Surgeon Major Thomas Heazle Parke (1857-1893): Irish doctor, soldier and explorer.

Science.gov (United States)

Parke, Andrew

2017-08-08

Surgeon Major Thomas Heazle Parke (1857-1893) was a doctor from Drumsna, County Roscommon, who after completing his education at the Royal College of Surgeons in Ireland joined the British army as a medical officer. After several years of serving in Ireland and Egypt, he volunteered to be medical officer of the Emin Pasha Relief Expedition of 1887-1889. This was to become Henry Morton Stanley's largest, longest and most controversial African expedition. The epic journey saw Stanley, his eight European officers and 800 African porters take almost 3 years to cross the African continent from West to East via the Congo River, Southern Sudan and Uganda. During this time, Parke had to single-handedly deal with the myriad diseases and injuries that beset the expedition's members. Barely 200 of the Zanzibari, Sudanese and Somali porters survived, and two British officers also perished. In completing the expedition, Parke became the first Irishman to cross Africa, and he had also become the first European to lay eyes on the ' Mountains of the Moon ' or ' Ruwenzori '. He returned home to great acclaim, and was bestowed copious honours and fellowships. His account of the expedition, My Experiences in Equatorial Africa , was a bestseller. However, his own health never recovered from the hardships of his time in Africa, and he died suddenly in 1893. His statue stands outside the Natural History Museum in Dublin. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Woman's Land Army: 1918-1920.

Science.gov (United States)

Laughlin, Margaret

1994-01-01

Describes the origins and work of the Women's Land Army, a World War I British volunteer agricultural production unit. Details similar program in the United States. Identifies the impact of the Women's Land Army including enhanced political, economic, and physical freedom for the participants and future generations of women. (CFR)

the relationship between british war correspondents in the field

African Journals Online (AJOL)

Lenovo

sometimes army officers writing the occasional despatch to the British metropolitan press. There was ..... defence”.27 He was backed both by the army's commander-in-chief, Field Marshal. Lord Wolseley ..... The role of the press was less significant under succeeding directors of. Intelligence ..... Financial Times ? Unknown.

Scouts Out! The Development of Reconnaissance Units in Modern Armies

Science.gov (United States)

2008-01-01

forces they encountered.61 The French command did not realize the Germans were still east of Neufchâteau, particularly after secondhand information...37; Seaton, 90–91; Robert Citino, Armored Forces: History and Source Book (Westport, CT: Greenwood Press, 1994), 57; Walter Goerlitz, History of the...British Army, 1943 (New York: Hippocrene Books , 1976), 41, 228; Ogorkiewicz, 57– 60. 43. Ellis and Chamberlain, 166; Leo Niehorster, “British Army

Inverting the Army Intelligence Pyramid

Science.gov (United States)

2011-05-19

British experience fighting the Provisional Irish Republican Army ( PIRA ) in Northern Ireland, which began an insurgency in 1969.91...they became extremely successful.”93 Martin Van Creveld posits that the British Army’s success against the PIRA in Northern Ireland stands out as...and MI6 (Secret Intelligence Service) to defeat the PIRA .97 92 John Kiszely, "Learning About

Body dysmorphia, self-mutilation and the reconstructive surgeon.

Science.gov (United States)

Chan, James Kwok-Kwan; Jones, Sophie M; Heywood, Anthony J

2011-01-01

Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Prevalence and socio-demographic correlates of obesity in the British Army.

Science.gov (United States)

Sanderson, Paul W; Clemes, Stacy A; Biddle, Stuart J H

2014-01-01

The trend of escalating obesity has prompted some armed forces to employ comprehensive health surveys to report obesity trends and prevalence, the findings of which suggest that obesity is a growing concern in these specific populations. To provide an appraisal of obesity prevalence and risk to obesity-related diseases in the British Army in relation to age, gender, military rank and employment. An observational cohort study (n = 50 635) consisting of 47 173 men and 3462 women was drawn from a study sample hosted on the Fitness Information Software System (FISS) (n = 54 854). Multiple logistic regression techniques were employed separately for men and women. According to BMI, 56.7% of the study population were overweight and of those individuals 12% were obese. Whilst a higher percentage of males were obese (12.2% and 8.6%, respectively), when waist circumference data were added to the BMI data, the results indicate that females displayed a higher percentage of risk to obesity-related diseases than males (30.4% and 24%, respectively). Armed service personnel should be made aware of the implications of obesity in regards to health and occupation. Specific focus should be given to those older individuals employed in managerial positions undertaking low levels of occupational physical activity.

Smartphones and the plastic surgeon.

Science.gov (United States)

Al-Hadithy, Nada; Ghosh, Sudip

2013-06-01

Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon. This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented. In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

British Intelligence Operations as They Relate to Britain’s Defeat at Yorktown, 1781

Science.gov (United States)

2010-06-11

121Matthew H. Spring, With Zeal and With Bayonets Only: The British Army on Campaign in North America, 1775-1783 ( Norman , OK: University of Oklahoma...humorously complained to Lieutenant Colonel Francis Lord Rawdon, “All my accounts about [Major General] Smallwood agree with yours, but mine are: ‘I...Matthew H. With Zeal and With Bayonets Only: The British Army on Campaign in North America, 1775-1783. Norman , OK: University of Oklahoma Press, 2008

From precocious fame to mature obscurity: David Walker (1837-1917) MD, LRCSI, surgeon and naturalist to the Fox Arctic Expedition of 1857-59.

Science.gov (United States)

Froggatt, Peter; Walker, Brian M

2012-11-01

The Belfast-born David Walker was the 19-year-old surgeon and naturalist on the epic Fox Arctic Expedition (1857-59) that established the fate of Sir John Franklin's unsuccessful (1845) search for the North-West Passage. On return the crew were fêted as heroes and decorated, and shared in a £5000 government bounty: Walker was also received by the Queen and (in Ireland) by the Lord Lieutenant, was honoured by the principal British and Irish natural history societies and his portrait was exhibited in the National Portrait Gallery, London. This paper describes his adventurous life, including the Fox Expedition, which from 1862 was spent abroad and included time in the Cariboo gold fields, service in the United States Army, practice in a notorious Californian frontier town and, in later life, the comparative quiet of general and occupational medical practice in Portland, Oregon. Once a household name, his death went unrecorded in the British and Irish medical and lay press.

Mentoring the Afghan Army at the Officer Academy in Kabul

DEFF Research Database (Denmark)

Mynster Christensen, Maya

Capacity building of host nation militaries is a central component of current multinational military operations, which is likely to become increasingly vital to future military interventions in conflict settings. Focusing on the mentoring of the Afghan National Army at the British-led officer...... academy in Kabul, this policy brief stresses the urgency with which Western militaries should improve military capacity building efforts. Based on qualitative data collected at the British Royal Military Academy Sandhurst and the Afghan National Army Officer Academy, the brief outlines five clusters...

Book Review: "Indigenous Peoples of the British Dominions and the ...

African Journals Online (AJOL)

Book Review: "Indigenous Peoples of the British Dominions and the First World War"by Timothy C. Winegard. ... Timothy Winegard saw active duty in the Canadian Reserve Force from 2001 to 2010 and served on detachment duty to the British Army for a two-year period. He obtained various academic degrees from 1999 ...

Florence Nightingale: on feeding an army.

Science.gov (United States)

Calkins, B M

1989-12-01

Florence Nightingale's work for the British Army during the Crimean War earned her the well-deserved honor of being considered the mother of modern nursing. Less well recognized is her involvement with the development of nutritional services for the military. A nutrient-intake analysis is developed here based on her recommendations and recipes for army troops. The intake profile is compared with modern recommendations for dietary intake for adequacy of the diet.

Planning for success: desired characteristics of special operations surgeons, a pilot study.

Science.gov (United States)

Campbell, Barrett H; Alderman, Shawn M

2012-01-01

Selection criteria for Special Operations Forces (SOF) physicians are often unclear to potential candidates without prior SOF experience. To date, no published career resource exists to guide the careers of physicians interested in becoming a SOF surgeon. Using a survey tool, desirable characteristics and personal attributes were identified that can be used to inform candidate career decisions and better prepare them for a future position in Special Operations. A descriptive, cross-sectional survey instrument was developed and distributed to current Army SOF Command Surgeons for further distribution to subordinate surgeons. RESULTS were analyzed as a cohort and by subordinate command. Respondents consisted of current SOF Surgeons. Uniformly, the individual characteristics most strongly desired are professionalism, being a team player, and leadership. Possessing or obtaining Airborne and Flight Surgeon qualifications prior to consideration for a surgeon position was highly desired. Residency training within Family Medicine or Emergency Medicine constituted the vast majority of specialty preference. Understanding which characteristics and attributes are desirable to current surgeons and commanders can aid physicians interested in SOF surgeon positions. Using this study and future studies can guide career planning and foster the selection of ideally trained physicians who will operate at the tip of the spear. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government. 2012.

[Viktor Borisovich von Gyubbenet--a military physician, a surgeon and a social activist].

Science.gov (United States)

Ishutin, O S

2015-02-01

The current article is dedicated to a talented surgeon, an organizer of military health care, an extraordinary personality and a public figure--Doctor of Medicine, a privy councilor Victor Borisovich von Guebbenet. A talent of von Gyubbenea as a doctor-surgeon and an organizer of the surgical help on theater of war was especially brightly shown during two big military conflicts of the beginning of the XX century--the Russo-Japanese War (1904-1905) and the First World War I (1914-1918). In the first case doctor von Gyubbenet, being a surgeon of the 3rd Siberian corps successfully manage the activity of military-medical divisions and establishments of Port Arthur garrison. In the second military conflict Victor Borisovich as a doctor and an organizer headed sanitary part of armies of the Western front and successfully directed a medical support of armies of the front since 1915 and until the end of war.

Lessons from the British Defeat Combating Colonial Hybrid Warfare in the 1781 Southern Theater of Operations

Science.gov (United States)

2014-05-22

Society for Army Historical Research 16, no. 61 (1937): 3-23; Henry Clinton, The Headquarters Papers of the British Army in North America During the War...Rejoinder to ‘Future Threats and Strategic Thinking,” Infinity Journal 2, no. 2 (Spring 2012): 24-29. 19Department of the Army, ADRP 3-0, Unified Land...represented his security zone. The colony provided food for Greene’s army, a staging base for manufactured material and forces from New England, and a

British-Zionist Military Cooperation in Palestine, 1917-1939

Directory of Open Access Journals (Sweden)

Mohsen M. Saleh

2003-12-01

Full Text Available The essence of the British military and security formula in Palestine was the smooth establishment of the Jewish national home with minimum costs of lives and money. However, this British pro-Zionist policy created a continuous security problem, and opened the door to all possibilities of Palestinian revolts and uprisings of both national and religious nature. The British were very active in disarming the Arabs and adopted stringent measures to crush their uprisings and revolts. But, they turned a blind eye to the Jewish arms smuggling and Jewish military organizations, especially, the Hagana, which later became the backbone of the Israeli Army. During Palestinian uprisings of 1920, 1921 and 1929 against the Zionists, most of the Palestinian casualties were inflicted by the British forces despite the fact that the Palestinians avoided attacking the British. The British-Zionist cooperation reached its peak during the Palestinian revolt of 1936-1939, and took different forms, including allowing the Jews to establish a military force of twenty two thousand men under the pretext of protecting the Jewish community.

Comparative analysis of field ration for military personnel of the ukrainian army and armies of other countries worldwide

Directory of Open Access Journals (Sweden)

M. Mardar

2017-04-01

Full Text Available For the purpose of improvement of the Ukrainian nutritional standards this Article provides comparative analysis of field rations of different countries worldwide to make a proposal on improvement of food-stuff assortment in food ration for military personnel in the Armed Forces of Ukraine, Army of USA, the British Army, Army of Germany, Army of Italy, Army of Canada, Army of France, Army of Belarus, Army of Armenia. In accordance with the comparative analysis it was established that ration composition used for the Armed Forces of Ukraine military personnel lags behind developed countries of the world both in nutrition arrangement and in nutrient composition, especially in relation to assortment and variety of ration food-stuff. Moreover, a field ration is strictly unified and doesn’t consider individual needs of military personnel in calories, proteins, fats, carbohydrates, food fibers. Selection of individual field ration takes to account only age of military personnel, i. e. individual needs related to nutrition composition such as physical abilities, level of physical activity, gender, type of occupation before military conscription and etc. are not consideredThe obtained results confirms practicability of assortment products assortment included to field rations for the purpose to correct nutrition rations towards optimal balance for military efficiency of army, adaptation of military personnel to physical and psychological loads.

Edward D. Churchill as a combat consultant: lessons for the senior visiting surgeons and today's military medical corps.

Science.gov (United States)

Cannon, Jeremy W; Fischer, Josef E

2010-03-01

In World War II, Edward D. Churchill volunteered as a combat consultant. In this role, he mentored many junior surgeons and challenged the Army leadership to treat hemorrhagic shock with blood rather than plasma. These lessons have continued relevance for today's Senior Visiting Surgeons and our military medical corps.

[The chief surgeon Claude Louis Sommé (1772-1855) French military physician, surgeon of Antwerp hospital].

Science.gov (United States)

Tricot, Jean-pierre

2015-01-01

Claude Louis Sommé was born in Paris in 1772. After surgical studies between 1790 and 1792, he successfully embraced a military career in the armies of Napoleon at different fronts and in several hospitals. In 1806 he submitted his doctoral thesis at the Special Medical School of Strasburg, Dissertation upon Pain. The same year he presented his dismissal from he imperial armies and became chief-surgeon at the St Elisabeth hospital of Antwerp where he stayed on duty until his death in 1855. Sommé wrote a lot of medical books: surgical, anatomical and physiological. After the battle of Waterloo one third of the injured soldiers were transferred to Antwerp and were attended in his department. He also played an important role as a professor at the Primary Medical School of Antwerp. Sommé also created the botanical garden of Antwerp, close to the hospital.

Building the Old Contemptibles: British Military Transformation and Tactical Development from the Boer War to the Great War, 1899-1914

National Research Council Canada - National Science Library

Risio, Andrew J

2005-01-01

Impressed with the tactical lessons of the Boer War, the British Army reformed its doctrine and training from 1899 to 1914, deploying a combat ready force, the "Old Contemptibles" of the British Expeditionary Force (BEF) in 1914...

The scientific contributions of British Plastic Surgeons to the Revue de Chirurgie Plastique and the Revue de Chirurgie Structive, Brussels (1931-1938).

Science.gov (United States)

Vrebos, J

2001-01-01

In 1931, Maurice Coelst, M.D. from Brussels started the publication of the first international journal of plastic surgery ever published: the Revue de Chirurgie Plastique (1931-1934), which eventually became the Revue de Chirurgie Structive (1935-1938). In 1936, he established the first European Society of Structive Surgery, which held its first congress in Brussels. Further congresses were held in London in 1937 and in Milan in 1938. It is the collaboration and the participation of British plastic surgeons in this Society, this journal, and these meetings that I want to stress, because I am firmly convinced that these documents fill a gap in the history of Plastic Surgery in Great Britain, since--as far as I know--no detailed information concerning this period was ever published in Plastic Surgery literature.

A history of US Army PAs.

Science.gov (United States)

Chalupa, Robyn L; Marble, W Sanders

2017-11-01

The US military has a long tradition of using physician assistants (PAs). The Army began using PAs in 1971 in an effort to supplement the physicians and surgeons in the medical corps. As their numbers grew, PAs gradually replaced general medical officers assigned to battalions. Later, specialty positions developed in aviation medicine, orthopedics, and emergency medicine. The need for a PA serving as an adviser in the major commands slowly developed at all levels of leadership. In 2015, the Army removed limitations on female PAs assigned to combat units. PAs lead in tactical and clinical settings, filling command roles, senior clinical positions, and administrative leadership roles.

From Surgeon General's bookshelf to National Library of Medicine: a brief history.

Science.gov (United States)

Blake, J B

1986-10-01

The National Library of Medicine originated as a few books in the office of the army's surgeon general, Joseph Lovell, between 1818 and 1836. It became the nation's largest medical library after the Civil War under the direction of John Shaw Billings and began publishing the Index-Catalogue of the Library of the Surgeon General's Office and preparing the Index Medicus. After Billings retired in 1895, the library marked time as army medical officers were rotated through as directors until modernization began under Harold Wellington Jones during World War II. during the directorship of Frank B. Rogers (1949-1963), who introduced MEDLARS, guided the move to a new building in Bethesda, and revitalized other operations, the institution received statutory authority as the National Library of Medicine within the Public Health Service (1956). By 1965, which was marked by the passage of the Medical Library Assistance Act, the library had again regained a position of world leadership.

Irish (Republic) versus British (North West) orthopaedic trainees: what are the differences?

LENUS (Irish Health Repository)

Banks, L N

2012-02-01

British Trainees have gradually had their working week curtained over the last 8 years. The Republic of Ireland Trainees have not been subjected to the European Working Time Directive prior to 2009 and have therefore worked on average, more hours than their British counterparts. We wanted to see if the differing schemes had an impact on recruiting and training orthopaedic surgeons. We surveyed Republic of Ireland orthopaedic specialist registrars (SpRs) and North West (NW) British SpRs\\/specialist trainees (ST3 and above) to see if there were any discernable differences in working patterns and subsequent training exposure. A standard proforma was given to Irish Trainees and to NW SpRs\\/STs at their National or regional teaching (January\\/February 2009). 62% of Irish and 47% of British NW Trainees responded. Irish trainees were more likely to have obtained a post-graduate degree (p = 0.03). The Irish worked more hours per week (p < 0.001) doing more trauma operative lists (p = 0.003) and more total cases per 6 months than the NW British (p = 0.003). This study suggests that more hours worked, equals more operative exposure, without detriment to the academic side of training. Obviously it is not possible to say whether fewer operations make for a poorer surgeon, but the evidence suggests that it may be true.

Army Task Force on Behavioral Health: Corrective Action Plan

Science.gov (United States)

2013-01-01

Veterans Affairs Legal Section KNOWLEDGE MGMT SECTION • KMO • CAA Analyst Figure I-1. Task Force Organization. ACRONYM Key ASA(M&RA): Assistant...Army Audit Agency OTIG: Office of the Inspector General OTSG: Office of the Surgeon General KMO : Knowledge Management Officer CAA: Center for

"Odds and Sods": Minorities in the British Empire's Campaign for Palestine, 1916-1919

OpenAIRE

Saltman, Julian

2013-01-01

This dissertation examines the role of minority soldiers in Britain's Army during the campaign for Palestine in the First World War. It compares the experiences of two distinct, yet parallel, groups--three battalions of black, British West Indians (the British West Indies Regiment) and three battalions of Jewish soldiers (the "Jewish Legion"). Past scholarship has mostly ignored the history of these men, and what does exist has tended to conflate or subsume the specific experiences of the men...

Mapping discussion of canine obesity between veterinary surgeons and dog owners: a provisional study.

Science.gov (United States)

Cairns-Haylor, Theodora; Fordyce, Peter

2017-02-11

This study maps communication between veterinary surgeons and dog owners on obesity management in four first-opinion practices in the UK. A total of 74 dog owners who met the study's inclusion criteria and 24 veterinary surgeons were interviewed using oral questionnaires between November 2013 and May 2014. The dog owner questionnaire was based on potential discussion areas that could influence an owner's intention to act (initiate a weight loss regime) based on Ajzen's Theory of Planned Behaviour. The veterinary surgeons' questionnaires assessed perception of canine obesity, their personal communication strategies and current practice-level interventions. The findings identify opportunities for more proactive approaches to obesity management by veterinary surgeons and their practices. British Veterinary Association.

Colonial army recruitment patterns and post-colonial Military Coups ...

African Journals Online (AJOL)

Since time immemorial, societies, states and state builders have been challenged and transformed by the need and quest for military manpower. European states relied on conscript armies to 'pacify' and retain colonies in parts of the non-European world. These facts underscore the meticulous attention paid by the British to ...

Cultural Frictions: Mentoring the Afghan Army at 'Sandhurst in the Sand'

DEFF Research Database (Denmark)

Mynster Christensen, Maya

2015-01-01

The Afghan National Army Officer Academy (ANAOA) is a significant indicator of the success of the NATO-led mission in Afghanistan. This success relies on the local ownership and sustainability of an academy modelled on the British Royal Military Academy Sandhurst. Based on qualitative research...

The world's best-known surgeon.

Science.gov (United States)

Walt, A J

1983-10-01

Henry Norman Bethune was born in Ontario in 1890 and was to become the best-known physician in the world. Bethune, a thoracic surgeon, spent his professional life in Detroit and Montreal, with these periods separated by a year spent as a patient in a tuberculosis sanatorium. This was where his interest in pulmonary disease was stimulated. Pioneer thoracic surgeon, councillor to the American Association for Thoracic Surgery, artist, poet, polemist, conservative-turned-communist, iconoclast, and soldier, Bethune was a highly complex individual. Diverting his energies from surgery to social issues during the depression, Bethune participated in the Spanish Civil War, at which time he designed the world's first mobile blood transfusion unit. Eight months later, Bethune joined Mao Tse-tung's Eight Route Army in China. In 1939 he died of septicemia acquired from a sliver of infected bone while he was operating on a wounded Chinese patient. Bethune's fame today derives principally from the popularization of his accomplishments by Mao, whom he met once and who subsequently decreed that all in China should learn about him. Bethune's posthumous influence played an important role in the reopening of relations between China and the West.

A Surgical Business Composite Score for Army Medicine.

Science.gov (United States)

Stoddard, Douglas R; Robinson, Andrew B; Comer, Tracy A; Meno, Jenifer A; Welder, Matthew D

2016-06-01

Measuring surgical business performance for Army military treatment facilities is currently done through 6 business metrics developed by the Army Medical Command (MEDCOM) Surgical Services Service Line (3SL). Development of a composite score for business performance has the potential to simplify and synthesize measurement, improving focus for strategic goal setting and implementation. However, several considerations, ranging from data availability to submetric selection, must be addressed to ensure the score is accurate and representative. This article presents the methodology used in the composite score's creation and presents a metric based on return on investment and a measure of cases recaptured from private networks. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Louisa Garrett Anderson (1873-1943), surgeon and suffragette.

Science.gov (United States)

Geddes, Jennian F

2008-11-01

Louisa Garrett Anderson, daughter of Britain's first woman doctor, has been largely forgotten today despite the fact that her contribution to the women's movement was as great as that of her mother. Recognized by her contemporaries as an important figure in the suffrage campaign, Anderson chose to lend her support through high-profile action, being one of the few women doctors in her generation who risked their professional as well as their personal reputation in the fight for women's rights by becoming a suffragette - in her case, even going so far as to spend a month in prison for breaking a window on a demonstration. On the outbreak of war, with only the clinical experience she had gained as outpatient surgeon in a women's hospital, Anderson established a series of women-run military hospitals where she was a Chief Surgeon. The most successful was the Endell Street Military Hospital in London, funded by the Royal Army Medical Corps and the only army hospital ever to be run and staffed entirely by women. Believing that a doctor had an obligation to take a lead in public affairs, Anderson continued campaigning for women's issues in the unlikely setting of Endell Street, ensuring that their activities remained in the public eye through constant press coverage. Anderson's achievement was that her work played no small part in expunging the stigma of the militant years in the eyes of the public and - more importantly - was largely instrumental in putting women doctors on equal terms with their male colleagues.

Hakim Mohammad: A Persian Military Surgeon in Safavid Era (1501-1736 CE).

Science.gov (United States)

Khodaie, S-Ali; Ghaffari, Farzaneh; Zargaran, Arman; Naseri, Mohsen

2017-12-31

Wars and injuries have accompanied mankind throughout history. Physicians and surgeons from various civilizations made difficult attempts to manage wounds and injuries. Among various civilizations, the Persian Empires had great armies which were well equipped. One of the most important organizations in Persian troops was the military surgery. This study presents a brief biography of Hakim Mohammad (a military surgeon in Safavid era) and introduces his book, Dhakhira-yi-Kamilah. Safavid kings (1501-1736 CE) with unifying all of Persian regions and provinces reconstructed the Persian Empire. Great scholars and physicians were raised in this era. It seems that Persian physicians and surgeons were well trained in Safavid era and many of them were even employed by other countries like Ottoman Empire and India. Hakim Mohammad as a military surgeon was one of such physicians who served in Ottoman Empire for some time. He gathered his surgical experiences and others in the book of Dhakhira-yi-Kamilah. This book was written in Persian. He has mainly written about the management of wounds and practical techniques. Later, he came back to his homeland and dedicated his book to the king of Persia.

The Development of a Coalition Operational Architecture: A British and US Army Approach

National Research Council Canada - National Science Library

Galvin, K. E; Madigan, J. C

2000-01-01

... (COA) to support a US Corps operating as a Combined Joint Task Force (CJTF) Headquarters with up to a UK Division as an integral part of its ORBAT would be investigated by staff from both countries' Army Operational Architecture (AOA) teams...

Strategic Analysis and Associated Management Products Supporting the Reengineering of Bayne-Jones Army Community Hospital: Consultative Products and Findings

National Research Council Canada - National Science Library

Fulton, Larry

1998-01-01

.... ̂Product 2 - "Bayne-Jones Army Community Hospital Web Site," a strategic Internet web site for marketing health and wellness, the TRICARE medical network, the Joint Readiness Training Center Surgeon's...

Army Hearing Program Status Report Quarter 1 Fiscal Year 2017

Science.gov (United States)

2017-03-27

Occupational Health Objectives for Fiscal Year 2016, 21 October 2015. Memorandum, Office of the Surgeon General, subject: Public Health Management System ...Army’s Safety and Occupational Health objectives. U.S. Army Medical Command (MEDCOM) Chief of Staff Memorandum, dated 15 December 2016, mandates... Occupational and Environmental Health Readiness System – Hearing Conservation (DOEHRS-HC), and an average of 2 CIV and 3 MIL losses were recorded

India’s British Army: the Honorable East India Company’s Lasting Military Impact

Science.gov (United States)

2017-06-09

Canfield, all helped to characterize the public liabilities King George and British Parliament accepted in order directly control British interests in...EIC employees indigenous languages such as Arabic, Persian , Hindi, Tamil, and Telugu (Crowell 1982, 108) and cultural practices of the subcontinent...Already conversant in the Arabic and Persian languages, Jones learned Sanskrit while in India because it is the ancient language that articulates

Basil A. Pruitt Jr. MD and the US Army Institute for Surgical Research: Five Decades of Science, Clinical Care, Mentorship, and Leadership.

Science.gov (United States)

Stewart, Ronald M

2017-08-24

Over the past half century Dr. Basil A. Pruitt, Jr., a great citizen, surgeon, innovator, mentor and leader, transformed our world through his dogged commitment to science and service to humanity. Dr. Pruitt's contribution lives on in the work of the US Army Institute of Surgical Research and the surgeons, physicians and scientists he shaped and inspired.

Brigadier General James Stevens Simmons (1890-1954), Medical Corps, United States Army: a career in preventive medicine.

Science.gov (United States)

Marble, Sanders

2012-02-01

James Simmons began his career in the US Army as a laboratory officer and his assignments progressed into tropical medicine research. His interests and work evolved into preventive medicine (PM, as the Army termed public health), and he took both a PhD and a Doctorate in Public Health. As the Army's leading PM officer he was appointed head of PM in 1940 and guided the Army's PM effort through World War II. His responsibility ran from gas masks through healthy nutrition and occupational health to an enormous variety of diseases; by the war's end, the breadth and importance of PM was reflected in the Preventive Medicine Division, having fully one-sixth of all military personnel at the Surgeon General's Office. Simmons used his strong professional credentials to tap into civilian medicine for expertise the Army lacked and he established organizations that survive to this day. After retirement, he sought to expand the field of public health and raise another generation of public health physicians.

2009 Center for Army Leadership Annual Survey of Army Leadership (CASAL): Army Education

Science.gov (United States)

2010-06-11

right time, handling pre- education attitudes, and tracking performance gains and career advantages related to academics.  Developing current, relevant...Army Leadership Technical Report 2010-2 2009 CENTER FOR ARMY LEADERSHIP ANNUAL SURVEY OF ARMY LEADERSHIP (CASAL): ARMY EDUCATION ...Joshua Hatfield ICF International John P. Steele Center for Army Leadership June 2010 The Center for Army Leadership An

The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

Science.gov (United States)

Gaydos, Joel C; Mallon, Timothy M; Rice, William A

2016-11-01

Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army. Records possibly related to the residency were reviewed, starting with 1954 since certification of physicians as Occupation Medicine specialists began in 1955. Interviews were conducted with selected physicians who had strong affiliations with the Army residency and the practice of Army OEM. The Army OEM residency began in 1960 and closed in 1996 with the transfer of Army OEM residency training to the Uniformed Services University of the Health Sciences, Bethesda, MD. Over 36 years, 47 uniformed residency graduates were identified; 44 were from the Army. Forty graduated between 1982 and 1996. The OEM residency was part of a dynamic cycle. Uniformed OEM leaders identified the knowledge and skills required of military OEM physicians and where these people should be stationed in the global Army. Rotations at military sites to acquire the needed knowledge and skills were integrated into the residency. Residency graduates were assigned to positions where they were needed. Having uniformed residents and preceptors facilitated the development of trust with military leaders and access to areas where OEM physician skills and knowledge could have a positive impact. Early reports indicated the residency was important in recruiting and retaining OEM physicians, with emphasis placed on supporting the Army industrial base. The late 1970s into the 1990s was a more dynamic period. There was

50 Div in Normandy: A Critical Analysis of the British 50th (Northumbrian) Division on D-Day and in the Battle of Normandy

National Research Council Canada - National Science Library

Williams, Ethan R

2007-01-01

In late 1943, the British Army ordered the veteran 7th Armored, 51st (Highland) and 50th (Northumbrian) Divisions to return to Great Britain to provide combat experienced troops for the D-Day invasion of northwest Europe...

Should we all go to the PROM? The first two years of the British Spine Registry.

Science.gov (United States)

Breakwell, L M; Cole, A A; Birch, N; Heywood, C

2015-07-01

The effective capture of outcome measures in the healthcare setting can be traced back to Florence Nightingale's investigation of the in-patient mortality of soldiers wounded in the Crimean war in the 1850s. Only relatively recently has the formalised collection of outcomes data into Registries been recognised as valuable in itself. With the advent of surgeon league tables and a move towards value based health care, individuals are being driven to collect, store and interpret data. Following the success of the National Joint Registry, the British Association of Spine Surgeons instituted the British Spine Registry. Since its launch in 2012, over 650 users representing the whole surgical team have registered and during this time, more than 27 000 patients have been entered onto the database. There has been significant publicity regarding the collection of outcome measures after surgery, including patient-reported scores. Over 12 000 forms have been directly entered by patients themselves, with many more entered by the surgical teams. Questions abound: who should have access to the data produced by the Registry and how should they use it? How should the results be reported and in what forum? ©2015 The British Editorial Society of Bone & Joint Surgery.

Revolting Soldiers: The Origins of Education in the Armies of the Empire in World War I.

Science.gov (United States)

Boshier, Roger

1985-01-01

Explores the circumstances surrounding the creation of education schemes in the armies of the British Empire. Discusses attitudes toward war and toward the soldier's role in the early 1900s, attitudes of the soldiers toward war, the University of Vimy Ridge, the Canadian Khaki University, the Oatlands program, and education for the New Zealand…

Open radical cystectomy in England: the current standard of care - an analysis of the British Association of Urological Surgeons (BAUS) cystectomy audit and Hospital Episodes Statistics (HES) data.

Science.gov (United States)

Jefferies, Edward R; Cresswell, Joanne; McGrath, John S; Miller, Catherine; Hounsome, Luke; Fowler, Sarah; Rowe, Edward W

2018-01-23

To establish the current standard for open radical cystectomy (ORC) in England, as data entry by surgeons performing RC to the British Association of Urological Surgeons (BAUS) database was mandated in 2013 and combining this with Hospital Episodes Statistics (HES) data has allowed comprehensive outcome analysis for the first time. All patients were included in this analysis if they were uploaded to the BAUS data registry and reported to have been performed in the 2 years between 1 January 2014 and 31 December 2015 in England (from mandate onwards) and had been documented as being performed in an open fashion (not laparoscopic, robot assisted or the technique field left blank). The HES data were accessed via the HES website. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures version 4 (OPCS-4) Code M34 was searched during the same 2-year time frame (not including M34.4 for simple cystectomy or with additional minimal access codes Y75.1-9 documenting a laparoscopic or robotic approach was used) to assess data capture. A total of 2 537 ORCs were recorded in the BAUS registry and 3 043 in the HES data. This indicates a capture rate of 83.4% of all cases. The median operative time was 5 h, harvesting a median of 11-20 lymph nodes, with a median blood loss of 500-1 000 mL, and a transfusion rate of 21.8%. The median length of stay was 11 days, with a 30-day mortality rate of 1.58%. This is the largest, contemporary cohort of ORCs in England, encompassing >80% of all performed operations. We now know the current standard for ORC in England. This provides the basis for individual surgeons and units to compare their outcomes and a standard with which future techniques and modifications can be compared. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

[Doctor Albéric Pont (1870-1960). Dental surgeon, doctor and creator of the center of maxillo-facial surgery of Lyon in 1914].

Science.gov (United States)

Riaud, Xavier

2008-01-01

As Stomatologist and Dental Surgeon Albéric Pont founded with six other Dental Surgeons the School of Dentistry in Lyons which he ran for a long time. When he enlisted in the French Army in 1914 he soon became aware of the extent of facial damage that occurred among the injured soldiers. His subsequent decision was to create and run a Centre for maxillofacial surgery in Lyons. He died in 1960 and left a significant scientific work as well as technical elements of surgery, dental index and devices which still bear his name.

Medical students' unique experience of army leadership training: a qualitative study.

Science.gov (United States)

Earis, John; Garner, J; Haddock, D; Jenkins, J; Jha, V

2017-10-01

To assess the interactive experience of first year medical students attending the leadership and management course hosted by a British Army Reserve Field Hospital developed in partnership with Liverpool University. 244 students submitted a 1000-word structured reflective learning assignment about their reaction to, learning from and any behaviour and attitude changes as a result of, the training. The assignments were thematically analysed to identify how aspects of the training had impacted upon the students' understanding of leadership and teamwork. Their comments relating to the army were analysed to gain insight into their views and experience of the training. Students were surprised at how enjoyable and useful they found the course. Initially they expressed scepticism about what they could learn in an army-based environment. However, the training, particularly command and planning tasks, helped them appreciate and understand the different skills individuals can bring to a team environment, and the importance of everyone contributing. While some students were challenged by aspects of the course, with support and encouragement from team-mates and the army personnel, they learned they could achieve more together. Teaching leadership and management skills to medical students is a challenge which can be effectively addressed by adapting and developing army training resources. Students overcame initial scepticism about participating, and learned a lot about themselves and each other. In addition, the army developed a better understanding of the doctors of the future. The expertise of the army in delivering this training was crucial to its success as the medical school could not have provided this experience unsupported. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Headed the Wrong Way: The British Army’s Painful Re-Acquaintance with Its Own COIN Doctrine in Southern Iraq

Science.gov (United States)

2011-06-10

Colonel John McCuen, taught COIN as an army officer at the US Army War College, after overseas tours in Vietnam, Thailand, and Indonesia that preceded...tactical advantages. The monsoon rains running June through September further hindered SAF‘s mobility and associated rough surf made resupply for

The United States Army Battalion Surgeon: Frontline Requirement or Relic of a Bygone Era?

Science.gov (United States)

2009-12-11

Battalion Aid Station BN Battalion BS Battalion Surgeon CBMM Core Battalion Medical Mission DOW Died of Wounds FSO Full Spectrum Operations GMO ...General Medical Officers or GMOs . Young, motivated, and greedy for knowledge, GMOs propelled the field of military medicine forward during...peacetime through analysis, research, and innovation. Their treated populations were small and exceedingly healthy. GMOs had no mission to treat dependents

Russian perceptions of the Boer and British Armies: An introduction through Russian documents

OpenAIRE

Gennady Shubin

2012-01-01

On the eve of the outbreak of the Anglo-Boer War in South Africa, Colonel N.S. Yermolov, the Russian Military agent [attaché] in London reported on October1, 1899: "The War is inevitable ... The decision has been made to dispatch there from Britain the first army corps and at least 70 thousand [troops] ... The War is scheduled for half a year; many mounted infantry are under preparation; carts and mules being purchased in America. The general draft disposition is to defend the border of Natal...

A cross-sectional study of the presence of United Kingdom (UK) plastic surgeons on social media.

Science.gov (United States)

Mabvuure, Nigel Tapiwa; Rodrigues, Jeremy; Klimach, Stefan; Nduka, Charles

2014-03-01

To determine the uptake and usage of websites and social media (SM) by UK consultant (attending) plastic surgeons. Professional profiles of full BAPRAS members were searched on Facebook, Twitter, LinkedIn, RealSelf, YouTube, ResearchGate in May 2013. Additional surgeons were identified from the follower lists of @BAPRASvoice and @BAAPSMedia. Website ownership was determined on Google. Searches were repeated three times. Dual BAAPS-BAPRAS members were identified from www.baaps.org.uk. There were 156 (48.3%) dual BAAPS-BAPRAS members and 36 BAPRAS-only members. Fifty seven (18%) surgeons had no account on any platform whereas 266 (82%) were on at least one platform. One hundred and sixty four (51%) had personal websites whilst 37 (11%) had profiles on partnership websites. One hundred and sixteen (36%) had no website presence whilst 2% had websites under construction. The platform most surgeons use is LinkedIn (52%) whilst smaller proportions used Facebook (4%) and Twitter (22%). Surgeons had a mean of 126 (range: 0-3270) Twitter followers and 368 (range: 7-3786) fans/'likes' of their Facebook profiles. Time spent in postgraduate practice was not predictive of website ownership or SM use. However, dual BAAPS-BAPRAS members were significantly more likely to own a personal website, Twitter, RealSelf and YouTube accounts. There has been an increase in the uptake of social media by UK plastic surgeons, especially in those with aesthetic surgery interests. However, very few surgeons have optimised their web presence. Continued education and appropriate usage guidance may promote uptake, particularly by reconstructive surgeons. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Preparing General Purpose Forces in the United States and British Armies for Counterinsurgent Operations

Science.gov (United States)

2010-12-10

Operations In Iraq: Planning, Combat, And Occupation,” Thomas Ricks’ Fiasco, and reports by Army historian Major Isaiah Wilson, and former CENCTOM J-4...established Multi-National Forces-Iraq, and Lieutenant General Thomas Metz, commander of the Army’s III Corps, assumed the mantle of Multi-National Corps...Donald P. Wright and Colonel Timothy R. Reese or Thomas Ricks’ Fiasco among other books. 18Dr. Carter Malkasian, “Counterinsurgency in Iraq: May 2003

Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons.

