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The aim of this study was to assess the characteristics of asylum-seeking children with medical complexity visiting a tertiary care hospital in Switzerland, detailing their underlying medical conditions and management. Asylum-seeking patients with frequent visits between January 2016 and December 2017 were identified using administrative and electronic health records. Of 462 patients, 19 (4%) fulfilled the inclusion criteria with 811 (45%) visits. The age of the 19 patients ranged from 0 to 16.7 years (median of 7 years) with two main age groups identified: < 2 years and > 12 years. Nine (47%) patients originated from Syria. A total of 34/811(4%) visits were hospital admissions, 66/811 (8%) emergency department visits and 320/811(39%) outpatient department visits. In children < 2 years genetic diseases (5/8; 63%) and nutritional problems (6/8; 75%) were most common; in adolescents, orthopedic diseases (4/8; 50%) and mental health problems (4/8; 50%). Asylum-seeking children with medical complexity represent a small but important group of patients requiring frequent medical consultations. The high proportion of young patients with genetic diseases and severe nutritional problems suggests that new strategies are required in the management of this specific group of asylum-seeking children. This could be achieved by improved co-ordination between hospital and non-hospital care exploring options for integrated care.

BACKGROUND: Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. METHODS: We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. RESULTS: A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. CONCLUSIONS: Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

BACKGROUND: In the last decade an increasing number of asylum-seeking children arrived in Europe and local healthcare systems have been challenged to adapt to their health needs. The aim of this study was to compare the spectrum of disease and management of asylum-seeking and non-asylum-seeking children requiring hospital admission. METHODS: This was a retrospective cohort study including health data from recently arrived asylum-seeking and non-asylum-seeking children admitted between January 2016 and December 2017. Data were collected using electronic administrative and medical records. RESULTS: Of 11,794 admissions of 9407 patients, 149 (1%) were asylum-seeking and 11,645 (99%) from non-asylum-seeking children. In asylum-seeking children the median age was 4 years (interquartile range [IQR] 0–13) with 61% males and in non-asylum-seeking children 4 years (IQR 0–11) years with 56% males. Respiratory infections accounted for 17–19% of admissions in both groups. Rare infectious diseases were more frequent in asylum-seeking children (15 vs 7%; difference in proportions 0.08, 95% confidence interval [CI] 0.02–0.14; p <0.001,). Injuries were more frequent in non-asylum-seeking children (22 vs 13%; difference in proportions 0.09, 95% CI 0.04–0.014; p <0.01). Admissions for mental health disorders were infrequent but more common in asylum-seeking children (6 vs 3%; difference in proportions 0.03, 95% CI −0.01 – 0.07; p = 0.02) Prescription of analgesics was lower in asylum-seeking than non-asylum-seeking children (3.4 vs 6.5 accounting units per admission). Antibiotic prescription was comparable in both groups. CONCLUSION: Asylum-seeking children represent a small number of total admissions. Age distribution and main reason for admission being diseases of the respiratory system were comparable in asylum-seeking and non-asylum-seeking children. Rare infections and mental health disorders are important diseases in asylum-seekin

BACKGROUND: Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients. METHODS: This is a retrospective, hospital-based study. The study was done at the University Children's Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients. All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes. The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score. RESULTS: A total of 75'199 hospital visits were included, of which 63'405 were emergency department visits and 11'794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients' admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297). CONCLUSIONS: Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations

OBJECTIVES: This study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited. SETTING: The study took place in a paediatric tertiary care hospital in Basel, Switzerland. PARTICIPANTS: Interviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data. RESULTS: The interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child's health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver-provider relationship, the presence of interpreters and immediate availability of treatment. CONCLUSIONS: A mismatch of personal competencies and external challenges importantly influences the caregiver-provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural traini

BACKGROUND: Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. METHODS: We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. RESULTS: Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. CONCLUSIONS: The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.

The results of the Phase 1 Toxics Loading study suggested that runoff from the land surface and atmospheric deposition directly to marine waters have resulted in considerable loads of contaminants to Puget Sound (Hart Crowser, Inc. 2007). The limited data available for atmospheric deposition fluxes throughout Puget Sound was recognized as a significant data gap. Therefore, this study provided revisions to prior estimates or first reported atmospheric deposition fluxes of polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), and select trace elements for Puget Sound. Samples representing bulk atmospheric deposition were collected during 2008 and 2009 at seven stations around Puget Sound spanning from Padilla Bay south to Nisqually River including Hood Canal and the Straits of Juan de Fuca. Revised annual loading estimates were calculated for each of the toxics and demonstrated an overall decrease in the atmospheric loading estimates except for PBDEs and total mercury (THg)., Published in the Journal of U.S. Army Med Dept p25-30, Apr-June 2007. Government or Federal Purpose Rights License. The original document contains color images.

