevations in alanine aminotransferase(157.0 ± 266.2 IU/L vs 19.8 ± 21.3 IU/L, p spartate aminotransferase(256.5 ± 485.9 U/L vs 28.2 ± 14.7 U/L, p phosphatase(218.0 ± 176.2 IU/L vs 85.9 ± 68.4 IU/L, p patients

关键词： sickle cell disease sickle cell hepatopathy Liver diseases Extreme hyperbilirubinemia Mortality

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Do patients in a primary Care practice Know the Current Cancer screening Guidelines?

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Open Journal of preventive Medicine 2014年第5期4卷 199-306页

作者： Neil D’souza morgan slater Aisha Lofters Department of Family and Community Medicine St. Michael’s Hospital-University of Toronto Toronto Canada

Background: In spite of supporting evidence and widespread promotional campaigns, screening rates for breast, cervical and colorectal cancers in Ontario are lower than expected. These low screening rates may be partially due to lack of knowledge on the part of patients. Given the importance of early detection to reduce cancer mortality and morbidity, it is prudent to investigate where knowledge deficits may exist. The purpose of this study was to assess patient knowledge of the Ontario screening guidelines for breast, cervical and colorectal cancers. Methods: patients of a family health team in Toronto, Ontario were surveyed regarding their knowledge of cancer screening guidelines. Questions included knowledge regarding the test, screening interval and age for cancer screening for breast, cervical and colorectal cancers as well as sociodemographic characteristics. Responses were summarized using descriptive statistics. Results: A total of 117 patients were surveyed. Knowledge of the appropriate screening test was high for breast and cervical cancer (85.5% and 70.1% respectively) though much lower for colorectal cancer (17.1%). Knowledge regarding the age that screening should occur and the screening intervals were much lower across all cancer types. For breast cancer, 16.2% knew the age screening should occur and 30.8% knew the screening interval. For cervical cancer, 6.8% knew the age screening should occur and only 4.3% knew the screening interval. For colorectal cancer, 32.5% knew the age to start screening and 26% knew the screening interval. Conclusions: Knowledge of the cancer screening guidelines appeared to be low across all cancer types, particularly for the ages at when screening should occur and the appropriate screening intervals. These results suggest that public health practitioners and cancer prevention organizations may need to increase efforts for patient education on cancer screening.

关键词： Cancer screening Health promotion Illness prevention

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Coherent-interface-induced strain in large lattice-mismatched materials:A new approach for modeling Raman shift

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Nano Research 2022年第3期15卷 2405-2412页

作者： Andrian V.Kuchuk Fernando Mde Oliveira pijush K.Ghosh Yuriy I.Mazur Hryhorii V.stanchu Marcio D.Teodoro morgan E.Ware Gregory J.salamo Institute for Nanoscience and Engineering University of ArkansasFayettevilleAR 72701USA Departamento de Física Universidade Federal de São CarlosSão CarlosSP 13565-905Brazil Department of Electrical Engineering University of ArkansasFayettevilleAR 72701USA

strain engineering as one of the most powerful techniques for tuning optical and electronic properties of III-nitrides requires reliable methods for strain *** this work,we reveal,that the linear model based on the experimental data limited to within a small range of biaxial strains(s widely used for the non-destructive Raman study of strain with nanometer-scale spatial resolution is not valid for the binary wurtzite-structure group-III nitrides GaN and ***,we found that the discrepancy between the experimental values of strain and those calculated via Raman spectroscopy increases as the strain in both GaN and AlN ***,a new model has been developed to describe the strain-induced Raman frequency shift in GaN and AlN for a wide range of biaxial strains(up to 2.5%).Finally,we proposed a new approach to correlate the Raman frequency shift and strain,which is based on the lattice coherency in the epitaxial layers of superlattice structures and can be used for a wide range of materials.