Science.gov (United States)

Coyne, L A; Latham, S M; Williams, N J; Dawson, S; Donald, I J; Pearson, R B; Smith, R F; Pinchbeck, G L

2016-11-01

The use of antimicrobials in food-producing animals has been linked with the emergence of antimicrobial resistance in bacterial populations, with consequences for animal and public health. This study explored the underpinning drivers, motivators and reasoning behind prescribing decisions made by veterinary surgeons working in the UK pig industry. A qualitative interview study was conducted with 21 veterinary surgeons purposively selected from all UK pig veterinary surgeons. Thematic analysis was used to analyse transcripts. Ensuring optimum pig health and welfare was described as a driver for antimicrobial use by many veterinary surgeons and was considered a professional and moral obligation. Veterinary surgeons also exhibited a strong sense of social responsibility over the need to ensure that antimicrobial use was responsible. A close relationship between management practices, health and economics was evident, with improvements in management commonly identified as being potential routes to reduce antimicrobial usage; however, these were not always considered economically viable. The relationship with clients was identified as being a source of professional stress for practitioners due to pressure from farmers requesting antimicrobial prescriptions, and concern over poor compliance of antimicrobial administration by some farmers. The drivers behind prescribing decisions by veterinary surgeons were complex and diverse. A combination of education, improving communication between veterinary surgeons and farmers, and changes in regulations, in farm management and in consumer/retailer demands may all be needed to ensure that antimicrobial prescribing is optimal and to achieve significant reductions in use. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Ageing midface: The impact of surgeon's experience on the consistency in the assessment and proposed management.

Science.gov (United States)

Hazrati, Ali; Izadpanah, Ali; Zadeh, Teanoosh; Gosman, Amanda; Chao, James J; Dobke, Marek K

2011-02-01

residents group produced variations with less consistency. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Prevention of suicidal behaviour among army personnel: a qualitative study.

Science.gov (United States)

Crawford, M J; Sharpe, D; Rutter, D; Weaver, T

2009-09-01

To examine the context of suicidal behaviour among soldiers in the United Kingdom and identify factors that could reduce the risk of such behaviour. A series of in-depth interviews with service providers involved in treating soldiers following deliberate self harm. Their responses were compared with those of a small sub-sample of soldiers who presented to Army medical services following self harm. We interviewed 21 service providers with a range of experience and professional backgrounds and 10 soldiers. Service providers told us that the rarity of suicide among soldiers together with lower levels of mental illness amongst those who end their lives made suicide prevention in the Army a difficult task. However they highlighted concerns about recruitment and retention of young soldiers, and stated that stigmatisation of mental illness in the Army sometimes prevented those with suicidal ideation seeking help. They also highlighted the role of alcohol use in precipitating self-harm. Soldiers who had self-harmed told us that they struggled to balance the demands of work and family life and described harming themselves impulsively often while intoxicated with alcohol. Soldiers look to sources of support outside the Army, and see commanding officers, rather than healthcare professionals, as helping resolve their problems. Neither service providers nor soldiers mentioned helplines and other 'independent' sources of confidential advice and support which are available to soldiers serving with the British Army. Our findings highlight problems associated with efforts to reduce suicide among soldiers but suggest that these should focus continuing to try to reduce stigmatisation of mental distress and specifically on the role of commanding officers. Greater efforts should also be made to publicise existing sources of help and reduce levels of alcohol misuse.

Attitudes and beliefs about placebo surgery among orthopedic shoulder surgeons in the United Kingdom.

Directory of Open Access Journals (Sweden)

Karolina Wartolowska

Full Text Available To survey surgeons on their beliefs and attitudes towards the use of placebo in surgery.British orthopedic shoulder surgeons, attending a national conference in the United Kingdom, were asked to complete a self-report online questionnaire about their beliefs and attitudes towards the use of placebo related to surgical intervention. The survey included questions about ethical issues, the mechanism of placebo effects, and any concerns regarding its use.100 surgeons who participated in the survey believed that placebo surgery is ethically acceptable (96%, especially as a part of a clinical trial (46%. Respondents thought that a placebo effect in surgery is real i.e. has a scientific basis (92%, that placebo can be therapeutically beneficial (77%, and that it involves psychological mechanisms (96%. Over half of the respondents (58% have used a surgical procedure with a significant placebo component at least once in their professional career. Their main concern about placebo use in surgery was that it might involve an element of deception.Surgeons generally agreed that a placebo component to surgical intervention might exist. They also supported placebo use in clinical trials and considered it ethical, providing it does not involve deception of patients. More studies are needed, particularly among other surgical specialties and with larger numbers of participants, to better understand the use of placebo in surgery.

Army Technology

Science.gov (United States)

2015-02-01

that allows them to perform applied research under the Institute for Biotechnology research team 1 2 3 20 | ARMY TECHNOLOGY MAGAZINE ...DASA(R&T) Deputy Assistant Secretary of the Army for Research and Technology Download the magazine , view online or read each individual story with...Army photo by Conrad Johnson) Front and back cover designs by Joe Stephens EXECUTIVE DEPUTY TO THE COMMANDING GENERAL Army Technology Magazine is an

Improving operation notes to meet British Orthopaedic Association guidelines.

Science.gov (United States)

Morgan, David; Fisher, Noel; Ahmad, Aman; Alam, Fazle

2009-04-01

Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA). A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed. A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality. Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.

The legacy of Douglas Guthrie (1885-1975), surgeon and medical historian.

Science.gov (United States)

Macintyre, Iain

2018-01-01

After graduating in medicine Douglas Guthrie embarked on a career as an ENT surgeon. When his Edinburgh hospital appointment ended in 1936 he began to write History of Medicine, which, thanks to a favourable review by George Bernard Shaw, became a worldwide best seller when first published in 1945. This marked the start of Guthrie's second career as a lecturer in history of medicine at the University of Edinburgh where his prime responsibility was delivering systematic lectures on medical history to medical undergraduates. At a time when history of medicine was virtually the exclusive preserve of medical doctors, Guthrie promoted to them the historiography techniques of the academic historian. His vision that social historians should become involved in the field and that history of medicine should be taught in arts and humanities faculties began to be adopted in British universities a decade or so after Guthrie made the recommendation. His legacy includes the Scottish Society of the History of Medicine and the British Society for the History of Medicine, both of which he helped to found. His name is commemorated in various charitable trusts which he established to promote the study of history of medicine.

Answering the Hottest Question in Army Education: What Is Army University?

Science.gov (United States)

Kem, John S.; LeBoeuf, Eugene J.; Martin, James B.

2016-01-01

The most common question heard by senior members of Army University is always, "What is Army University?" The newest education institution in the U.S. Army was created to unify the training and educational institutions of the Army, making the large learning organization more effective and efficient for its soldiers, bringing together 37…

Women surgeons in the new millennium.

Science.gov (United States)

Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph

2009-07-01

Women are increasingly entering the surgical profession. To assess professional and personal/family life situations, perceptions, and challenges for women vs men surgeons. National survey of American Board of Surgery-certified surgeons. A questionnaire was mailed to all women and men surgeons who were board certified in 1988, 1992, 1996, 2000, or 2004. Of 3507 surgeons, 895 (25.5%) responded. Among these, 178 (20.3%) were women and 698 (79.7%) were men. Most women and men surgeons would choose their profession again (women, 82.5%; men, 77.5%; P = .15). On multivariate analysis, men surgeons (odds ratio [OR], 2.5) and surgeons of a younger generation (certified in 2000 or 2004; OR, 1.3) were less likely to favor part-time work opportunities for surgeons. Most of the surgeons were married (75.6% of women vs 91.7% of men, P women surgeons (OR, 5.0) and surgeons of a younger generation (OR, 1.9) were less likely to have children. More women than men surgeons had their first child later in life, while already in surgical practice (62.4% vs 32.0%, P women surgeons vs 79.4% of men surgeons (P women surgeons than men surgeons thought that maternity leave was important (67.8% vs 30.8%, P work (86.5% vs 69.7%, P Women considering a surgical career should be aware that most women surgeons would choose their profession again. Strategies to maximize recruitment and retention of women surgeons should include serious consideration of alternative work schedules and optimization of maternity leave and child care opportunities.

Influence of new military athletic footwear on the kinetics and kinematics of running in relation to army boots.

Science.gov (United States)

Sinclair, Jonathan; Taylor, Paul J

2014-10-01

Musculoskeletal injuries in the lower extremities are common in military recruits. Army boots have frequently been cited as a potential mechanism behind these high injury rates. In response to this, the British Army introduced new footwear models, the PT-03 (cross-trainer) and PT1000 (running shoes), which are issued to each new recruit in an attempt to reduce the incidence of these injuries. The aim of the current investigation was to examine the kinetics and kinematic of the PT-03 and PT1000 footwear in relation to conventional army boots. Thirteen participants ran at 4.0 m·s in each footwear condition. Three-dimensional kinematics from the hip, knee, and ankle were measured using an 8-camera motion analysis system. In addition, simultaneous ground reaction forces were obtained. Kinetic parameters were obtained alongside joint kinematics and compared using repeated-measures analyses of variance. The kinetic analysis revealed that impact parameters were significantly greater when running in the army boot compared with the PT-03 and PT1000. The kinematic analysis indicated that, in comparison with the PT-03 and PT1000, running in army boots was associated with significantly greater eversion and tibial internal rotation. It was also found that when running in the PT-03 footwear, participants exhibited significantly greater hip adduction and knee abduction compared with the army boots and PT1000. The results of this study suggest that the army boots and PT-03 footwear are associated with kinetic and kinematic parameters that have been linked to the etiology of injury; thus, it is recommended that the PT1000 footwear be adopted for running exercises.

[The surgeon and deontology].

Science.gov (United States)

Sucila, Antanas

2002-01-01

The aim of study is to recall surgeons deontological principles and errors. The article demonstrates some specific deontological errors, performed by surgeon on patients and his colleagues; points out painful sequela of these errors as well. CONCLUSION. The surgeon should take in account deontological principles rigorously in routine daily practice.

Portraying the Army Reserve Components in Army War Games and Exercises

National Research Council Canada - National Science Library

Dillon, Dick

2002-01-01

.... Ensuring that accuracy and realism was the primary purpose of the Role of the Army National Guard and Army Reserve in Army Exercises workshop conducted at the Collins Center for Strategic Leadership from 23-26 September 2002.

The Demography of Royal Navy Surgeons: Some Views on the Process of Prosopography

Directory of Open Access Journals (Sweden)

Christopher H Myers

2015-08-01

Full Text Available This study is a brief social biography and demography of British naval doctors during the nineteenth century, asking why Scottish-educated surgeons were so prominent.  Understanding the demography and changing dynamics of naval surgeons’ labor illuminates the complex relationship among the military, discrimination, and nationalism that shaped this influential labor market. This study reviews how to collect demographic information from multiple types of sources: university archives, matriculation records, digitized medical journals, and student rolls.  It also uses chi-square tests to show the significance of the demographic information collected.  The results show us the entangled relationship between database conceptualization, data collection, and data analysis.  

Shark attack-related injuries: Epidemiology and implications for plastic surgeons.

Science.gov (United States)

Ricci, Joseph A; Vargas, Christina R; Singhal, Dhruv; Lee, Bernard T

2016-01-01

The increased media attention to shark attacks has led to a heightened fear and public awareness. Although few sharks are considered dangerous, attacks on humans can result in large soft tissue defects necessitating the intervention of reconstructive surgeons. This study aims to evaluate and describe the characteristics of shark-related injuries in order to improve treatment. The Global Shark Accident File, maintained by the Shark Research Institute (Princeton, NJ, USA), is a compilation of all known worldwide shark attacks. Database records since the 1900s were reviewed to identify differences between fatal and nonfatal attacks, including: geography, injury pattern, shark species, and victim activity. Since the 1900s, there have been 5034 reported shark attacks, of which 1205 (22.7%) were fatal. Although the incidence of attacks per decade has increased, the percentage of fatalities has decreased. Characteristics of fatal attacks included swimming (p = 0.001), boating (p = 0.001), three or more bite sites (p = 0.03), limb loss (p = 0.001), or tiger shark attack (p = 0.002). The most common attacks were bites to the legs (41.8%) or arms (18.4%), with limb loss occurring in 7% of attacks. Geographically, the majority of attacks occurred in North America (36.7%) and Australia (26.5%). Most attacks in the USA occurred in Florida (49.1%) and California (13.6%). Although rare, shark attacks result in devastating injuries to patients. As these injuries often involve multiple sites and limb loss, this creates a significant challenge for reconstructive surgeons. Proper identification of the characteristics of the attack can aid in providing optimal care for those affected. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills.

Science.gov (United States)

Henrickson Parker, Sarah; Flin, Rhona; McKinley, Aileen; Yule, Steven

2013-06-01

Surgeons must demonstrate leadership to optimize performance and maximize patient safety in the operating room, but no behavior rating tool is available to measure leadership. Ten focus groups with members of the operating room team discussed surgeons' intraoperative leadership. Surgeons' leadership behaviors were extracted and used to finalize the Surgeons' Leadership Inventory (SLI), which was checked by surgeons (n = 6) for accuracy and face validity. The SLI was used to code video recordings (n = 5) of operations to test reliability. Eight elements of surgeons' leadership were included in the SLI: (1) maintaining standards, (2) managing resources, (3) making decisions, (4) directing, (5) training, (6) supporting others, (7) communicating, and (8) coping with pressure. Interrater reliability to code videos of surgeons' behaviors while operating using this tool was acceptable (κ = .70). The SLI is empirically grounded in focus group data and both the leadership and surgical literature. The interrater reliability of the system was acceptable. The inventory could be used for rating surgeons' leadership in the operating room for research or as a basis for postoperative feedback on performance. Copyright © 2013 Elsevier Inc. All rights reserved.

Department of the Army - The Fiscal Year 2008 Military Personnel, Army Appropriation and the Antideficiency Act

Science.gov (United States)

2010-06-22

of the Army, U.S. Army Audit Agency, Budgeting for the Military Personnel, Army Appropriation, Report No. A-2010-0028- FFM (Jan. 6, 2010); Department...of the Army, U.S. Army Audit Agency, Military Personnel, Army FY 05 Subsistence Charges, Report No. A-2008-0037- FFM (Feb. 12, 2008); Department of

Legacy in the Sand: The United States Army Armament, Munitions and Chemical Command in Operations Desert Shield and Desert Storm

Science.gov (United States)

1992-12-21

States Army Medical Department, over 1.5 million British-designed Small Box Respirator ( SBR ) masks, utilizing activated coconut charcoal as a filter, had...conflicts this nation will tfce-short in rjuration but of high intensity. In such a war, relance must bpp oaced upon the established stockpile and the...Supply System SAW squad automatic weapon SBA Small Business Administration SBR small box respirator SCR senior command representati’e SCRAM self-contained

Comparing U.S. Army suicide cases to a control sample: initial data and methodological lessons.

Science.gov (United States)

Alexander, Cynthia L; Reger, Mark A; Smolenski, Derek J; Fullerton, Nicole R

2014-10-01

Identification of risk and protective factors for suicide is a priority for the United States military, especially in light of the recent steady increase in military suicide rates. The Department of Defense Suicide Event Report contains comprehensive data on suicides for active duty military personnel, but no analogous control data is available to permit identification of factors that differentially determine suicide risk. This proof-of-concept study was conducted to determine the feasibility of collecting such control data. The study employed a prospective case-control design in which control cases were randomly selected from a large Army installation at a rate of four control participants for every qualifying Army suicide. Although 111 Army suicides were confirmed during the study period, just 27 control soldiers completed the study. Despite the small control sample, preliminary analyses comparing suicide cases to controls identified several factors more frequently reported for suicide cases, including recent failed intimate relationships, outpatient mental health history, mood disorder diagnosis, substance abuse history, and prior self-injury. No deployment-related risk factors were found. These data are consistent with existing literature and form a foundation for larger control studies. Methodological lessons learned regarding study design and recruitment are discussed to inform future studies. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

2013 CENTER FOR ARMY LEADERSHIP ANNUAL SURVEY OF ARMY LEADERSHIP (CASAL): MAIN FINDINGS

Science.gov (United States)

2014-04-30

The Center for Army Profession and Ethic (CAPE) has fielded education and training materials (including doctrine, pamphlets , videos, brochures , and...Army Pamphlet (DA PAM) 600-3, Commissioned Officer Development and Career Management, states that a goal of warrant officer training and education... Pamphlet 600-25, U.S. Army noncommissioned officer professional development and career management. Washington, D.C.: Headquarters, Department of the Army

Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents' and Surgeons' Expectations.

Science.gov (United States)

Choe, Jennie K; Ibarra, Christopher; Feinn, Richard S; Rodriguez-Davalos, Manuel I; Carter, Cordelia W

2018-06-01

The common practice of performing concurrent or overlapping operations has been intensely scrutinized by lay media and academic press to investigate its safety and cost-effectiveness. However, there is little information about its use within the pediatric population. Even less is known about parents' expectations about the surgeon's role on the day of operation and how they align with those of pediatric surgeons and surgical trainees, despite the potential for significant discrepancies in expectations to erode trust and damage the physician-family relationship. A 5-point Likert-style survey was designed to characterize expectations about the degree of involvement by pediatric attending surgeons throughout a surgical case (1 = strongly disagree, 3 = neutral, 5 = strongly agree). The survey was administered to parents of pediatric patients undergoing elective operations during a 3-month interval at a single academic institution. The survey was also administered to surgeons and surgical residents at the same institution. Multivariate multiplicity-adjusted t-tests were used to identify significant differences between responders. One hundred and ten parents and 84 pediatric surgeons and trainees completed the survey. Parents' responses to the survey ranged from 4.15 to 4.89, compared with 2.75 to 4.86 from surgeons. The differences achieved statistical significance (p children. There is a significant mismatch between parents' expectations and those of pediatric surgeons about the role of the surgeon on the day of operation, with parents consistently expecting more direct involvement by the attending surgeon. These discrepancies can have implications for both parent/patient satisfaction and medical education. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Who should lead a trauma team: surgeon or non surgeon? A systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Shahab Hajibandeh

2017-05-01

Full Text Available Background: Presence of a trauma team leader (TTL in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data. Results: Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR: 0.82, 95% confidence interval (CI 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03. Conclusions: Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare

Review of orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2011-2012.

Science.gov (United States)

Goodson, Alexander M C; Payne, Karl F B; Tahim, Arpan; Colbert, Serryth; Brennan, Peter A

2015-04-01

This review summarises all orthognathic and related papers published between January 2011 and December 2012 in the British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 36 articles were published, a high proportion of which (78%) were full-length papers. The remainder consisted of short communications and technical notes. The topics included operative planning and postoperative outcomes, and there was a strong focus on distraction osteogenesis. There were fewer orthognathic articles published in BJOMS than articles on other subspecialties such as trauma or head and neck oncology. Only 8 (29%) of the full-length articles were prospective studies or randomised trials, which highlights a need for well-designed clinical studies in orthognathic research. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of Complications and Surgical Outcomes of Adolescent Idiopathic Scoliosis Between Junior Attending Surgeons and Senior Attending Surgeons.

Science.gov (United States)

Qiao, Jun; Xiao, Lingyan; Xu, Leilei; Shi, Benlong; Qian, Bangping; Zhu, Zezhang; Qiu, Yong

2018-04-24

To our knowledge, few studies have compared complications and surgical outcomes of adolescent idiopathic scoliosis (AIS) between junior attending surgeons and senior attending surgeons. To compare surgical strategies, complications, and outcomes of posterior corrective surgery for AIS between junior attending surgeons and senior attending surgeons. According to experience level of operation surgeons, the patients were assigned to 2 groups. Group A was the "junior surgeon" group. Group B was the "senior surgeon" group. The following parameters were compared between the 2 groups: age, sex, diagnosis, hospital of record, surgeon experience level, type of instrumentation, type of screws, estimated blood loss, duration of surgery, length of fusion, correction techniques, main curve correction, and thoracic kyphosis correction. A total of 132 patients with AIS were included in group A, whereas 207 were in group B. The translational technique was used more often in group A (P Senior surgeons used more monoaxial screws than junior surgeons (P senior group (P senior group had significant better correction rates of severe main curve (>70°) and thoracic kyphosis than the junior group (P Senior attending surgeons outperformed junior surgeons in blood loss control, thoracic kyphosis correction, and correction of severe curves. Copyright © 2018 Elsevier Inc. All rights reserved.

The Nonwhite Woman Surgeon: A Rare Species.

Science.gov (United States)

Frohman, Heather A; Nguyen, Thu-Hoai C; Co, Franka; Rosemurgy, Alexander S; Ross, Sharona B

2015-01-01

As of 2012, 39% of medical student graduates were nonwhite, yet very few nonwhite women graduates chose to become surgeons. To better understand issues regarding nonwhite women in surgery, an online survey was sent to surgeons across the United States. Results are based on self-reported data. Mean data are reported. A total of 194 surgeons (42% women) completed the survey; only 12% of responders were nonwhite. Overall, 56% of nonwhite women felt they earned less than what men surgeons earn for equal work. Nonwhite women surgeons earned less than what men surgeons ($224,000 vs. 351,000, p women surgeons ($285,000, p = 0.02) earned. Overall, 96% of nonwhite surgeons believed that racial discrimination currently exists among surgeons. The few nonwhite women surgeons in the United States recognize that they are paid significantly less than what other surgeons are paid. Inequitable remuneration and a discriminatory work environment encountered by nonwhite women surgeons must be addressed. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Diversity Issues in the Army as Perceived by Army Students at the United States Army War College

National Research Council Canada - National Science Library

Webster, Cecil

1997-01-01

..., welfare, and other related programs. In recognizing this diversity, this paper identifies some diversity issues within the Army, analyzes the perception of those diversity issues by the resident Army students in the USAWC Class of 1997...

Thomas Vicary, barber-surgeon.

Science.gov (United States)

Thomas, Duncan P

2006-05-01

An Act of Parliament in 1540 uniting the barbers and surgeons to form the Barber-Surgeons' Company represented an important foundation stone towards better surgery in England. Thomas Vicary, who played a pivotal role in promoting this union, was a leading surgeon in London in the middle of the 16th century. While Vicary made no direct contribution to surgical knowledge, he should be remembered primarily as one who contributed much towards the early organization and teaching of surgery and to the consequent benefits that flowed from this improvement.

Stress in surgeons.

Science.gov (United States)

Green, A; Duthie, H L; Young, H L; Peters, T J

1990-10-01

A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.

Administration: Army Congressional Fellowship Program

National Research Council Canada - National Science Library

2000-01-01

This printing publishes a new Army Regulation. This regulation presents the policies and procedures under which the Army manages the Army Congressional Fellowship Program and supplements applicable Department...

Conference Proceedings: Photography and Britishness

Directory of Open Access Journals (Sweden)

Sean Willcock

2016-11-01

Full Text Available The video-recordings presented here were made at the conference Photography and Britishness, held at the Yale Center for British Art on November 4 – 5, 2016. The conference was the result of a collaboration between the Yale Center for British Art, New Haven, the Paul Mellon Centre for Studies in British Art, London, and the Huntington Library, Art Collections, and Botanical Gardens in San Marino—three research institutions that have a converging interest in British art. The conference sought to investigate the various ways in which notions of “Britishness” have been communicated, inflected, and contested through the photographic image. It was not a conference about the history of photography in Britain, or about British photography. Rather, it sought to consider the nature of the relationship between photography and Britishness: the notion that photography can capture images of Britishness, at the same time that our sense of what Britishness constitutes is produced by the photographic image. A key question for the conference was whether Britishness can have a photographic referent—or whether it is itself an effect of representation. Speakers at the conference approached these questions from a wide range of perspectives and focusing on a diverse number of photographic materials—from family albums and studio portraits to advertisements, reportage, and aerial photography—which demonstrated the complexities and instabilities not only of the term Britishness, but also of the medium of photography. The conference was opened with an introduction by John Tagg. The videos included here are presented in the order they were delivered.

What Is a Pediatric Heart Surgeon?

Science.gov (United States)

... Text Size Email Print Share What is a Pediatric Heart Surgeon? Page Content Article Body If your ... require heart surgery. What Kind of Training Do Pediatric Heart Surgeons Have? Pediatric heart surgeons are medical ...

British Sign Name Customs

Science.gov (United States)

Day, Linda; Sutton-Spence, Rachel

2010-01-01

Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

Washington’s War: A Study in Operational Design

Science.gov (United States)

2013-04-05

traditional European powers such as the Franch Army. However, size being equal, the British Army outmatched any army on the European continent at the...cheaply sell or donate food and supplies to the Army and gave the local farmers no alternative other than the Continental Army. 37 The small...the winter of 1777-78. This site did offer the proximity needed to the British, but it provided little existing Gross 17 shelter, supplies, food

Discovering the Army's Core Competencies

National Research Council Canada - National Science Library

Rudesheim, Frederick

2001-01-01

This paper seeks to answer the question, "Has the Army correctly identified its core competencies to ensure the Army can adequately respond to the national military strategy?" FM 1, The Army (Prototype Draft...

The Plastic Surgeon at Work and Play: Surgeon Health, Practice Stress, and Work-Home Balance.

Science.gov (United States)

Bentz, Michael L

2016-10-01

Plastic surgeon wellness encompasses physical and mental health, considered in the context of practice stress. In addition, the challenges of work-home balance can lead to substantial negative impact on the surgeon, family, staff, and patients. The data-driven impact of each of these three components with personal vignettes, both individually and collectively, is presented by Michael Bentz, MD as the 2016 presidential address of American Association of Plastic Surgeons.

Burnout and career satisfaction among American surgeons.

Science.gov (United States)

Shanafelt, Tait D; Balch, Charles M; Bechamps, Gerald J; Russell, Thomas; Dyrbye, Lotte; Satele, Daniel; Collicott, Paul; Novotny, Paul J; Sloan, Jeff; Freischlag, Julie A

2009-09-01

To determine the incidence of burnout among American surgeons and evaluate personal and professional characteristics associated with surgeon burnout. : Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons. Members of the American College of Surgeons (ACS) were sent an anonymous, cross-sectional survey in June 2008. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments. Of the approximately 24,922 surgeons sampled, 7905 (32%) returned surveys. Responders had been in practice 18 years, worked 60 hours per week, and were on call 2 nights/wk (median values). Overall, 40% of responding surgeons were burned out, 30% screened positive for symptoms of depression, and 28% had a mental QOL score >1/2 standard deviation below the population norm. Factors independently associated with burnout included younger age, having children, area of specialization, number of nights on call per week, hours worked per week, and having compensation determined entirely based on billing. Only 36% of surgeons felt their work schedule left enough time for personal/family life and only 51% would recommend their children pursue a career as a physician/surgeon. Burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice. Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons.

The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons.

Science.gov (United States)

Seelandt, Julia C; Kaderli, Reto M; Tschan, Franziska; Businger, Adrian P

2014-01-01

The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. With respect to the factors that promote surgery as a profession, 40.8% (209/492) of the surgeons stated that surgery is a calling, 29.1% (149/492) of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492) of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492) of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492) of the surgeons provided problematic contextual characteristics. This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

21 CFR 878.4460 - Surgeon's glove.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's glove. 878.4460 Section 878.4460 Food... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4460 Surgeon's glove. (a) Identification. A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by...

Medical practice in New Zealand 1769-1860.

Science.gov (United States)

Lawrenson, Ross

2004-06-01

New Zealand was discovered by Captain Cook in 1769. Over the next ninety years, increasing numbers of medical practitioners visited and began to settle in what became a British colony. The first medical visitors were usually naval surgeons or served on board whaling ships. The major influx of doctors occurred at the behest of the New Zealand Company between 1840 and 1848, although Christian missionaries, army doctors, and individual medical entrepreneurs also emigrated and provided services. This paper describes the pattern of medical settlement in the colony's earliest years and relates this to the health of the population and the development of medical and hospital services.

Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon.

Science.gov (United States)

Ettner, Randi; Ettner, Frederic; White, Tonya

2016-01-01

Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient-provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures. Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making. Results: The results generally confirm previous findings regarding how patients select providers. Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort.

Science.gov (United States)

Bletsis, Patrick P; Bouwer, Lesley R; Ultee, Klaas H; Cromheecke, Michel; van der Lei, Berend

2018-04-16

Literature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants, and thus far, studies have failed to demonstrate the visible difference in implants that are in practice compared to those that are round. This study was undertaken to evaluate (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants and (2) their opinion with regard to naturalness and attractiveness of these augmented breasts. Twenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 to 400 g. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive, and unattractive breast shapes on a schematic depiction of breast types with varying upper poles. The rate of correct implant identifications was 74.0% (1480/2000 observations, p lay and 67.3% (202/300 observations, p lay participants and surgeons. Participants preferred breasts with a neutral or slightly negative upper pole contour. Participants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

British plastic surgeons who contributed to the Revue de Chirurgie Plastique and the Revue de Chirurgie Structive (1931-1938): "the Big Four" in their Speciality.

Science.gov (United States)

Rogers, B O

2001-01-01

The Revue de Chirurgie Plastique and the Revue de Chirurgie Structive, Brussels (1931-1938), edited by Maurice Coelst, M.D. from Brussels, were the first, full-fledged medical publications devoted specifically to plastic, reconstructive, and aesthetic surgery. Publishing original articles by H.D. Gillies, P.T. Kilner, A.H. McIndoe, and R. Mowlem--the "Big Four" as they were known to both English and American plastic surgeons--the Revues drew attention to these four surgeons who were mainly responsible for developing the prestige of English plastic surgery in the early 1930s.

Surgeons' vision rewarded.

Science.gov (United States)

Baillie, Jonathan

2010-08-01

Surgeons and clinical staff, theatre circulation and scrub personnel, and anaesthetists, as well as the estates and facilities team at Kent's Maidstone Hospital, have worked with specialist supplier of integrated audio, video, and instrumentation systems for the operating room, Olympus Medical, to develop what is claimed is among the UK's most advanced operating theatres yet built for laparoscopic and endoscopic surgery. HEJ editor Jonathan Baillie discussed the project with Amir Nisar, the surgeon who championed efforts to get the facility built, and Olympus Medical national sales manager, systems integration, James Watts.

Opportunities in Total Knee Arthroplasty: Worldwide Surgeons' Perspective.

Science.gov (United States)

Dunbar, Michael; Newman, Jared M; Khlopas, Anton; Chughtai, Morad; Martinez, Nick; Bhowmik-Stoker, Manoshi; Mont, Michael A

2017-07-25

This study surveyed a group of US and international orthopaedic surgeons to prioritize areas of improvement in primary total knee arthroplasty (TKA). Specifically, we assessed surgeon responses regarding the top five areas of TKA needing improvement; which were stratified by: a) US surgeons, b) international surgeons, c) US surgeons' implant-brand-loyalty, and d) surgeons' years of experience and case volume. Four hundred and eighteen surgeons who were board-certified, in practice for at least two years, spent 60% of their time in clinical practice, and performed a minimum of 25 lower extremity joint arthroplasties per year were surveyed. They chose the top five areas (among 17) needing improvement for TKA. Results were stratified by surgeons' location (US and international), implant-brand-loyalty, years of experience, and case volume. Functional outcomes was the top identified area for improvement (US 63% and international 71%), followed by brand loyalty (Company I 68%, other brand 59%, and multi-brand/no loyalty 66%), years of experience (early-career 64%, mid-career 63%, and late-career 75%) and case volume (low-volume 69%, mid-volume 60%, and high-volume 71%). Following this was costs for US surgeons (47%) and implant survivorship for international surgeons (57%). While costs were the next highest area for specific Company-loyal surgeons (57%), implant survivorship was the next highest area for the other two cohorts. Implant survivorship was the second most important area of improvement regardless of years of experience and for low- and mid-volume surgeons. Surgeons identified functional outcomes as the most important area needing improvement. Cost of implants was more important for American as compared to international surgeons.

British Dance: Black Routes

OpenAIRE

Adair, C.; Burt, Ramsay, 1953-

2016-01-01

British Dance: Black Routes re-examines the distinctive contributions made to British dance by dancers who are Black. Covering the period 1946 to the present, it presents a radical re-reading of dancers and their companies, placing their achievements within a broader historical, cultural and artistic context. The result of a two year research project, British Dance and the African Diaspora, led by editors Christy Adair and Ramsay Burt, the collection looks at artists working with contempor...

The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons.

Directory of Open Access Journals (Sweden)

Julia C Seelandt

Full Text Available BACKGROUND: The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. METHODS: Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. RESULTS: With respect to the factors that promote surgery as a profession, 40.8% (209/492 of the surgeons stated that surgery is a calling, 29.1% (149/492 of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492 of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492 of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492 of the surgeons provided problematic contextual characteristics. CONCLUSION: This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

Short communications published online in the British Journal of Oral and Maxillofacial Surgery during 2010-2011.

Science.gov (United States)

Colbert, S; Southorn, B; Rosenbaum, G; Aldridge, T; Brennan, P A

2012-09-01

The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

America’s Army: The Strength of the Nation. 2010 Army Posture Statement

Science.gov (United States)

2010-02-19

that the Army Soldier is the best equipped and most re- spected combatant in the world. In order to ex- ecute Army Modernization and ensure the con...Force Traumatic Brain Injury ( TBI ) Unaccompanied Personnel Housing (UPH) Unmanned Aircraft, Raven Small System Unmanned Aircraft, Shadow System Unmanned...Services TBI Traumatic Brain Injury 30 LoyaLty | Duty | Respect | seLfLess seRvice | HonoR | integRity | peRsonaL couRage 2010 Army

Women in the Army

Science.gov (United States)

1980-06-06

Army womenpower re- quirements with no apparent end in sight. No country, not even Russia or Israel, has ever made a conscious decision to include...provide a basis for decision making. iiI CHAPTER ONE AN HISTORICAL OVERVIEW Few books have been written which outline the history of military women...with a bill introducing the Women’s Army Auxillary Corps (WAAC). In order 7 that the Army could maintain control over this sensitive issue, General

Business knowledge in surgeons.

Science.gov (United States)

Satiani, Bhagwan

2004-07-01

Surgeons and residents in training receive little, if any, formal education in the economic side of clinical practice during medical school or residency. As medical professionals face shrinking reimbursement, loss of control over health care decisions, and limited resources, surgical specialties must reevaluate the need to teach their members business survival skills. Before designing business related-teaching modules, educators must know the exact gaps in knowledge that exist among surgeons. This article reports a survey of 133 surgeons in the Midwest who were asked to rate their knowledge base in 11 business topics relevant to the practice of medicine. The survey showed that the average surgeon perceives himself or herself to be poorly equipped to understand basic financial accounting principles, financial markets, economics of health care, tools for evaluating purchases, marketing, budgets, antitrust and fraud and abuse regulations, and risk and return on investments. Armed with this data, teaching faculty, health care systems, and medical specialty societies should design business education seminars to better position surgical specialists and trainees to communicate with insurers, hospital administrators, health care organizations, and their own personal financial advisors.

The Center for the Army Profession and Ethic (CAPE) Annual Survey of the Army Profession (CASAP FY16)

Science.gov (United States)

2016-12-30

incredibly fatiguing which cuts into my personal time to include mental health, physical health, and emotional well-being.” Understand this...April 2016. Its findings contribute to shared understanding of the State of the Army Profession within the Army Culture of Trust -- informing senior...Army leaders regarding the effectiveness of policies and practices intended to inspire and motivate Army professionals to “live by and uphold the Army

What Is a Foot and Ankle Surgeon?

Science.gov (United States)

... A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle surgeons are the surgical ... every age. What education has a foot and ankle surgeon received? After completing undergraduate education, the foot ...

Army Contract Writing System (ACWS)

Science.gov (United States)

2016-03-01

2016 Major Automated Information System Annual Report Army Contract Writing System (ACWS) Defense Acquisition Management Information Retrieval...Information 4 Responsible Office 4 References 4 Program Description 5 Business Case 5 Program Status 6 Schedule 7 Performance...Program Information Program Name Army Contract Writing System (ACWS) DoD Component Army Responsible Office Program Manager References MAIS

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Science.gov (United States)

Millner, Alexander J; Ursano, Robert J; Hwang, Irving; J King, Andrew; Naifeh, James A; Sampson, Nancy A; Zaslavsky, Alan M; Stein, Murray B; Kessler, Ronald C; Nock, Matthew K

2017-09-19

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre- and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide. © 2017 The American Association of Suicidology.

Commentary on "The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)": Army STARRS: a Framingham-like study of psychological health risk factors in soldiers.

Science.gov (United States)

Ressler, Kerry J; Schoomaker, Eric B

2014-01-01

Although historically the Army suicide rate has been significantly lower than the civilian rate, in 2004, the suicide and accidental death rates began trending upward. By 2008, the Army suicide rate had risen above the national average (20.2 per 100,000). In 2009, 160 active duty Soldiers took their lives, making suicide the third leading cause of death among the Army population. If accidental death, frequently the result of high-risk behavior, is included, then more Soldiers died by their own actions than in combat in 2009. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) was thus created in 2009 to begin to address these problems. The Army STARRS project is a large consortium of seven different studies to develop data-driven methods for mitigating or preventing suicide behaviors and improving the overall mental health and behavioral functioning of Army Soldiers during and after their Army service. The first research articles from the Army STARRS project were published in late 2013 and early 2014. This work has already begun to outline important facets of risk in the military, and it is helping to drive an empirically derived approach to improvements in understanding mental disorders and risk behavior and to improve prevention and support of mental health and resilience. The Framingham Heart Study, started in the 1940s, marked a watershed event in utilizing large cross-sectional and prospective longitudinal collaborative research to identify and understand risk factors for cardiovascular disease. The Army STARRS project, through its collaborative, prospective, and robust innovative design and implementation, may provide the beginning of a similar scientific cohort in mental disorders. The work of this project will help understand biological and psychological aspects of military service, including those leading to suicide. When coupled with timely feedback to Army leadership, it permits near real-time steps to diagnose, mitigate, and

77 FR 50089 - Army Education Advisory Committee Meeting

Science.gov (United States)

2012-08-20

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Committee Meeting AGENCY... the Army announces the following committee meeting: Name of Committee: Army Education Advisory... learning environment. The agenda will include topics relating to Army Learning Model 2015 and support to...

77 FR 11084 - Army Education Advisory Committee Meeting

Science.gov (United States)

2012-02-24

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Committee Meeting AGENCY... the Army announces the following committee meeting: Name of Committee: Army Education Advisory... Army 2020 learning environment. The agenda will include topics relating Arm Learning Model 2015 and to...

Techniques used by United Kingdom consultant plastic surgeons to select implant size for primary breast augmentation.

Science.gov (United States)

Holmes, W J M; Timmons, M J; Kauser, S

2015-10-01

Techniques used to estimate implant size for primary breast augmentation have evolved since the 1970s. Currently no consensus exists on the optimal method to select implant size for primary breast augmentation. In 2013 we asked United Kingdom consultant plastic surgeons who were full members of BAPRAS or BAAPS what was their technique for implant size selection for primary aesthetic breast augmentation. We also asked what was the range of implant sizes they commonly used. The answers to question one were grouped into four categories: experience, measurements, pre-operative external sizers and intra-operative sizers. The response rate was 46% (164/358). Overall, 95% (153/159) of all respondents performed some form of pre-operative assessment, the others relied on "experience" only. The most common technique for pre-operative assessment was by external sizers (74%). Measurements were used by 57% of respondents and 3% used intra-operative sizers only. A combination of measurements and sizers was used by 34% of respondents. The most common measurements were breast base (68%), breast tissue compliance (19%), breast height (15%), and chest diameter (9%). The median implant size commonly used in primary breast augmentation was 300cc. Pre-operative external sizers are the most common technique used by UK consultant plastic surgeons to select implant size for primary breast augmentation. We discuss the above findings in relation to the evolution of pre-operative planning techniques for breast augmentation. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

75 FR 19302 - Radiation Sources on Army Land

Science.gov (United States)

2010-04-14

... possession of ionizing radiation sources by non-Army agencies (including their civilian contractors) on an... radiation sources on Army land. The Army requires Non-Army agencies (including their civilian contractors... ionizing radiation sources on an Army Installation. For the purpose of this proposed rule, ``ionizing...

Retention of Mohs surgeons in academic dermatology.

