Challenges and experiences of young medical specialists in establishing private clinical practice

Background@#The field of medicine is constantly changing. Notable changes occur in the patterns of clinical practice, business of medicine, shift in demographics/generation of the health care workforce, emergence of sub-specialization; and advances in research and technology. These changes can affect the way young physicians establish their practice and this is an area not addressed by the medical education and training. @*Purpose@#There is little data in the literature regarding the experience of young physicians in establishing clinical practice. This study was undertaken to answer the central question: Among physicians in the field of Internal Medicine with or without subspecialty who graduated from training in 2013 to 2018, what were the issues and challenges that they faced as they established their clinical practice in the urban or mixed setting?@*Methodology@#Qualitative research-case study; Key informant interview was conducted among junior Internal Medicine consultants who satisfied the inclusion criteria. Data analysis used thematic analysis consisting of reading, writing notes, describing, and classifying transcripts according to categories and themes. @*Results@#After a comprehensive analysis of narratives, five emergent themes surfaced: “Tough Days” (Period of figuring out the system; Need for Self-introduction; Few patients and Feelings of frustration and depression); “Torn and Divided” (Unpredictable work schedule and workload; Lack of time for issues outside career); “Temporary Debt” (Large start-up cost; Expensive maintenance); “Difficult but Tolerable” (Family support; Call-a-colleague; Debt of gratitude to mentors) and lastly “Dreams and To-do’s”. @*Conclusions@#Our respondents have experienced substantial challenges in starting clinical practice. Learning the ways of the healthcare business, effectively promoting oneself to the community, dealing with the emotional turmoil of having few patients, coming up with a strategic schedule and area of practice, and looking for funds and paying it back, were the challenges and experiences of these young medical specialists as they establish their careers in the urban and/or rural setting.

Research Advances in the Action of Toll-like Receptor 2 in Acupuncture Information Start-up and Conduction Mechanism / 上海针灸杂志

This article summarizes the literature about studies onToll-like receptor 2and acupuncture points and explores thecorrelationand action of Toll-like receptor 2inacupuncture information start-up and conduction mechanism from the biological characteristics of Toll-like receptor 2and the relationship of Toll-like receptor 2-mediated signal pathways tomast cells, acupuncture effects and the immuno-neuro-endocrine network.

Biofilm formation for organic matter and sulphate removal in gas-lift reactors

A start-up strategy was presented and evaluated to obtain a well-established biofilm in a gas lift-reactor capable both for the removal of organic matter and sulphate. Pumice stone was used as material support. The influence of shear forces, given by the biogas recirculation, the effect of the COD/SO4-2 ratio and the OLRs increase were evaluated on the reactor performance. From the first stages, cell colonization was observed along with the presence of extracellular polymeric substances. The COD and sulphate removal was over 70 percent, for all conditions. The increase of gas flow did not have an adverse effect on biofilm development even though there was some detachment. Specific methanogenic activity of the biofilm increased along the experiments. Operational parameters as alkalinity and alkalinity ratio were within the recommended values for the operation with sulphate-rich wastewater. For gas-lift reactors operation it becomes fundamental to have a suitable start-up strategy that takes into account the initial biofilm development from a non-acclimatized biomass.

Evaluation of sequential aerated treatment of wastewater from hardboard mill

Wastewater from a hardboard mill characterized by a high organic content (15-30 g/L COD) was studied in a bench scale sequential aerated system in order to define a start up strategy. Inlet COD concentration varied from 0.5 to 25 g/L and the hydraulic retention time was maintained at 5 days. The sequential system proposed could reduce BOD, COD, TSS and phenol over 90 percent except when the inlet COD concentration was lower than 25 g/L.

Água residual proveniente de uma indústria de tabuleiro de fibra dura caracterizada por ter um elevado conteúdo orgânico (15-30 g/L DQO) foi estudada utilizando um sistema arejado seqüêncial de forma a definir uma estratégia de start up. A concentração de DQO na entrada do sistema variou na faixa de 0,5-25 g/L e o tempo de residência hidráulico foi mantido em 5 dias. O sistema seqüêncial proposto reduziu DBO, DQO, SST e fenol sobre 90 por cento quando a concentração de DQO na entrada foi menor a 25 g/L.