关键词： Raman spectroscopy strain lattice coherency III-nitrides high-resolution X-ray diffraction(HRXRD)

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Multi-Institutional Us Experience of the Occlutech AFR Device in Congenital and Acquired Heart Disease

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Congenital Heart Disease 2022年第1期17卷 107-116页

作者： Barry O’Callaghan Jenny Zablah Joseph Vettukattil Daniel Levi Morris salem Allison Cabalka Jason Anderson Makram Ebeid Ryan Alexy Gareth J.morgan The Heart Institute Children’s Hospital ColoradoAuroraUSA pediatric Cardiology Helen DeVos Children’s HospitalGrand RapidsUSA pediatric Cardiology UCLA HealthMattel Children’s HospitalLos AngelesUSA pediatric Cardiology UCLA Medical CentreLos AngelesUSA pediatric Cardiology Mayo ClinicRochesterUSA pediatric Cardiology University of Mississippi Medical CenterJacksonUSA pediatric Cardiology Riley Hospital for Children at Indiana University HealthIndianapolisUSA

Objectives:To detail the Us multi-institutional experience with the Occlutech©(Occlutech International AB,Helsingborg,sweden)atrial flow regulator(AFR)in children and adults with acquired or congenital heart ***:The creation of a long-term atrial communication is desirable in several cardiovascular disease phenotypes,most notably pulmonary arterial hypertension,disorders of increased left ventricular filling and increased cavopulmonary pressures in patients with a Fontan type ***:patients were identified for inclusion from the AFR device manufacturer *** was collected using a RedCap database following IRB approval.8 weeks of follow up data was sought for each patient based on available *** was analyzed and summarized using ***:We report the experience of 6 Us centers in the implantation of AFR devices in 15 patients,across a wide age range,with different disease phenotypes and a variety of *** was technically successful in all patients and improvement was noted in both clinical and hemodynamic *** were no immediate or intermediate term complications reported.3 patients died remote from *** deaths were not felt to be related to the AFR device or related procedural ***:Compassionate use of the AFR device in children and adults with congenital&acquired heart disease is technically feasible and produces beneficial short term hemodynamic and symptomatic *** uptake of this technique and treatment at specialist centers has the potential to provide significant benefits to a variety of complex patients with currently limited treatment options and indeterminate prognosis.

关键词： Congenital heart disease pulmonary hypertension left atrial hypertension single ventricle palliation diastolic heart failure

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Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres

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World Journal of Gastroenterology 2019年第39期25卷 5991-6005页

作者： Melissa Frizziero Xin Wang Bipasha Chakrabarty Alexa Childs Tu V Luong Thomas Walter Mohid s Khan Meleri morgan Adam Christian Mona Elshafie Tahir shah Annamaria Minicozzi Wasat Mansoor Tim Meyer Angela Lamarca Richard A Hubner Juan W Valle Mairéad G McNamara Department of Medical Oncology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of Analytics and Development The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of pathology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of Medical Oncology Royal Free London NHS Foundation TrustLondon NW3 2QGUnited Kingdom UCL Cancer Institute University College LondonLondon WC1E 6AGUnited Kingdom Department of Histopathology Royal Free London NHS Foundation TrustLondon NW3 2QGUnited Kingdom Department of Gastroenterology and Medical Oncology Edouard Herriot HospitalHospices Civils de LyonLyon 69003France Department of Gastroenterology Cardiff and Vale University Health BoardUniversity Hospital of WalesCardiff CF14 4XWUnited Kingdom Department of Cellular pathology Cardiff and Vale University Health BoardUniversity Hospital of WalesCardiff CF14 4XWUnited Kingdom Department of pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B15 2THUnited Kingdom Department of Hepatology University Hospitals Birmingham NHS Foundation TrustBirmingham B15 2THUnited Kingdom Department of surgical Oncology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Division of Cancer sciences University of ManchesterManchester M13 9PLUnited Kingdom

BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic *** is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be *** To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of *** Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European *** data were retrospectively collected from medical *** samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of *** responses to systemic treatment were assessed according to the Response Evaluation Criteria in solid Tumours ***-Meier analysis was applied to estimate survival *** between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).REsULTs sixty-nine consecutive patients identified;Median age at diagnosis:64 ***:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases *** distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine ***-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of *** was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal *** localised cases,median recurre

关键词： Mixed neuroendocrine non-neuroendocrine neoplasm 2017 World Health Organisation classification Mixed adeno-neuroendocrine carcinoma Gastro-enteropancreatic tract Digestive system Neuroendocrine neoplasms survival outcomes

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