Science.gov (United States)

Zhang, Shali; Mina, Mary Alice; Brown, Marc D; Zwald, Fiona O

2015-08-01

Retention of academic Mohs surgeons is important for the growth of this specialty and teaching of residents and students. To examine factors that influence retention of Mohs surgeons in academics and to better understand reasons for their departure. A survey was electronically distributed to academic Mohs surgeons in the American College of Mohs Surgery, asking them to rate the importance of several variables on their decision to remain in academia. Private practice Mohs surgeons who had left academics were also surveyed. Two hundred thirty-six dermatologic surgeons completed the survey. Twenty-nine percent work full time in academics, and approximately 7% work part time. The top reasons for practicing in the academic setting are intellectual stimulation, teaching opportunities, and collaboration with other university physicians and researchers. Seventy-one percent of respondents reported they would stay in academics, 7% indicated they would not, and 22% were unsure. Unfair compensation, inadequate support staff, poor leadership, increased bureaucracy, and decreased autonomy were top reasons that may compel a Mohs surgeon to leave. Opportunities for intellectual stimulation, collaboration, and teaching remain the main draw for academic Mohs surgeons. A supportive environment, strong leadership, and establishing fair compensation are imperative in ensuring their stay.

76 FR 72914 - Army Educational Advisory Committee

Science.gov (United States)

2011-11-28

...: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting: December 14, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command... issues and matters related to the continued growth and development of the United States Army War College...

The Evolution of Army Leader Development

Science.gov (United States)

2013-03-01

Human Resources Command, OPMD- MFE -I. 4 U.S. Army General Officer Management Office, Army General Officer Roster (Washington, DC, U.S. Department of the...Human Resources Command, Command Management Branch post board data analysis. 15 Data from the United States Army Human Resources Command, OPMD- MFE -A...May 1, 2008), D-1. 25 19 Data from the United States Army Human Resources Command, OPMD- MFE -A, 01 February, 2013. 20 U.S. Joint Chiefs of

76 FR 66282 - Army Educational Advisory Committee

Science.gov (United States)

2011-10-26

... Committee: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting: November 15, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command... issues and matters related to the continued growth and development of the United States Army War College...

Solving the surgeon ergonomic crisis with surgical exosuit.

Science.gov (United States)

Liu, Shanglei; Hemming, Daniel; Luo, Ran B; Reynolds, Jessica; Delong, Jonathan C; Sandler, Bryan J; Jacobsen, Garth R; Horgan, Santiago

2018-01-01

The widespread adoption of laparoscopic surgery has put new physical demands on the surgeon leading to increased musculoskeletal disorders and injuries. Shoulder, back, and neck pains are among the most common complaints experienced by laparoscopic surgeons. Here, we evaluate the feasibility and efficacy of a non-intrusive progressive arm support exosuit worn by surgeons under the sterile gown to reduce pain and fatigue during surgery. This is a prospective randomized crossover study approved by the Internal Review Board (IRB). The study involves three phases of testing. In each phase, general surgery residents or attendings were randomized to wearing the surgical exosuit at the beginning or at the crossover point. The first phase tests for surgeon manual dexterity wearing the device using the Minnesota Dexterity test, the Purdue Pegboard test, and the Fundamentals of Laparoscopic Surgery (FLS) modules. The second phase tests the effect of the device on shoulder pain and fatigue while operating the laparoscopic camera. The third phase rates surgeon experience in the operating room between case-matched operating days. Twenty subjects were recruited for this study. Surgeons had the similar dexterity scores and FLS times whether or not they wore the exosuit (p value ranges 0.15-0.84). All exosuit surgeons completed 15 min of holding laparoscopic camera compared to three non-exosuit surgeons (p Exosuit surgeons experienced significantly less fatigue at all time periods and arm pain (3.11 vs 5.88, p = 0.019) at 10 min. Surgeons wearing the exosuit during an operation experienced significant decrease in shoulder pain and 85% of surgeons reported some form of pain reduction at the end of the operative day. The progressive arm support exosuit can be a minimally intrusive device that laparoscopic surgeons wear to reduce pain and fatigue of surgery without significantly interfering with operative skills or manual dexterity.

Surgeon Participation in Early Accountable Care Organizations.

Science.gov (United States)

Resnick, Matthew J; Graves, Amy J; Buntin, Melinda B; Richards, Michael R; Penson, David F

2018-03-01

We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

Surgeon Reliability for the Assessment of Lumbar Spinal Stenosis on MRI: The Impact of Surgeon Experience.

Science.gov (United States)

Marawar, Satyajit V; Madom, Ian A; Palumbo, Mark; Tallarico, Richard A; Ordway, Nathaniel R; Metkar, Umesh; Wang, Dongliang; Green, Adam; Lavelle, William F

2017-01-01

Treating surgeon's visual assessment of axial MRI images to ascertain the degree of stenosis has a critical impact on surgical decision-making. The purpose of this study was to prospectively analyze the impact of surgeon experience on inter-observer and intra-observer reliability of assessing severity of spinal stenosis on MRIs by spine surgeons directly involved in surgical decision-making. Seven fellowship trained spine surgeons reviewed MRI studies of 30 symptomatic patients with lumbar stenosis and graded the stenosis in the central canal, the lateral recess and the foramen at T12-L1 to L5-S1 as none, mild, moderate or severe. No specific instructions were provided to what constituted mild, moderate, or severe stenosis. Two surgeons were "senior" (>fifteen years of practice experience); two were "intermediate" (>four years of practice experience), and three "junior" (< one year of practice experience). The concordance correlation coefficient (CCC) was calculated to assess inter-observer reliability. Seven MRI studies were duplicated and randomly re-read to evaluate inter-observer reliability. Surgeon experience was found to be a strong predictor of inter-observer reliability. Senior inter-observer reliability was significantly higher assessing central(p<0.001), foraminal p=0.005 and lateral p=0.001 than "junior" group.Senior group also showed significantly higher inter-observer reliability that intermediate group assessing foraminal stenosis (p=0.036). In intra-observer reliability the results were contrary to that found in inter-observer reliability. Inter-observer reliability of assessing stenosis on MRIs increases with surgeon experience. Lower intra-observer reliability values among the senior group, although not clearly explained, may be due to the small number of MRIs evaluated and quality of MRI images.Level of evidence: Level 3.

Surgeons in Difficulty: An Exploration of Differences in Assistance-Seeking Behaviors between Male and Female Surgeons.

Science.gov (United States)

Sanfey, Hilary; Fromson, John; Mellinger, John; Rakinic, Jan; Williams, Michael; Williams, Betsy

2015-08-01

Physician burnout is associated with diminished ability to practice with requisite skill and safety. Physicians are often reluctant to seek help for an impaired colleague or for impairment that affects their own ability to practice. To better support surgeons in difficulty, we explored sex differences in assistance-seeking behaviors under stress. Surgeons in 3 national societies completed an IRB-approved anonymous multiple-choice and free-text response survey. Responses were explored with the general linear model using item-specific continuous and categorical methods. Two hundred and twelve surgeons (n = 79 [37.3%] male, n = 133 [63%] female) responded. Although men and women worked similar hours (p > 0.05), women worked more clinical (p work-life balance, as identified by aggregate variables related to emotional/decisional partnership, non-work-related chore support, and personal fulfillment (F = 15.29; df 3/16; p < 0.01), but change jobs less frequently (F = 4.23; df 1/201; p < 0.05). Males are more likely to seek help from colleagues (chi-square 107.5; p < 0.01) or friends (chi-square 123.8; p < 0.01) and women are more likely to seek support from professional counselors (chi-square 146.8; p < 0.01). Almost one-third of surgeons would ignore behaviors that adversely impact well being and could result in potential personal or patient safety. The differences between the assistance-seeking and reporting behaviors of male and female surgeons in distress could have implications for identification and treatment of this population. These findings can be used to develop educational activities to teach surgeons how to effectively handle these challenging situations. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Educating the surgeon-scientist: A qualitative study evaluating challenges and barriers toward becoming an academically successful surgeon.

Science.gov (United States)

Kodadek, Lisa M; Kapadia, Muneera R; Changoor, Navin R; Dunn, Kelli Bullard; Are, Chandrakanth; Greenberg, Jacob A; Minter, Rebecca M; Pawlik, Timothy M; Haider, Adil H

2016-12-01

The advancement of surgical science relies on educating new generations of surgeon-scientists. Career development awards (K Awards) from the National Institutes of Health, often considered a marker of early academic success, are one way physician-scientists may foster skills through a mentored research experience. This study aimed to develop a conceptual framework to understand institutional support and other factors leading to a K Award. A national, qualitative study was conducted with academic surgeons. Participants included 15 K Awardees and 12 surgery department Chairs. Purposive sampling ensured a diverse range of experiences. Semistructured, in-depth telephone interviews were conducted. Interviews were audio recorded and transcribed verbatim, and 2 reviewers analyzed the transcripts using Grounded Theory methodology. Participants described individual and institutional factors contributing to success. K Awardees cited personal factors such as perseverance and team leadership skills. Chairs described the K Awardee as an institutional "investment" requiring protected time for research, financial support, and mentorship. Both K Awardees and Chairs identified a number of challenges unique to the surgeon-scientist, including financial strains and competing clinical demands. Institutional support for surgeons pursuing K Awards is a complex investment with significant initial costs to the department. Chairs act as stewards of institutional resources and support those surgeon-scientists most likely to be successful. Although the K Award pathway is one way to develop surgeon-scientists, financial burdens and challenges may limit its usefulness. These findings, however, may better prepare young surgeons to develop career plans and identify new mechanisms for academic productivity. Copyright © 2016 Elsevier Inc. All rights reserved.

Self-Esteem: A Cross-Cultural Comparison of British-Chinese, White British and Hong Kong Chinese Children.

Science.gov (United States)

Chan, Yiu Man

2000-01-01

Evaluates the self-esteem scores of 1303 children, including Chinese children from Britain and Hong Kong and white British children, using the Coopersmith Self-Esteem Inventory. Finds that British Chinese have significantly higher self-esteem than the Hong Kong children, but there is little difference among white British children. (CMK)

The Army Ethic

Science.gov (United States)

2015-06-12

The Constitution and Declaration of Independence simultaneously hold two different views of human nature, an individualist and a collectivist view...Profession, defines the Army Ethic as “the evolving set of laws, values, and beliefs, deeply embedded within the core of the Army culture and...incorporate other viewpoints or respond to shifts in morality, religion, economics, and other socio- cultural factors. This thesis will use the term

Burnout in the Plastic Surgeon: Implications and Interventions.

Science.gov (United States)

Prendergast, Christina; Ketteler, Erika; Evans, Gregory

2017-03-01

A career as a plastic surgeon is both rewarding and challenging. The road to becoming a surgeon is a long arduous endeavor and can bring significant challenges not only to the surgeon but their family. A study by the American College of Surgeons (ACS) suggested that over 40% of surgeons experience burnout and a recent survey of American Society of Plastic Surgeons (ASPS) showed that more than one-fourth of plastic surgeons have signs of professional burnout. Burnout is a state of physical and mental exhaustion. The three main components of burnout are emotional exhaustion, depersonalization, and reduced personal accomplishment. Exhaustion occurs as a result of emotional demands. Depersonalization refers to a cynical, negative or a detached response to patient care. The reduced accomplishment refers to a belief that one can no longer work effectively. There has been a recent explosion in the literature characterizing burnout within the surgical profession. Reports of burnout, burnout victims, and burnout syndrome are filling the medical literature, books, blogs, and social media across all different specialties. Burnout in a plastic surgeon has negative and potentially fatal repercussions to the surgeon, their family, their patients, their staff, colleagues, coworkers, and their organization. To date, there are a limited number of publications addressing burnout in the plastic surgery community. The goals of this paper are to review the symptoms of burnout, its effect on plastic surgeons, and discuss potential solutions for burnout prevention and physician wellness.

Impact of Different Surgeons on Dental Implant Failure.

Science.gov (United States)

Chrcanovic, Bruno Ramos; Kisch, Jenö; Albrektsson, Tomas; Wennerberg, Ann

To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons. This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon. A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons' technique, skills, and/or judgment may negatively influence implant survival rates.

Danish surgeons' views on minimally invasive surgery

DEFF Research Database (Denmark)

Edwards, Hellen; Jørgensen, Lars Nannestad

2014-01-01

BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

Kant and the cosmetic surgeon.

Science.gov (United States)

Carey, J S

1989-07-01

Philosophers know that modern philosophy owes a great debt to the intellectual contributions of the 18th century philosopher Immanuel Kant. This essay attempts to show how cosmetic surgeons, and all surgeons at that, could learn much from his work. Not only did Kant write about the structure of human reasoning and how it relates to appearances but he also wrote about the nature of duties and other obligations. His work has strongly influenced medical ethics. In a more particular way, Kant wrote the most important work on aesthetics. His theory still influences how philosophers understand the meaning of the beautiful and how it pertains to the human figure. This essay presents an exercise in trying to apply Kantian philosophy to aesthetic plastic surgery. Its intention is to show cosmetic surgeons some of the implicit and explicit philosophical principles and potential arguments undergirding their potential surgical evaluations. It is meant to challenge the surgeon to reconsider how decisions are made using philosophical reasoning instead of some of the more usual justifications based on psychology or sociology.

The Army study to assess risk and resilience in servicemembers (Army STARRS).

Science.gov (United States)

Ursano, Robert J; Colpe, Lisa J; Heeringa, Steven G; Kessler, Ronald C; Schoenbaum, Michael; Stein, Murray B

2014-01-01

IMPORTANCE/OBJECTIVE: Although the suicide rate in the U.S. Army has traditionally been below age-gender matched civilian rates, it has climbed steadily since the beginning of the Iraq and Afghanistan conflicts and since 2008 has exceeded the demographically matched civilian rate. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent epidemiological and neurobiological study designed to generate actionable evidence-based recommendations to reduce Army suicides and increase knowledge about risk and resilience factors for suicidality and its psychopathological correlates. This paper presents an overview of the Army STARRS component study designs and of recent findings. DESIGN/SETTING/PARTICIPANTS/INTERVENTION: Army STARRS includes six main component studies: (1) the Historical Administrative Data Study (HADS) of Army and Department of Defense (DoD) administrative data systems (including records of suicidal behaviors) for all soldiers on active duty 2004-2009 aimed at finding administrative record predictors of suicides; (2) retrospective case-control studies of fatal and nonfatal suicidal behaviors (each planned to have n = 150 cases and n = 300 controls); (3) a study of new soldiers (n = 50,765 completed surveys) assessed just before beginning basic combat training (BCT) with self-administered questionnaires (SAQ), neurocognitive tests, and blood samples; (4) a cross-sectional study of approximately 35,000 (completed SAQs) soldiers representative of all other (i.e., exclusive of BCT) active duty soldiers; (5) a pre-post deployment study (with blood samples) of soldiers in brigade combat teams about to deploy to Afghanistan (n = 9,421 completed baseline surveys), with sub-samples assessed again one, three, and nine months after returning from deployment; and (6) a pilot study to follow-up SAQ respondents transitioning to civilian life. Army/DoD administrative data are being linked prospectively to the large-scale survey

Surgeon General's Family Health History Initiative

Science.gov (United States)

... Source Code The Surgeon General's Family Health History Initiative To help focus attention on the importance of ... health campaign, called the Surgeon General's Family History Initiative, to encourage all American families to learn more ...

32 CFR 631.14 - Army policy.

Science.gov (United States)

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy. (a...

Shell Shock and the Kloppe: war neuroses amongst British and Belgian troops during and after the First World War.

Science.gov (United States)

Reid, Fiona; Van Everbroeck, Christine

2014-01-01

During the First World War combatants of all armies were prey to nervous disorders or psychological breakdown. These war neuroses were a response to the highly-industrialised nature of the warfare as well as to the fatigue engendered over four years of intense conflict. Yet while fear and mental breakdown were universal, national responses varied. A comparison of British and Belgian shell shock indicates that men suffered in very similar ways but that symptoms met with rather different responses: in Britain treatment and diagnostic regimes stressed the importance of class difference and shell shock was often linked to cowardice. These issues were not of overriding importance in the Belgian army. In the longer term shell shock became, and remained, a topic of political and social concern in Britain whereas in Belgium men suffering from kloppe (extreme fear) tended to be forgotten and the topic has not excited much popular interest or scholarly attention. Yet despite these differences one overarching theme remains clear, namely that despite the extensive experience of war neuroses during and after the First World War, there still remains a fierce stigma about the mental wounds of war.

Occupational Stress and Burnout among Surgeons in Fiji.

Science.gov (United States)

Patel, Rajeev; Huggard, Peter; van Toledo, Annik

2017-01-01

This study examined the levels of occupational stress and burnout among surgeons in Fiji. A document set comprising a cover letter; a consent form; a sociodemographic and supplementary information questionnaire; the Maslach Burnout Inventory (MBI); the 12-item General Health Questionnaire (GHQ-12); the Alcohol Use Disorders Identification Test (AUDIT); and the Professional Quality of Life (ProQOL) questionnaires were provided to surgeons from three public divisional hospitals in Fiji. Thirty-six of 43 (83.7%) invited surgeons participated in the study. According to their MBI scores, surgeons suffered from low (10, 27.8%), moderate (23, 63.9%), and high (3, 8.3%) levels of burnout. Comparatively, 23 (63.9%) demonstrated moderate burnout according to their ProQOL scores. Substantial psychiatric morbidity was observed in 16 (44.0%) surgeons per their GHQ-12 scores. Consumption of alcohol was noted in 29 (80.6%) surgeons, and 12 (33.4%) had AUDIT scores characterizing their alcohol use in excess of low-risk guidelines or as harmful or hazardous drinking. Surgeons of Fijian nationality showed higher MBI emotional exhaustion and depersonalization scores compared with surgeons of other nationalities. Surgeons with an awareness of the availability of counseling services at their hospitals showed low AUDIT and ProQOL burnout scores. Smokers, alcohol drinkers, and kava drinkers showed higher AUDIT scores. This study highlights a level of occupational stress and burnout among surgeons in Fiji and a lack of awareness of their mental and physical well-being. The authors recommend that occupational stress and burnout intervention strategies be put in place in hospitals in Fiji.

The Total Army

Science.gov (United States)

2016-01-01

http://thediplomat.com/2015/04/chinas-growing-cyberwar-capabilities/ (accessed April 25, 2016); Nicolas Giacometti, “China’s Nuclear Modernization and...link between the operational and tactical levels of war.48 47. Michelle Tan , “US Army Generals Criticize Outdated Deployment Model: ‘We’ve Gotten...unveils-its-big-8-initiatives/81882852/ (accessed March 16, 2016). 58. Michelle Tan , “US Army Generals Criticize Outdated Deployment Model: ‘We’ve

British passports

CERN Multimedia

IT Department

2008-01-01

Please note that from 01/01/2009, the passport section of the British Consulate will move from Geneva to Paris. This change is part of a global initiative to rationalize passport services and reduce administrative costs while ensuring that the quality of the service remains high. The aim is to issue new passports within 10 working days of receiving applications (excluding transit time). From 1st January 2009 passport applications should be sent by courier or registered post directly to: British Consulate General BP111-08 75363 Paris CEDEX 08 France For further information please refer to: http://ukinswitzerland.fco.gov.uk/en/passports/passport-move/

The Future Medical Science and Colorectal Surgeons.

Science.gov (United States)

Kim, Young Jin

2017-12-01

Future medical technology breakthroughs will build from the incredible progress made in computers, biotechnology, and nanotechnology and from the information learned from the human genome. With such technology and information, computer-aided diagnoses, organ replacement, gene therapy, personalized drugs, and even age reversal will become possible. True 3-dimensional system technology will enable surgeons to envision key clinical features and will help them in planning complex surgery. Surgeons will enter surgical instructions in a virtual space from a remote medical center, order a medical robot to perform the operation, and review the operation in real time on a monitor. Surgeons will be better than artificial intelligence or automated robots when surgeons (or we) love patients and ask questions for a better future. The purpose of this paper is looking at the future medical science and the changes of colorectal surgeons.

ARMY CYBER STRUCTURE ALIGNMENT

Science.gov (United States)

2016-02-16

content/?q=historic-cyber-unit-begins- daily-action . 14 John M. McHugh , Secretary of the Army, HQDA General Order 2014-02, Affirmation of Secretary of...support-plays-role-in-tactical-operations/75545442/. McHugh , John M., Secretary of the Army, HQDA General Order 2014-02, Affirmation of Secretary of

Army Business Transformation - Next Steps

National Research Council Canada - National Science Library

2006-01-01

As a follow-on to the Army Science Board 2005 Summer Study on Best Practices, the Army Science Board was tasked to identify areas where alternative approaches and application of transforming practices...

Mentorship as Experienced by Women Surgeons in Japan.

Science.gov (United States)

Yorozuya, Kyoko; Kawase, Kazumi; Akashi-Tanaka, Sadako; Kanbayashi, Chizuko; Nomura, Sachiyo; Tomizawa, Yasuko

2016-01-01

Women have accounted for over 30% of new medical students since 1995 in Japan. Establishing support systems for women surgeons to continue their work is a major issue in Japan. Mentorship can be one of the most effective means to help women surgeons to continue their work. The purpose of this study was to clarify the current status of mentorship among Japanese women surgeons and to discuss the role of mentors for women surgeons. Invitation letters were sent to all female members of the Japan Association of Women Surgeons in April 2011. An 84-item questionnaire survey was sent to those who agreed to participate in this study via the internet. Fifty-five surgeons participated in this study, a response rate of 48.7%. Sixty-seven percent of respondents found it difficult to continue in their job; 85% thought mentorship was necessary for women surgeons to progress in their careers; and 84% reported that they already had a mentor. Respondents thought that a mentor helped them to advance their clinical career, to stay in their job, and to provide moral support. However, mentors appeared to be less useful in helping them to advance their research career, to network, to increase their status, and to achieve a work-life balance. This study revealed areas where mentors appeared to be less helpful to women surgeons. The survey gave an indication of how to help improve and develop the career and personal life of women surgeons in Japan.

Robotics In Manufacturing: Army View

Science.gov (United States)

Michel, F. J.

1983-05-01

(Figure 1) This is an outline of my presentation today. The U. S. Army has a dual interest in the use of robots, namely: 1. As a substitute for or an extension of the soldier in the battlefield, and 2. in the factories that make Army materiel, or - as we call it -the the production base. The Production Base can again be divided into three separate segments, i.e., the Army owned and operated facilities or GOG6s, such as Rock Island and Watervliet arsenals, and not to be overlooked, the depot operations. There the Army manufactures gun tubes and other related parts for artillery weapons and repairs and overhauls them. A second category is the Army owned and contractor operated facilities or GOCOs,such as the ammunition plants, the tank plants at Lima, Ohio and Warren, Michigan and the Stratford Engine Plant in Connecticut where gas turbines for helicopter and the Abrams tank are manufactured. The last category covers the industrial base, that is those factories which are not only operated but also owned by the contractor himself also referred to as COCOs. You can see from this description that the Army is supported by a base which produces a diversified line of products. Therefore, the task of technology development and technology insertion is considerably more complex than what one encounters in the average U. S. Manufacturing organization.

Army Healthcare Enterprise Management System

National Research Council Canada - National Science Library

2001-01-01

... to buy the Enterprise Management System. The Information Technology Business Center provides information technology services to Fort Sam Houston tenants which include the Army Medical Command and the Army Medical Department Center and School...

Civil Surgeon Info

Data.gov (United States)

Department of Homeland Security — USCIS designates certain doctors (also known as civil surgeons) to perform the medical exam required for most Green Card applicants. This data set represents the...

War of the British Worlds

DEFF Research Database (Denmark)

Mercau, Ezequiel

2016-01-01

The 1982 Falklands War was shrouded in symbolism, bringing to the fore divergent conceptions of Britishness, kinship, and belonging. This article casts light on the persistent purchase of the idea of Greater Britain long after the end of empire, addressing a case that would normally be deemed...... outside its spatial and temporal boundaries. By highlighting the inherent contradictions of this transnational bond, the South Atlantic conflict had a profound effect on an underexposed British community with a lingering attachment to a “British world”: the Anglo-Argentines. As they found themselves...... wedged between two irreconcilable identities, divisions threatened to derail this already enfeebled grouping. Yet leaders of the community, presuming a common Britishness with the Falkland Islanders and Britons in the United Kingdom, sought to intervene in the conflict by reaching out to both...

Surgeon-patient communication during awake procedures.

Science.gov (United States)

Smith, Claire S; Guyton, Kristina; Pariser, Joseph J; Siegler, Mark; Schindler, Nancy; Langerman, Alexander

2017-06-01

Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature. Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached. Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned. Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

The Internet and the paediatric surgeon.

Science.gov (United States)

Srinivas, M; Inumpudi, A; Mitra, D K

1998-12-01

The Internet, which has truly united the world, is an extensive network of inter-linked computers storing immense bytes of information that can be accessed by anyone, transcending all barriers. The paediatric surgery Internet consists of exponentially growing material that deals with information specifically for paediatric surgeons and patients of the paediatric age group. We reviewed the methods available to take advantage of this network to enable busy paediatric surgeons to accrue the benefits easily and efficiently rather than be lost in the information ocean by surfing individually. By getting connected to the Internet, the paediatric surgeon gains enormous information that can be useful for patient care. The Internet has revolutionised scientific publications by virtue of its fast and accurate transmission of manuscripts. Paediatric surgeons can send manuscripts by this channel and also access journals, obviating the inherent lag period of communication by post.

Projecting surgeon supply using a dynamic model.

Science.gov (United States)

Fraher, Erin P; Knapton, Andy; Sheldon, George F; Meyer, Anthony; Ricketts, Thomas C

2013-05-01

To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028. The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care. The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors. : Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines. The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.

78 FR 33074 - Army Science Board Summer Study Session

Science.gov (United States)

2013-06-03

...--This study evaluates what science and technology competencies the Army must maintain and/or develop as... DEPARTMENT OF DEFENSE Department of the Army Army Science Board Summer Study Session AGENCY... the Army announces the following committee meeting: 1. Name of Committee: Army Science Board (ASB). 2...

Risk of ionising radiation to trainee orthopaedic surgeons.

Science.gov (United States)

Khan, Ishrat A; Kamalasekaran, Senthil; Fazal, M Ali

2012-02-01

We undertook this study to determine the amount of scattered radiation received by the primary surgeon, assistant and patient during dynamic hip screw fixation for proximal femoral fractures. Data was collected from fifty patients. Five registrars were included as operating surgeon and four senior house officers as assistant surgeon. Radiation was monitored by thermo luminescent dosimeters placed on the surgeon and assistant. The approximate distance of surgeon and assistant from the operative site was measured. A dosimeter on the unaffected hip of patients measured the radiation to the patient. The results show that the surgeon's dominant hand receives the highest dose of radiation and radiation exposure is dependent on the experience of the operator. Our study concludes that exposure to radiation during this procedure is well below the toxic levels; however greater awareness is needed for harmful effects of exposure to long term low dose radiation.

Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout.

Science.gov (United States)

van Wulfften Palthe, Olivier D R; Neuhaus, Valentin; Janssen, Stein J; Guitton, Thierry G; Ring, David

2016-08-01

Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions. We asked: (1) For surgeons treating musculoskeletal conditions, what risk factors are associated with worse job dissatisfaction? (2) What risk factors are associated with burnout symptoms? Two hundred ten (52% of all active members of the Science of Variation Group [SOVG]) surgeons who treat musculoskeletal conditions (94% orthopaedic surgeons and 6% trauma surgeons; in Europe, general trauma surgeons do most of the fracture surgery) completed the Global Job Satisfaction instrument, Shirom-Malamed Burnout Measure, and provided practice and surgeon characteristics. Most surgeons were male (193 surgeons, 92%) and most were academically employed (186 surgeons, 89%). Factors independently associated with job satisfaction and burnout were identified with multivariable analysis. Greater symptoms of burnout (β, -7.13; standard error [SE], 0.75; 95% CI, -8.60 to -5.66; p job satisfaction. Having children (β, -0.45; SE, 0.0.21; 95% CI, -0.85 to -0.043; p = 0.030; adjusted R(2), 0.046) was the only factor independently associated with fewer symptoms of burnout. Among an active research group of largely academic surgeons treating musculoskeletal conditions, most are satisfied with their job. Efforts to limit burnout and job satisfaction by optimizing engagement in and deriving meaning from the work are effective in other settings and merit attention among surgeons. Level II, prognostic study.

A History of the Army Ground Forces; Study Number 16. The Army Ground Forces History of the Second Army

Science.gov (United States)

1945-09-01

proficiency in conjunction with other arms and services.7 GHQ and Second Army placed great stress on the development of instructors and the proper training of...separate units. This was clearly brought out in a report of iuspection of Second Army units at Ft. Knox, Ky., by Maj. Gen. J. M. Cumins , Commander of the...covered were food and water, hygiene, housing, field sanitation, and contagious and communicable diseases. Physical exercise stressed mass calisthenics

The lesser spotted pregnant surgeon.

Science.gov (United States)

Hamilton, L C

2017-10-19

With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. It is important for women in surgery to know that it is possible to continue their training while pregnant so they do not feel pressured into changing to a less demanding specialty or even leaving medicine entirely. It is also important for other professionals to understand the risks and choices faced by pregnant surgeons so that they can better support them in the workplace.

British power generation/delivery handbook

Energy Technology Data Exchange (ETDEWEB)

Bagley, R.

1986-01-01

Describes the British electricity-supply system and covers: the CEGB, nuclear power - AGR design, boiler plant development coal-fired boilers and oil-fired boilers, steam turbine/generators, boiler-feed pumps, pumped storage, gas turbine plants, transmission system including the link to France, the Sizewell-BPWR, future AGR development, future coal-fired stations, fluidized bed combustion, coal gasification, and wind energy developments. Also included is a list of British equipment suppliers to the electricity supply industry, and a buyer's guide to British equipment and services.

Real/Life: New British Art and the Reception of Contemporary British Art in Japan

Directory of Open Access Journals (Sweden)

Kajiya Kenji

2016-07-01

Full Text Available This essay explores the ways in which the exhibition Real/Life: New British Art was conceived and received in Japan, where contemporary British art has been shown since the 1960s. Taking place at five museums in the country between 1998 and 1999, the exhibition aimed to showhow British artists in the 1990s struggled with realities, internal and external, but its response was not as satisfactory as was expected. The essay examines the exhibition as a turning point for the transformation of exhibition culture in Japan from nationally themed exhibitions to showcases of contemporary art in the global context.

Current trends in chaperone use by plastic and reconstructive surgeons.

Science.gov (United States)

Choudry, Umar; Barta, Ruth J; Kim, Nicholas

2013-06-01

There is a paucity of literature regarding the use of chaperones by surgeons when examining patients. Use of a chaperone not only makes the patient comfortable but also potentially protects the surgeon from perceived misconduct. This is especially true for plastic surgeons who examine sensitive areas commonly. The purpose of this study was to determine the current trends in chaperone use by plastic surgeons when examining patients. A 23-question online survey was sent to all members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student t test and Pearson χ test. A P use by plastic surgeons during all examinations of patients was 30%. This rate increased up to 60% while examining sensitive areas. Male surgeons reported a higher frequency of chaperone use than female surgeons (P use compared to reconstructive surgeons (P = 0.001). Similarly, surgeons who had been in practice for more than 20 years reported a higher rate of chaperone use compared to surgeons in practice for less than 20 years (P = 0.032). Sixty-one (7.6%; 56 male and 5 female) surgeons reported being accused of inappropriate behavior by patients, of whom 49 (80%) did not have a chaperone present. There was no significant difference among male and female surgeons in rates of being accused of inappropriate behavior (7.9% vs 4.2%, P = 0.19). There was a higher rate of chaperone use by male plastic surgeons, surgeons with more than 20 years experience, and cosmetic surgeons. Despite the difference in chaperone use between the sexes, both had similar rates of being accused of inappropriate behavior during examinations by patients, and although these incidents were quite low, most had no chaperone present during those examinations.

Army Study Shows Decline In Behavioral Health Stigma

Science.gov (United States)

2012-01-01

Army Study Shows Decline in Behavioral Health Stigma By Rob McIlvaine Army News Service WASHINGTON, Jan. 20, 2012 - A newly released Army study on...conference yesterday. The three-year study outlines the problem of suicide in the Army and related issues of substance abuse, spouse abuse and child abuse...REPORT TYPE 3. DATES COVERED 00-00-2012 to 00-00-2012 4. TITLE AND SUBTITLE Army Study Shows Decline In Behavioral Health Stigma 5a. CONTRACT

Army medical imaging system: ARMIS

International Nuclear Information System (INIS)

Siedband, M.P.; Kramp, D.C.

1987-01-01

Recent advances of stimulable phosphor screens, data cards using optical storage means, and new personal computers with image processing capability have made possible the design of economical filmless medical imaging systems. The addition of communication links means that remote interpretation of images is also possible. The Army Medical Imaging System uses stimulable phosphor screens, digital readout, a small computer, an optical digital data card device, and a DIN/PACS link. Up to 200 images can be stored in the computer hard disk for rapid recall and reading by the radiologist. The computer permits image processing, annotation, insertion of text, and control of the system. Each device contains an image storage RAM and communicates with the computer via the small computer systems interface. Data compression is used to reduce the required storage capacity and transmission times of the 1-mB images. The credit card-size optical data cards replace film and can store 12 or more images. The data cards can be read on an independent viewer. The research is supported by the U.S. Army Biomedical Research and Development Laboratory

Surgeons' musculoskeletal pain in minimally invasive surgery

DEFF Research Database (Denmark)

Dalager, Tina; Søgaard, Karen; Bech (Katrine Tholstrup Pedersen), Katrine Tholstrup

in surgeons performing MIS is high and derives mainly from static postures. Positioning of monitor, adjustment of table height and instrument design also contribute substantially. Robotic assisted laparoscopy seems less physically demanding for the surgeon compared with conventional laparoscopy. However, some...... put the patients at a higher risk of complications, and on the longer term there is an increasing risk for the surgeon to develop chronic musculoskeletal pain that will disable him/her to perform his/her job. Therefore, surgeons’ musculoskeletal health is of vital importance and must be considered...... alongside patient safety. The present literature study supports the need for a randomized controlled trial evaluating the effect of an individually designed training program for surgeons performing MIS....

Perspectives of South African general surgeons regarding their ...

African Journals Online (AJOL)

Objectives. To canvass the perceptions of SA general surgeons regarding certain aspects of their training. Methods. An electronic postal survey was conducted. All general surgeons on the Association of Surgeons of South Africa database were requested to complete a structured questionnaire. Four Likert scale items were ...

Assessing the Impact of Surgeon Experience on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy: Results of Four High-Volume Surgeons.

Science.gov (United States)

Fossati, Nicola; Di Trapani, Ettore; Gandaglia, Giorgio; Dell'Oglio, Paolo; Umari, Paolo; Buffi, Nicolò Maria; Guazzoni, Giorgio; Mottrie, Alexander; Gaboardi, Franco; Montorsi, Francesco; Briganti, Alberto; Suardi, Nazareno

2017-09-01

To test the impact of surgeon experience on urinary continence (UC) recovery after robot-assisted radical prostatectomy (RARP). The study included 1477 consecutive patients treated with RARP by four surgeons between 2006 and 2014. UC recovery was defined as being completely dry over a 24-hour period at follow-up. Surgeon experience was coded as the total number of RARP performed by the surgeon before the patient's operation. Multivariable analysis tested the association between surgeon experience and UC recovery. Covariates consisted of patient age, Charlson comorbidity index, preoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), nerve-sparing surgery (none vs unilateral vs bilateral), and preoperative risk groups (low- vs intermediate- vs high risk). The number of cases performed by each surgeon was 541, 413, 411, and 112, respectively. Median follow-up was 24 months (inter-quartile range: 18, 40). The UC recovery rate at 1 year after surgery was 82%. At multivariable analyses, surgeon experience represented an independent predictor of UC recovery (hazard ratio: 1.02, p < 0.001). The surgical learning curve was similar among surgeons, moving linearly from ∼60% of UC rate at the initial cases to almost 90% after more than 400 procedures. In patients undergoing RARP, surgeon experience is a significant predictor of UC recovery. The surgical learning curve of UC recovery does not reach a plateau even after more than 100 cases, suggesting a continuous improvement of the surgical technique. These findings deserve attention for patient counseling and future comparative studies evaluating functional outcomes after RARP.

Being a surgeon--the myth and the reality: a meta-synthesis of surgeons' perspectives about factors affecting their practice and well-being.

Science.gov (United States)

Orri, Massimiliano; Farges, Olivier; Clavien, Pierre-Alain; Barkun, Jeffrey; Revah-Lévy, Anne

2014-11-01

Synthesize the findings from individual qualitative studies about surgeons' account of their practice. Social and contextual factors of practice influence doctors' well-being and therapeutic relationships. Little is known about surgery, but it is generally assumed that surgeons are not affected by them. We searched international publications (2000-2012) to identify relevant qualitative research exploring how surgeons talk about their practice. Meta-ethnography (a systematic analysis of qualitative literature that compensates for the potential lack of generalizability of the primary studies and provides new insight by their conjoint interpretation) was used to identify key themes and synthesize them. We identified 51 articles (>1000 surgeons) from different specialties and countries. Two main themes emerged. (i) The patient-surgeon relationship, described surgeons' characterizations of their relationships with patients. We identified factors influencing surgical decision making, communication, and personal involvement in the process of care; these were surgeon-related, patient-related, and contextual. (ii) Group relations and culture described perceived issues related to surgical culture (image and education, teamwork, rules, and guidelines); it highlighted the influence of a social dimension on surgical practice. In both themes, we uncovered an emotional dimension of surgeons' practice. Surgeons' emphasis on technical aspects, individuality, and performance seems to impede a modern patient-centered approach to care and to act as a barrier to well-being. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgical innovation, surgeons' well-being, and the attractiveness of this specialty.

Effectiveness of the Army Mentorship Program

National Research Council Canada - National Science Library

Nieberding, Richard J

2007-01-01

...). From the artifacts associated with this mentorship program, it appears that the Army highly values this program as a way to create a culture and climate that fosters learning and development for future leadership. This project will examine the effectiveness of mentorship in the today's Army and evaluate whether the program is sufficient to meet the needs for the Army's next generation of soldiers and leaders.

Factors predicting health behaviors among Army Reserve, active duty Army, and civilian hospital employees.

Science.gov (United States)

Wynd, Christine A; Ryan-Wenger, Nancy A

2004-12-01

This study identified health-risk and health-promoting behaviors in military and civilian personnel employed in hospitals. Intrinsic self-motivation and extrinsic organizational workplace factors were examined as predictors of health behaviors. Because reservists represent a blend of military and civilian lifestyles, descriptive analyses focused on comparing Army Reserve personnel (n = 199) with active duty Army (n = 218) and civilian employees (n = 193), for a total sample of 610. Self-motivation and social support were significant factors contributing to the adoption of health-promoting behaviors; however, organizational workplace cultures were inconsistent predictors of health among the three groups. Only the active Army subgroup identified a hierarchical culture as having an influence on health promotion, possibly because of the Army's mandatory physical fitness and weight control standards. Social support and self-motivation are essential to promoting health among employees, thus hospital commanders and chief executive officers should encourage strategies that enhance and reward these behaviors.

Post-Conflict Realities and the Future of Stability in Nepal

Science.gov (United States)

2017-03-01

British Army states that they have selected 310 recruits from Nepal, among which 230 will go to the British Army and the remaining 80 will join the...Workers’ Union 12. All Nepal Hotel and Restaurant Workers’ Union 13. All Nepal Carpet Workers’ Union 14. All Nepal Meter Tempo Workers’ Union 15

76 FR 56406 - Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army...

Science.gov (United States)

2011-09-13

... DEPARTMENT OF DEFENSE Office of the Secretary Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army Research, Development and Engineering Command; Tank... personnel management demonstration project for eligible TARDEC employees. Within that notice the table...

