Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.

The isolation of microcrystalline cellulose (MCC) from empty fruit bunch fibre (EFB-fibre) using acid hydrolysis through steam treatment (autoclave) followed by ultrasonication has been successfully established. The important parameter studied was the concentration of sulphuric acid (5%, 15% and 25%) at variable fixed reaction time and temperature. The resulting MCC was characterized using FTIR, TGA, XRD and SEM. FTIR transmission at 1163 cm-1 confirmed that the structure of cellulose was retained after undergoing acid hydrolysis. Thermal stability of MCC increased after being treated with H2SO4, which was determined using TG analysis. The morphological features were identified using Scanning Electron microscope (SEM), which showed the diameters of MCC to be in the range of 10 to 200 µm. The structural property of MCC was studied using X-ray diffraction (XRD) and the results showed that the MCC produced has crystallinity index of 72%. The results revealed that the parameters used tend to influence the physicochemical properties of MCC produced. Therefore, the MCC isolated from EFB fibres will be used as precursor for future EFB derived nanocellulose as well as a promising subject in nanocomposite research.

The interest for microfibrillated cellulose (MFC) has been present within the academic sector since the 1980s, but recently this material has become commercially available as it is growing significantly in the industrial sector. Therefore, in this study the oil palm empty fruit bunch fibre was selected to be synthesised into MFC. This study focused on the effect of acid concentrations on the isolation of MFC from oil palm empty fruit bunch fibre (OPEFB-fibre) using the acid hydrolysis method, followed by ultrasonication. The important parameter studied was the concentration of sulphuric acid (10% to 40%) while reaction time and temperature were kept constant. The resulting MFC was analysed using fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), x-ray diffractometer (XRD) and scanning electron microscope (SEM). Based on the FTIR results, it was found that the structure of cellulose was retained after undergoing the acid hydrolysis process. The highest thermal stability was obtained when MFC was treated with 20% H 2 SO 4 which was determined by using TGA. The XRD method was used to study the structural property of the MFC and the result showed that the MFC produced had 60% of crystallinity index. The morphological features were identified using SEM. The results showed that the particle size of MFC ranged between 10 µm to 200 µm. As a result, the parameters used tend to influence the physico-chemical properties of MFC produced and it has the potential to facilitate filler increase in wood free papers industry.

Nanocellulose was fabricated from empty fruit bunch (EFB)-derived microcrystalline cellulose (MCC) through combined acid hydrolysis with sulfuric and hydrochloric acids and high-pressure homogenization. The effects of acid-to-MCC ratio and the number of high-pressure homogenizations passes on nanoparticle morphology were investigated. The MCC was treated with different concentrations of sulphuric acid (5% to 25%) through the hydrolysis process. The diameter of the acid treated MCC fibres was reduced to roughly 8 m in Scanning Electron Microscopy (SEM) micrographs, while the length of the fibres was reduced by several microns when compared to untreated fibres. The suspensions of MCC were passed through a high pressure homogenizer at a constant pressure of 800 bar with passing times of 10, 20 and 30 cycles. After 30 cycles, the final suspension of nanocellulose (NC) became cloudy. This was a visual indication that the particles were converted to smaller sizes and were less entangled. Field Emission Scanning Electron Microscopy (FESEM) results showed that the particle size of nanocellulose ranged between 18 to 20 nm. As a result, the combination of sulphuric acid hydrolysis and high-pressure homogenization operations could be used as an efficient chemo29 mechanical technique for producing nanocellulose from various cellulosic sources.

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