Integrating contaminated sediment clean up and restoration issues within the larger perspective of watershed management are especially critical in populated coastal and estuarine areas with multiple sources of stress from urbanization and development as well as sediment contaminated from historical sources. Sinclair Inlet and Dyes Inlet, located in the Puget Sound WA, have received historical inputs of contamination from military installations, industrial activities, municipal outfalls, and other nonpoint sources. As part of the record of decision to remediate contaminated sediments near the Puget Sound Naval Shipyard in Sinclair Inlet, sediments were dredged from contaminated areas, placed in an adjacent confined aquatic disposal pit, and covered with clean material dredged to deepen the navigational channel and turning basin. Other cleanup activities included restoring shoreline areas to minimize contaminated soil infiltration and improve shoreline habitat, and conducting a comprehensive cleaning, inspection, and repair of the Shipyard's storm water system. Concurrently, the City of Bremerton, also located in the Inlets, has made significant improvements to its combined sewer and storm water system, nearly eliminating combined sewer overflows and achieving a marked improvement in the water quality of the Inlets. Historical trends of contamination in the Inlets obtained from age-dated sediment cores show contamination levels peaking between 1940 and 1960 followed by an obvious decease in contaminant loads in the most recent deposits. During the interval between 1997-1978 and 2003 (following clean up activities) the sediments in Sinclair Inlet and Dyes Inlet changed significantly in texture by becoming, on average, nearly a full phi size coarser. Currently, models are being developed to simulate contaminant runoff and loading from the watershed and the fate and transport of contaminants in Sinclair and Dyes Inlets., Presented at the International Conference on Remediation of Contaminated Sediments (3rd) held in New Orleans, LA on 24-27 January 2005. The original document contains color images.

Sinclair Inlet and Dyes Inlet were listed on the State of Washington's 1998 Section 303(d) list of impaired waters because of fecal coliform contamination in marine waters and tributary streams, heavy metals and toxic organics in the bottom sediments, and polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyl (PCBs), aldrin, dieldrin, mercury (Hg), and arsenic (As) in the tissues of marine organisms. A cooperative watershed agreement for the inlets was established among the Puget Sound Naval Shipyard (PSNS) and Intermediate Maintenance Facility (IMF); the Environmental Protection Agency (EPA); the Washington State Department of Ecology (Ecology); and other technical stakeholders. The ENVironmental inVESTment group (ENVVEST) was formed to assist regulatory agencies in developing total maximum daily loads (TMDL) and to assess ecological risk within the watershed. ENVVEST identified contaminant loading during storm events as a data gap for the inlets. The 2005 storm water sampling program collected flow and water quality data from selected marine locations, representative streams, storm water outfalls, storm water drainages, and waste water treatment outfalls discharging in the Sinclair and Dyes Inlet watershed during seven winter/spring storm events. Storm event mean samples were analyzed for conventional water quality parameters, metals, and organic contaminants. The 2005 storm water data were reported in a series of three reports: conventional parameters, metals chemistry, and organic contaminants. This report summarizes the 2005 conventional water quality data and quality control sample information., Prepared in collaboration with Battelle Marine Sciences Laboratory, Sequim, Washington and Pacific Northwest National Laboratory, Richland, Washington. Sponsored in part by Dept. of Energy.

Sinclair Inlet and Dyes Inlet were listed on the State of Washington's 1998 Section 303(d) list of impaired waters because of fecal coliform contamination in marine waters and tributary streams, heavy metals and toxic organics in the bottom sediments, and polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyl (PCBs), aldrin, dieldrin, mercury (Hg), and arsenic (As) in the tissues of marine organisms. A cooperative watershed agreement for the inlets was established among the Puget Sound Naval Shipyard (PSNS) and Intermediate Maintenance Facility (IMF); the Environmental Protection Agency (EPA); the Washington State Department of Ecology (Ecology); and other technical stakeholders. The ENVironmental inVESTment group (ENVVEST) was formed to assist regulatory agencies in developing total maximum daily loads (TMDL) and to assess ecological risk within the watershed. ENVVEST identified contaminant loading during storm events as a data gap for the inlets. The 2005 storm water sampling program collected flow and water quality data from selected marine locations, representative streams, storm water outfalls, storm water drainages, and waste water treatment outfalls discharging in the Sinclair and Dyes Inlet watershed during seven winter/spring storm events. Storm event mean samples were analyzed for conventional water quality parameters, metals, and organic contaminants. The 2005 storm water data were reported in a series of three reports: conventional parameters, metals chemistry, and organic contaminants. This report summarizes the 2005 organic contaminants data and quality control sample information., Sponsored in part by DOE.