76 FR 12087 - Army Educational Advisory Committee

Science.gov (United States)

2011-03-04

...: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting: March 24, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command... faculty; table and examine online College issues; assess resident and distance education programs, self...

75 FR 7255 - Army Educational Advisory Committee

Science.gov (United States)

2010-02-18

... Committee: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Date of Meeting: March 11, 2010. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command...; table and examine online College issues; assess resident and distance education programs, self- study...

Lifelong Learning for the Hand Surgeon.

Science.gov (United States)

Adkinson, Joshua M; Chung, Kevin C

2015-09-01

Hand surgeons are faced with the impossible task of mastering a rapidly expanding pool of knowledge and surgical techniques. Dedication to lifelong learning is, therefore, an essential component of delivering the best, most up-to-date care for patients. Board certification, participation in continuing medical education and maintenance of certification activities, and attendance at national meetings are essential mechanisms by which hand surgeons may foster the acquisition of essential knowledge and clinical skills, This article highlights the history, current status, and emerging needs in continuing medical education for the hand surgeon. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons.

Science.gov (United States)

Ichikawa, Nobuki; Homma, Shigenori; Yoshida, Tadashi; Ohno, Yosuke; Kawamura, Hideki; Kamiizumi, You; Iijima, Hiroaki; Taketomi, Akinobu

2018-01-01

The use of laparoscopic colectomy is becoming widespread and acquisition of its technique is challenging. In this study, we investigated whether supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The outcomes of 23 right colectomies and 19 high anterior resections for colon cancers performed by five novice surgeons (experience level of <10 cases) between 2014 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries as the teaching assistant. In the right colectomy group, one patient (4.3%) required conversion to open surgery and postoperative morbidities occurred in two cases (8.6%). The operative time moving average gradually decreased from 216 to 150 min, and the blood loss decreased from 128 to 28 mL. In the CUSUM charts, the values for operative time decreased continuously after the 18th case, as compared to the Japanese standard. The values for blood loss also plateaued after the 18th case. In the high anterior resection group, one patient (5.2%) required conversion to open surgery and no postoperative complication occurred in any patient. The operative time moving average gradually decreased from 258 to 228 min, and the blood loss decreased from 33 to 18 mL. The CUSUM charts showed that the values of operative time plateaued after the 18th case, as compared to the Japanese standard. In the CUSUM chart for blood loss, no distinguishing peak or trend was noted. Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The trainee's learning curve in this study represents successful mentoring by the laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System.

HISTORICAL NOTE JOHN HUNTER (SURGEON) John Hunter FRS ...

African Journals Online (AJOL)

JOHN HUNTER (SURGEON). John Hunter FRS (13 February 1728-16 October 1793) was a Scottish surgeon, one of the most distinguished scientists and surgeons of his day. He was an early advocate of careful observation and scientific method in medicine. He was the husband of Anne Hunter, a teacher, friend and ...

Young transplant surgeons and NIH funding.

Science.gov (United States)

Englesbe, M J; Sung, R S; Segev, D L

2011-02-01

Transplant surgeons have historically been instrumental in advancing the science of transplantation. However, research in the current environment inevitably requires external funding, and the classic career development pathway for a junior investigator is the NIH K award. We matched transplant surgeons who completed fellowships between 1998 and 2004 with the NIH funding database, and also queried them regarding research effort and attitudes. Of 373 surgeons who completed a fellowship, only 6 (1.8%) received a K award; of these, 3 subsequently obtained R-level funding. An additional 5 individuals received an R-level grant within their first 5 years as faculty without a K award, 3 of whom had received a prior ASTS-sponsored award. Survey respondents reported extensive research experience during their training (78.8% spent median 24 months), a high proportion of graduate research degrees (36%), and a strong desire for more research time (78%). However, they reported clinical burdens and lack of mentorship as their primary perceived barriers to successful research careers. The very low rate of NIH funding for young transplant surgeons, combined with survey results that indicate their desire to participate in research, suggest institutional barriers to access that may warrant attention by the ASTS and the transplant surgery community. ©2010 The Authors Journal compilation©2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

Canadian cardiac surgeons' perspectives on biomedical innovation.

Science.gov (United States)

Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M

2012-01-01

Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

78 FR 24735 - Army Education Advisory Committee Meeting

Science.gov (United States)

2013-04-26

... include topics relating to the Army Learning Model that seeks to improve the Army's learning model by leveraging technology without sacrificing standards so the Army can provide credible, rigorous, and relevant...

Specialization and the Current Practices of General Surgeons

Science.gov (United States)

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy.

Science.gov (United States)

Lee, Doh Young; Baek, Seung-Kuk; Jung, Kwang-Yoon

2017-01-01

This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.

Dame Maud McCarthy (1859-1949): Matron-in-Chief, British Expeditionary Forces France and Flanders, First World War.

Science.gov (United States)

Shields, Rosemary; Shields, Linda

2016-11-01

Emma Maud McCarthy was one of the most decorated nurses of the First World War. Born in Sydney in 1859, she trained as a nurse at The London Hospital in England. She was one of the first nurses to go to the South African War and in 1914 was one of the first members of Queen Alexandra's Imperial Nursing Service. Maud McCarthy went to France as Matron-in-Chief of British, Colonial and US nursing services until the end of hostilities in 1918. After the First World War she became Matron-in-Chief of the Territorial Army Nursing Service and retired five years later. She was appointed Dame Grand Cross in 1918 and earned awards from Britain, France, Belgium and America. Her influence on nursing was profound. One of the first senior nurses to recognise the impact of war on minds, she set up separate units for men who had self-harmed and she pioneered nurse anaesthetists in the British Armed Forces. Dame Maud McCarthy was an administrator par excellence whose determination to provide the best conditions possible for both her nurses and the men for whom they cared made possible the highest standards of nursing care in the First World War. © The Author(s) 2015.

Patient Attitudes Toward Orthopedic Surgeon Ownership of Related Ancillary Businesses.

Science.gov (United States)

Yi, Paul H; Cross, Michael B; Johnson, Staci R; Rasinski, Kenneth A; Nunley, Ryan M; Della Valle, Craig J

2016-08-01

Physician ownership of businesses related to orthopedic surgery, such as surgery centers, has been criticized as potentially leading to misuse of health care resources. The purpose of this study was to determine patients' attitudes toward surgeon ownership of orthopedic-related businesses. We surveyed 280 consecutive patients at 2 centers regarding their attitudes toward surgeon ownership of orthopedic-related businesses using an anonymous questionnaire. Three surgeon ownership scenarios were presented: (1) owning a surgery center, (2) physical therapy (PT), and (3) imaging facilities (eg, Magnetic Resonance Imaging scanner). Two hundred fourteen patients (76%) completed the questionnaire. The majority agreed that it is ethical for a surgeon to own a surgery center (73%), PT practice (77%), or imaging facility (77%). Most (>67%) indicated that their surgeon owning such a business would have no effect on the trust they have in their surgeon. Although >70% agreed that a surgeon in all 3 scenarios would make the same treatment decisions, many agreed that such surgeons might perform more surgery (47%), refer more patients to PT (61%), or order more imaging (58%). Patients favored surgeon autonomy, however, believing that surgeons should be allowed to own such businesses (78%). Eighty-five percent agreed that patients should be informed if their surgeon owns an orthopedic-related business. Although patients express concern over and desire disclosure of surgeon ownership of orthopedic-related businesses, the majority believes that it is an ethical practice and feel comfortable receiving care at such a facility. Copyright © 2016 Elsevier Inc. All rights reserved.

Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

DEFF Research Database (Denmark)

Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels

2015-01-01

surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all...... of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...... symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own...

78 FR 69077 - Army Education Advisory Subcommittee Meeting Notice

Science.gov (United States)

2013-11-18

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Subcommittee Meeting Notice... leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation...: ATFL-APO, Monterey, CA 93944, [email protected]us.army.mil , (831) 242-5828. SUPPLEMENTARY INFORMATION...

77 FR 4026 - Army Education Advisory Subcommittee Meeting Notice

Science.gov (United States)

2012-01-26

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Subcommittee Meeting Notice... Visitors, U.S. Army War College Subcommittee. Date of Meeting: February 23, 2012. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle...

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

NARCIS (Netherlands)

Janssen, Stein J.; Teunis, Teun; Guitton, Thierry G.; Ring, David; Spoor, Andy B.; Chauhan, Aakash; Shafritz, Adam B.; Wasterlain, Amy; Terrono, Andrew L.; Neviaser, Andrew S.; Schmidt, Andrew; Nelson, Andy; Miller, Anna N.; Kristan, Anze; Apard, Thomas; Berner, Arne; Ilyas, Asif; Jubel, Axel; Jost, Bernhard; Babis, George; Watkins, Barry; Kreis, Barbara; Nolan, Betsy M.; Crist, Brett D.; Cross, Brian J.; Wills, Brian P. D.; Barreto, Camilo Jose Romero; Ekholm, Carl; Swigart, Carrie; Spath, Catherine; Zalavras, Charalampos; Cassidy, Charles; Garnavos, Christos; Moreno-Serrano, Constanza L.; Rodner, Craig; Klostermann, Cyrus; Osei, Daniel A.; Rikli, Daniel A.; Haverkamp, Daniel; Polatsch, Daniel; Drosdowech, Darren; Edelstein, David M.; Eygendaal, Denise; Verbeek, Diederik O. F.; Doornberg, Job N.; van den Bekerom, Michel P. J.; Schep, Niels; Kloen, Peter; Haverlag, Robert; Schepers, Tim

2015-01-01

There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. (1) Are surgeons more likely to recommend surgery when choosing for

Characterizing and fostering charity care in the surgeon workforce.

Science.gov (United States)

Wright, D Brad; Scarborough, John E

2011-07-01

We sought to determine which demographic and practice characteristics are associated with both a surgeon's willingness to provide any charity care as well as the amount of charity care provided. Although it is known that surgeons tend to provide a greater amount of charity care than other physicians, no studies have attempted to look within the surgeon population to identify which factors lead some surgeons to provide more charity care than others. Using 4 rounds of data from the Community Tracking Study, we employ a 2-part multivariate regression model with fixed effects. A greater amount of charity care is provided by surgeons who are male, practice owners, employed in academic medical centers, or earn a greater proportion of their revenue from Medicaid. Surgeons who work in a group HMO are significantly less likely to provide any charity care. Personal resources (eg, time and money) had a minimal association with charity care provision. Surgeons whose characteristics are associated with a greater propensity for charity care provision as suggested by this study, should be considered as a potential source for building the volunteer workforce.

Army Cost Culture: What Is It? What Should It Become?

Science.gov (United States)

2013-03-01

Army leaders to implement inclusion of this Army cost culture value into the larger Army culture. Kotter warns us that failure to complete each step...inculcation of a cost culture. However, this circumstance does not really apply to the Army. Army senior leaders clearly understand that mission comes...changed: In this challenging environment, an improved Army cost culture will enable senior leaders to preserve the nation’s security. This Strategy

Army Leader Transitions Handbook

Science.gov (United States)

2008-01-01

The courseware allows users to tailor training materials to specific needs. Users access this at the CAL AKO website or Army eLearning https...usarmy.skillport.com/ skillportfe/login/usarmylogin.cfm. New users must register with eLearning . Then login, select “Army Custom Curricula” and scroll to...challenges of your transition. Patience, flexibility and a good understanding of influence techniques on your part will help make any needed realignment a

77 FR 27209 - Army Education Advisory Subcommittee Meeting Notice

Science.gov (United States)

2012-05-09

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Subcommittee Meeting Notice...: Board of Visitors, U.S. Army War College Subcommittee. Date of Meeting: May 31, 2012. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle...

78 FR 23759 - Army Education Advisory Subcommittee Meeting Notice

Science.gov (United States)

2013-04-22

... DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Subcommittee Meeting Notice... Visitors, U.S. Army War College Subcommittee. Dates of Meeting: May 16, 2013. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle Barracks...

Hazardous Waste Surveys of Two Army Installations and an Army Hospital.

Science.gov (United States)

1980-08-01

232 Nickel-63 Uranium-238 Plutonium-239 Polonium - 210 6 Army Medical Treatment Facilities: General Administration Army Regulation (AR) 40-2, 42A peren...Adhesive BN R 0x AU DOI545AO GI. 312 F 44 0,3 27)d17 N6341( 2 14,5 0 6 Adhesive 81 A XY AO D041419A0 PI 210 82140 O0 5824596 RO.34 140376139 Adhesi E ON...conform to clean air pollutant standards. 46 4 Noninfectious Solid Waste. Most wastes in this category are: (1) food waste from the military mess and

Army Programs: Army Finance and Accounting Quality Assurance Program

National Research Council Canada - National Science Library

1988-01-01

This regulation discusses the primary responsibilities of commanders and staff officers at installation and higher levels for execution of the Army Finance and Accounting Quality Assurance (QA) Program...

Hand dominance in orthopaedic surgeons.

LENUS (Irish Health Repository)

Lui, Darren F

2012-08-01

Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.

A leadership development program for surgeons: First-year participant evaluation.

Science.gov (United States)

Pradarelli, Jason C; Jaffe, Gregory A; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B

2016-08-01

In a dynamic health care system, strong leadership has never been more important for surgeons. Little is known about how to design and conduct effectively a leadership program specifically for surgeons. We sought to evaluate critically a Leadership Development Program for practicing surgeons by exploring how the program's strengths and weaknesses affected the surgeons' development as physician-leaders. At a large academic institution, we conducted semistructured interviews with 21 surgical faculty members who applied voluntarily, were selected, and completed a newly created Leadership Development Program in December 2012. Interview transcripts underwent qualitative descriptive analysis with thematic coding based on grounded theory. Themes were extracted regarding surgeons' evaluations of the program on their development as physician-leaders. After completing the program, surgeons reported personal improvements in the following 4 areas: self-empowerment to lead, self-awareness, team-building skills, and knowledge in business and leadership. Surgeons felt "more confident about stepping up as a leader" and more aware of "how others view me and my interactions." They described a stronger grasp on "giving feedback" as well as a better understanding of "business/organizational issues." Overall, surgeon-participants reported positive impacts of the program on their day-to-day work activities and general career perspective as well as on their long-term career development plans. Surgeons also recommended areas where the program could potentially be improved. These interviews detailed self-reported improvements in leadership knowledge and capabilities for practicing surgeons who completed a Leadership Development Program. A curriculum designed specifically for surgeons may enable future programs to equip surgeons better for important leadership roles in a complex health care environment. Copyright © 2016 Elsevier Inc. All rights reserved.

Trust: Implications for the Army Profession

Science.gov (United States)

2013-10-01

Georgia Institute of Technology, a MMAS from the School of Advance Military Studies, and an MSS from the U.S. Army War College. He was the U.S. Army...degrees from the School of Advance Military Studies, the US Army War College, and Webster University. His current research focus is senior military...The Repeal of Don’t Ask, Don’t Tell—1 Year Later,” Center for American Progress, from <http://www.americanprogress.org/issues/ lgbt /report/2012/09

British Teachers' Transnational Work within and beyond the British Empire after the Second World War

Science.gov (United States)

Whitehead, Kay

2017-01-01

Focusing on British graduates from Gipsy Hill Training College (GHTC) in London, this article illustrates transnational history's concerns with the reciprocal flows of people and ideas within and beyond the British Empire. GHTC's progressive curriculum and culture positioned women teachers as agents of change, and the article highlights the lives…

An online review of plastic surgeons in southern California.

Science.gov (United States)

Lewis, Priya; Kobayashi, Emily; Gupta, Subhas

2015-05-01

It has become commonplace for patients to access online reviews of physicians when making choices about health care, just as any consumer would in today's computer-dependent world. Previous studies have shown that online reviews of physicians are generally positive. However, 1 negative review has the potential to adversely affect business and reputations. To characterize the online presence of plastic surgeons in Southern California as portrayed by physician rating websites (PRWs). An extensive online database of board-certified plastic surgeons was used to generate a list of surgeons within a 50-mile radius of Pomona, CA. Ratings from the PRWs HealthGrades.com, Vitals.com, and UCompareHealthcare.com were cataloged by number of reviews and ratings. Two hundred sixty-three surgeons were evaluated with the most-represented cities being Beverly Hills (N=47), Los Angeles (N=31), and Newport Beach (N=27). Ninety-seven percent of the surgeons were rated on at least 1 of the 3 PRWs chosen. In general, surgeons were rated highly, with a mean rating of 85%, SD, 14% (Ponline ratings ranged from 0 to 222 per surgeon. The median number of total reviews was 25 and the mean rating for those surgeons above and below the median were equivocal, at 86% and 85%, respectively (P=0.284). In this study, we found that plastic surgeons in Southern California have an online presence that can be influenced by their patients; they should be aware of this and conscious of their online reputations. Overall, the ratings were high, regardless of the number of reviews.

British coal-down to the line

International Nuclear Information System (INIS)

Anon.

1993-01-01

The long-running saga of British Coal's decline is in its final stages with virtually no change from last October when the British government announced plants to close 31 of the 50 remaining mines. That announcement produced a political outcry but having privatized the electricity industry in 1990 the government had effectively left itself up the creek without a paddle. It had no powers to force the generators to buy more coal. The status of the British coal industry is discussed

Surgeon-performed ultrasonography

DEFF Research Database (Denmark)

Todsen, Tobias

2017-01-01

Surgeons are increasingly using ultrasonography (US) in their clinical management of patients. However, US is a very user-dependent imaging modality and proper skills of the US operator are needed to ensure quality in patient care. This thesis explores the validity evidence for assessment...

Musculoskeletal pain among surgeons performing minimally invasive surgery

DEFF Research Database (Denmark)

Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup

2017-01-01

BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this ......BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons......, and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality...... fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18. DISCUSSION: Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological...

Can Access to Data Prevent Army Suicides Identifying Optimal Response Strategies for Army Leaders

Science.gov (United States)

2016-01-01

activities. One shortfall of this approach, however, is the lack of guidance on how Army leaders should interpret and use these data. To address this gap ...records Personal relationships Divorce, Army Community Service records Financial problems Wage garnishment, creditor notification agreed that leaders...endorsed by three panelists. compared, noting that there are significant differences between battalions with respect to age, gender , and rank

A Cross-Sectional Comparison of Army Advertising Attributes

Science.gov (United States)

1990-11-01

ARMY ADVERTISING ATTRIBUTES EXECUTIVE SUMMARY Research Requirement: In order to assess the impact of the Army’s advertising strategy and campaigns...Sample sizes varied from 4,875 to 4,926 for the NRS and from 3,569 to 3,602 for ACOMS. Improvement type themes. This advertising strategy would make...and college. I recommend that the Army focus advertising strategy on the Army as a positive step between high school and college in addition to work

Musculoskeletal Pain in Gynecologic Surgeons

Science.gov (United States)

Adams, Sonia R.; Hacker, Michele R.; McKinney, Jessica L.; Elkadry, Eman A.; Rosenblatt, Peter L.

2013-01-01

Objective To describe the prevalence of musculoskeletal pain and symptoms in gynecologic surgeons. Design Prospective cross-sectional survey study (Canadian Task Force classification II-2). Setting Virtual. All study participants were contacted and participated via electronic means. Participants Gynecologic surgeons. Interventions An anonymous, web-based survey was distributed to gynecologic surgeons via electronic newsletters and direct E-mail. Measurements and Main Results There were 495 respondents with complete data. When respondents were queried about their musculoskeletal symptoms in the past 12 months, they reported a high prevalence of lower back (75.6%) and neck (72.9%) pain and a slightly lower prevalence of shoulder (66.6%), upper back (61.6%), and wrist/hand (60.9%) pain. Many respondents believed that performing surgery caused or worsened the pain, ranging from 76.3% to 82.7% in these five anatomic regions. Women are at an approximately twofold risk of pain, with adjusted odds ratios (OR) of 1.88 (95% confidence interval [CI], 1.1–3.2; p 5 .02) in the lower back region, OR 2.6 (95% CI, 1.4–4.8; p 5 .002) in the upper back, and OR 2.9 (95% CI, 1.8–4.6; p 5 .001) in the wrist/hand region. Conclusion Musculoskeletal symptoms are highly prevalent among gynecologic surgeons. Female sex is associated with approximately twofold risk of reported pain in commonly assessed anatomic regions. Journal of Minimally Invasive Gynecology (2013) 20, 656-660 PMID:23796512

Department of the Army Installation Restoration Program

International Nuclear Information System (INIS)

Anderson, A.W.

1988-01-01

The Army's Installation Restoration Program (IRP) was established in 1975 in response to regulatory action at several installations where past disposal practices had caused contamination of streams and groundwater. The need to decontaminate excess Army-owned real estate also was considered in early IRP activities. A variety of site types have been discovered on Army installations. The major site types evaluated to date include: contaminated soil areas, landfills, lagoons, buildings, burning grounds, sumps, pits, storage tanks, sewage treatment plants, storage pads, industrial wastewater treatment plants, and salvage yards. Twenty Army installations have been proposed for or listed on the National Priorities List (NPL). The need for taking action at hazardous waste sites, however, is based on threats they pose to human health, welfare or the environment. Sites do not have to be on the SPL in order to be cleaned up through IRP activities. All of the sites that caused Army installations to be proposed for the NPL are being evaluated and cleaned up. In addition, all Army properties have been or will be assessed and where needed they will be addressed by the IRP

Society of Thoracic Surgeons

Science.gov (United States)

... Apply for Membership Membership Directory Pay Your Dues Industry Mailing List License & eBlast Communications Programs Advertise on ... Hotel Discount Copyright © 2017 The Society of Thoracic Surgeons. ...

Army Blast Claims Evaluation Procedures

Science.gov (United States)

1994-03-01

ATIN: AFZX-JA Building 4551 Fort Polk, LA 71459-5000 Commander U.S. Army Engineer Center and Fort Leonard Wood ATIN: AlZT-JA Building 1706 East...U.S. Armed Forces Claims Service, Korea APO AP 96205-0084 No. of Copies Organization 1 Commander U.S. Army South ATI’N: SOJA Building 154 APO

Army Vocational Guidance in Two-Year Colleges

Science.gov (United States)

1987-11-01

worklife . Second, counselors were quite receptive to the idea of having high quality Army information available that could aid student career planning...the CVG/JOIN information presentations to be informative and rather objective (i.e., balanced pros and cons about Army life/options). Nonetheless...presentation; variety, color is excellant. - Very honest and balanced presentations. "* 130 0 - - - - - - - - - - 15) quality of "Army Jobs" info

A Modular Laparoscopic Training Program for Pediatric Surgeons

Science.gov (United States)

Wasa, Masafumi; Takiguchi, Shuji; Taniguchi, Eiji; Soh, Hideki; Ohashi, Shuichi; Okada, Akira

2003-01-01

Objectives: A structured endoscopic training program for pediatric surgeons has not yet been established. This study was conducted to develop a modular training program (MTP) for pediatric surgeons and to evaluate its effectiveness for surgeons with and without previous experience in laparoscopic surgery. Methods: Nine pediatric surgeons participated in the study. They were divided into 2 groups: group A (n=4), surgeons who had experienced more than 10 cases of laparoscopic surgery prior to MTP; group B (n=5), those who had experienced fewer than 10 cases. They participated in a standardized MTP workshop, which consisted of 2 “see-through” and 3 “laparoscopic” tasks. Each participant's psychomotor skills were evaluated objectively before and after MTP with a computer-generated virtual simulator and were evaluated for precision, efficiency, and speed. Results: In participants, speed was significantly enhanced after MTP. In group A, no differences were observed after MTP, whereas significant improvements were noted in efficiency and speed after MTP in group B. Before MTP, efficiency was significantly higher in group A than in group B; however, no difference remained between the 2 groups after MTP. Conclusions: MTP is effective for nonlaparoscopic pediatric surgeons to become familiar with basic endoscopic skills. PMID:12722996

The Great British Music Hall: Its Importance to British Culture and ‘The Trivial’

Directory of Open Access Journals (Sweden)

Steven Gerrard

2013-12-01

Full Text Available By 1960, Britain’s once-thriving Music Hall industry was virtually dead. Theatres with their faded notions of Empire gave way to Cinema and the threat of Television. Where thousands once linked arms singing popular songs, watch acrobatics, see feats of strength, and listen to risqué jokes, now the echoes of those acts lay as whispers amongst the stalls’ threadbare seats. The Halls flourished in the 19th Century, but had their origins in the taverns of the 16th and 17th Centuries. Minstrels plied their trade egged on by drunken crowds. As time passed, the notoriety of the Music Hall acts and camaraderie produced grew. Entrepreneurial businessman tapped into this commerciality and had purpose-built status symbol theatres to provide a ‘home’ for acts and punters. With names like The Apollo giving gravitas approaching Olympian ideals, so the owners basked in wealth and glory. The Music Hall became the mass populist entertainment for the population. Every town had one, where everyone could be entertained by variety acts showing off the performers’ skills. The acts varied from singers, joke-tellers, comics, acrobats, to dancers. They all aimed to entertain. They enabled audiences to share a symbiotic relationship with one another; became recruitment officers for the Army; inspired War Poets; showed short films; and they and the halls reflected both the ideals and foibles of their era. By using Raymond Williams’ structures of feeling as its cornerstone, the article will give a brief history of the halls, whilst providing analysis into how they grew into mass populist entertainment that represented British culture. Case studies of famous artistes are given, plus an insight into how Music Hall segued into radio, film and television.

How surgeons make decisions when the evidence is inconclusive

NARCIS (Netherlands)

Hageman, Michiel G. J. S.; Guitton, Thierry G.; Ring, David; Osterman, A. Lee; Spoor, A. B.; van der Zwan, A. L.; Shrivastava, Abhay; Wahegaonkar, Abhijeet L.; Aida, E. Garcia G.; Aita, M. A.; Castillo, Alberto Pérez; Marcus, Alexander; Ladd, Amy; Terrono, Andrew L.; Gutow, Andrew P.; Schmidt, Andrew; Wang, Angela A.; Eschler, Anica; Miller, Anna N.; Wikerøy, Annette K. B.; Barquet, Antonio; Armstrong, April D.; van Vugt, Arie B.; Bedi, Asheesh; Shyam, Ashok K.; Mazzocca, Augustus D.; Jubel, Axel; Babst, Reto H.; Nolan, Betsy M.; Arciero, Bob; Bremer, Vanden; Bamberger, Brent; Peterson, Bret C.; Crist, Brett D.; Cross, Brian J.; Badman, Brian L.; Henley, C. Noel; Ekholm, Carl; Swigart, Carrie; Manke, Chad; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Cornell, Charles; Getz, Charles L.; Metzger, Charles; Wilson, Chris; Heiss, Christian; Perrotto, Christian J.; Wall, Christopher J.; Walsh, Christopher J.; Garnavos, Christos; Jiang, Chunyan; Lomita, Craig; Torosian, Craig M.; Rikli, Daniel A.; Whelan, Daniel B.; Wascher, Daniel C.; Hernandez, Daniel; Polatsch, Daniel; Beingessner, Daphne; Drosdowech, Darren; Tate, David E.; Hak, David; Rowland, David J.; Kalainov, David M.; Nelson, David; Weiss, David; McKee, Desirae M.; van Deurzen, D. F. G.; Endrizzi, Donald; Erol, Konul; Overbeck, Joachim P.; Baer, Wolfgang; Schwab, Eckart; Maza, Edgardo Ramos; Harvey, Edward; Rodriguez, Edward K.; Preloggler, Elisabeth; Schemitsch, Emil H.; Shin, Eon K.; Hofmeister, Eric P.; Kaplan, Thomas D.; Beeres, F. J. P.; Suarez, Fabio; Fernandes, C. H.; Cayón, Fidel Ernesto Cayón; Dolatowski, Filip Celestyn; Martin, Fischmeister; Sierra, Francisco Javier Aguilar; Lopez-Gonzalez, Francisco; Walter, Frank; Seibert, Franz Josef; Baumgaertel, Fred; Frihagen, Frede; Fuchs, P. C.; Huemer, Georg M.; Kontakis, George; Athwal, George S.; Dyer, George S. M.; Thomas, George; Kohut, Georges; Williams, Gerald; Hernandez, German Ricardo; Caro, Gladys Cecilia Zambrano; Garrigues, Grant; Merrell, Greg; DeSilva, Gregory; Della Rocca, Gregory J.; Regazzi, Gustavo; de Azevedo, Gustavo Borges Laurindo; Ruggiero, Gustavo Mantovani; Helling, H. J.; MccUtchan, Hal; Goost, Hans; Kreder, Hans J.; Hasenboehler, Paula M.; Routman, Howard D.; van der Heide, Huub; Kleinlugtenbelt, I.; McGraw, Iain; Harris, Ian; Ibrahim, Ibrahim Mohammad; Lin, Ines C.; Iossifidis, A.; Andrew, J.; Trenholm, I.; Goslings, J. Carel; Wiater, J. Michael; Choueka, Jack; Ahn, Jaimo; Kellam, James; Biert, Jan; Pomerance, Jay; Johnson, Jeff W.; Greenberg, Jeffrey A.; Yao, Jeffrey; Watson, Jeffry T.; Giuffre, Jennifer L.; Hall, Jeremy; Park, Jin-Young; Fischer, Jochen; Murachovsky, Joel; Howlett, John; McAuliffe, John; Evans, John P.; Taras, John; Braman, Jonathan; Hobby, Jonathan L.; Rosenfeld, Jonathan; Boretto, Jorge; Orbay, Jorge; Rubio, Jorge; Ortiz, Jose A.; Abboud, Joseph; Conflitti, Joseph M.; Vroemen, Joseph P. A. M.; Adams, Julie; Clarke, J. V.; Kabir, K.; Chivers, Karel; Prommersberger, Karl-Josef; Segalman, Keith; Lee, Kendrick; Eng, Kevin; Chhor, Kimberlly S.; Ponsen, K. J.; Jeray, Kyle; Marsh, L.; Poelhekke, L. M. S. J.; Mica, Ladislav; Borris, Lars C.; Halperin, Lawrence; Weiss, Lawrence; Benson, Leon; Elmans, Leon; de Mendonca, Leonardo Alves; Rocha, Leonardo; Katolik, Leonid; Lattanza, Lisa; Taitsman, Lisa; Guenter, Lob; Catalano, Louis; Buendia, Luis Antonio; Austin, Luke S.; Palmer, M. Jason; de Vries, M. R.; Bronkhorst, Maarten W. G. A.; Abdel-Ghany, Mahmoud I.; van de Sande, M. A. J.; Swiontkowski, Marc; Rizzo, Marco; Lehnhardt, Marcus; Pirpiris, Marinis; Baratz, Mark; Lazarus, Mark D.; Boyer, Martin; Richardson, Martin; Kastelec, Matej; Mormino, Matt; Budge, Matthew D.; Turina, Matthias; Wood, Megan M.; Baskies, Michael; Baumgaertner, Michael; Behrman, Michael; Hausman, Michael; Jones, Michael; LeCroy, Michael; Moskal, Michael; Nancollas, Michael; Prayson, Michael; Grafe, Michael W.; Kessler, Michael W.; van den Bekerom, Michel P. J.; Mckee, Mike; Merchant, Milind; Tyllianakis, Minos; Felipe, Naquira Escobar Luis; Chen, Neal C.; Saran, Neil; Wilson, Neil; Shortt, Nicholas L.; Schep, Niels; Rossiter, Nigel; Lasanianos, N. G.; Kanakaris, Nikolaos; Weiss, Noah D.; Harvey, Norah M.; van Eerten, P. V.; Melvanki, Parag; McCulloch, Patrick T.; Martineau, Paul A.; Appleton, Paul; Guidera, Paul; Levin, Paul; Giannoudis, Peter; Evans, Peter J.; Jebson, Peter; Kloen, Peter; Krause, Peter; Brink, Peter R. G.; Peters, J. H.; Blazar, Philip; Streubel, Philipp N.; Inna, Prashanth; Prashanth, S.; Solanki, Punita V.; Wang, Qiugen; Quell, M.; Benafield, R. Bryan; Haverlag, R.; Peters, R. W.; Varma, Rajat; Nyszkiewicz, Ralf; Costanzo, Ralph M.; de Bedout, Ramon; Ranade, Ashish S.; Smith, Raymond Malcolm; Abrams, Reid; Fricker, Renato M.; Omid, Reza; Barth, Richard; Buckley, Richard; Jenkinson, Richard; GIlbert, Richard S.; Page, Richard S.; Wallensten, Richard; Zura, Robert D.; Feibel, Robert J.; Gray, Robert R. L.; Tashijan, Robert; Wagenmakers, Robert; Pesantez, Rodrigo; van Riet, Roger; Norlin, Rolf; Pfeifer, Roman; Liem, Ronald; Kulick, Roy G.; Poolman, Rudolf W.; Shatford, Russell; Klinefelter, Ryan; Calfee, Ryan P.; Moghtaderi, Sam; Sodha, Samir; Sprujt, Sander; Kakar, Sanjeev; Kaplan, Saul; Duncan, Scott; Kluge, Sebastian; Rodriguez-Elizalde, Sebastian; Checchia, Sergio L.; Rowinski, Sergio; Dodds, Seth; Hurwit, Shep; Sprengel, K.; van der Stappen, W. A. H.; Kronlage, Steve; Belded, Steven; Morgan, Steven J.; Rhemrev, Steven J.; Hilliard, Stuart; Gosens, Taco; Sasaki, Takashi; Taleb, C.; Pritsch, Tamir; Tosounidis, Theodoros; Wyrick, Theresa; DeCoster, Thomas; Dienstknecht, Thomas; Stackhouse, Thomas G.; Hughes, Thomas; Wright, Thomas; Ly, Thuan V.; Havenhill, Timothy G.; Omara, Timothy; Siff, Todd; McLaurin, Toni M.; Wanich, Tony; Rueger, Johannes M.; Vallim, Frederico C. M.; Sabesan, Vani J.; Nikolaou, Vasileios S.; Knoll, Victoria D.; Telang, Vidyadhar; Iyer, Vishwanath M.; Jokhi, Vispi; Batson, W. Arnnold; Willems, W. Jaap; Smith, Wade R.; Belangero, William Dias; Wolkenfelt, J.; Weil, Yoram

2013-01-01

To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when

Working night shifts affects surgeons' biological rhythm

DEFF Research Database (Denmark)

Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob

2015-01-01

BACKGROUND: Chronic sleep deprivation combined with work during the night is known to affect performance and compromise residents' own safety. The aim of this study was to examine markers of circadian rhythm and the sleep-wake cycle in surgeons working night shifts. METHODS: Surgeons were monitor...

Cardiac Surgeons after Vacation: Refreshed or Rusty?

Science.gov (United States)

Welk, Blayne; Winick-Ng, Jennifer; McClure, Andrew; Dubois, Luc; Nagpal, Dave

2017-10-01

Many surgeons describe feeling a bit out of practice when they return from a vacation. There have been no studies assessing the impact of surgeon vacation on patient outcomes. We used administrative data from the province of Ontario to identify patients who underwent a coronary artery bypass grafting. Using a propensity score, we matched patients who underwent their procedure immediately after their surgeon returned from vacation of at least 7 days (n = 1,161) to patients who were not operated immediately before or after a vacation period (n = 2,138). There was no significant difference in patient mortality (odds ratio: 1.23, p = 0.52), length of operation (relative risk [RR]: 1.00 p = 0.58), or intensive care unit/ hospital stay (RR: 0.97 p = 0.66/RR: 0.98 p = 0.54, respectively). There was not a significant change in risk of death, operative length, or hospital stay after a surgeon vacation.

Income, productivity, and satisfaction of breast surgeons.

Science.gov (United States)

Bendorf, David C; Helmer, Stephen D; Osland, Jacqueline S; Tenofsky, Patty L

2010-03-01

The purpose of this study was to assess how the practice patterns of breast surgeons affect their income and job satisfaction. A 19-question survey regarding practice patterns and income and job satisfaction was mailed to all active US members of the American Society of Breast Surgeons. There were 772 responses. An increasing percentage of breast care was associated with lower incomes (P=.0001) and similar income satisfaction (P=.4517) but higher job satisfaction (P=.0001). The increasing proportion of breast care was also associated with fewer hours worked per week (P=.0001). Although incomes were lower in surgeons with a higher proportion of their practice in breast care, income satisfaction was not affected. Although cause and effect relationships between income and breast surgery are difficult to establish, several trends do emerge. Most significantly, we found that dedicated breast surgeons have higher job satisfaction ratings and similar income satisfaction despite lower incomes. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty.

Science.gov (United States)

Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J

2017-09-01

Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (Pnew implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.]. Copyright 2017, SLACK Incorporated.

2014 Center for Army Leadership Annual Survey of Army Leadership (CASAL): Military Leader Findings

Science.gov (United States)

2015-09-22

of representativeness across the Army. The respondent sample closely approximated the population of the Army in distribution of component and gender ...standards are types of behaviors that hinder trust by creating climates of perceived inequality . As expected, the display of favoritism is negatively...or ‘favorites’ in lieu of the most qualified personnel, unequal enforcement of standards and discipline, and use of discretion in workplace justice

[Management abilities of the head surgeon: essential for survival!].

Science.gov (United States)

Jähne, J

2012-04-01

Due to increased economic challenges in the management of hospitals head surgeons do not only need excellent surgical expertise but also significant management qualities. The personality of head surgeons should include authenticity, sincerity, fairness and the ability to cooperate. Visionary leadership, strategic thinking and strategic management of the personnel are further prerequisites for success. Besides good abilities in communication head surgeons need knowledge of the operating figures for interpretation. To keep up with the own capabilities time and self-management is essential. A survival as head surgeon is likely if these qualities and abilities exist.

Army Reserve Military Intelligence: Time for Change

Science.gov (United States)

2010-04-20

Miramax Books, 2002. Goleman , Daniel . Emotional Intelligence . New York: Bantam Books, 1997. Goleman , Daniel , Richard Boyatzis, and Annie McKee...or position of the Department of the Army, Department of Defense, or the U.S. Government. ARMY RESERVE MILITARY INTELLIGENCE : TIME FOR CHANGE...Research Project 3. DATES COVERED 00-00-2009 to 00-00-2010 4. TITLE AND SUBTITLE Army Reserve Military Intelligence : Time for Change 5a

The United States Army 1996 Modernization Plan.

Science.gov (United States)

1996-03-08

time and with less risk. IMA technology improvements are leveraged and inserted into the Army’s information architectures as the competitive market place...to procure a family of complementary, interoperable systems. At the end of the near-term, "Active Defense RD&A Startegy Army will begin fielding...Haul and Engineer tractors were fielded that brought modern technologies from the commercial market to the Army. However, adequate quantities were

Terror Weapons: The British Experience of Gas and Its Treatment in the First World War.

Science.gov (United States)

Jones, Edgar

2014-07-01

Chemical weapons accounted for only 1 per cent of the 750,000 British troops killed in the First World War and yet caused disproportionate casualties (estimated at 180,100). The considerable investment in the development of new toxins and methods of delivery was designed to maintain the elements of surprise and uncertainty as these accentuated their psychological effect. Soldiers were continually challenged on the battlefield by combinations of different types of agent designed to undermine their confidence in respirators, disorientate them, and erode their morale. At first, army doctors practised defensive medicine, invaliding their patients for protracted periods to the UK or base hospitals. By 1917, progressive study of the physical and psychological effects of different types of toxin allowed physicians to design new management strategies. Borrowing ideas from shell shock, specialist units were set up closer to the front line and medical officers taught to identify crucial points in the course of illness to accelerate recovery times and forestall the accretion of psychosomatic symptoms.

Practice patterns and job satisfaction in fellowship-trained endocrine surgeons.

Science.gov (United States)

Tsinberg, Michael; Duh, Quan-Yang; Cisco, Robin M; Gosnell, Jessica E; Scholten, Anouk; Clark, Orlo H; Shen, Wen T

2012-12-01

Debates about the difficult job market for young endocrine surgeons are ongoing. This study aimed to analyze the practice patterns and work-related satisfaction levels of recently trained endocrine surgeons. An anonymous survey was utilized. Participants were divided into 3 groups: "Young" (5 years). Fifty-six of 78 surgeons (72%) responded to the survey. Time in practice ranged from 1 to 9 years (mean, 3.9 ± 0.28). Forty-five (80%) described their practice as academic. Participants performed 244.1 ± 17.8 operations within the last year; 75.4 ± 3.3% were endocrine cases. More surgeons in the "young" group have academic practices (92%) and joined established endocrine surgery groups (54%) versus older surgeons (67% and 42%; P = .05). Of surgeons in the "young" group, 4% started their own practice versus 33% in the "older" group (P = .04). Level of satisfaction with financial compensation (3.2 on a 4-point scale versus 2.9) and lifestyle (3.6 vs 3.1) was also higher in the younger group (P = .009). Despite widespread speculation about scarcity of academic jobs after fellowship, recently trained endocrine surgeons are more likely to practice in academic settings and join established endocrine surgery practices when compared with older surgeons. Overall satisfaction level is higher among recently trained surgeons. Copyright © 2012 Mosby, Inc. All rights reserved.

Army Hearing Program Status Report Quarter 2 Fiscal Year 2017

Science.gov (United States)

2017-07-01

U.S. Army Publ ic Heal th Center Army Hearing Program Status Report Q2 FY17 Clinical Public Health and Epidemiology Directorate Army... Hearing Division General Medical: 500A July 2017 Approved for public release; distribution unlimited Army Hearing Program Status Report, Q2FY17...56               INTRODUCTION The Army Hearing Program Status Report (AHPSR) is a component of the Public Health

Drowning of British children abroad.

Science.gov (United States)

Cornall, P; Howie, S; Mughal, A; Sumner, V; Dunstan, F; Kemp, A; Sibert, J

2005-09-01

To quantify the risks of British children drowning abroad. The numbers of British children drowning abroad were estimated for 1996-2003 using the RoSPA/RLSS press cutting database. We compared these figures with the numbers of British children going abroad from the International Passenger Survey from the Office of National Statistics. Sixty-eight children (45 boys-23 Girls) drowned in the eight-year period: 48 (71%) in swimming pools (mostly in hotels). Allowing for exposure, the rate was higher in North America [5.2 (CI 2.9-9.4)/million tourists] than the European Union [1.9 (CI 1.4-2.5)/million tourists] p = 0.002. On average eight British children drown each year abroad. This is therefore a rare but tragic event. Most of these episodes happen in swimming pools and this needs to be compared to the one child that dies each year in municipal swimming pools in the United Kingdom where there is adequate lifeguarding. It may be that parents have a false sense of security for their children in pools abroad. We believe that there needs to be action from the European Union on this important event.

Report from the Committee for Improving the Work Environment of Japanese Surgeons: survey on effects of the fee revision for medical services provided by surgeons.

Science.gov (United States)

Hanazaki, Kazuhiro; Tominaga, Ryuji; Nio, Masaki; Iwanaka, Tadashi; Okoshi, Kae; Kaneko, Koichi; Nagano, Hiroaki; Nishida, Takahiro; Nishida, Hiroshi; Hoshino, Ken; Maehara, Tadaaki; Masuda, Munetaka; Matsufuji, Hiroshi; Yanaga, Katsuhiko; Tabayashi, Koichi; Satomi, Susumu; Kokudo, Norihiro

2013-11-01

The aim of this study was to achieve improvements in the work environment of Japanese surgeons and shortage of surgeons. Questionnaires were distributed to selected Japanese surgical Society (JSS) members. Retrospective analysis was conducted comparing the current 2011 survey with previous 2007 survey. To examine the influence of 2010 revision of the fee for medical services performed by surgeons, we distributed a second questionnaire to directors of hospitals and administrators of clerks belonging to official institutes in JSS. Collective data were analyzed retrospectively. The main potential causes for the shortage of surgeons in Japan were long hours (72.8 %), excessive emergency surgeries (69.4 %), and high risk of lawsuit (67.7 %). Mean weekly working hours of surgeons in national or public university hospitals and private university hospitals were 96.2 and 85.6, respectively. Approximately 70 % of surgeons were forced to do hardworking tasks, possibly leading to death from overwork. Of note, approximately 25 % of surgeons had over time of more than 100 h a week, coinciding to the number of hours that might lead to death from fatigue, described in the Japanese labor law. Although the total medical service fee in hospitals, especially in large-scale hospitals with more than 500 beds, increased markedly after 2010 revision of the fee for medical services performed by surgeons, few hospitals gave perquisites and/or incentives to surgeons. To prevent and avoid collapse of the surgical specialty in Japan, an improvement in the work environment of surgeons by initiation of the JSS would be required as soon as possible.

Meta-Analysis of Surgeon Burnout Syndrome and Specialty Differences.

Science.gov (United States)

Bartholomew, Alex J; Houk, Anna K; Pulcrano, Marisa; Shara, Nawar M; Kwagyan, John; Jackson, Patrick G; Sosin, Michael

2018-02-27

Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory (MBI) complicates the interpretation of surgeon burnout. The purpose of this study is to apply a standardized interpretation of severe surgeon burnout termed, "burnout syndrome" to analyze inherent variation within surgical specialties. A systematic literature search was performed using MEDLINE, PsycINFO, and EMBASE to identify studies reporting MBI data by surgical specialty. Data extraction was performed to isolate surgeon specific data. A meta-analysis was performed. A total of 16 cross-sectional studies were included in this meta-analysis, totaling 3581 subjects. A random effects model approximated burnout syndrome at 3.0% (95% CI: 2.0%-5.0%; I 2 = 78.1%). Subscale analysis of emotional exhaustion, depersonalization, and personal accomplishment indicated subscale burnout in 30.0% (CI: 25.0%-36.0%; I 2 = 93.2%), 34.0% (CI: 25.0%-43.0%; I 2 = 96.9%), and 25.0% (CI: 18.0%-32.0%; I 2 = 96.5%) of surgeons, respectively. Significant differences (p burnout termed "burnout syndrome," although surgeon burnout may occur in up to 34% of surgeons, characterized by high burnout in 1 of 3 subscales. Surgical specialties have significantly different rates of burnout subscales. Future burnout studies should target the specialty-specific level to understand inherent differences in an effort to better understand methods of improving surgeon burnout. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Surgeon and Advocacy

African Journals Online (AJOL)

and how the hospital administration handles and resolves ... regard to having systems that improve patient care. Surgeons have been ... implementation of the Surgical safety checklist (9). ... aviation industry, has helped to streamline patient.

Evaluating Mobile Device Ownership and Usage in the U.S. Army: Implications for Army Training

Science.gov (United States)

2014-07-01

Mercado University of Central Florida Randall D. Spain U.S. Army Research Institute July 2014 United States Army...NUMBER 633007 6. AUTHOR(S) Joseph E. Mercado ; Randall D. Spain 5c. PROJECT NUMBER A792 5d. TASK NUMBER 5e...13. SUPPLEMENTARY NOTES Subject Matter POC and Subject Matter Expert: Joseph E. Mercado 14. ABSTRACT (Maximum 200 words): As the U.S

Issues and Insights from the Army Technology Seminar Game

National Research Council Canada - National Science Library

Darilek, Richard

2001-01-01

...). The AAN goals were to link Army XXI to a long-term vision of the Army extending well into the 21st century and to ensure that this vision informed evolving Army research and development requirements...

Surgeon-reported conflict with intensivists about postoperative goals of care.

Science.gov (United States)

Paul Olson, Terrah J; Brasel, Karen J; Redmann, Andrew J; Alexander, G Caleb; Schwarze, Margaret L

2013-01-01

To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients. Cross-sectional incentivized US mail-based survey. Private and academic surgical practices. A total of 2100 vascular, neurologic, and cardiothoracic surgeons. Surgeon-reported rates of conflict with intensivists and nurses about goals of care for patients with poor postsurgical outcomes. The adjusted response rate was 55.6%. Forty-three percent of surgeons reported sometimes or always experiencing conflict about postoperative goals of care with intensivists, and 43% reported conflict with nurses. Younger surgeons reported higher rates of conflict than older surgeons with both intensivists (57% vs 32%; P = .001) and nurses (48% vs 33%; P = .001). Surgeons practicing in closed intensive care units reported more frequent conflict than those practicing in open intensive care units (60% vs 41%; P = .005). On multivariate analysis, the odds of reporting conflict with intensivists were 2.5 times higher for surgeons with fewer years of experience compared with their older colleagues (odds ratio, 2.5; 95% CI, 1.6-3.8) and 70% higher for reporting conflict with nurses (odds ratio, 1.7; 95% CI, 1.1-2.6). The odds of reporting conflict with intensivists about goals of postoperative care were 40% lower for surgeons who primarily managed their intensive care unit patients than for those who worked in a closed unit (odds ratio, 0.60; 95% CI, 0.40-0.96). Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.

The Effect of Surgeon Empathy and Emotional Intelligence on Patient Satisfaction

Science.gov (United States)

Weng, Hui-Ching; Steed, James F.; Yu, Shang-Won; Liu, Yi-Ten; Hsu, Chia-Chang; Yu, Tsan-Jung; Chen, Wency

2011-01-01

We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits.…

Comprehensive feedback on trainee surgeons' non-technical skills

DEFF Research Database (Denmark)

Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi

2015-01-01

OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. METHODS: Trainee surgeons and their supervisors used the Non...... qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed. RESULTS: Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected...

The nature of surgeon human capital depreciation.

Science.gov (United States)

Hockenberry, Jason M; Helmchen, Lorens A

2014-09-01

To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. Copyright © 2014 Elsevier B.V. All rights reserved.

Army dreamers.

Science.gov (United States)

1988-05-14

The birth of the Army Nursing Service took place in 1854, when Florence Nightingale, at the request of the Secretary of State for War, recruited and took to Scutari Hospital 38 women to tend the wounded of the Crimean war.

Ergonomics in the operating room: protecting the surgeon.

Science.gov (United States)

Rosenblatt, Peter L; McKinney, Jessica; Adams, Sonia R

2013-01-01

To review elements of an ergonomic operating room environment and describe common ergonomic errors in surgeon posture during laparoscopic and robotic surgery. Descriptive video based on clinical experience and a review of the literature (Canadian Task Force classification III). Community teaching hospital affiliated with a major teaching hospital. Gynecologic surgeons. Demonstration of surgical ergonomic principles and common errors in surgical ergonomics by a physical therapist and surgeon. The physical nature of surgery necessitates awareness of ergonomic principles. The literature has identified ergonomic awareness to be grossly lacking among practicing surgeons, and video has not been documented as a teaching tool for this population. Taking this into account, we created a video that demonstrates proper positioning of monitors and equipment, and incorrect and correct ergonomic positions during surgery. Also presented are 3 common ergonomic errors in surgeon posture: forward head position, improper shoulder elevation, and pelvic girdle asymmetry. Postural reset and motion strategies are demonstrated to help the surgeon learn techniques to counterbalance the sustained and awkward positions common during surgery that lead to muscle fatigue, pain, and degenerative changes. Correct ergonomics is a learned and practiced behavior. We believe that video is a useful way to facilitate improvement in ergonomic behaviors. We suggest that consideration of operating room setup, proper posture, and practice of postural resets are necessary components for a longer, healthier, and pain-free surgical career. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

British Celtic influence on English phonology

NARCIS (Netherlands)

Laker, Stephen

2010-01-01

The dissertation assesses the influence of British Celtic on the phonological development of English during and shortly after the Anglo-Saxon settlement period, ca. AD 450–700. By reconstructing and then comparing the phonological systems of both British Celtic and English at the time of contact, an

Operational Reach: Is Current Army Doctrine Adequate?

National Research Council Canada - National Science Library

Heintzelman, Scott

2003-01-01

The term operational reach, an element of operational design, is new to U.S. Army doctrine. Operational reach is not found in the previous edition of the Army's basic operational doctrine, Field Manual...

Society of Laparoendoscopic Surgeons

Science.gov (United States)

... the Minimally Invasive Surgery and Therapy World. Nezhat’s History of Endoscopy In 2005 pioneering surgeon Dr. Camran Nezhat was awarded a fellowship by The American College of Obstetrics and Gynecology to research and write this important ...

Optimizing the Sustainment of U.S. Army Weapon Systems

Science.gov (United States)

2016-03-17

Dale Carnegie , Fellowship, etc.) NA None of the above OPTIMIZING SUSTAINMENT OF ARMY SYSTEMS 36 Question 11: Army Civilian Education System...Darden, Dale Carnegie , Fellowship, etc.) None of the above 11. Army Civilian Education System (check all that apply) Action Officer Development Course

Ethical challenges in surgery as narrated by practicing surgeons

Directory of Open Access Journals (Sweden)

Nordam Ann

2005-02-01

Full Text Available Abstract Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.

Cultural Changes Required in the Army to Truly Achieve a Total Force

Science.gov (United States)

2016-02-16

tailored to achieve anticipated objectives.”1 Honorable John M. McHugh , Secretary of the Army Army Directive 2012-08 (Army Total Force Policy...United States Soldier. 16 End Notes 1 McHugh , John M. “Army Directive 2012-08 (Army Total Force Policy).” Secretary of the Army, September 4...1 (February 2006): 40–42. McCullough, Amy. “Out of Reserve (Air Force Reserve Command)” 94, no. 12 (2011): 40. McHugh , John M. “Army Directive 2012

Toward late career transitioning: a proposal for academic surgeons.

Science.gov (United States)

Richards, Robin; McLeod, Robin; Latter, David; Keshavjee, Shaf; Rotstein, Ori; Fehlings, Michael G; Ahmed, Najma; Nathens, Avery; Rutka, James

2017-09-01

In the absence of a defined retirement age, academic surgeons need to develop plans for transition as they approach the end of their academic surgical careers. The development of a plan for late career transition represents an opportunity for departments of surgery across Canada to initiate a constructive process in cooperation with the key stakeholders in the hospital or institution. The goal of the process is to develop an individual plan for each faculty member that is agreeable to the academic surgeon; informs the surgical leadership; and allows the late career surgeon, the hospital, the division and the department to make plans for the future. In this commentary, the literature on the science of aging is reviewed as it pertains to surgeons, and guidelines for late career transition planning are shared. It is hoped that these guidelines will be of some value to academic programs and surgeons across the country as late career transition models are developed and adopted.

Disclosure of Individual Surgeon's Performance Rates During Informed Consent

Science.gov (United States)

Burger, Ingrid; Schill, Kathryn; Goodman, Steven

2007-01-01

Objective: The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail. Methods: Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks? Results: Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust. Conclusion: At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of

African Journals Online: Virgin Islands (British)

African Journals Online (AJOL)

African Journals Online: Virgin Islands (British). Home > African Journals Online: Virgin Islands (British). Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Browse By Category · Browse Alphabetically · Browse By Country · List All Titles · Free to read Titles This Journal ...

Developing an Army Market Research Index in Support of Army Recruiting

National Research Council Canada - National Science Library

Morath, Ray

2001-01-01

.... Generating appropriate market research for the Army requires first cataloguing the existing market research databases and identifying the critical questions that are not answered by current research...

Description of Mexican Cleft Surgeons' Experience With Foreign Surgical Volunteer Missions in Mexico.

Science.gov (United States)

Schoenbrunner, Anna R; Kelley, Kristen D; Buckstaff, Taylor; McIntyre, Joyce K; Sigler, Alicia; Gosman, Amanda A

2018-05-01

Mexican cleft surgeons provide multidisciplinary comprehensive cleft lip and palate care to children in Mexico. Many Mexican cleft surgeons have extensive experience with foreign, visiting surgeons. The purpose of this study was to characterize Mexican cleft surgeons' domestic and volunteer practice and to learn more about Mexican cleft surgeons' experience with visiting surgeons. A cross-sectional validated e-mail survey tool was sent to Mexican cleft surgeons through 2 Mexican plastic surgery societies and the Asociación Mexicana de Labio y Paladar Hendido y Anomalías Craneofaciales, the national cleft palate society that includes plastic and maxillofacial surgeons who specialize in cleft surgery. We utilized validated survey methodology, including neutral fact-based questions and repeated e-mails to survey nonresponders to maximize validity of statistical data; response rate was 30.6% (n = 81). Mexican cleft surgeons performed, on average, 37.7 primary palate repairs per year with an overall complication rate of 2.5%; 34.6% (n = 28) of respondents had direct experience with patients operated on by visiting surgeons; 53.6% of these respondents performed corrective surgery because of complications from visiting surgeons. Respondents rated 48% of the functional outcomes of visiting surgeons as "acceptable," whereas 43% rated aesthetic outcomes of visiting surgeons as "poor"; 73.3% of respondents were never paid for the corrective surgeries they performed. Thirty-three percent of Mexican cleft surgeons believe that there is a role for educational collaboration with visiting surgeons. Mexican cleft surgeons have a high volume of primary cleft palate repairs in their domestic practice with good outcomes. Visiting surgeons may play an important role in Mexican cleft care through educational collaborations that complement the strengths of Mexican cleft surgeons.

Adaptive Army: Embracing the Concept of Operational Manoeuvre from the Sea

Science.gov (United States)

2010-05-05

PEACE Source: Headquarters Training Command- Army. Land Warfare Doctrine LWD 3-01: Formation Tactics. Australian Army, November 27, 2003. 27...Amphibious Capability Implementation Team, June 15, 2009. Headquarters Training Comrriand- Army. Land Warfare Doctrine LWD 3-0: Operations. Australian Army

Successful linking of the Society of Thoracic Surgeons Database to Social Security data to examine the accuracy of Society of Thoracic Surgeons mortality data.

Science.gov (United States)

Jacobs, Jeffrey P; O'Brien, Sean M; Shahian, David M; Edwards, Fred H; Badhwar, Vinay; Dokholyan, Rachel S; Sanchez, Juan A; Morales, David L; Prager, Richard L; Wright, Cameron D; Puskas, John D; Gammie, James S; Haan, Constance K; George, Kristopher M; Sheng, Shubin; Peterson, Eric D; Shewan, Cynthia M; Han, Jane M; Bongiorno, Phillip A; Yohe, Courtney; Williams, William G; Mayer, John E; Grover, Frederick L

2013-04-01

The Society of Thoracic Surgeons Adult Cardiac Surgery Database has been linked to the Social Security Death Master File to verify "life status" and evaluate long-term surgical outcomes. The objective of this study is explore practical applications of the linkage of the Society of Thoracic Surgeons Adult Cardiac Surgery Database to Social Securtiy Death Master File, including the use of the Social Securtiy Death Master File to examine the accuracy of the Society of Thoracic Surgeons 30-day mortality data. On January 1, 2008, the Society of Thoracic Surgeons Adult Cardiac Surgery Database began collecting Social Security numbers in its new version 2.61. This study includes all Society of Thoracic Surgeons Adult Cardiac Surgery Database records for operations with nonmissing Social Security numbers between January 1, 2008, and December 31, 2010, inclusive. To match records between the Society of Thoracic Surgeons Adult Cardiac Surgery Database and the Social Security Death Master File, we used a combined probabilistic and deterministic matching rule with reported high sensitivity and nearly perfect specificity. Between January 1, 2008, and December 31, 2010, the Society of Thoracic Surgeons Adult Cardiac Surgery Database collected data for 870,406 operations. Social Security numbers were available for 541,953 operations and unavailable for 328,453 operations. According to the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the 30-day mortality rate was 17,757/541,953 = 3.3%. Linkage to the Social Security Death Master File identified 16,565 cases of suspected 30-day deaths (3.1%). Of these, 14,983 were recorded as 30-day deaths in the Society of Thoracic Surgeons database (relative sensitivity = 90.4%). Relative sensitivity was 98.8% (12,863/13,014) for suspected 30-day deaths occurring before discharge and 59.7% (2120/3551) for suspected 30-day deaths occurring after discharge. Linkage to the Social Security Death Master File confirms the accuracy of

Gambian-British and Nigerian-British Children's and Families' Experiences of Migration "Back" to West Africa. Research Briefing No. 13

Science.gov (United States)

Roberts-Holmes, Guy

2013-01-01

This research looks at the factors motivating Gambian-British and Nigerian-British parents to send their children "back" to West Africa and what this means for parents, children and families on both continents.

Teaching (about) Britishness? An Investigation into Trainee Teachers' Understanding of Britishness in Relation to Citizenship and the Discourse of Civic Nationalism

Science.gov (United States)

Jerome, Lee; Clemitshaw, Gary

2012-01-01

This research was prompted by the developing political discourse proposing the teaching of Britishness and British values in the context of the United Kingdom. This discourse will be reviewed in the first part of the article, in the context of previous work which has sought to assess how Britishness and related concepts might be promoted through…

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery.

Science.gov (United States)

Reames, Bradley N; Bacal, Daniel; Krell, Robert W; Birkmeyer, John D; Birkmeyer, Nancy J O; Finks, Jonathan F

2015-01-01

Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon׳s speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass. We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], Ppatient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% versus 7.1%, P=.039), prolonged length of stay (14.0% versus 4.4%, P=.002), and VTE (0.39% versus .22%, P<.001). Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery. Copyright © 2015 American Society for Bariatric Surgery. Published by

Surgeons' Leadership Styles and Team Behavior in the Operating Room.

Science.gov (United States)

Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

2016-01-01

The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

We Want You: It Takes a Village To Market the Army

Science.gov (United States)

2013-03-01

controls over its marketing activities. While policy governs Army behavior, principles of marketing shape it as well. In marketing , the brand...18. 92 Ibid., 18. 93 Head, 4. 94 Kotler and Lee, 239. 95 Ibid., 209. 96 Ibid., 218. 97 U.S. Army Marketing and Research Group, “Army...We Want You: It Takes a Village To Market the Army by Lieutenant Colonel Daniel C. Hodne United States Army

Practice Patterns and Job Satisfaction of Mohs Surgeons.

Science.gov (United States)

Kohli, Nita; Golda, Nicholas

2018-01-01

There is a paucity of data on Mohs surgery workforce patterns. To identify if gender differences exist in practice patterns of Mohs surgeons, factors that influence these differences, and factors influencing job satisfaction among Mohs surgeons. An electronic survey was distributed to dermatology organizations targeting members of the American College of Mohs Surgery (ACMS), from October 2015 to April 2016. Two hundred twenty-seven ACMS members responded; 37% were women. Twenty-five percent of women and 19% of men work part time. Thirty-seven percent of women practice in academia versus 22% of men. Forty-three percent of women and 23% of men identified children as a factor affecting their ability to work full time. Gender comparisons for current job satisfaction show 57% of men and 35% of women being very satisfied. Supervision/feedback/recognition adds to satisfaction at a higher rate for women (53%) than for men (29%). For both genders combined, work content, patient base, and autonomy had the highest average job satisfaction ratings. Gender differences exist in practice patterns and job satisfaction of Mohs surgeons. This study demonstrates factors that could influence job satisfaction among female Mohs surgeons-knowledge that is important to individuals who lead, mentor, or supervise female Mohs surgeons.

Designing a leadership development program for surgeons.

Science.gov (United States)

Jaffe, Gregory A; Pradarelli, Jason C; Lemak, Christy Harris; Mulholland, Michael W; Dimick, Justin B

2016-01-01

Although numerous leadership development programs (LDPs) exist in health care, no programs have been specifically designed to meet the needs of surgeons. This study aimed to elicit practicing surgeons' motivations and desired goals for leadership training to design an evidence-based LDP in surgery. At a large academic health center, we conducted semistructured interviews with 24 surgical faculty members who voluntarily applied and were selected for participation in a newly created LDP. Transcriptions of the interviews were analyzed using analyst triangulation and thematic coding to extract major themes regarding surgeons' motivations and perceived needs for leadership knowledge and skills. Themes from interview responses were then used to design the program curriculum specifically to meet the leadership needs of surgical faculty. Three major themes emerged regarding surgeons' motivations for seeking leadership training: (1) Recognizing key gaps in their formal preparation for leadership roles; (2) Exhibiting an appetite for personal self-improvement; and (3) Seeking leadership guidance for career advancement. Participants' interviews revealed four specific domains of knowledge and skills that they indicated as desired takeaways from a LDP: (1) leadership and communication; (2) team building; (3) business acumen/finance; and (4) greater understanding of the health care context. Interviews with surgical faculty members identified gaps in prior leadership training and demonstrated concrete motivations and specific goals for participating in a formal leadership program. A LDP that is specifically tailored to address the needs of surgical faculty may benefit surgeons at a personal and institutional level. Copyright © 2016 Elsevier Inc. All rights reserved.

Norwegian supply of goods and services to the British offshore sector

International Nuclear Information System (INIS)

Heide, M.; Noedland, S.I.

1991-02-01

Representatives from ten Norwegian companies in the offshore supplies industry were interviewed to explore the opportunities and barriers they had experienced in their effort to enter the British offshore sector. The interviews revealed that there are mainly four reasons why British sector is regarded as a favorable market: British sector is a natural homemarket, buyers operate both on the British and the Norwegian sector, the British sector can be a ''door-opener'' to the rest of the English speaking world, and finally the British sector is a market of considerable size. The companies had mainly encountered three types of barriers: British culture/communication problems, heavy competition from British suppliers, and protectionism. The report is concluded by summarizing what we believe are the critical success factors for entering the British sector. Directions for further research are also given

Patient perceptions of surgeon-industry relations in a military setting.

Science.gov (United States)

Ortiz, Dionisio; Jenne, Joel

2014-12-01

Investigations into the financial relationships between orthopedic surgeons and device manufacturers have recently been investigated. Despite these investigations, the public appears to maintain trust and confidence that their surgeons are acting in patients' best interest. However, patient perceptions of these relationships have not been investigated in a military treatment setting. We surveyed patients' perception of the surgeon-industry relationship in a single military treatment facility. From March 2012 to March 2013, we surveyed 282 preoperative and postoperative spine and arthroplasty patients in a single military treatment facility. Patients were eligible if they were adult TRICARE beneficiaries being followed in one of those clinics and within the age requirements. Most patients were aware of private industry involvement in the manufacture of orthopedic implants (77%). Most patients thought that it was beneficial for surgeons to serve in an advisory role to device companies (81%) and most (65%) felt that the relationship was appropriate and beneficial for patient care. A minority (29%) felt their surgeon should receive payment for this role. Most patients in the military setting had a positive view of the relationship that their surgeons had with industry, which is reflective of data obtained in the civilian literature. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Big and Little Feet Provincial Profiles: British Columbia

Directory of Open Access Journals (Sweden)

Sarah Dobson

2017-09-01

Full Text Available This communiqué provides a summary of the production- and consumption-based greenhouse gas emissions accounts for British Columbia, as well as their associated trade flows. It is part of a series of communiqués profiling the Canadian provinces and territories.1 In simplest terms, a production-based emissions account measures the quantity of greenhouse gas emissions produced in British Columbia. In contrast, a consumptionbased emissions account measures the quantity of greenhouse gas emissions generated during the production process for final goods and services that are consumed in British Columbia through household purchases, investment by firms and government spending. Trade flows refer to the movement of emissions that are produced in British Columbia but which support consumption in a different province, territory or country (and vice versa. For example, emissions at the Port of Vancouver that are associated with goods that are subsequently exported to Ontario for sale are recorded as a trade flow from British Columbia to Ontario. Moving in the opposite direction, emissions associated with the production of Alberta crude oil that is refined in British Columbia and sold as motor gasoline to a British Columbia consumer are recorded as a trade flow from Alberta to British Columbia. For further details on these results in a national context, the methodology for generating them and their policy implications, please see the companion papers to this communiqué series: (1 Fellows and Dobson (2017; and (2 Dobson and Fellows (2017. Additionally, the consumption emissions and trade flow data for each of the provinces and territories are available at: http://www.policyschool.ca/embodied-emissions-inputs-outputs-datatables-2004-2011/.

Role of Surgeons in Determining Outcome of Histopathology ...

African Journals Online (AJOL)

Conclusion: To ensure the quality of histopathological diagnosis with minimal turnaround time, the surgeon plays a vital role by ensuring adequate and prompt fixation of tissue biopsies, put in the right container and accompanied by well labeled request cards. Keywords: Formalin, fixative, outcome, pathologist, surgeon ...

British Columbia : an alternative design

International Nuclear Information System (INIS)

Ostergaard, P.

2003-01-01

This PowerPoint presentation outlined the British Columbia Ministry of Energy and Mines' approach to the electricity market. A brief overview of the electric system in the province was provided, examining capacity (primarily hydro based) and the utility sector with its public ownership. In British Columbia, 80 per cent of the electricity is generated by British Columbia Hydro (BC Hydro). The rates are based on cost of service. British Columbia's market is western North America. A comparison of monthly bills for several large cities, both Canadian and American, was displayed. The market reviews conducted in 1995, 1998, and 2002 were reviewed and the major recommendations discussed. The author identified the opportunities in the province, discussing natural gas and coal for electricity production, resource potential, demand, and private sector capacity. The challenges facing the province are: cost effective development of resources to meet energy demand; aging infrastructure, high reliability requirements and economic growth; evolving electricity market structure in the United States; and, monopoly. The transmission system was reviewed with reference to trade with the Pacific Northwest, flexibility and storage. The energy plan objectives for the future were presented, including low rates and public ownership, secure and reliable supply, more private sector opportunities, and environmental responsibility. The alternative market structure includes regulated market characteristics, access to trade, and customer focus. figs

[Improving the surgeon's image: introduction].

Science.gov (United States)

Tajima, Tomoo

2004-05-01

The number of medical students who aspire to become surgeons has been decreasing in recent years. With a vicious spiral in the decreasing number and the growing deterioration of surgeons' working conditions, there is fear of deterioration of surgical care and subsequent disintegration of overall health care in Japan. The purpose of this issue is to devise a strategy for improving surgeons' image and their working conditions to attract future medical students. However, we cannot expect a quick cure for the problem of the decreasing number of applicants for surgery since this issue is deeply related to many fundamental problems in the health care system in Japan. The challenge for surgical educators in coming years will be to solve the problem of chronic sleep deprivation and overwork of surgery residents and to develop an efficient program to meet the critical educational needs of surgical residents. To solve this problem it is necessary to ensure well-motivated surgical residents and to develop an integrated research program. No discussion of these issues would be complete without attention to the allocation of scarce medical resources, especially in relation to financial incentives for young surgeons. The authors, who are conscientious representatives of this society, would like to highlight these critical problems and issues that are particularly relevant to our modern surgical practice, and it is our sincere hope that all members of this society fully recognize these critical issues in the Japanese health care system to take leadership in improving the system. With the demonstration of withholding unnecessary medical conducts we may be able to initiate a renewal of the system and eventually to fulfill our dreams of Japan becoming a nation that can attract many patients from all over the world. Furthermore, verification of discipline with quality control and effective surgical treatment is needed to avoid criticism by other disciplines for being a self

32 CFR 553.7 - Design and layout of Army national cemeteries.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Design and layout of Army national cemeteries... RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.7 Design and layout of Army national cemeteries. (a) General cemetery layout plans, landscape planting plans and gravesite layout plans for Army...

The Army Communications Objectives Measurement System (ACOMS) Users’ Manual

Science.gov (United States)

1988-07-01

and analysis system to support Army (1) assessments of advertising program effectiveness; (2) assessments of advertising strategy efficiencies; (3...advertising program effectiveness in a timely fashion; 2 (2) To support Army assessments of advertising strategy in an integrated framework; and (3...ACOMS data to assess the Army’s advertising strategy . ACOMS was designed to be used to examine the extent to which the Army’s intended messages are

Army industrial, landscaping, and agricultural water use

Energy Technology Data Exchange (ETDEWEB)

Stoughton, Kate McMordie [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Loper, Susan A. [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Boyd, Brian K. [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States)

2014-09-18

The Pacific Northwest National Laboratory conducted a task for the Deputy Assistant Secretary of the Army to quantify the Army’s ILA water use and to help improve the data quality and installation water reporting in the Army Energy and Water Reporting System.

Army Model and Simulation Standards Report FY98

National Research Council Canada - National Science Library

1997-01-01

...) standards efforts as work progresses towards the objective Army M&S environment. This report specifically documents projects approved for funding through the Army Model and Improvement Program (AMIP...

Work-life balance of female versus male surgeons in Hong Kong based on findings of a questionnaire designed by a Japanese surgeon.

Science.gov (United States)

Kwong, Ava; Chau, Wai Wang; Kawase, K

2014-01-01

We evaluated the attitudes of female and male surgeons in Hong Kong to work, personal life, and work-life balance, through a questionnaire survey. We sent an online questionnaire survey designed by a female Japanese surgeon to 142 female surgeons practicing in Hong Kong, while its customized version was sent to 953 of their male counterparts. "Home life" and "Work" were the first and second priorities for both the women and the men. More of the female surgeons reported that they could not find enough time to participate in community activities (p = 0.038) or rest (p = 0.024). Both reported moderate satisfaction at work (p = 0.114) and in their life outside work (p = 0.346), as well as equality at home (p = 0.548) and at work (p = 0.177). Of the men, 89 % agreed with the necessity for granting paternity leave and reported that they would like to work part-time during the child-rearing years (p = 0.013). The number of female surgeons involved in key roles is increasing in parallel with the increasing number of female medical students. The introduction of paternity leave for male surgeons is an important concern. The issues of work-life balance may need to be addressed to attract more talent into an important specialty in Hong Kong and this is likely to apply to other parts of Asia as well.

Workload assessment of surgeons: correlation between NASA TLX and blinks.

Science.gov (United States)

Zheng, Bin; Jiang, Xianta; Tien, Geoffrey; Meneghetti, Adam; Panton, O Neely M; Atkins, M Stella

2012-10-01

Blinks are known as an indicator of visual attention and mental stress. In this study, surgeons' mental workload was evaluated utilizing a paper assessment instrument (National Aeronautics and Space Administration Task Load Index, NASA TLX) and by examining their eye blinks. Correlation between these two assessments was reported. Surgeons' eye motions were video-recorded using a head-mounted eye-tracker while the surgeons performed a laparoscopic procedure on a virtual reality trainer. Blink frequency and duration were computed using computer vision technology. The level of workload experienced during the procedure was reported by surgeons using the NASA TLX. A total of 42 valid videos were recorded from 23 surgeons. After blinks were computed, videos were divided into two groups based on the blink frequency: infrequent group (≤ 6 blinks/min) and frequent group (more than 6 blinks/min). Surgical performance (measured by task time and trajectories of tool tips) was not significantly different between these two groups, but NASA TLX scores were significantly different. Surgeons who blinked infrequently reported a higher level of frustration (46 vs. 34, P = 0.047) and higher overall level of workload (57 vs. 47, P = 0.045) than those who blinked more frequently. The correlation coefficients (Pearson test) between NASA TLX and the blink frequency and duration were -0.17 and 0.446. Reduction of blink frequency and shorter blink duration matched the increasing level of mental workload reported by surgeons. The value of using eye-tracking technology for assessment of surgeon mental workload was shown.

Surgeons' Emotional Experience of Their Everyday Practice - A Qualitative Study.

Directory of Open Access Journals (Sweden)

Massimiliano Orri

Full Text Available Physicians' emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon. 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons' emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital-surgeons' own emotions, their perception of patients' emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues, the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon, as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability.Emotions are ubiquitous in surgeons' experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.

Surgeon-nurse anesthetist collaboration advanced surgery between 1889 and 1950.

Science.gov (United States)

Koch, Bruce Evan

2015-03-01

To meet the need for qualified anesthetists, American surgeons recruited nurses to practice anesthesia during the Civil War and in the latter half of the 19th century. The success of this decision led them to collaborate with nurses more formally at the Mayo Clinic in Minnesota. During the 1890s, Alice Magaw refined the safe administration of ether. Florence Henderson continued her work improving the safety of ether administration during the first decade of the 20th century. Safe anesthesia enabled the Mayo surgeons to turn the St. Mary's Hospital into a surgical powerhouse. The prominent surgeon George Crile collaborated with Agatha Hodgins at the Lakeside Hospital in Cleveland to introduce nitrous oxide/oxygen anesthesia. Nitrous oxide/oxygen caused less cardiovascular depression than ether and thus saved the lives of countless trauma victims during World War I. Crile devised "anoci-association," an outgrowth of nitrous oxide/oxygen anesthesia. Hodgins' use of anoci-association made Crile's thyroid operations safer. Pioneering East Coast surgeons followed the lead of the surgeons at Mayo. William Halsted worked closely with Margaret Boise, and Harvey Cushing worked closely with Gertrude Gerard. As medicine became more complex, collaboration between surgeons and nurse anesthetists became routine and necessary. Teams of surgeons and nurse anesthetists advanced thoracic, cardiovascular, and pediatric surgery. The team of Evarts Graham and Helen Lamb performed the world's first pneumonectomy. Surgeon-nurse anesthetist collaboration seems to have been a uniquely American phenomenon. This collaboration facilitated both the "Golden Age of Surgery" and the profession we know today as nurse anesthesia.

Implant vendors and hospitals: competing influences over product choice by orthopedic surgeons.

Science.gov (United States)

Burns, Lawton R; Housman, Michael G; Booth, Robert E; Koenig, Aaron

2009-01-01

Vendors of hip and knee implants court orthopedic surgeons to adopt their products. Hospitals, which have to pay for these products, now court the same surgeons to help reduce the number of vendors and contain implant costs. This study measures the surgeon's perceived alignment of interests with both vendors and hospitals and gauges surgeons' exposure and receptivity to hospital cost-containment efforts. We surveyed all practicing orthopedists performing 12 or more implant procedures annually in Pennsylvania. The survey identified the surgeon's preferred vendor, tenure with that vendor, use of the vendor during residency training, receipt of financial payments from the vendor, alignment of interests with both vendor and hospital stakeholders, and exposure and receptivity to hospital cost-containment efforts. Surgeons have long-standing relationships with implant vendors, but only a small proportion receive financial payments. Surgeons align most closely with the vendor's sales representative and least closely with the hospital's purchasing manager. Paradoxically, surgeons support hospital efforts to limit the number of vendors but report that their own choice of vendor is not constrained. The major drivers of surgeons' alignment and stance toward cost containment are their tenure with and receipt of financial payments from the vendor. Hospitals face a competitive disadvantage in capturing the attention of orthopedists, compared with implant vendors. The vendors' advantage stems from historical, financial, and service benefits offered to surgeons. Hospital executives now seek to offer comparable benefits to surgeons.

Surveyed opinion of American trauma surgeons in management of colon injuries.