This document presents the 2005 storm-event sampling plan for the Puget Sound Naval Shipyard & Intermediate Maintenance Facility (PSNS&IMF) Project ENVVEST. This plan has been prepared under the Project ENVVEST Final Project Agreement as a cooperative project among PSNS&IMF, the Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology), and technical stakeholders to help improve the environmental quality of the Sinclair and Dyes Inlet Watershed (US Navy, EPA and Ecology 2002). This sampling plan describes specific sampling activities to obtain data necessary to determine the loading and model the fate and transport of contaminants entering the receiving waters of Sinclair and Dyes Inlets (Table 1). This document identifies the objectives, procedures, and quality assurance/quality control (QA/QC) requirements for storm event sampling to be completed by Project ENVVEST for 2005. Upon completion of logistical planning and coordination with project participants and stakeholders, the 2005 sampling will commence in January 2005 and continue until sampling objectives are completed (June 2005). The major emphasis of the sampling will be to collect storm event samples from streams and storm water outfalls currently being monitored for flow within the watershed (Figure 1). Additional goals are to obtain data to support total loading and modeling analysis of contaminants discharged into Sinclair and Dyes Inlets, develop preliminary data on contaminant levels in nonpoint source runoff in Gorst to evaluate the potential for developing restoration alternatives, and assess the impact of storm event runoff on the water quality of the Inlets. Also, in cooperation with Ecology's Manchester Environmental Laboratory (MEL), a subset of stream and selected storm water outfalls will be screened for pesticide and herbicide compounds.

A system has been designed and constructed for high accuracy neutron cross section measurements using pulsed beam time-of-flight techniques. The detection system has been used to obtain neutron scattering cross sections for Al, Si, Fe, Ni, and Co at 9.0 MeV incident neutron energy and to obtain a survey of neutron scattering by Carbon from 7 to 9 MeV incident energy. The cross sections have a normalization uncertainty or accuracy of about 5%, precision of 2-3% for strongly excited groups, and a precision of 5-10% for weakly excited groups. The report presents detailed design criteria for the detection system, and a description of detector shielding constructed for the measurements. It also contains a study of the data corrections which most strongly influence the accuracy of results. (Modified author abstract)

The environmental legacy of uranium mining was evaluated by investigating the phase distribution of trace metals and oxyanions, including U and As, in two surface water bodies within a south Texas watershed hosting a high density of surface uranium mine pits and tailings. A livestock pond bordered by tailings was used as a model case-study site for evaluating oxyanion cycling under changing redox conditions while a quantitative mass balance model was constructed from monthly hydrological data for a downstream reservoir serving about 350 000 people. No evidence was found of anthropogenic impact of the uranium mines beyond a purely local scale, arsenic within the drainage basin being related to the interreaction of surface and groundwaters with U- and As-rich geological formations rather than to large-scale transport of contaminants from the pit and tailings. Seasonal evaporative concentration of As in the reservoir indicated the predominance of hydrodynamic over geochemical constraints on its cycling., The environmental legacy of uranium mining was evaluated by investigating the phase distribution of trace metals and oxyanions, including U and As, in two surface water bodies within a south Texas watershed hosting a high density of surface uranium mine pits and tailings. A livestock pond bordered by tailings was used as a model case-study site for evaluating oxyanion cycling under changing redox conditions while a quantitative mass balance model was constructed from monthly hydrological data for a downstream reservoir serving about 350 000 people. No evidence was found of anthropogenic impact of the uranium mines beyond a purely local scale, arsenic within the drainage basin being related to the interreaction of surface and groundwaters with U- and As-rich geological formations rather than to large-scale transport of contaminants from the pit and tailings. Seasonal evaporative concentration of As in the reservoir indicated the predominance of hydrodynamic over geochemical constraints on its cycling.