Science.gov (United States)

Eshraghi, N; Mullins, R J; Mayberry, J C; Brand, D M; Crass, R A; Trunkey, D D

1998-01-01

Primary repair or resection and anastomosis of colon wounds have been advocated in many recent studies, but the proportion of trauma surgeons accepting these recommendations is unknown. To determine the current preferences of American trauma surgeons for colon injury management. Four hundred forty-nine members of the American Association for the Surgery of Trauma were surveyed regarding their preferred management of eight types of colon wounds among three options: diverting colostomy (DC), primary repair (PR), or resection and anastomosis (RA). The influence of selected patient factors and surgeons' characteristics on the choice of management was also surveyed. Seventy-three percent of surgeons completed the survey. Ninety-eight percent chose PR for at least one type of injury. Thirty percent never selected DC. High-velocity gunshot wound was the only injury for which the majority (54%) would perform DC. More than 55% of the surgeons favored RA when the isolated colon injury was a contusion with possible devascularization, laceration greater than 50% of the diameter, or transection. Surgeons who managed five or fewer colon wounds per year chose DC more frequently (p colon wounds per year. The prevailing opinion of trauma surgeons favors primary repair or resection of colon injuries, including anastomosis of unprepared bowel. Surgeons who manage fewer colon wounds prefer colostomy more frequently.

ORIGINAL ARTICLES Surgeons and HIV: South African attitudes

African Journals Online (AJOL)

2009-02-01

Feb 1, 2009 ... Local policies and those from developed countries may not .... National Health Act 61 of 2003, such information (surgeon HIV ... specialist surgeon trainees established that 91% did not think .... 2008 Report on the Global AIDS ... Schulman KA, McDonald RC, Lynn LA, Frank I, Christakis NA, Schwartz JS.

Log Books and the Law of Storms: Maritime Meteorology and the British Admiralty in the Nineteenth Century.

Science.gov (United States)

Naylor, Simon

2015-12-01

This essay contributes to debates about the relationship between science and the military by examining the British Admiralty's participation in meteorological projects in the first half of the nineteenth century. It focuses on attempts to transform Royal Navy log books into standardized meteorological registers that would be of use to both science and the state. The essay begins with a discussion of Admiralty Hydrographer Francis Beaufort, who promoted the use of standardized systems for the observation of the weather at sea. It then examines the application of ships' logs to the science of storms. The essay focuses on the Army engineer William Reid, who studied hurricanes while stationed in Barbados and Bermuda. Reid was instrumental in persuading the Admiralty to implement a naval meteorological policy, something the Admiralty Hydrographer had struggled to achieve. The essay uses the reception and adoption of work on storms at sea to reflect on the means and ends of maritime meteorology in the mid-nineteenth century.

Counter - Drug: Mandate for the Army.

Science.gov (United States)

1991-03-01

this comprehensive review will provide a basis for responding to new missions assigned...observations for determining the short-, mid-, and long-term direction of Army support to the national counter-drug effort. Also, this comprehensive review will provide...and long-term direction of Army support to the national counter-drug effort. Also, this comprehensive review will provide a basis for responding

The Cultural Dimension of Army Transition

Science.gov (United States)

2012-12-06

by the conveyor belt of training. Instead of spending so much of their time as resource managers, the challenges become those of the operational...adaptability. 19The ARMY 2020 project defined the design of the future Army. A design team lead by...iterations, a design based approach uses systemic analysis to resolve these criteria. 27 Systems thinking reflects a departure from the common

2004 Army Research Office in Review

Science.gov (United States)

2004-01-01

the thermal decomposition of nitrate - ester propellants. This is the first such data ever measured and will provide reliable input for Army...strain has been set for the actuator. The research program includes: Multiscale modeling of microstructural evolution and its affect on mechanical... Multiscale modeling and process optimization for engineered microstructural complexity” have had multiple transition interactions with the Army Research

Inspector General, DoD, Oversight of the Army Audit Agency Audit of the FY 1998 Army General Fund Financial Statements

National Research Council Canada - National Science Library

1999-01-01

... Financial Statements for Fiscal Year 1998: Summary Audit Rep oft." Our objective was to determine the accuracy and completeness of the Army Audit Agency audit of the FY 1998 Army General Fund Fund Financial Statements...

Surgeons' Leadership Styles and Team Behavior in the Operating Room

Science.gov (United States)

Hu, Yue-Yung; Parker, Sarah Henrickson; Lipsitz, Stuart R; Arriaga, Alexander F; Peyre, Sarah E; Corso, Katherine A; Roth, Emilie M; Yule, Steven J; Greenberg, Caprice C

2016-01-01

Background The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards, whereas transformational (team-oriented) leaders inspire performance beyond expectations. Study Design We video-recorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon-researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information-sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (MLQ) was correlated with surgeon behavior (SLI) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. Results All surgeons scored similarly on transactional leadership (2.38-2.69), but varied more widely on transformational leadership (1.98-3.60). Each 1-point increase in transformational score corresponded to 3× more information-sharing behaviors (psupportive behaviors (pleadership and its impact on team performance in the OR. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development therefore has the potential to improve the efficiency and safety of operative care. PMID:26481409

32 CFR Appendix G to Part 623 - Continental US Army Boundaries

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army Boundaries...

Productivity change of surgeons in an academic year.

Science.gov (United States)

Nakata, Yoshinori; Watanabe, Yuichi; Otake, Hiroshi; Nakamura, Toshihito; Oiso, Giichiro; Sawa, Tomohiro

2015-01-01

The goal of this study was to calculate total factor productivity of surgeons in an academic year and to evaluate the effect of surgical trainees on their productivity. We analyzed all the surgical procedures performed from April 1 through September 30, 2013 in the Teikyo University Hospital. The nonradial and nonoriented Malmquist model under the variable returns-to-scale assumptions was employed. A decision-making unit is defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of physicians who assisted in surgery, and the time of surgical operation from skin incision to skin closure. The output was defined as the surgical fee for each surgery. April is the beginning month of a new academic year in Japan, and we divided the study period into April to June and July to September 2013. We computed each surgeon's Malmquist index, efficiency change, and technical change. We analyzed 2789 surgical procedures that were performed by 105 surgeons. The Malmquist index of all surgeons was significantly greater than 1 (p = 0.0033). The technical change was significantly greater than 1 (p productive in the beginning months of a new academic year. The main factor of this productivity loss is considered to be surgical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Glass Houses of Attending Surgeons: An Assessment of Unprofessional Behavior on Facebook Among Practicing Surgeons.

Science.gov (United States)

Langenfeld, Sean J; Sudbeck, Craig; Luers, Thomas; Adamson, Peter; Cook, Gates; Schenarts, Paul J

2015-01-01

Our recent publication demonstrated that unprofessional behavior on Facebook is common among surgical residents. In the formulation of standards and curricula to address this issue, it is important that surgical faculty lead by example. Our current study refocuses on the Facebook profiles of faculty surgeons involved in the education of general surgery residents. The American College of Surgeons (ACS) web site was used to identify general surgery residencies located in the Midwest. Departmental web sites were then searched to identify teaching faculty for the general surgery residency. Facebook was then searched to determine which faculty had profiles available for viewing by the general public. Profiles were then placed in 1 of the 3 following categories: professional, potentially unprofessional, or clearly unprofessional. A chi-square test was used to determine significance. In all, 57 residency programs were identified on the ACS web site, 100% of which provided an institutional web site listing the surgical faculty. A total of 758 general surgery faculty were identified (133 women and 625 men), of which 195 (25.7%) had identifiable Facebook accounts. In all, 165 faculty (84.6%) had no unprofessional content, 20 (10.3%) had potentially unprofessional content, and 10 (5.1%) had clearly unprofessional content. Inter-rater reliability was good (88.9% agreement, κ = 0.784). Clearly unprofessional behavior was found only in male surgeons. For male surgeons, clearly unprofessional behavior was more common among those in practice for less than 5 years (p = 0.031). Alcohol and politics were the most commonly found variables in the potentially unprofessional group. Inappropriate language and sexually suggestive material were the most commonly found variables in the clearly unprofessional group. Unprofessional behavior on Facebook is less common among surgical faculty compared with surgical residents. However, the rates remain unacceptably high, especially among men and

The British Monarchy On Screen

OpenAIRE

Merck, Mandy

2016-01-01

Moving images of the British monarchy, in fact and fiction, are almost as old as the moving image itself, dating back to an 1895 American drama, The Execution of Mary Queen of Scots. British monarchs even appeared in the new ‘animated photography’ from 1896, led by Queen Victoria. Half a century later, the 1953 coronation of Elizabeth II was a milestone in the adoption of television, watched by 20 million Britons and 100 million North Americans. At the century’s end, Princess Diana’s funeral ...

The Army National Guard: Part of the Operational Force and Strategic Reserve

Science.gov (United States)

2016-05-26

Training periods. John M. McHugh , the Secretary of the Army, published Army Directive 2012-08 (Army Total Force Policy) on September 4, 2012. The...Defense for Personnel and Readiness Jo Ann Rooney, “Equipping the Reserve Forces,” 2. 35 US Secretary of the Army John M. McHugh , “Army Directive 2012-08...Washington, DC: April 4, 2012. Accessed January 21, 2016. http://www.dtic.mil/whs/directives/corres/pdf/123512p.pdf. US Secretary of the Army John M. McHugh

Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons.

Science.gov (United States)

Gupta, Asheesh; Suarez-Ahedo, Carlos; Redmond, John M; Gerhardt, Michael B; Hanypsiak, Bryan; Stake, Christine E; Finch, Nathan A; Domb, Benjamin G

2015-09-01

To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the

2013 Center for Army Leadership Annual Survey of Army Leadership (CASAL): Army Civilian Leaders

Science.gov (United States)

2014-05-30

Army civilian workforce with regard to gender and ethnic origin (Office of the Assistant G-1 for Civilian Personnel, 2013). The reported education...climates of perceived inequality . Civilian leader comments frequently referenced favoritism as reflecting cronyism, unfair personnel actions, and...interests of others, unequal enforcement of standards and discipline, and use of discretion in workplace justice. As demonstrated in previous CASAL

2007 Posture Statement, Army Reserve: An Operational Force

National Research Council Canada - National Science Library

Stultz, Jack C

2007-01-01

The 2007 Army Reserve Posture Statement describes how the Army Reserve continues to transform from a strategic reserve to an operational force, meeting today's challenges as it better prepares for future uncertainties...

Key performance indicators in British military trauma.

Science.gov (United States)

Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

2008-08-01

Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

High occupational stress and low career satisfaction of Korean surgeons.

Science.gov (United States)

Kang, Sang Hee; Boo, Yoon Jung; Lee, Ji Sung; Han, Hyung Joon; Jung, Cheol Woong; Kim, Chong Suk

2015-02-01

Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.

Can Surgeon Demographic Factors Predict Postoperative Complication Rates After Elective Spinal Fusion?

Science.gov (United States)

Chun, Danielle S; Cook, Ralph W; Weiner, Joseph A; Schallmo, Michael S; Barth, Kathryn A; Singh, Sameer K; Freshman, Ryan D; Patel, Alpesh A; Hsu, Wellington K

2018-03-01

Retrospective cohort. Determine whether surgeon demographic factors influence postoperative complication rates after elective spine fusion procedures. Surgeon demographic factors have been shown to impact decision making in the management of degenerative disease of the lumbar spine. Complication rates are frequently reported outcome measurements used to evaluate surgical treatments, quality-of-care, and determine health care reimbursements. However, there are few studies investigating the association between surgeon demographic factors and complication outcomes after elective spine fusions. A database of US spine surgeons with corresponding postoperative complications data after elective spine fusions was compiled utilizing public data provided by the Centers for Medicare and Medicaid Services (2011-2013) and ProPublica Surgeon Scorecard (2009-2013). Demographic data for each surgeon was collected and consisted of: surgical specialty (orthopedic vs. neurosurgery), years in practice, practice setting (private vs. academic), type of medical degree (MD vs. DO), medical school location (United States vs. foreign), sex, and geographic region of practice. General linear mixed models using a Beta distribution with a logit link and pairwise comparison with post hoc Tukey-Kramer were used to assess the relationship between surgeon demographics and complication rates. 2110 US-practicing spine surgeons who performed spine fusions on 125,787 Medicare patients from 2011 to 2013 met inclusion criteria for this study. None of the surgeon demographic factors analyzed were found to significantly affect overall complication rates in lumbar (posterior approach) or cervical spine fusion. Publicly available complication rates for individual spine surgeons are being utilized by hospital systems and patients to assess aptitude and gauge expectations. The increasing demand for transparency will likely lead to emphasis of these statistics to improve outcomes. We conclude that none of the

Ultrasound of the acute abdomen performed by surgeons in training

DEFF Research Database (Denmark)

Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.

2008-01-01

, specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound...... perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All...... participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound. RESULTS: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity...

The Army Ethic-Inchoate but Sufficient

Science.gov (United States)

2015-06-12

are constraints imposed by this thesis. Delimitations include the scope, jus ad bellum, cultural relativism , descriptive ethics , and implementation...politicians. Third, this thesis will not look in depth at cultural relativism and how changes in laws and society’s philosophical and ethical ...THE ARMY ETHIC –INCHOATE BUT SUFFICIENT A thesis presented to the Faculty of the U.S. Army Command and General Staff College

Surgeon distress as calibrated by hours worked and nights on call.

Science.gov (United States)

Balch, Charles M; Shanafelt, Tait D; Dyrbye, Lotte; Sloan, Jeffrey A; Russell, Thomas R; Bechamps, Gerald J; Freischlag, Julie A

2010-11-01

The relationships of working hours and nights on call per week with various parameters of distress among practicing surgeons have not been previously examined in detail. More than 7,900 members of the American College of Surgeons responded to an anonymous, cross-sectional survey. The survey included self-assessment of their practice setting, a validated depression screening tool, and standardized assessments of burnout and quality of life. There was a clear gradient between hours and burnout, with the prevalence of burnout ranging from 30% for surgeons working hours/week, 44% for 60 to 80 hours/week, and 50% for those working >80 hours/week (p hours and nights on call (both p worked >80 hours/week reported a higher rate of medical errors compared with those who worked hours/week (10.7% versus 6.9%; p work and home conflicts were higher among surgeons who worked longer hours or had ≥2 nights on call. A significantly higher proportion of surgeons who worked >80 hours/week or had >2 nights on call/week would not become a surgeon again (p hours worked and nights on call per week appear to have a substantial impact on surgeons, both professionally and personally. These factors are strongly related to burnout, depression, career satisfaction, and work and home conflicts. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

British Television and Official Film, 1946-1951.

Science.gov (United States)

Wildy, Tom

1988-01-01

Discusses the relationships between the British Government's Information Services and both the British Broadcasting Corporation (BBC) and the commercial film trade after the BBC's television service resumed independent broadcasts in 1946. Examines proposals for using television as an alternative outlet for commercial and official films. (GEA)

Army Communicator. Volume 27, Number 3, Fall 2002

Science.gov (United States)

2002-01-01

play in the Army’s transformation to the Objec- tive Force.” Gizmo’s debut in the Beatle Bailey comic strip came July 4. And according to a source close...Approved for public release; distribution is unlimited. Headquarters, Department of the Army ARMY COMMUNICATOR Voice of the Signal Regiment ! PB 11...02-3 Fall 2002 Vol. 27 No. 3 ! Special focus: radio’s resurgence -- its “new” uses in the current and near- future Army, Pgs. 2-18 ! Signal-planning

The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

Directory of Open Access Journals (Sweden)

K Gnassingbé

2011-01-01

Full Text Available Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33% responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%, scholarship from a non-governmental organisations in 14 (34.15% and self-sponsorships in 20 (48.78%. The average salary was 450 Euros (€ (range: 120-1 400 Euros. Most of the paediatric surgeons (68.29% had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80% had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons.

Science.gov (United States)

Lee, Jung Jeung; Park, Nam Hee; Lee, Kun Sei; Chee, Hyun Keun; Sim, Sung Bo; Kim, Myo Jeong; Choi, Ji Suk; Kim, Myunghwa; Park, Choon Seon

2016-12-01

While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors

Unchained Interests: American-British-Dutch-Australian Command 1942

Science.gov (United States)

2014-05-22

KNIL Koninklijk Nederlands Indisch Leger (Royal Netherlands East Indies Army) ABDAfloat ABDACOM combined naval forces ABDAair ABDACOM combined and...20Willmott, Empires in the Balance, 15. 21G. Teitler and P. J. Drooglever, De Val van Nederlands -Indië (Dieren: Bataafsche Leeuw, 1982), 82...military presence in the Netherlands East Indies. The armed forces were composed of the Royal Netherlands East Indies Army (Koninklijk Nederlands

Discrepancies in the female pelvic medicine and reconstructive surgeon workforce.

Science.gov (United States)

Muffly, Tyler M; Weterings, Robbie; Barber, Mathew D; Steinberg, Adam C

2015-01-01

It is unclear whether the current distribution of surgeons practicing female pelvic medicine and reconstructive surgery in the United States is adequate to meet the needs of a growing and aging population. We assessed the geographic distribution of female pelvic surgeons as represented by members of the American Urogynecologic Society (AUGS) throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels. County-level data from the AUGS, American Congress of Obstetricians and Gynecologists, and the United States Census were analyzed in this observational study. State and national patterns of female pelvic surgeon density were mapped graphically using ArcGIS software and 2010 US Census demographic data. In 2013, the 1058 AUGS practicing physicians represented 0.13% of the total physician workforce. There were 6.7 AUGS members available for every 1 million women and 20 AUGS members for every 1 million postreproductive-aged women in the United States. The density of female pelvic surgeons was highest in metropolitan areas. Overall, 88% of the counties in the United States lacked female pelvic surgeons. Nationwide, there was a mean of 1 AUGS member for every 31 practicing general obstetrician-gynecologists. These findings have implications for training, recruiting, and retaining female pelvic surgeons. The uneven distribution of female pelvic surgeons throughout the United States is likely to worsen as graduating female pelvic medicine and reconstructive surgery fellows continue to cluster in urban areas.

Fiscal Year 2011 United States Army Annual Financial Report. America’s Army: At a Strategic Crossroads

Science.gov (United States)

2011-01-01

successful in any operational scenario. In FY 2011, the Army updated the Cost of the Doctrinal Army Model using improved and refined methods and the...General Fund uses engineering estimates and independently validated models to estimate environmental cleanup liabilities. The Remedial Action Cost ...Standard Price LCM = Lower of Cost or Market AC = Actual Cost O = Other MAC = Moving Average Cost Abnormal Balance The Revaluation Allowance for

The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis.

Science.gov (United States)

Cahill, Patrick J; Pahys, Joshua M; Asghar, Jahangir; Yaszay, Burt; Marks, Michelle C; Bastrom, Tracey P; Lonner, Baron S; Shah, Suken A; Shufflebarger, Harry L; Newton, Peter O; Betz, Randal R; Samdani, Amer F

2014-08-20

Single-surgeon series investigating the learning curve involved in surgery for spinal deformity may be confounded by changes in technology and techniques. Our objective with this multicenter, prospective study was to present a cross-sectional analysis of the impact of surgeon experience on surgery for adolescent idiopathic scoliosis. All posterior-only surgical procedures for adolescent idiopathic scoliosis performed in the 2007 to 2008 academic year, with a minimum of two years of patient follow-up, were included. Two groups were created on the basis of surgeon experience: a young surgeons' group, which included patients of surgeons with less than five years of experience, and an experienced surgeons' group, which included patients of surgeons with five or more years of experience. Nine surgeons (four young and five experienced) operated on a total of one hundred and sixty-five patients with adolescent idiopathic scoliosis. The surgeons' experience ranged from less than one year to thirty-six years in practice. The two groups had similar preoperative curve-magnitude measurements, SRS-22 (Scoliosis Research Society-22) scores, and distribution by Lenke curve type. There were significant operative and postoperative differences. The young surgeons fused an average of 1.2 levels more than the experienced surgeons (p = 0.045). The mean intraoperative estimated blood loss (EBL) of the young surgeons' group was more than twice that of the experienced surgeons' group (2042 mL compared with 1013 mL; p self-image (p = 0.008), and function (p adolescent idiopathic scoliosis were significantly and positively correlated with surgeon experience. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Disparities between resident and attending surgeon perceptions of intraoperative teaching.

Science.gov (United States)

Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

2011-03-01

This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

DEFF Research Database (Denmark)

Carstensen, Lena; Rose, Michael; Bentzon, Niels

2015-01-01

symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own...... of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...

Britishness and Community Cohesion in Muslim News Online

Directory of Open Access Journals (Sweden)

Hassen ZRIBA

2013-12-01

Full Text Available The issues of British national identity and social cohesion have become pressing concerns within the multicultural fabric of contemporary British society. The increasing number of immigrants and their offspring, along with the maintenance of their cultural roots, seem to represent a serious defiance to social cohesion and the alleged “purity” of Britishness. A number of race related reports were produced by the official authorities to churn out the necessary steps to be followed by the British (immigrants and host community in order to keep social stability and community cohesion. Thus, the politics of community cohesion came to the fore as the neologism of contemporary British political discourse. Such new discourse of governance has been digested and processed differently by different mass media. It has been decoded, for instance, preferably by mainstream news agencies like BBC News Online. However, arguably, it is read appositionally or at best negotiatedly by ethnicity-related news agencies such as Muslim News Online. In this article, attempt has been made to adopt media discourse analysis tools to decipher the ways Muslim News Online decoded and then encoded the hegemonic official discourses of Britishness and community cohesion. A critical and interpretative approach is used to accomplish such study. The corpus of this study is primarily extracted from the website of the Muslim News Online.

Inspector General, DoD, Oversight of the Army Audit Agency Audit of the FY 2000 Army Working Capital Fund Financial Statements

National Research Council Canada - National Science Library

2001-01-01

Our objectives were to oversee the Army Audit Agency audit of the FY 2000 Department of the Army Working Capital Fund financial statements to verify whether we can rely on their work and to determine...

There's No Such Thing as British Art

Directory of Open Access Journals (Sweden)

Richard Johns

2015-11-01

Full Text Available “Conversation Piece” is a British Art Studies series that draws together a group of contributors to respond to an idea, provocation or question. The conversation will develop as more respondents enter the debate. Fifteen contributors respond to the provocation "There's No Such Thing as British Art".

General of the Army George C. Marshall’s Strategic Leadership

Science.gov (United States)

2017-03-15

Depression to perform conservation tasks in rural areas.31 In 1938, Marshall moved to the War Plans Division of the General Staff. Unbeknownst to...125 US Army Center of Military History, “Omar Nelson Bradley: The Centennial ,” US Army, 2006...Omar Nelson Bradley: The Centennial .” US Army, 2006. Accessed April 2, 2017. http://www.history.army.mil/brochures/bradley/bradley.htm. Watson

Emergent management of postpartum hemorrhage for the general and acute care surgeon

Directory of Open Access Journals (Sweden)

Blankenship Charles L

2009-11-01

Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

Army Maintenance System Transformation

National Research Council Canada - National Science Library

Gilbertson, Frank V

2006-01-01

.... Used in conjunction with pertinent historical data and developed with Army transformation goals in mind, General Systems thinking can provide the framework for guiding maintenance transformation...

A Worldwide Survey on Peyronie's Disease Surgical Practice Patterns Among Surgeons.

Science.gov (United States)

Chung, Eric; Wang, Run; Ralph, David; Levine, Laurence; Brock, Gerald

2018-04-01

Despite published guidelines on Peyronie's disease (PD), there are limited data on actual surgical practice among surgeons. To evaluate the surgical practice patterns in PD among surgeons from different continents and members of various sexual medicine societies. An anonymous survey on various pre-, intra-, and postoperative aspects of PD surgical care was distributed in printed format during International Society of Sexual Medicine meetings and as an online survey to International Society of Sexual Medicine members. 390 surgeons responded to the survey, with great variations in pre-, intra-, and postoperative strategies in PD surgical care. Most surgeons performed fewer than 10 penile plications and 10 graft surgeries per year. Modified Nesbit plication was the preferred option by most surgeons. Surgeons who received fellowship training were more likely to perform autologous than allograft surgery (odds ratio = 1.79, 95% CI = 1.13-2.82, P = .01). The use of penile color duplex ultrasound was inconsistently performed, with higher-volume surgeons (ie, >20 cases operated a year) more likely to use this diagnostic modality (odds ratio = 70.18, 95% CI = 20.99-234.6, P worldwide survey study has the potential to assist in the formation of a new practice guideline and serve as the basis for future prospective multinational studies. This is one of the largest surveys on PD practice and, to our knowledge, the only survey conducted across various sexual medicine societies, with the inclusion of many high-volume and experienced PD surgeons. This also is the 1st study to comprehensively evaluate many key aspects in surgical practice patterns for PD. However, the categorization on the questionnaire used in this survey was not designed to allow for direct comparison given the possibility of some surgeons with dual society memberships, reporting biases, large CIs in outcomes, different patient demographics, and cultural acceptance. There is great variation in surgical

The West African currency board and economic integration of British ...

African Journals Online (AJOL)

WACB) as an economic integration effort in British West Africa. Through a collaborative effort between this public institution and a private company, the Bank of British West Africa, British West African colonies were not only unified but also the way ...

[How much business management does a surgeon need?].

Science.gov (United States)

Bork, U; Koch, M; Büchler, M W; Weitz, J

2010-08-01

The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.

Patient Satisfaction and its Relation to Perceived Visit Duration With a Hand Surgeon.

Science.gov (United States)

Parrish, Raymond C; Menendez, Mariano E; Mudgal, Chaitanya S; Jupiter, Jesse B; Chen, Neal C; Ring, David

2016-02-01

To determine whether patient perception of time spent with a hand surgeon relates to patient satisfaction after a single new-patient office visit. Prior to each visit, 112 consecutive new patients predicted how much time they expected to spend with the surgeon. Following the visit, patients were asked to estimate the time spent with the surgeon, indicate whether the surgeon appeared rushed, and rate their overall satisfaction with the surgeon. Wait time and actual visit duration were measured. Patients also completed a sociodemographic survey, the Consultation and Relational Empathy Measure, the Newest Vital Sign Health Literacy test, and 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper Extremity Function, Pain Interference, and Depression. Multivariable logistic and linear regression models were used to determine predictors of patient satisfaction, patient-perceived surgeon rush, and high previsit expectations of visit duration. Patient satisfaction was not associated with perceived visit duration but did correlate strongly with patient-rated surgeon empathy and symptoms of depression. Neither visit duration nor previsit expectations of visit length were determinants of patient-perceived surgeon rush. Only surgeon empathy was associated. Less-educated patients anticipated needing more time with the surgeon. Patient satisfaction with the surgeon and with the time spent during the office visit was primarily linked to surgeon empathy rather than to visit duration or previsit expectation of visit length. Efforts to make hand surgery office visits more patient-centered should focus on improving dialogue quality, and not necessarily on making visits longer. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Dissecting Attending Surgeons' Operating Room Guidance: Factors That Affect Guidance Decision Making.

Science.gov (United States)

Chen, Xiaodong Phoenix; Williams, Reed G; Smink, Douglas S

2015-01-01

The amount of guidance provided by the attending surgeon in the operating room (OR) is a key element in developing residents' autonomy. The purpose of this study is to explore factors that affect attending surgeons' decision making regarding OR guidance provided to the resident. We used video-stimulated recall interviews (VSRI) throughout this 2-phase study. In Phase 1, 3 attending surgeons were invited to review separately 30 to 45 minute video segments of their prerecorded surgical operations to explore factors that influenced their OR guidance decision making. In Phase 2, 3 attending surgeons were observed and documented in the OR (4 operations, 341min). Each operating surgeon reviewed their videotaped surgical performance within 5 days of the operation to reflect on factors that affected their decision making during the targeted guidance events. All VSRI were recorded. Thematic analysis and manual coding were used to synthesize and analyze data from VSRI transcripts, OR observation documents, and field notes. A total of 255 minutes of VSRI involving 6 surgeons and 7 surgical operations from 5 different procedures were conducted. A total of 13 guidance decision-making influence factors from 4 categories were identified (Cohen's κ = 0.674): Setting (case schedule and patient morbidity), content (procedure attributes and case progress), resident (current competency level, trustworthiness, self-confidence, and personal traits), and attending surgeon (level of experience, level of comfort, preferred surgical technique, OR training philosophy, and responsibility as surgeon). A total of 5 factors (case schedule, patient morbidity, procedure attributes, resident current competency level, and trustworthiness) influenced attending surgeons' pre-OR guidance plans. "OR training philosophy" and "responsibility as surgeon" were anchor factors that affected attending surgeons' OR guidance decision-making patterns. Surgeons' OR guidance decision making is a dynamic process

Comparing industry compensation of cardiothoracic surgeons and interventional cardiologists.

Science.gov (United States)

Parreco, Joshua; Donath, Elie; Kozol, Robert; Faber, Cristiano

2017-02-01

The purpose of this study was to compare payment trends between cardiothoracic surgeons and interventional cardiologists using the Open Payments website made available for the public by the Center for Medicare and Medicaid Services. Data were extracted from the second release of the Open Payments database, which includes payments made between August 1, 2013 and December 31, 2014. Total payments to individual physicians were aggregated based on specialty, region of the country, and payment type. The Gini index was calculated for each specialty to measure income disparity. A Gini index of 1 indicates all the payments went to one individual, whereas a Gini index of 0 indicates all individuals received equal payments. During the study period of interest, data were made available for 3587 (80%) cardiothoracic surgeons compared with 2957 (99%) interventional cardiologists. Mean total payments to cardiothoracic surgeons were $7770 (standard deviation, $52,608) compared with a mean of $15,221 (standard deviation, $98,828) for interventional cardiologists. The median total payments to cardiothoracic surgeons was $1050 (interquartile range, $233-$3612) compared with $1851 (interquartile range, $607-$5462) for interventional cardiologists. The overall Gini index was 0.932, whereas the Gini index was 0.862 for interventional cardiologists and 0.860 for cardiothoracic surgeons. The vast majority of interventional cardiologists and cardiothoracic surgeons received payments from drug and device manufacturers. The mean total payments to interventional cardiologists were higher than any other specialty. However, like cardiothoracic surgery, they were among the most equitably distributed compared with other specialties. Copyright © 2016 Elsevier Inc. All rights reserved.

Surgeon specialization and use of sentinel lymph node biopsy for breast cancer

Science.gov (United States)

Yen, Tina W.F.; Laud, Purushuttom W.; Sparapani, Rodney A.; Nattinger, Ann B.

2014-01-01

IMPORTANCE Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node-negative breast cancer patients. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to clinically node-negative patients, this practice pattern could lead to unnecessary axillary lymph node dissections (ALND) and lymphedema. OBJECTIVE To explore potential measures of surgical expertise (including a novel objective specialization measure – percentage of a surgeon’s operations devoted to breast cancer determined from claims) on the use of SLNB for invasive breast cancer. DESIGN Population-based prospective cohort study. Patient, tumor, treatment and surgeon characteristics were examined. SETTING California, Florida, Illinois PARTICIPANTS Elderly (65+ years) women identified from Medicare claims as having had incident invasive breast cancer surgery in 2003. MAIN OUTCOME MEASURES Type of axillary surgery performed. RESULTS Of the 1,703 women treated by 863 different surgeons, 56% underwent an initial SLNB, 37% initial ALND and 6% no axillary surgery. The median annual surgeon Medicare volume of breast cancer cases was 6 (range: 1.5–57); the median surgeon percentage of breast cancer cases was 4.6% (range: 0.7%–100%). After multivariable adjustment of patient and surgeon factors, women operated on by surgeons with higher volumes and percentages of breast cancer cases had a higher likelihood of undergoing SLNB. Specifically, women were most likely to undergo SLNB if operated on by high volume surgeons (regardless of percentage) or by lower volume surgeons with a high percentage of cases devoted to breast cancer. In addition, membership in the American Society of Breast Surgeons (OR 1.98, CI 1.51–2.60) and Society of Surgical Oncology (OR 1.59, CI 1.09–2.30) were independent predictors of women undergoing an initial SLNB. CONCLUSIONS AND RELEVANCE Patients treated

Diffusion of laparoscopic cholecystectomy among general surgeons in the United States.

Science.gov (United States)

Escarce, J J; Bloom, B S; Hillman, A L; Shea, J A; Schwartz, J S

1995-03-01

Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.

The Role of the US Army Reserve in Support of the US Army Force 2025 and Beyond: Challenges and Opportunities

Science.gov (United States)

2015-06-12

the Army Reserve mission or force structure will radically be rebalanced , but it did point to a new emerging mindset which the Total Army will be...verified and validated within individual portfolio reviews, professional certifications and trade credentials in support of civilian career requirements

Benchmarking surgeon satisfaction at academic health centers: a nationwide comparative survey.

Science.gov (United States)

Drachman, D A

1996-01-01

Forty-six academic health centers (AHCs) belonging to the University HealthSystem consortium joined forces to compare the efficiency of their surgical services and to identify best practices. In addition to measures of operational performance, surgeon satisfaction with the surgical services provided was measured by using a standardized questionnaire. From hospital records, indicators of the efficiency of surgical services were collected in three main areas: scheduling, preoperative testing and assessment, and the intraoperative process. Responding to a mail questionnaire, a sample of surgeons rated their satisfaction with key aspects of surgical services including scheduling, operating room staff, and equipment/supplies. On the basis of a review of the operational measures and the survey results, high performers were identified. Site visits were made to several of these high performers to uncover the critical factors responsible for their success. The survey revealed distinct variations in surgeon satisfaction across the participating institutions. Numerical benchmarks were obtained for surgeon satisfaction with each key component of surgical services. Scheduling was the most important component of overall surgeon satisfaction, explaining 71% of the variance in the rating of overall satisfaction with surgical services. High operational efficiency and high surgeon satisfaction were not incompatible. Several of the participating institutions were able to achieve both. These results were disseminated to all of the participants at a national meeting as well as in written form. The surgeon satisfaction survey allowed the participants to establish benchmarks for surgeon satisfaction for each key component of the surgical services they receive. The site visits revealed several common characteristics of highly efficient surgical services. Taken by themselves, the participating institutions might have been reluctant to consider adopting these best practices for fear of

British Values and British Identity: Muddles, Mixtures, and Ways Ahead

Science.gov (United States)

Richardson, Robin

2015-01-01

In the final eleven months of its five-year term, the Coalition Government placed much emphasis in the education system on what it called fundamental British values (FBV). The phrase had its origins in counter-terrorism strategies that were of dubious validity both conceptually and operationally, and the trigger for its introduction into the…

Command Liaison at the Corps Level.

Science.gov (United States)

1983-05-20

not bring them together, for they disliked each other’s cuisine . When, owing to the sudden German onslaught on Verdun, the Tenth French Army was...and strategies, and personalities into a cohesive fighting force. BRITISH/ FRENCH The most complete recount of liaison in WW I (or any other conflict for...that matter) is that written by E. Spears concerning his activities as a young lieutenant liaison officer from the British to the French Army. In the

Military Classics

Science.gov (United States)

1988-01-01

the relation of religion and politics to seventeenth-century English military history. Frederick II, King of Prussia. Frederick the Great on the Art...Beginning with the reign of King Henry VIII, Barnett’s work explores the history of the British Army as an institution and fighting force. The volume...native clans led by Shaka , to its fall under the guns of the British Army by 1878. The Zulus produced a formidable military force, and this excellent

Weapons Systems, United States Army 1997.

Science.gov (United States)

1997-01-01

Mexico, Morocco , Philippines, Turkey Co-Production: Korea The Army began fielding the UH-60 in 1978. Between 1978 and 1989 the Army procured UH-60A...Improvement Program ( CSR TEP) to all Area Common User System (ACUS) switch users (except AN/TTC-39-A(V)l). Incorporate Enhanced Switch Operation Program...Finland, Greece, Italy, Kuwait, Morocco , Saudi Arabia National Guard, SHAPE Tech Ctr (NATO), Spain, Special Def Acq Fund (pre-purchased export

Chronic stress and coping among cardiac surgeons: a single center study

Directory of Open Access Journals (Sweden)

Kyriakos Spiliopoulos

2014-09-01

Full Text Available Introduction: Cardiac surgeons stress may impair their quality of life and professional practice. Objective: To assess perceived chronic stress and coping strategies among cardiac surgeons. Methods: Twenty-two cardiac surgeons answered two self-assessment questionnaires, the Trier Inventory for Chronic Stress and the German SGV for coping strategies. Results: Participants mean age was 40±14.1 years and 13 were male; eight were senior physicians and 14 were residents. Mean values for the Trier Inventory for Chronic Stress were within the normal range. Unexperienced physicians had significantly higher levels of dissatisfaction at work, lack of social recognition, and isolation (P<0.05. Coping strategies such as play down, distraction from situation, and substitutional satisfaction were also significantly more frequent among unexperienced surgeons. "Negative" stress-coping strategies occur more often in experienced than in younger colleagues (P=0.029. Female surgeons felt more exposed to overwork (P=0.04 and social stress (P=0.03. Conclusion: Cardiac surgeons show a tendency to high perception of chronic stress phenomena and vulnerability for negative coping strategies.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

Directory of Open Access Journals (Sweden)

Jung Jeung Lee

2016-12-01

Full Text Available Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time

English law for the surgeon II: clinical negligence.

Science.gov (United States)

Jerjes, Waseem; Mahil, Jaspal; Upile, Tahwinder

2011-12-21

Traditionally, in the United Kingdom and Europe, the surgeon was generally not troubled by litigation from patients presenting as elective as well as emergency cases, but this aspect of custom has changed. Litigation by patients now significantly affects surgical practice and vicarious liability often affects hospitals. We discuss some fundamental legal definitions, a must to know for a surgeon, and highlight some interesting cases.

Army Sustainment. Volume 44, Issue 5. September-October 2012

Science.gov (United States)

2012-10-01

Department of Defense or any of its agencies, and do not change or supersede official Army publications. The masculine pro - noun may refer to either gender...the Army Test and Evaluation Command (ATEC), AMC, and the Army staff, who con - stitute the candidate selection panel. CASCOM provides the TRADOC...improper use of these items that causes the fires. The Occupational Safety and Health Administration ( OSHA ) states that equipment needs to be used

Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures.

Science.gov (United States)

Gallagher, Anthony G; Smith, C Daniel; Bowers, Steven P; Seymour, Neal E; Pearson, Adam; McNatt, Steven; Hananel, David; Satava, Richard M

2003-09-01

Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a surgeon to acquire and master. Although assessment technologies have been proposed, precise and objective psychomotor skills assessment of surgeons performing laparoscopic procedures has not been detailed. Two hundred ten surgeons attending the 2001 annual meeting of the American College of Surgeons in New Orleans who reported having completed more than 50 laparoscopic procedures participated. Subjects were required to complete one box-trainer laparoscopic cutting task and a similar virtual reality task. These tasks were specifically designed to test only psychomotor and not cognitive skills. Both tasks were completed twice. Performance of tasks was assessed and analyzed. Demographic and laparoscopic experience data were also collected. Complete data were available on 195 surgeons. In this group, surgeons performed the box-trainer task better with their dominant hand (p psychomotor skills is now possible. Surgeons who had performed more than 50 laparoscopic procedures showed considerable variability in their performance on a simple laparoscopic and virtual reality task. Approximately 10% of surgeons tested performed the task significantly worse than the group's average performance. Studies such as this may form the methodology for establishing criteria levels and performance objectives in objective assessment of the technical skills component of determining surgical competence.

Improving life-cycle cost management in the US. Army: analysis of the U.S. Army and Commercial Businesses life-cycle cost management.

OpenAIRE

White, Bradley A.

2001-01-01

The roles and responsibilities of the Army acquisition and logistics communities, as they pertain to the life-cycle management, are undergoing fundamental change. The early identification and total control of life-cycle cost, in particular operations and sustainment costs which comprises as much as 70-80% of a systems total life-cycle cost, is a high priority for the Army. The basis of this change is adoption of commercial best practices to support the Army's goal to organize. tram. equip, an...

British Box Business: A History of OCL

DEFF Research Database (Denmark)

Poulsen, René Taudal

2018-01-01

Book review of British Box Business: A History of OCL / edited by A. Bott SCARA, Goldaming, 2009, £17 (hb) 288 pages, illustrations, bibliography, index iSBn 139780955922701......Book review of British Box Business: A History of OCL / edited by A. Bott SCARA, Goldaming, 2009, £17 (hb) 288 pages, illustrations, bibliography, index iSBn 139780955922701...

The Current Canon in British Romantics Studies.

Science.gov (United States)

Linkin, Harriet Kramer

1991-01-01

Describes and reports on a survey of 164 U.S. universities to ascertain what is taught as the current canon of British Romantic literature. Asserts that the canon may now include Mary Shelley with the former standard six major male Romantic poets, indicating a significant emergence of a feminist perspective on British Romanticism in the classroom.…

Role Of The Army In Modern Pakistan

Directory of Open Access Journals (Sweden)

Vladislav Viktorovich Vorobiev

2014-01-01

Full Text Available The article studies the political development of the country in the modern period. Special attention is paid to the position of the army and its role in the Pakistani society. The article explores in detail the processes of gradual distancing of the army from politics and strengthening of civil society institutions. It is the first time in the Pakistani history that the civilian government managed to complete its full five-year constitutional term. Meanwhile, the country has been advancing on the path to democracy even after the elections 2013: a new civilian government has been formed in Pakistan. As compared with the previous phases of the country's development, the status of the army has considerably changed, evolved from "guiding force" to "shadow" guarantee of democratic development. The process has been largely encouraged by popular among officers feeling of tiredness: many of them are not ready to take power into their own hands and committed to their strictly constitutional duties. Despite this recent positive trend, the army continues to enjoy great authority in the society, often brokers political crisis and helps civilian authorities in settling such pressing problems as, for example, fight against extremism. The military will exert influence on government unless civil authorities are able to resist the current challenges and settle the actual problems. The role of "power broker" fully serves the interests of the top army brass.

ROLE OF THE ARMY IN MODERN PAKISTAN

Directory of Open Access Journals (Sweden)

Vladislav Viktorovich Vorobiev

2014-01-01

Full Text Available The article studies the political development of the country in the modern period. Special attention is paid to the position of the army and its role in the Pakistani society. The article explores in detail the processes of gradual distancing of the army from politics and strengthening of civil society institutions. It is the first time in the Pakistani history that the civilian government managed to complete its full five-year constitutional term. Meanwhile, the country has been advancing on the path to democracy even after the elections 2013: a new civilian government has been formed in Pakistan. As compared with the previous phases of the country's development, the status of the army has considerably changed, evolved from "guiding force" to "shadow" guarantee of democratic development. The process has been largely encouraged by popular among officers feeling of tiredness: many of them are not ready to take power into their own hands and committed to their strictly constitutional duties. Despite this recent positive trend, the army continues to enjoy great authority in the society, often brokers political crisis and helps civilian authorities in settling such pressing problems as, for example, fight against extremism. The military will exert influence on government unless civil authorities are able to resist the current challenges and settle the actual problems. The role of "power broker" fully serves the interests of the top army brass.

Was the real Sherlock Holmes a pediatric surgeon?

Science.gov (United States)

Raffensperger, John

2010-07-01

This article reviews the pioneering efforts of Joseph Bell, the model for Sherlock Holmes, in the surgical care of children during the antiseptic era. I reviewed biographies of Sir Arthur Conan Doyle; the biography of Joseph Bell; his surgical textbook, Edinburgh Medical Journals; and the history of the Royal Edinburgh Hospital for Sick Children. Dr Bell was a colleague of Joseph Lister and one of the first surgeons to apply antiseptic methods to operations involving children. He was the surgeon appointed to the first surgical ward of the Royal Edinburgh Hospital for Sick Children; in that role, he cared for many children with surgical diseases. Dr Joseph Bell, by his compassion for children and his surgical skill, was indeed a pioneer pediatric surgeon. Copyright 2010 Elsevier Inc. All rights reserved.

The anatomy lessons of the Amsterdam Guild of Surgeons

NARCIS (Netherlands)

IJpma, F.F.A.

2014-01-01

Mandatory lessons in anatomy, taught by the praelector anatomiae (lecturer in anatomy) of the Amsterdam Guild of Surgeons, were an important part of the surgical training starting in the 16th century. We describe how surgeons were trained approximately 350 years ago at the Surgeons’ Guild. The role

Review of CD Rom: The Virtual Surgeon: ACL Reconstruction ...

African Journals Online (AJOL)

THE VIRTUAL SURGEON: ACL RECONSTRUCTION Professor George Bentley ChM FRCS, Russell E LVindsor MD, Mr Andrew Williams FRCS(0rth); 4150 + VAT(UK) The Virtual Surgeon - 3D Anatomy of the Knee 469 + VAT(UK). TVF Multimedia Ltd, 375 City Road, London, EClV lNB, UK ...

Department of the Army, FY 1999 Amended Budget Estimates, Army Working Capital Fund

National Research Council Canada - National Science Library

1998-01-01

The Department of the Army has historically operated a significant number of its organic commercial and industrial facilities under revolving fund concepts to encourage these activities to function...

Non-technical skills of surgical trainees and experienced surgeons.

Science.gov (United States)

Gostlow, H; Marlow, N; Thomas, M J W; Hewett, P J; Kiermeier, A; Babidge, W; Altree, M; Pena, G; Maddern, G

2017-05-01

In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees. Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared. For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score -0·015 units per year), implementing and reviewing decisions (-0·020 per year), establishing a shared understanding (-0·014 per year), setting and maintaining standards (-0·024 per year), supporting others (-0·031 per year) and coping with pressure (-0·015 per year). The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

U.S. Army Space Operational Narrative

Science.gov (United States)

2012-03-20

fire, and effects ( MFE ), the operational support (OS), and the functional support division (FSD); it is further divided into many more specialties...cyberspace expertise at the highest levels is a must for the Army. Both ARCYBERCOM and USASMDC/ARSTRAT commands are key positions filled by MFE officers... MFE officers with the majority from infantry and armor (31). The FA, AD, and EN branches will round out the top five.47 Half of the Army branches are

Patient-specific hip prostheses designed by surgeons

Directory of Open Access Journals (Sweden)

Coigny Florian

2016-09-01

Full Text Available Patient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods [1], [2], [3]. But extracting 3D shape information from CT Data and designing individual implants is demanding and requires multiple surgeon-to-engineer interactions. For manufacturing purposes, Additive Manufacturing offers various advantages, especially for low volume manufacturing parts, such as patient specific implants. To ease these new approaches and to avoid surgeon-to-engineer interactions a new design software approach is needed which offers highly automated and user friendly planning steps.

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon.

Science.gov (United States)

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer; Mayberry, John

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon

Science.gov (United States)

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization. PMID:29766123

Democratic civilian control of the Nepalese Army

Science.gov (United States)

2013-06-14

following are recommendations or principles the Army must institutionalize to guide it through the still-evolving civil-military relationship discussions...society. The following are recommendations or principles the Army must institutionalize to guide it through the still-evolving civil-military...hence, the principal–agent framework developed in microeconomics and already used in various political applications can be profitably extended to

The Effect of Price on Surgeons' Choice of Implants: A Randomized Controlled Survey.

Science.gov (United States)

Wasterlain, Amy S; Melamed, Eitan; Bello, Ricardo; Karia, Raj; Capo, John T

2017-08-01

Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naïve" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Price awareness significantly influences surgeons' choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons' cost awareness. Economic/Decision Analyses I. Copyright © 2017 American

Assessing Army Professional Forums Metrics for Effectiveness and Impact

National Research Council Canada - National Science Library

Cianciolo, Anna T; Heiden, Charles G; Prevou, Michael I

2006-01-01

... meet the challenges brought on by Army transformation. Army professional forums (APFs), powered by advances in collaborative toolsets and multimedia presentation software, provide a means for leader self-development and professional growth...

Contemporary use of social media by consultant colorectal surgeons.

Science.gov (United States)

McDonald, J J; Bisset, C; Coleman, M G; Speake, D; Brady, R R W

2015-02-01

There is evidence of significant growth in the engagement of UK health-care professionals with 'open' social media platforms, such as Twitter and LinkedIn. Social media communication provides many opportunities and benefits for medical education and interaction with patients and colleagues. This study was undertaken to evaluate the uptake of public social media membership and the characteristics of use of such media channels amongst contemporary UK consultant colorectal surgeons. Colorectal surgeons were identified from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) national registry of colorectal mortality outcomes and were cross-referenced with the General Medical Council (GMC) register. Individuals were identified by manual searching on a number of social media platforms. Matching accounts were then examined to confirm ownership and to evaluate key markers of use. Six-hundred and eighteen individual consultant colorectal surgeons from 142 health authorities were studied (79.5% were ACPGBI members and 90.8% were male). Two-hundred and twenty-nine (37.1%) had LinkedIn profiles (37.7% male surgeons, 29.8% female surgeons; P = 0.2530). LinkedIn membership was significantly higher in ACPGBI members (P social media than reported studies from other health-care professional groups. Further education and appropriate guidance on usage may encourage uptake and confidence, particularly in younger consultants. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Effect of Thoracic Surgeons on Lung Cancer Patients’ Survival

Directory of Open Access Journals (Sweden)

Ning LI

2018-02-01

Full Text Available Background and objective Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact. Methods A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences. Results A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients. Conclusion Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.

Outlier experienced surgeon's performances impact on benchmark for technical surgical skills training.

Science.gov (United States)

Gallagher, Anthony G; Henn, Patrick J; Neary, Paul C; Senagore, Anthony J; Marcello, Peter W; Bunting, Brendan P; Seymour, Neal E; Satava, Richard M

2018-03-23

Training in medicine must move to an outcome-based approach. A proficiency-based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency. In study one, 100 experienced laparoscopic surgeons' performances on virtual reality and box-trainer simulators were assessed for two similar laparoscopic tasks. In study two, 15 experienced surgeons and 16 trainee colorectal surgeons performed one simulated hand-assisted laparoscopic colorectal procedure. Performance scores of experienced surgeons in both studies were standardized (i.e. Z-scores) using the mean and standard deviations (SDs). Performances >1.96 SDs from the mean were excluded in proficiency definitions. In study one, 1-5% of surgeons' performances were excluded having performed significantly below their colleagues. Excluded surgeons made significantly fewer correct incisions (mean = 7 (SD = 2) versus 19.42 (SD = 4.6), P 4 SDs for time to complete the procedure and >6 SDs for path length. After their exclusions, experienced surgeons' performances were significantly better than trainees for path length: P = 0.031 and for time: P = 0.002. Objectively assessed atypical expert performances were few. Z-score standardization identified them and produced a more robust quantitative definition of proficiency. © 2018 Royal Australasian College of Surgeons.

Sales Training for Army Recruiter Success: Sales Strategies and Skills Used by Excellent U. S. Army Recruiters

Science.gov (United States)

1987-11-01

Army recruiters. Neurolinguistic programming (NLP) was used as the protocol for modeling performance and acquiring information on the communication...kills -Linguistic pattern~ Sales cycle, Communica tion s trategies Mode-H.R-g. Sales skills, {:( ~Expert kn0\\vlc dge1 ’ Neurolinguist ic~ Sales...describe s a program of r esearch on the communicat ion st rate - gies a nd skills use d by excellen t Army r ecrui t e rs. Information to be used to

The Effects of Multiple Deployments on Army Adolescents

Science.gov (United States)

2010-01-01

deployment-related feelings.12 Focusing on a parent’s absence, dwelling on potential negative outcomes, or ruminating on problems often sends a child...maintain balance in the pull of both noble institutions. Some Army adolescents contend poorly in this dilemma; others—many more than soldiers or Army

76 FR 6692 - Radiation Sources on Army Land

Science.gov (United States)

2011-02-08

... possession of ionizing radiation sources by non-Army entities (including their civilian contractors) on an... Radiation Permit (ARP) from the garrison commander to use, store, or possess ionizing radiation sources on an Army installation. For the purpose of this rule, ``ionizing radiation source'' means any source...

Using Texting for Clinical Communication in Surgery: A Survey of Academic Staff Surgeons.

Science.gov (United States)

Firdouse, Mohammed; Devon, Karen; Kayssi, Ahmed; Goldfarb, Jeremy; Rossos, Peter; Cil, Tulin D

2018-03-01

Text messaging has become ubiquitous and is being increasingly used within the health care system. The purpose of this study was to understand texting practices for clinical communication among staff surgeons at a large academic institution. Staff surgeons in 4 subspecialties (vascular, plastics, urology, and general surgery) were surveyed electronically. A total of 62 surgeons from general surgery (n = 33), vascular surgery (n = 6), plastic surgery (n = 13), and urology (n = 10) completed the study (response rate 30%). When conveying urgent patient-related information, staff surgeons preferred directly calling other staff surgeons (61.5%) and trainees (58.8%). When discussing routine patient information, staff surgeons used email to reach other staff surgeons (54.9%) but preferred texting (62.7%) for trainees. The majority of participants used texting because it is fast (65.4%), convenient (69.2%) and allows transmitting information to multiple recipients simultaneously (63.5%). Most felt that texting enhances patient care (71.5%); however, only half believed that it enhanced trainees' educational experiences. The majority believed that texting identifiable patient information breaches patient confidentiality. Our data showed high adoption of text messaging for clinical communication among surgeons, particularly with trainees. The majority of surgeons acknowledge security concerns inherent in texting for patient care. Existing mobile communication platforms fail to meet the needs of academic surgeons. Further research should include guidelines related to texting in clinical practice, educational implications of texting, and technologies to better meet the needs of clinicians working in an academic surgical settings.

Exploring the Use of Microworld Models to Train Army Logistics Management Skills

National Research Council Canada - National Science Library

Levy, Dina

2001-01-01

The Army faces new challenges in training its logistics managers. As the Army evolves into a force-projection Army, the design and management of large-scale logistics systems assume increasing importance...

Decreased heart rate variability in surgeons during night shifts

DEFF Research Database (Denmark)

Amirian, Ilda; Toftegård Andersen, Lærke; Rosenberg, Jacob

2014-01-01

BACKGROUND: Heart rate variability (HRV) has been used as a measure of stress and mental strain in surgeons. Low HRV has been associated with death and increased risk of cardiac events in the general population. The aim of this study was to clarify the effect of a 17-hour night shift on surgeons'...

Surgeon Experience and Complications of Transvaginal Prolapse Mesh.

Science.gov (United States)

Kelly, Erin C; Winick-Ng, Jennifer; Welk, Blayne

2016-07-01

To measure the proportion of women with transvaginal prolapse mesh complications and their association with surgeon volume. We conducted a retrospective, population-based cohort study of all women who underwent a mesh-based prolapse procedure using administrative data (hospital procedure and physician billing records) between 2002 and 2013 in Ontario, Canada. The primary outcome was surgical revision of the mesh. Primary exposure was surgeon volume: high (greater than the 75th percentile, requiring a median of five [interquartile range 5-6] procedures per year) and very high (greater than the 90th percentile, requiring a median of 13 [interquartile range 11-14] procedures per year) volume mesh implanters were identified each year. Primary analysis was an adjusted Cox proportional hazards model. A total of 5,488 women underwent mesh implantation by 1 of 368 unique surgeons. Median follow-up time was 5.4 (interquartile range 3.0-8.0) years. We found that 218 women (4.0%) underwent mesh reoperation a median of 1.17 (interquartile range 0.58-2.90) years after implantation. The hazard of reoperation for complications was only lower for patients of very high-volume surgeons (3.0% [145/3,001] compared with 4.8% [73/2,447], adjusted hazards ratio 0.59, 95% confidence interval 0.40-0.86). In multivariable modeling, younger age, concomitant hysterectomy, blood transfusion, and increased medical comorbidity were all associated with vaginal mesh reoperation. Approximately 5% of women who underwent mesh-based prolapse surgery required reoperation for a mesh complication within 10 years. The risk of reoperation was lowest for surgeons performing 14 or more procedures per year.

Antimicrobial Stewardship: A Call to Action for Surgeons

Science.gov (United States)

Duane, Therese M.; Catena, Fausto; Tessier, Jeffrey M.; Coccolini, Federico; Kao, Lillian S.; De Simone, Belinda; Labricciosa, Francesco M.; May, Addison K.; Ansaloni, Luca; Mazuski, John E.

2016-01-01

Abstract Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients. PMID:27828764

Army AL&T, October-December 2007

Science.gov (United States)

2007-12-01

appearance. The results of this research have been exploited in movies such as Spider Man II, Superman Returns and King Kong. A new challenge being...project manager/superintendent and quality control manager at LEAD who work from an office trailer in the depot’s industrial area. The availability of...and I think AMC as a command is much better to do that for the Army. The 3.5-day event also included a tour of and reception at the U.S. Army

British auditors in Poland in the interwar period

Directory of Open Access Journals (Sweden)

Jerzy Cieślik

2015-12-01

Full Text Available This article presents the results of historical research on the operation of British accounting firm Whin-ney, Murray & Co in Poland before World War II. Based on our findings this was the only foreign ac-counting firm active in Poland at that time. Following their clients, British accounting firms expanded their operations abroad at the turn of the 19th century. During the 1920s and 1930s the number of audit assignments on the European continent increased rapidly, which necessitated the establishment of branches (offices in major European cities and industrial districts. Whinney, Murray & Co set up an office in Warsaw in 1932 taking into account its convenient location as a base for undertaking audit assignments throughout the Eastern European region. The Warsaw office concentrated initially on inter-national clients active in Poland but was also engaged in audits of Polish power plants and participated as financial advisor in the electrification program of Polish railways with involvement of British investors. Whinney, Murray & Co contributed to the development of Polish-British economic cooperation before World War II. Its representative was one of the founders of the Polish-British Chamber of Commerce established in Warsaw in 1933.

A Transformed Army in Europe For a Transformed World

National Research Council Canada - National Science Library

Brown, James

2003-01-01

General Gordon R. Sullivan was the Army Chief of Staff when he wrote, "Ultimately, the Army's objective in leveraging change is to create a "learning organization," one that adapts in ever-quicker response cycles...

Army Communicator. Voice of the Signal Regiment. Volume 33, Number 2, Spring 2008

Science.gov (United States)

2008-01-01

Militant Islam, and one on Cultural Aware- ness. Many of these works can be downloaded. http://www-cgsc.army.mil/carl/resources/ biblio ...CAC_counterinsurgency.asp http://www-cgsc.army.mil/carl/resources/ biblio /CAC_militant.asp http://www-cgsc.army.mil/carl/resources/ biblio /CAC_cultural.asp Are you...deploying to Iraq or Afghanistan? http://cgsc.leavenworth.army.mil/carl/re- sources/ biblio /3acrart.asp http://cgsc.leavenworth.army.mil/carl/re- sources

Psychophysical workload in the operating room: primary surgeon versus assistant.

Science.gov (United States)

Rieger, Annika; Fenger, Sebastian; Neubert, Sebastian; Weippert, Matthias; Kreuzfeld, Steffi; Stoll, Regina

2015-07-01

Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p NASA-TLX sum score (p < 0.01; η(2) = 0.287). Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.

Accompanying role of hepato-biliary-pancreas surgeon in urological surgery

Directory of Open Access Journals (Sweden)

Atsushi Nanashima

Full Text Available Introduction: The present case reports demonstrated the accompanying surgical support from hepato-biliary-pancreas (HBP surgeons for urological surgery to secure operative safety because HBP surgeons are well experienced in dissecting techniques for mobilization of the liver or pancreas. We experienced 9 consecutive patients who underwent nephrectomy, adrenectomy or resection of retroperitoneal tumors by urological surgeons. Cardiovascular intervention was also required in cases of long tumor thrombus into the vena cava. Cases: All patients had no severe co-existing diseases except the main tumor. Reverse T-shape incision was performed in 7 cases and thoracolaparotomy in two. Dissection and mobilization at the site of severe compression by the urinary tumors were performed in three cases. Partial liver resection was performed for testicular liver metastases in two, and right hepatectomy for right renal cancer was performed in one. Encircling the vena cava and preparation of transection for tumor thrombi were performed in three, and among these, cardiovascular intervention was necessary in two because of extension into the right atrium. During admission, all patient outcomes were uneventful without severe complications. We herein showed the representative two cases of combined surgery. Discussion: and conclusion The point of this case report is the coordination between each surgeon and anesthesiologist under precise perioperative planning or management. The role of HBP surgeons is to provide information as a specialist on the operative field for urological or cardiovascular surgery to achieve operative safety. Keywords: Hepato-biliary-pancreas surgeon, Joint surgery, Urology

Action ethical dilemmas in surgery: an interview study of practicing surgeons

Directory of Open Access Journals (Sweden)

Nordam Ann

2005-07-01

Full Text Available Abstract Background The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. Methods Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. Conclusion The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.

Creativity and Strategic Vision: The Key to the Army’s Future

Science.gov (United States)

1993-04-21

future strategic leadership . 22 ENDNOTES 1. U.S. Army War College, Army Command. Leadership , and Management : Theory and Practice ([Carlisle Barracks...referring to a strategic leader, the Army War College reference text on command, leadership and management quoted earlier states. "he develops and...strategic leadership , are still applicable. He suggests that the Army should identify and track creative Individuals at the accession point, managing

Role of the plastic surgeon in a cancer hospital

International Nuclear Information System (INIS)

Sinclair, M.H.

1979-01-01

This paper discusses and illustrates the complicated problems faced by the plastic surgeon in a cancer hospital. His patients are often weakened, both physically and psychologically, not only by the cancer itself, but also by extensive ablative surgery. The goal of the plastic surgeon is rehabilitation of the patient after he is cured of cancer. Good planning with the cancer surgeon before the ablative operation is very important, as is immediate repair, whenever possible. The simplest procedure with the fewest stages that can accomplish satisfactory repair in the shortest time should be chosen, as we can never, even after the most extensive cancer operation, be sure that no recurrence will appear. Partial surgical repair and the use of a prosthesis should be considered for complicated defects in old and weak patients. Postoperative radiation therapy, if indicated, can be given after the flap has healed into the defect but before the pedicle is separated. The plastic surgeon should always be aware that his most important goal is speedy and satisfactory rehabilitation of the patient

[Women pioneers: first female cardiothoracic surgeons in the USA and in Israel].

Science.gov (United States)

Fertouk, Michal; Bekerman, Ziv; Kremer, Ran; Adler, Zvi; Bolotin, Gil

2014-08-01

At the beginning of the 1960's, three female doctors managed to break the glass ceiling and become the first female cardiothoracic surgeons in the USA. Since then, the number of certified female cardiothoracic surgeons has steadily increased. Nevertheless, females stilt only account for a minority of cardiothoracic surgeons in the USA. In Israel, three women have become specialists in cardiothoracic surgery over the last two decades, aLthough these surgeons are working as general thoracic surgery consultants, without any representative females in cardiac surgery.

Army Energy and Water Reporting System Assessment

Energy Technology Data Exchange (ETDEWEB)

Deprez, Peggy C.; Giardinelli, Michael J.; Burke, John S.; Connell, Linda M.

2011-09-01

There are many areas of desired improvement for the Army Energy and Water Reporting System. The purpose of system is to serve as a data repository for collecting information from energy managers, which is then compiled into an annual energy report. This document summarizes reported shortcomings of the system and provides several alternative approaches for improving application usability and adding functionality. The U.S. Army has been using Army Energy and Water Reporting System (AEWRS) for many years to collect and compile energy data from installations for facilitating compliance with Federal and Department of Defense energy management program reporting requirements. In this analysis, staff from Pacific Northwest National Laboratory found that substantial opportunities exist to expand AEWRS functions to better assist the Army to effectively manage energy programs. Army leadership must decide if it wants to invest in expanding AEWRS capabilities as a web-based, enterprise-wide tool for improving the Army Energy and Water Management Program or simply maintaining a bottom-up reporting tool. This report looks at both improving system functionality from an operational perspective and increasing user-friendliness, but also as a tool for potential improvements to increase program effectiveness. The authors of this report recommend focusing on making the system easier for energy managers to input accurate data as the top priority for improving AEWRS. The next major focus of improvement would be improved reporting. The AEWRS user interface is dated and not user friendly, and a new system is recommended. While there are relatively minor improvements that could be made to the existing system to make it easier to use, significant improvements will be achieved with a user-friendly interface, new architecture, and a design that permits scalability and reliability. An expanded data set would naturally have need of additional requirements gathering and a focus on integrating

Clinical decision making: how surgeons do it.

Science.gov (United States)

Crebbin, Wendy; Beasley, Spencer W; Watters, David A K

2013-06-01

Clinical decision making is a core competency of surgical practice. It involves two distinct types of mental process best considered as the ends of a continuum, ranging from intuitive and subconscious to analytical and conscious. In practice, individual decisions are usually reached by a combination of each, according to the complexity of the situation and the experience/expertise of the surgeon. An expert moves effortlessly along this continuum, according to need, able to apply learned rules or algorithms to specific presentations, choosing these as a result of either pattern recognition or analytical thinking. The expert recognizes and responds quickly to any mismatch between what is observed and what was expected, coping with gaps in information and making decisions even where critical data may be uncertain or unknown. Even for experts, the cognitive processes involved are difficult to articulate as they tend to be very complex. However, if surgeons are to assist trainees in developing their decision-making skills, the processes need to be identified and defined, and the competency needs to be measurable. This paper examines the processes of clinical decision making in three contexts: making a decision about how to manage a patient; preparing for an operative procedure; and reviewing progress during an operative procedure. The models represented here are an exploration of the complexity of the processes, designed to assist surgeons understand how expert clinical decision making occurs and to highlight the challenge of teaching these skills to surgical trainees. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

The Army Lawyer

Science.gov (United States)

2007-07-01

authors in the articles do not necessarily reflect the view of The Judge Advocate General or the Department of the Army. Masculine or feminine...for the hegemonic power (read ‘United States’) and its followers to determine international public enemy on a case-by-case basis. A legal

The National Health Service Breast Screening Programme and British Association of Surgical Oncology audit of quality assurance in breast screening 1996-2001.

Science.gov (United States)

Sauven, P; Bishop, H; Patnick, J; Walton, J; Wheeler, E; Lawrence, G

2003-01-01

The National Health Service Breast Screening Programme (NHSBSP) is an example of a nationally coordinated quality assurance programme in which all the professional groups involved participate. Surgeons, radiologists and pathologists defined the clinical outcome measures against which they would subsequently be audited. The NHSBSP and the Association of Breast Surgery at BASO are jointly responsible for coordinating an annual audit of all surgical activities undertaken within the NHSBSP. The trends for key outcome measures between 1996 and 2001 are provided. The preoperative diagnosis rate (minimum standard 70 per cent or more) improved from 63 to 87 per cent. This rise was mirrored by an increase in the use of core biopsy in preference to fine-needle cytology. The proportion of patients in whom lymph node status was recorded improved from 81 to 93 per cent. There was no significant change in the number of women treated by low case-load surgeons and waiting times for surgery increased through the study interval. The BASO-NHSBSP Breast Audit has recorded major changes in clinical practice over 5 years. A key feature has been the dissemination of good practice through feedback of the results at local and national level. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd

The impact of sleep deprivation on surgeons' performance during night shifts.

Science.gov (United States)

Amirian, Ilda

2014-09-01

The median incidence of adverse events that may result in patient injury is a total of 9% of all in-hospital admissions. In order to reduce this high incidence initiatives are continuously worked on that can reduce the risk of patient harm during admission by strengthening hospital systems. However, the influence of physicians' shift work on the risk on adverse events in patients remains controversial. In the studies included in this PhD thesis we wished to examine the impact of sleep deprivation and circadian rhythm disturbances on surgeons' during night shifts. Further we wished to examine the impact sleep deprivation had on surgeons' performance as a measure of how patient safety would be affected. We found that sleep deprivation subjectively had an impact on the surgeons and that they were aware of the effect fatigue had on their work performance. As a result they applied different mechanisms to cope with fatigue. Attending surgeons felt that they had a better overview now, due to more experience and better skills, than when they were residents, despite the fatigue on night shifts. We monitored surgeons' performance during night shifts by laparoscopic simulation and cognitive tests in order to assess their performance; no deterioration was found when pre call values were compared to on call values. The surgeons were monitored prospectively for 4 days across a night shift in order to assess the circadian rhythm and sleep. We found that surgeons' circadian rhythm was affected by working night shifts and their sleep pattern altered, resembling that of shift workers on the post call day. We assessed the quality of admission in medical records as a measure of surgeons' performance, during day, evening and night hours and found no deterioration in the quality of night time medical records. However, consistent high errors were found in several categories. These findings should be followed up in the future with respect of clarifying mechanism and consequences for

Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair?

Science.gov (United States)

Köckerling, F; Bittner, R; Kraft, B; Hukauf, M; Kuthe, A; Schug-Pass, C

2017-02-01

For open and endoscopic inguinal hernia surgery, it has been demonstrated that low-volume surgeons with fewer than 25 and 30 procedures, respectively, per year are associated with significantly more recurrences than high-volume surgeons with 25 and 30 or more procedures, respectively, per year. This paper now explores the relationship between the caseload and the outcome based on the data from the Herniamed Registry. The prospective data of patients in the Herniamed Registry were analyzed using the inclusion criteria minimum age of 16 years, male patient, primary unilateral inguinal hernia, TEP or TAPP techniques and availability of data on 1-year follow-up. In total, 16,290 patients were enrolled between September 1, 2009, and February 1, 2014. Of the participating surgeons, 466 (87.6 %) had carried out fewer than 25 endoscopic/laparoscopic operations (low-volume surgeons) and 66 (12.4 %) surgeons 25 or more operations (high-volume surgeons) per year. Univariable (1.03 vs. 0.73 %; p = 0.047) and multivariable analysis [OR 1.494 (1.065-2.115); p = 0.023] revealed that low-volume surgeons had a significantly higher recurrence rate compared with the high-volume surgeons, although that difference was small. Multivariable analysis also showed that pain on exertion was negatively affected by a lower caseload <25 [OR 1.191 (1.062-1.337); p = 0.003]. While here, too, the difference was small, the fact that in that group there was a greater proportion of patients with small hernia defect sizes may have also played a role since the risk in that group was higher. In this analysis, no evidence was found that pain at rest [OR 1.052 (0.903-1.226); p = 0.516] or chronic pain requiring treatment [OR 1.108 (0.903-1.361); p = 0.326] were influenced by the surgeon volume. As confirmed by previously published studies, the data in the Herniamed Registry also demonstrated that the endoscopic/laparoscopic inguinal hernia surgery caseload impacted the outcome. However

The Army rolls through Indianapolis: Fieldwork at the Virtual Army Experience

Directory of Open Access Journals (Sweden)

Robertson Allen

2009-03-01

Full Text Available This essay takes an ethnographic look at the individuals and institutions associated with the development, production, and implementation of the Virtual Army Experience (VAE, a mobile mission simulator that travels across the United States to venues such as state fairs and air shows. As an explicit aid to Army recruitment and interaction with the public, the VAE is an interesting nexus point that often channels public anxieties surrounding the medium of the video game and its role in the militarization of society. Here, I present my own experience of doing ethnography at this site, describing how it is received by visitors and interpreted by its employees. By means of the example of the VAE, I argue that polarizing media reports and academic criticisms that pit the processes of militarization against critical reflection of those processes are counterproductive and result in silencing more nuanced and thoughtful critical reflection that is already present at sites such as the VAE.

Assessment, surgeon, and society.

Science.gov (United States)

Norcini, John; Talati, Jamsheer

2009-08-01

An increasing public demand to monitor and assure the quality of care provided by physicians and surgeons has been accompanied by a deepening appreciation within the profession of the demands of self-regulation and the need for accountability. To respond to these developments, the public and the profession have turned increasingly to assessment, both to establish initial competence and to ensure that it is maintained throughout a career. Fortunately, this comes at a time when there have been significant advances in the breadth and quality of the assessment tools available. This article provides an overview of the drivers of change in assessment which includes the educational outcomes movement, the development of technology, and advances in assessment. It then outlines the factors that are important in selecting assessment devices as well as a system for classifying the methods that are available. Finally, the drivers of change have spawned a number of trends in the assessment of competence as a surgeon. Three of them are of particular note, simulation, workplace-based assessment, and the assessment of new competences, and each is reviewed with a focus on its potential.

Quality assurance of lower limb venous duplex scans performed by vascular surgeons.

Science.gov (United States)

Kordowicz, A; Ferguson, G; Salaman, R; Onwudike, M

2015-02-01

Duplex scanning is the gold standard for investigating venous reflux; increasingly surgeons perform these scans themselves. There has been no data published analysing the accuracy of Duplex scans performed by vascular surgeons. We aimed to evaluate an objective method of comparing the results of lower limb Duplex scans performed by one consultant vascular surgeon with those performed by a vascular technologist. We assessed 100 legs with symptomatic varicose veins. Each patient underwent two lower limb venous Duplex scans; one performed by a consultant vascular surgeon and one by a vascular technologist. Scan results were randomised and sent to two consultant vascular surgeons blinded to the identity and experience of the sonographer. They were asked to recommend treatment. A k score was calculated in each case to assess the level of agreement between the scans performed by the consultant and the technologist. Eighty-one patients were studied (53 females). The kappa score for assessor 1 was 0.60 (95%CI:0.44-0.75) and for assessor 2 was 0.62 (95%CI:0.48-0.75). k scores >0.60 represent a substantial strength of agreement. Duplex scans performed by this surgeon were comparable to those performed by a vascular technologist. It is possible to quality-assure duplex performed by vascular surgeons without directly observing the scanning process or reviewing digitally recorded images. We propose standardisation of training, assessment and quality assurance for vascular surgeons wishing to perform ultrasound scans.

US Army primary radiation standards complex

Energy Technology Data Exchange (ETDEWEB)

Rogers, S.C. [Radiation Standards and Dosimetry Laboratory, Redstone Arsenal, AL (United States)

1993-12-31

This paper describes the U.S. Army Primary Radiation Standards Complex (PRSC) to be constructed at Redstone Arsenal, Alabama. The missions of the organizations to be located in the PRSC are described. The health physics review of the facility design is discussed. The radiation sources to be available in the PRSC and the resulting measurement capabilities of the Army Primary Standards Laboratory Nucleonics section are specified. Influence of the National Voluntary Laboratory Accrediation Program (NVLAP) accreditation criteria on facility design and source selection is illustrated.

Army Business Transformation: The Utility of Using Corporate Business Models within the Institutional Army

National Research Council Canada - National Science Library

Bailer, Jr., John J

2007-01-01

.... Through a survey of the literature of published corporate business plans and models, military reports, Army depot case studies, and comparative analysis of emerging computer software technology...

Analysis of Lean Six Sigma in the Army Contracting Process

Science.gov (United States)

2011-12-01

xii THIS PAGE INTENTIONALLY LEFT BLANK xiii LIST OF ACRONYMS AND ABBREVIATIONS AC Acquisition Center ACA Army Acquisition Agency ACAT... Utilizing the Results of Lean Six Sigma efforts (www.armyobt.army.mil) The Army mimics the DoD structure for Business Transformation to align with the DoD...understand the marketplace and work collaboratively to clearly describe the government’s requirements in a way that can generate robust competition. 15

Do Surgeons React?: A Retrospective Analysis of Surgeons' Response to Harassment of a Colleague During Simulated Operating Theatre Scenarios.

Science.gov (United States)

Gostlow, Hannah; Vega, Camila Vega; Marlow, Nicholas; Babidge, Wendy; Maddern, Guy

2017-07-24

To assess and report on surgeons' ability to identify and manage incidences of harassment. The Royal Australasian College of Surgeons is committed to driving out discrimination, bullying, harassment, and sexual harassment from surgical training and practice, through changing the culture of the workplace. To eradicate these behaviors, it is first critical to understand how the current workforce responds to these actions. A retrospective analysis of video data of an operating theatre simulation was conducted to identify how surgeons, from a range of experience levels, react to instances of harassment. Thematic analysis was used to categorize types of harassment and participant response characteristics. The frequency of these responses was assessed and reported. The type of participant response depended on the nature of harassment being perpetuated and the seniority of the participant. In the 50 instances of scripted harassment, active responses were enacted 52% of the time, acknowledgment responses 16%, and no response enacted in 30%. One senior surgeon also perpetuated the harassment (2%). Trainees were more likely to respond actively compared with consultants. It is apparent that trainees are more aware of instances of harassment, and were more likely to intervene during the simulated scenario. However, a large proportion of harassment was unchallenged. The hierarchical nature of surgical education and the surgical workforce in general needs to enable a culture in which the responsibility to intervene is allowed and respected. Simulation-based education programs could be developed to train in the recognition and intervention of discrimination, bullying, harassment and sexual harassment.

The Impact of Irregular Warfare on the US Army

National Research Council Canada - National Science Library

McDonald, III, Roger L

2006-01-01

Although the U.S. Army has yet to clearly define irregular warfare, it is imperative that the Army take near-term action to enhance the ability of Soldiers and units to operate effectively in an irregular warfare environment...

Operational Reservations: Considerations for a Total Army Force

Science.gov (United States)

2014-06-01

individually proficient. To answer some of the questions about the viabil- ity of a 5-year training cycle for RC units, Major Gen- eral Tim Orr, the Adjutant...resident school). 85. “Structured Self-Development,” Ft. Bliss , TX: U.S. Army Sergeants Major Academy, available from https://usasma.bliss. army.mil

Occupational stress in the armed forces: An Indian army perspective

Directory of Open Access Journals (Sweden)

Sakshi Sharma

2015-09-01

Full Text Available This study attempts to explore factors influencing occupational stress faced by Indian army soldiers and evaluate applicability of the scale used for measuring occupational stressors. Structured interview schedules were used to collect first hand data from a sample of 415 soldiers. Exploratory Factor Analysis (EFA highlights lack of control at work, role conflict, inadequate awareness about profession, workload and job pressure, and indifferent organisational attitude as the major occupational stressors in the Indian army. In addition, Confirmatory Factor Analysis (CFA confirms occupational stressor as an eight factor model in the army. The study recommends implementing commitment-based management approach and techniques such as Sahaja Yoga meditation in the army.

Leadership Stability in Army Reserve Component Units

Science.gov (United States)

2013-01-01

OMB control number. 1. REPORT DATE 2013 2. REPORT TYPE 3. DATES COVERED 00-00-2013 to 00-00-2013 4. TITLE AND SUBTITLE Leadership Stability in...standards for research quality and objectivity. Leadership Stability in Army Reserve Component Units Thomas F. Lippiatt, J. Michael Polich NATIONAL SECURITY...RESEARCH DIVISION Leadership Stability in Army Reserve Component Units Thomas F. Lippiatt, J. Michael Polich Prepared for the Office of the

Patient views on financial relationships between surgeons and surgical device manufacturers.

Science.gov (United States)

Camp, Mark W; Gross, Allan E; McKneally, Martin F

2015-10-01

Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging public trust in the surgical profession. We explored postoperative Canadian patients' knowledge and opinions about financial relationships between surgeons and surgical device manufacturers. This complex issue was explored using qualitative methods. We conducted semistructured face-to-face interviews with postoperative patients in follow-up arthroplasty clinics at an academic hospital in Toronto, Canada. Interviews were audiotaped, transcribed and analyzed. Patient-derived concepts and themes were uncovered. We interviewed 33 patients. Five major themes emerged: 1) many patients are unaware of the existence of financial relationships between surgeons and surgical device manufacturers; 2) patients approve of financial relationships that support innovation and research but are opposed to relationships that involve financial incentives that benefit only the surgeon and the manufacturer; 3) patients do not support disclosure of financial relationships during the consent process as it may shift focus away from the more important risks; 4) patients support oversight at the professional level but reject the idea of government involvement in oversight; and 5) patients entrust their surgeons to make appropriate patient-centred choices. This qualitative study deepens our understanding of financial relationships between surgeons and industry. Patients support relationships with industry that provide potential benefit to current or future patients. They trust our ability to self-regulate. Disclosure combined with appropriate oversight will strengthen public trust in professional collaboration with industry.

Netherlands Army Long Range Anti Armour Study - Status Report

OpenAIRE

Schagen, P.A.B. van

1989-01-01

At the end of the nineties the munition for the TOW weapon system in use at The Netherlands army, has to be replaced. The Life of Type of The Tow carrier ends in 2005. The long range anti armour study is to gain insight into the possibilities and limitations for the Netherlands army to deploy future (time period 1995-2000) weapon systems in the long range anti armour battle. The first study results are expected at the end of 1989. The study is sponsored by the Netherlands army and is carried ...

Army TLS

Science.gov (United States)

2014-12-10

Fast Deflation Device Tether marking Pennants Balloon / Tether marking LED Flashing light Loading Ramps Customized Trailer for transportation and Field...amount of xtra lift that permits the ballon to rise (if Res_Lift = 0, balloon is at equilibrium) RL = NL – Payload – Tether Payload: the weight of...Army TLS The TLS uses tethered aerodynamic blimps and precision-powered winches to loft one or more specialty-designed meteorological payloads that

Surgeon Involvement in Pre-Clinical Medical Education: Attitudes of Directors of Education

Directory of Open Access Journals (Sweden)

Simon Turner

2012-04-01

Full Text Available Background: Application rates to surgical residencies have shown a downward trend recently. Introducing students to surgeons early in medical school can increase interest in surgery as a career and enhance the instruction of important surgical topics. Directors of undergraduate medical education have unique insight and influence regarding the participation of surgeons in pre-clinical education. Methods: To understand the attitudes of these educators towards surgeons as teachers in pre-clinical programs, a survey was administered to the directors of undergraduate medical education at each of the English-language medical schools in Canada. Results: Educators estimate the participation of surgeons in all categories of pre-clinical education to be low, despite being valuable, and think that it should be increased. The most significant barrier to participation identified was a lack of surgeons’ time. Conclusions: Despite the value of surgeons participating in pre-clinical education, their rate of participation is low. Steps should be taken to facilitate the involvement of surgeons in this phase of education, which may lead to improved education for students and increased student interest in surgery residencies.

Boundaries - US Army Corps of Engineers - St. Paul District (MVP) Civil Works

Data.gov (United States)

Army Corps of Engineers, Department of the Army, Department of Defense — The US Army Corps of Engineers - St. Paul District Civil Works boundary. Boundary is based on 1:24k watershed data and coordination with MVR to determine shared...

Cost analysis when open surgeons perform minimally invasive hysterectomy.

Science.gov (United States)

Shepherd, Jonathan P; Kantartzis, Kelly L; Ahn, Ki Hoon; Bonidie, Michael J; Lee, Ted

2014-01-01

The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P depreciation included (P < .001) but similar costs if these variables were excluded. Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.

Army Healthcare Enterprise Management System

National Research Council Canada - National Science Library

2001-01-01

.... The complaint alleged that the Army Healthcare Enterprise Management System was not properly competed, potential conflicts of interest existed, and possible contract performance problems existed...

British firms mark progress off Viet Nam

International Nuclear Information System (INIS)

Anon.

1992-01-01

British companies are making more inroads in exploring for oil and gas off Viet Nam. British Gas plc won a 25 year production sharing contract for a license off southern Viet Nam in the South China Sea. Meantime, London independent Lasmo plc started seismic surveys on the block adjoining the British Gas block. Separately, Thailand and Viet Nam have reached agreement to jointly explore for and develop oil and gas found in waters claimed by both countries. Plans call for the two countries to draw up joint development plans covering oil and gas resources in the southeastern fringe of the Gulf of Thailand. Bangkok officials say they would have preferred to delineate maritime boundaries with Hanoi, but opted for the joint development accord, noting that Thailand and Malaysia had taken 12 years to resolve a similar dispute

Army Business Transformation: The Utility of Using Corporate Business Models within the Institutional Army

National Research Council Canada - National Science Library

Bailer, Jr., John J

2007-01-01

.... This study finds that working corporate models, such as Lean Six Sigma (LSS), are available which are already enabling the transformation of a very specific aspect within the institutional Army...

Effect of Individual Surgeons and Anesthesiologists on Operating Room Time

NARCIS (Netherlands)

van Eijk, Ruben P A; van Veen-Berkx, Elizabeth; Kazemier, Geert; Eijkemans, Marinus J C

BACKGROUND:: Variability in operating room (OR) time causes overutilization and underutilization of the available ORs. There is evidence that for a given type of procedure, the surgeon is the major source of variability in OR time. The primary aim was to quantify the variability between surgeons and

Privatisation of the British coal industry

Energy Technology Data Exchange (ETDEWEB)

Cowles, R.V. (Norton Rose, London (UK))

1991-01-01

The article discusses the possible consequences of the impending privatisation of British Coal. It seems likely that deep mine operations will probably be divided up geographically but opencast mines may be left in single ownership. Freehold ownership of coal is likely to be transferred to the Crown and British Coal's powers to license small mines and opencast sites are likely to be absorbed into a general licensing system under control of the Department of Energy. Possible difficulties of public share issues are discussed - subsidence, environmental problems and also the uncertainty of the future market for British coal are mentioned. As an alternative, a series of contract sales of groups of mine properties could be made. Issues of common concern to future owners of the coal industry may lead to the creation of a new mineowner's trade association. Constraints in the areas of procurement and coal sales are discusssed briefly. Although a gloomy scenario is presented, it is suggested that some mines could become highly profitable. 1 ref.

The Process of Curriculum Innovations in the Army

Science.gov (United States)

2016-08-01

just tell them they were wrong. The hands-on exercises were viewed as one way of developing the technical competence needed, as instructors...PowerPoint) __Soldier competencies per the Army Learning Model __Learner-centered and/or problem solving activities/ exercises /scenarios __Principles...Diffusion of Innovations, Program of Instruction, Instructional Techniques, Curriculum Development, Soldier Competencies , Army Training and Education 16

A Candidate Army Energy and Water Management Strategy

National Research Council Canada - National Science Library

Fournier, Donald F; Westervelt, Eileen T

2004-01-01

.... This work augments on-going energy and water management initiatives within the Army by developing a new candidate Army level strategy that responds to anticipated legislation; reflects current DOD and DA requirements, vision, and values in light of the current world situation; incorporates sound science and management principles; and organizes and focuses efforts into an integrated program.

Meeting Increasing Demands for Rural General Surgeons.

Science.gov (United States)

Mccarthy, Mary C; Bowers, Howard E; Campbell, Damon M; Parikh, Priti P; Woods, Randy J

2015-12-01

Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed.

Risk adjustment for case mix and the effect of surgeon volume on morbidity.

Science.gov (United States)

Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

2013-06-01

Retrospective studies of large administrative databases have shown higher mortality for procedures performed by low-volume surgeons, but the adequacy of risk adjustment in those studies is in doubt. To determine whether the relationship between surgeon volume and outcomes is an artifact of case mix using a prospective sample of carotid endarterectomy cases. Observational cohort study from January 1, 2008, through December 31, 2010, with preoperative, immediate postoperative, and 30-day postoperative assessments acquired by independent monitors. Urban, tertiary academic medical center. All 841 patients who underwent carotid endarterectomy performed by a vascular surgeon or cerebrovascular neurosurgeon at the institution. Carotid endarterectomy without another concurrent surgery. Stroke, death, and other surgical complications occurring within 30 days of surgery along with other case data. A low-volume surgeon performed 40 or fewer cases per year. Variables used in a comparison administrative database study, as well as variables identified by our univariate analysis, were used for adjusted analyses to assess for an association between low-volume surgeons and the rate of stroke and death as well as other complications. RESULTS The rate of stroke and death was 6.9% for low-volume surgeons and 2.0% for high-volume surgeons (P = .001). Complications were similarly higher (13.4% vs 7.2%, P = .008). Low-volume surgeons performed more nonelective cases. Low-volume surgeons were significantly associated with stroke and death in the unadjusted analysis as well as after adjustment with variables used in the administrative database study (odds ratio, 3.61; 95% CI, 1.70-7.67, and odds ratio, 3.68; 95% CI, 1.72-7.89, respectively). However, adjusting for the significant disparity of American Society of Anesthesiologists Physical Status classification in case mix eliminated the effect of surgeon volume on the rate of stroke and death (odds ratio, 1.65; 95% CI, 0.59-4.64) and other

Practice patterns and career satisfaction of Canadian female general surgeons.

Science.gov (United States)

Hebbard, Pamela C; Wirtzfeld, Debrah A

2009-06-01

We wanted to study how female general surgeons in Canada manage lifestyle and career demands. All female Canadian general surgeons registered with the Royal College of Physicians and Surgeons of Canada were asked to complete a survey evaluating their practice patterns, personal lives, and levels of satisfaction related to these factors. Eighty-five surveys (66%) were returned. Most respondents work in full-time clinical practices. While it was rare to find women in part-time or shared practices, 35% of women reported interest in these alternative models. Respondents described the necessary factors for a transition into alternative models. Job satisfaction was high (3.8 out of 5), with personal and parenting satisfaction being less highly rated (3.3 and 3.2, respectively). Canadian female general surgeons have active and satisfying careers, although many would like to work in alternative practice models that better conform to their lifestyle demands. This pressure will have a significant impact on the future surgical workforce.

Social media and your practice: navigating the surgeon-patient relationship.

Science.gov (United States)

McLawhorn, Alexander S; De Martino, Ivan; Fehring, Keith A; Sculco, Peter K

2016-12-01

Utilization of social media both in the private and professional arenas has grown rapidly in the last decade. The rise of social media use within health care can be viewed as the Internet-based corollary of the patient-centered care movement, in which patient perspectives and values are central to the delivery of quality care. For orthopedic surgeons and their practices, general-purpose online social networks, such as Facebook and Twitter, are convenient platforms for marketing, providing patient education and generating referrals. Virtual health communities are used less frequently by orthopedic surgeons but provide forums for patient engagement and active surgeon-to-patient communication via blogs and ask-the-doctor platforms. This commentary reviews the current state of social media use in orthopedic practice, with particular emphasis on managing the extension of the surgeon-patient relationship online, including the unique practice risks social media poses, such as privacy concerns, potential liability, and time consumption.

Army Secure Operating System: Information Security for Real Time Systems

National Research Council Canada - National Science Library

Anderson, Eric

1984-01-01

The Army Secure Operating System (ASOS) project, under the management of the U.S. Army CECOM organization, will provide real time systems software necessary for fielding modern Battlefield Automation Systems...

Orthopedic surgeons' knowledge regarding risk of radiation exposition: a survey analysis.

Science.gov (United States)

Tunçer, Nejat; Kuyucu, Ersin; Sayar, Şafak; Polat, Gökhan; Erdil, İrem; Tuncay, İbrahim

2017-01-01

The purpose of this study is to evaluate the knowledge levels of orthopedic surgeons working in Turkey about the uses and possible risks of fluoroscopy and assess methods for preventing radiation damage. A questionnaire with a total of 12 questions was sent to 1121 orthopedic surgeons working in Turkey. The questionnaire evaluated participants' knowledge about the uses and risks of fluoroscopy and methods for preventing damage. One thousand and twenty-four orthopedic surgeons were found to be suitable for inclusion in the study. The effects of fluoroscopy on patients were not assessed in our study. The data obtained were statistically evaluated. Of the surveyed surgeons, 313 (30%) had used fluoroscopy in over 50% of their operations. The average number of fluoroscopy shots per case was 54.5. A lead apron was the most commonly used (88%) protection from the harmful effects of radiation. Fluoroscopy shots were performed with the help of operating room personnel (86%). A dosimeter was used 5% of the time. According to the survey results, the need for fluoroscopy was very high in orthopedic surgery. However, orthopedic surgeons have inadequate knowledge about the uses and risks of fluoroscopy and methods for preventing damage. Therefore, we believe that training on this topic should be provided to all orthopedic surgeons. © The Authors, published by EDP Sciences, 2017.

How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?

Science.gov (United States)

Stefanidis, Dimitrios; Chintalapudi, Nikita; Anderson-Montoya, Brittany; Oommen, Bindhu; Tobben, Daniel; Pimentel, Manuel

2017-01-01

The reported incidence (0.16-1.5 %) of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is higher than during open cholecystectomy and has not decreased over time despite increasing experience with the procedure. The "critical view of safety" (CVS) technique may help to prevent BDI when certain criteria are met prior to division of any structures. This study aimed to evaluate the adherence of practicing surgeons to the CVS criteria during LC and the impact of a training intervention on CVS identification. LC procedures of general surgeons were video-recorded. De-identified recordings were reviewed by a blinded observer and rated on a 6-point scale using the previously published CVS criteria. A coaching program was conducted, and participating surgeons were re-assessed in the same manner. The observer assessed ten LC videos, each involving a different surgeon. The CVS was adequately achieved by two surgeons (20 %). The remaining eight surgeons (80 %) did not obtain adequate CVS prior to division of any structures, despite two surgeons dictating that they did; the mean score of this group was 1.75. After training, five participating surgeons (50 %) scored > 4, and the mean increased from 1.75 (baseline) to 3.75 (p < 0.05). The CVS criteria were not routinely used by the majority of participating surgeons. Further, one-fourth of those who claimed to obtain the CVS did so inadequately. All surgeons who participated in training showed improvement during their post-assessment. Our findings suggest that education of practicing surgeons in the application of the CVS during LC can result in increased implementation and quality of the CVS. Pending studies with larger samples, our findings may partly explain the sustained BDI incidence despite increased experience with LC. Our study also supports the value of direct observation of surgical practices and subsequent training for quality improvement.

Economic impact of a head and neck oncologic surgeon: the case mix index.

Science.gov (United States)

Jalisi, Scharukh; Sanan, Akshay; Mcdonough, Katie; Hussein, Khalil; Platt, Michael; Truong, Minh Tam; Couch, Marion; Burkey, Brian B

2014-10-01

Head and neck oncologic surgery is a time-consuming specialty that requires extensive resources and manpower. Case mix index (CMI) is used in evaluating the complexity and economic impact of surgeons. Head and neck oncologic surgeons generate significant revenue for hospitals, yet compensation is relatively low. Retrospective review of a tertiary hospital's case mix data for 605 otolaryngology admissions from 2009 to 2011 was performed. CMI comparison for head and neck oncologic surgeons versus general otolaryngology was performed. In an otolaryngology department of 9 surgeons; there was a significant difference (p 1) favoring head and neck oncologic surgeons. Head and neck oncologic surgeons increase the CMI for hospitals and ultimately influence the hospital's reimbursement. There is a need for increased collaboration between hospitals and departments in fostering and furthering their head and neck surgical oncology programs by taking CMI into consideration. © 2013 Wiley Periodicals, Inc.

Nostalgia in the Army (17th-19th Centuries).

Science.gov (United States)

Battesti, Michèle

2016-01-01

People died from nostalgia in the army in the 17th-19th centuries. The term 'nostalgia', created by the doctor Johannes Hofer (1669-1752), from Mulhouse, came from the Germanic Heimweh, or 'homesickness'. It affected the young people enrolled in the army, such as Swiss mercenaries. Longing for their native land, they were consumed by an ongoing desire to return home. If it was impossible to do so, they sank into 'a sadness accompanied with insomnia, anorexia and other unpleasant symptoms' that could lead to death. Nostalgia became classified as a disease during the last quarter of the 18th century and ravaged the French army during the Revolution and the Napoleonic wars. However, as soon as the wars ended, it ceased to exist in the army (except the colonial army). It was removed from the nosology in the first half of the 19th century. Rapidly explained as an example of a misdiagnosis or a confusion between 'connection and cause', nostalgia needs to be assessed in regard to the medical debate between 'alienists' and 'organicists'. Creating much concern, nostalgia needs to be considered in the historical context of a society destabilized by modernity, with some individuals uprooted by the sudden transition from civil society to military life. It raises questions about the role that the army played in the creation of the French national union. Nostalgia may have also covered psychic traumatisms later designated as combat fatigue, war neurosis, or post-traumatic stress disorder. © 2016 S. Karger AG, Basel.

Cardiac surgeons and the quality movement: the Michigan experience.

Science.gov (United States)

Prager, Richard L; Armenti, Frederick R; Bassett, Joseph S; Bell, Gail F; Drake, Daniel; Hanson, Eric C; Heiser, John C; Johnson, Scott H; Plasman, F B; Shannon, Francis L; Share, David; Theurer, Patty; Williams, Jaelene

2009-01-01

The Michigan Society of Thoracic and Cardiovascular Surgeons created a voluntary quality collaborative with all the cardiac surgeons in the state and all hospitals doing adult cardiac surgery. Utilizing this collaborative over the last 3 years and creating a unique relationship with a payor, an approach to processes and outcomes has produced improvements in the quality of care for cardiac patients in the state of Michigan.

Gender differences in the professional and private lives of plastic surgeons.

Science.gov (United States)

Halperin, Terri J; Werler, Martha M; Mulliken, John B

2010-06-01

There are over 700 female members in the American Society of Plastic Surgeons. The purpose of this study was to assess possible differences between female and male plastic surgeons with respect to their practice characteristics, duration of practice, and some aspects of their private lives. We designed a 41 question survey to compare the practice features and personal demographics of female and male members of the American Society of Plastic Surgeons. A total of 1498 questionnaires were sent via e-mail to all female members (n = 687) and a random cohort of male members (n = 811). The respondents were age stratified by decade and their responses were compared by gender using chi tests. The overall response rate was 36.3%: 337 females (49%) and 207 males (25.5%) (P women had no children, as compared to 11.5% of men (P Men also tended to have more children than their female counterparts, across all age groups. The majority of women (58.8%) delayed child-rearing until after residency, as compared to only 25.7% of men (P earn an income greater than $400,000 per year (P < 0.001). Of 39 respondents who stated that they were no longer practicing, 21 (54%) were male and 18 (46%) were female (P = NS). Female plastic surgeons are significantly more likely to be unmarried, to postpone having children or be childless, as compared to their male counterparts. Furthermore, female plastic surgeons have a lower income than their male colleagues despite similar hours and practice profile. Nevertheless, female plastic surgeons appear to have similar career satisfaction and are no more likely to retire earlier or more frequently than male plastic surgeons.

Getting AM Up to SpeedAcross the Army Life Cycle

Science.gov (United States)

2016-12-01

Getting AM Up to Speed Across the Army Life Cycle Stacey L. Clark Clark is deputy director of Systems Engineering for the U.S. Army Research...In general, the Army is interested in the promise of AM for the following reasons : • Point-of-use manufacturing—the ability to produce spare parts...acquisition domain, more engi- neering work is needed to better define what standards should be used in Data Item Descriptions (DID) and Contract Data

A Systematic Review of the Factors that Patients Use to Choose their Surgeon.

Science.gov (United States)

Yahanda, Alexander T; Lafaro, Kelly J; Spolverato, Gaya; Pawlik, Timothy M

2016-01-01

Given surgery's inherent risks, a patient should be able to make the most informed decisions possible in selecting surgical treatment. However, there is little information on what factors patients deem important when choosing a surgeon. We performed a systematic review of the literature focused on how patients select surgical care, focusing on identification of factors that influence patient choice as well as important sources of information used by patients. A search of all available literature on factors associated with choice of surgeon/surgical care, as well as sources of information used by patients before undergoing surgery, was conducted using the MEDLINE/PubMed electronic database. Of the 2315 publications identified, 86 studies met inclusion criteria. Overall, patients draw upon a wide range of factors when choosing surgical care. Surgeon reputation and competency stood out as the most valued professional attributes. Patients also often selected surgeons based on their interpersonal skills. Many patients chose surgical care using hospital, rather than surgeon, characteristics. For these patients, hospital reputation and hospital distance were factors of primary importance. Importantly, most patients relied on word-of-mouth and physician referrals when choosing a surgeon. Patients also expressed interest in quality information on surgeons, indicating that these data would be useful in decision-making. Patients draw upon a myriad of factors when choosing a surgeon and the circumstances surrounding patients' decisions maybe differ based on sociodemographic, cultural, as well as other factors. Additional information on how patients choose surgeons or hospitals will help providers assist patients in finding their preferred caregivers.

Global Combat Support System - Army Increment 2 (GCSS-A Inc 2)

Science.gov (United States)

2016-03-01

2016 Major Automated Information System Annual Report Global Combat Support System - Army Increment 2 (GCSS-A Inc 2) Defense Acquisition...Secretary of Defense PB - President’s Budget RDT&E - Research, Development, Test, and Evaluation SAE - Service Acquisition Executive TBD - To Be...Date Assigned: Program Information Program Name Global Combat Support System - Army Increment 2 (GCSS-A Inc 2) DoD Component Army Responsible

Operational, Social, and Religious Influences upon the Army Chaplain Field Manual, 1926-1952

National Research Council Canada - National Science Library

Nay, Robert

2008-01-01

The early formulation of the Army Chaplain Field Manual reveals the Army Chaplaincy struggling with individuals using the Army Chaplain Field Manual to further their social and religious beliefs upon other chaplains...

Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

Science.gov (United States)

O'Brien, Michael J; O'Toole, Robert V; Newell, Mary Zadnik; Lydecker, Alison D; Nascone, Jason; Sciadini, Marcus; Pollak, Andrew; Turen, Clifford; Eglseder, W Andrew

2012-11-07

Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained. We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing. Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests. Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.

Southern Cameroons' financial contributions to British Second World ...

African Journals Online (AJOL)

The serious damage done to the British economy during World War II compelled the leaders of the British Government to look for ways of repairing the damage. Hence, they turned to the colonies for help. Inter alia, they needed financial assistance because of their inability to pay for imports from the United States. Imports of ...

Surgeons' preferences and practice patterns regarding intraoperative frozen section during partial nephrectomy.

Science.gov (United States)

Sidana, Abhinav; Donovan, James F; Gaitonde, Krishnanath

2014-08-01

Intraoperative frozen section (FS) evaluation for tumor margin during partial nephrectomy (PN) is a matter of controversy in urologic oncology. We evaluated the preferences and practice patterns of urologists regarding intraoperative FS during PN. A 17-item questionnaire was designed to collect information on surgeons' preferences and practice patterns regarding FS during PN. The survey was sent to the members of the Society of Urologic Oncology and Endourological Society. A total of 197 responses were received. Overall, 69% and 58% of respondents chose to obtain FS (always or sometimes) during open PN (OPN) and laparoscopic PN (LPN), respectively. There was a strong correlation between the surgeons' preferences during OPN and LPN. Younger surgeons are less likely to obtain FS during OPN. For surgeons who did not routinely obtain FS, "confidence about complete resection" was the most common reason (79%), followed by "no change in management with positive margins" (35%). Most surgeons (75%) believed the margins to be negative, if surgical margin was free of tumor microscopically by a single cell layer. Older surgeons considered negative margins to be free of tumor microscopically by ≥5 mm. Overall, 54% and 42% of respondents would repeat FS for positive microscopic margins during OPN and LPN, respectively. Of the respondents, 95% would not recommend additional treatment for positive margins on final pathology. Despite recent literature pointing to low clinical utility of FS, most surgeons still obtain FS during PN. Older surgeons tend to obtain FS more often. Fellowship training and practice type do not appear to influence preferences and practice patterns in regard to FS. Copyright © 2014 Elsevier Inc. All rights reserved.

Avoiding burnout: the personal health habits and wellness practices of US surgeons.

Science.gov (United States)

Shanafelt, Tait D; Oreskovich, Michael R; Dyrbye, Lotte N; Satele, Daniel V; Hanks, John B; Sloan, Jeff A; Balch, Charles M

2012-04-01

To evaluate the health habits, routine medical care practices, and personal wellness strategies of American surgeons and explore associations with burnout and quality of life (QOL). Burnout and low mental QOL are common among US surgeons and seem to adversely affect quality of care, job satisfaction, career longevity, and risk of suicide. The self-care strategies and personal wellness promotion practices used by surgeons to deal with the stress of practice are not well explored. Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in October 2010. The survey included self-assessment of health habits, routine medical care practices, and personal wellness strategies and standardized assessments of burnout and QOL. Of 7197 participating surgeons, 3911 (55.0%) participated in aerobic exercise and 2611 (36.3%) in muscle strengthening activities, in a pattern consistent with the Centers for Disease Control and Prevention recommendations. The overall and physical QOL scores were superior for surgeons' following the Centers for Disease Control and Prevention recommendations (all P work, focusing on what is important in life, maintaining a positive outlook, and embracing a philosophy that stresses work/life balance were less likely to be burned out (all P < 0.0001). Although many factors associated with lower risk of burnout were also associated with achieving a high overall QOL, notable differences were observed, indicating surgeons' need to employ a broader repertoire of wellness promotion practices if they desire to move beyond neutral and achieve high well-being. This study identifies specific measures surgeons can take to decrease burnout and improve their personal and professional QOL.

The Army Family Team Building Program: Facilitating a Transformative Learning Process--An Intrinsic Case Study

Science.gov (United States)

Gall, Joseph A.

2009-01-01

This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…

Industrial natural gas supply options in British Columbia

International Nuclear Information System (INIS)

1994-01-01

Information is provided on the availability and cost of natural gas in British Columbia for use by firms interested in establishing gas-intensive industrial facilities in the province. British Columbia has an abundant supply of natural gas, originating mainly from deposits in the westernmost part of the Western Canadian Sedimentary Basin in the northeast part of the province. Recoverable resources in British Columbia are estimated at 1,000-1,400 billion m 3 . Over 200 producers compete to sell natural gas for both domestic and export markets. Gathering, processing, and transmission of the gas is undertaken mainly by the Westcoast Energy pipeline system, and distribution is undertaken by several distribution utilities. At present, all large industrial gas users buy their firm gas requirements directly from gas producers, often using gas marketers or brokers to assist in purchasing. Regulation of the gas industry is performed by the British Columbia Utilities Commission, which sets rules for energy supply contracts, and by the National Energy Board, which sets tolls for gathering, processing, and transporting gas. Factors affecting gas pricing are discussed, with reference to both the wellhead price and the cost of gathering, processing, and transportation. Firm gas costs for two hypothetical industrial loads in British Columbia are illustrated. Potential intensive uses of natural gas in the province are outlined, including power generation, liquefaction for export, manufacturing, production of direct reduced iron, and as petrochemical feedstocks. 5 figs., 2 tabs

The Evolution of Capitalism: A Comparison of British and American Literature

Science.gov (United States)

Stanwick, Peter A.

2016-01-01

This paper discusses the evolution of capitalism in British and American literature. The impact of capitalism on the lives of individuals has been well represented in both American and British literature throughout the centuries. The paper will discuss how seminal British authors such as Thomas More, William Shakespeare, Charles Dickens and George…

Surgical travellers: tapestry to Bayeux.

Science.gov (United States)

Hedley-Whyte, John; Milamed, Debra R

2014-09-01

The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

Phonemic Transcriptions in British and American Dictionaries

Directory of Open Access Journals (Sweden)

Rastislav Šuštaršič

2005-06-01

Full Text Available In view of recent criticisms concerning vowel symbols in some British English dictionaries (in particular by J. Windsor Lewis in JIPA (Windsor Lewis, 2003, with regard to the Oxford Dictionary of Pronunciation (Upton, 2001, this article extends the discussion on English phonemic transcriptions by including those that typically occur in standard American dictionaries, and by comparing the most common conventions of British and American dictionaries. In addition to symbols for both vowels and consonants, the paper also deals with the different representations of word accentuation and the issue of consistency regarding application of phonemic (systemic, broad, rather than phonetic (allophonic, narrow transcription. The different transcriptions are assessed from the points of view of their departures from the International Phonetic Alphabet, their overlapping with orthographic representation (spelling and their appropriateness in terms of reflecting actual pronunciation in standard British and/or American pronunciation.

Is the Chinese Army the Real Winner in PLA Reforms

Science.gov (United States)

2016-10-01

44 Commentary / The Chinese Army and PLA Reforms JFQ 83, 4th Quarter 2016 Is the Chinese Army the Real Winner in PLA Reforms? By Phillip C. Saunders...and John Chen G round force officers run China’s military, the People’s Liberation Army ( PLA ). About 70 percent of PLA soldiers serve in the PLA ...Saunders and Chen 45 services and arms of the PLA ” has meant reductions in “technologically backward” PLAA units and personnel increases for the other

Surgeon and nonsurgeon personalities at different career points.

Science.gov (United States)

Drosdeck, Joseph M; Osayi, Sylvester N; Peterson, Laura A; Yu, Lianbo; Ellison, Edwin Christopher; Muscarella, Peter

2015-06-01

Previous studies have demonstrated correlations between personality traits and job performance and satisfaction. Evidence suggests that personality differences exist between surgeons and nonsurgeons, some of which may develop during medical training. Understanding these personality differences may help optimize job performance and satisfaction among surgical trainees and be used to identify individuals at risk of burnout. This study aims to identify personality traits of surgeons and nonsurgeons at different career points. We used The Big Five Inventory, a 44-item measure of the five factor model. Personality data and demographics were collected from responses to an electronic survey sent to all faculty and house staff in the Departments of Surgery, Medicine, and Family Medicine at The Ohio State University College of Medicine. Data were analyzed to identify differences in personality traits between surgical and nonsurgical specialties according to level of training and to compare surgeons to the general population. One hundred ninety-two house staff and faculty in surgery and medicine completed the survey. Surgeons scored significantly higher on conscientiousness and extraversion but lower on agreeableness compared to nonsurgeons (all P personality differences between surgical and nonsurgical specialties. The use of personality testing may be a useful adjunct in the residency selection process for applicants deciding between surgical and nonsurgical specialties. It may also facilitate early intervention for individuals at high risk for burnout and job dissatisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

Army Plasma/Propellant Interaction Workshop - U.S. Army Research Office, 17-18 November 1998

National Research Council Canada - National Science Library

Shaw, Robert

1999-01-01

.... Army Research Laboratory (ARL)-ARO effort to develop a coordinated research program to address the needs of advanced gun propulsion, in particular, in the application of plasmas as ignition and energy augmentation sources...

Burnout syndrome in oral and maxillofacial surgeons: a critical analysis.

Science.gov (United States)

Porto, G G; Carneiro, S C; Vasconcelos, B C; Nascimento, M M; Leal, J L F

2014-07-01

The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

High incidence of hemiarthroplasty for shoulder osteoarthritis among recently graduated orthopaedic surgeons.

Science.gov (United States)

Mann, Tobias; Baumhauer, Judith F; O'Keefe, Regis J; Harrast, John; Hurwitz, Shepard R; Voloshin, Ilya

2014-11-01

Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, pguidelines for the treatment of glenohumeral osteoarthritis published by the American Academy of Orthopaedic Surgeons. These guidelines favor using TSA over HSA in the treatment of shoulder arthritis. Further investigation is needed to clarify if these practice patterns are isolated to recently graduated board

U.S. Army weapon systems human-computer interface style guide. Version 2

Energy Technology Data Exchange (ETDEWEB)

Avery, L.W.; O`Mara, P.A.; Shepard, A.P.; Donohoo, D.T.

1997-12-31

A stated goal of the US Army has been the standardization of the human computer interfaces (HCIs) of its system. Some of the tools being used to accomplish this standardization are HCI design guidelines and style guides. Currently, the Army is employing a number of HCI design guidance documents. While these style guides provide good guidance for the command, control, communications, computers, and intelligence (C4I) domain, they do not necessarily represent the more unique requirements of the Army`s real time and near-real time (RT/NRT) weapon systems. The Office of the Director of Information for Command, Control, Communications, and Computers (DISC4), in conjunction with the Weapon Systems Technical Architecture Working Group (WSTAWG), recognized this need as part of their activities to revise the Army Technical Architecture (ATA), now termed the Joint Technical Architecture-Army (JTA-A). To address this need, DISC4 tasked the Pacific Northwest National Laboratory (PNNL) to develop an Army weapon systems unique HCI style guide, which resulted in the US Army Weapon Systems Human-Computer Interface (WSHCI) Style Guide Version 1. Based on feedback from the user community, DISC4 further tasked PNNL to revise Version 1 and publish Version 2. The intent was to update some of the research and incorporate some enhancements. This document provides that revision. The purpose of this document is to provide HCI design guidance for the RT/NRT Army system domain across the weapon systems subdomains of ground, aviation, missile, and soldier systems. Each subdomain should customize and extend this guidance by developing their domain-specific style guides, which will be used to guide the development of future systems within their subdomains.

U.S. Army War College Key Strategic Issues List, 2015-2016

Science.gov (United States)

2015-09-28

the Army outsource to contractors in a deployed environment before we risk operational effectiveness? What are the pitfalls for moving entire...support of expeditionary operations? What are the appropriate timelines for bringing better QOL to our soldiers? (POC: COL Stephanie Howard, CSLD...717- 245-3457) 79. How do Army Conventional Forces and Army Special Operations Forces build and maintain modern, scalable C2 structures that ensure

Incidence of clinically suspected venous thromboembolism in British Indian patients.

Science.gov (United States)

Siddiqui, B M; Patel, M S; Rudge, S; Best, A; Mangwani, J

2018-05-01

Introduction Venous thromboembolism (VTE) remains a major public health issue around the world. Ethnicity is known to alter the incidence of VTE. To our knowledge, there are no reports in the literature investigating the incidence of VTE in British Indians. The aim of this study was to investigate the rates of symptomatic VTE in British Indian patients in the UK. Methods Patients referred to our institution between January 2011 and August 2013 with clinically suspected VTE were eligible for inclusion in the study. Those not of British Indian or Caucasian ethnicity were excluded. A retrospective review of these two cohorts was conducted. Results Overall, 15,529 cases were referred to our institution for suspected VTE. This included 1,498 individuals of British Indian ethnicity. Of these, 182 (12%) had confirmed VTE episodes. A further 13,159 of the patients with suspected VTE were coded as Caucasian, including 2,412 (16%) who had confirmed VTE events. VTE rates were a third lower in British Indians with clinically suspected VTE than in the equivalent Caucasian group. The British Indian cohort presented with VTE at a much earlier age than Caucasians (mean 57.0 vs 68.0 years). Conclusions This study suggests that British Indian patients have a lower incidence of VTE and are more likely to present at an earlier age than Caucasians. There was no significant difference in VTE type (deep vein thrombosis vs pulmonary embolism) among the ethnic groups. Clinicians should be aware of variations within ethnicities but should continue to adhere to existing VTE prevention guidance.

Preoperative and Postoperative Nomograms Incorporating Surgeon Experience for Clinically Localized Prostate Cancer

Science.gov (United States)

Kattan, Michael W.; Vickers, Andrew J.; Yu, Changhong; Bianco, Fernando J.; Cronin, Angel M.; Eastham, James A.; Klein, Eric A.; Reuther, Alwyn M.; Pontes, Jose Edson; Scardino, Peter T.

2012-01-01

BACKGROUND Accurate preoperative and postoperative risk assessment has been critical for counseling patients regarding radical prostatectomy for clinically localized prostate cancer. In addition to other treatment modalities, neoadjuvant or adjuvant therapies have been considered. The growing literature suggested that the experience of the surgeon may affect the risk of prostate cancer recurrence. The purpose of this study was to develop and internally validate nomograms to predict the probability of recurrence, both preoperatively and postoperatively, with adjustment for standard parameters plus surgeon experience. METHODS The study cohort included 7724 eligible prostate cancer patients treated with radical prostatectomy by 1 of 72 surgeons. For each patient, surgeon experience was coded as the total number of cases conducted by the surgeon before the patient’s operation. Multivariable Cox proportional hazards regression models were developed to predict recurrence. Discrimination and calibration of the models was assessed following bootstrapping methods, and the models were presented as nomograms. RESULTS In this combined series, the 10-year probability of recurrence was 23.9%. The nomograms were quite discriminating (preoperative concordance index, 0.767; postoperative concordance index, 0.812). Calibration appeared to be very good for each. Surgeon experience seemed to have a quite modest effect, especially postoperatively. CONCLUSIONS Nomograms have been developed that consider the surgeon’s experience as a predictor. The tools appeared to predict reasonably well but were somewhat little improved with the addition of surgeon experience as a predictor variable. PMID:19156928

Bile duct reconstruction by a young surgeon in living donor liver transplantation using right liver graft.

Science.gov (United States)

Kim, Jong Man; Cho, Wontae; Kwon, Choon Hyuck David; Joh, Jae-Won; Park, Jae Berm; Ko, Justin Sangwook; Gwak, Mi Sook; Kim, Gaab Soo; Kim, Sung Joo; Lee, Suk-Koo

2014-09-01

Biliary strictures and bile leaks account for the majority of biliary complications after living donor liver transplantation (LDLT). The aim of this study was to examine differences in biliary complications after adult LDLTs were performed by an experienced senior surgeon and an inexperienced junior surgeon. Surgeries included bile duct reconstruction after adult LDLT using a right liver graft, and risk factors for biliary stricture were identified. We retrospectively reviewed the medical records of 136 patients who underwent LDLT in order to identify patients who developed biliary complications. The senior surgeon performed 102 surgeries and the junior surgeon performed 34 surgeries. The proportion of patients with biliary stricture was similar between the senior and the junior surgeons (27.5% vs 26.5%; P = 0.911). However, the incidence of biliary leakage was higher in patients of the junior surgeon than in those of the senior surgeon (23.5% vs 2.9%; P = 0.001). The frequency of percutaneous drainage was also higher for the junior surgeon than the senior surgeon because of the junior surgeon's high leakage rate of the drainage. When the junior surgeon performed bile duct anastomosis, biliary leakage occurred in 7 patients between the 11th and 20th cases. However, biliary leakage occurred in only 1 case thereafter. Bile duct reconstruction performed by beginner surgeons in LDLT using right lobe grafts should be cautiously monitored and observed by a senior surgeon until an inexperienced junior surgeon has performed at least 20 cases, because of the high incidence of biliary leakage related to surgeon's inexperience in bile duct reconstructions in LDLT.

Conflict resolution: practical principles for surgeons.

Science.gov (United States)

Lee, Liz; Berger, David H; Awad, Samir S; Brandt, Mary L; Martinez, George; Brunicardi, F Charles

2008-11-01

Historically, surgeons have had little formal training in conflict resolution; however, there has been an increasing body of evidence that poor conflict resolution skills may have an adverse impact on patient outcomes and career advancement. Furthermore, the Accreditation Council for Graduate Medical Education has recognized the importance of conflict resolution skills in resident training by mandating the training of communication skills and professionalism. These skills have often been taught in other professions, and surgeons may need to acquaint themselves with the literature from those fields. Conflict resolution techniques such as the 7-step model or principle-based conflict resolution can be applied to conflict in the operating room, wards, and among colleagues. We propose a model for conflict resolution by using the basic tools of the history and physical exam, a process well known to all physicians.

US Army Weapon Systems Human-Computer Interface (WSHCI) style guide, Version 1

Energy Technology Data Exchange (ETDEWEB)

Avery, L.W.; O`Mara, P.A.; Shepard, A.P.

1996-09-30

A stated goal of the U.S. Army has been the standardization of the human computer interfaces (HCIS) of its system. Some of the tools being used to accomplish this standardization are HCI design guidelines and style guides. Currently, the Army is employing a number of style guides. While these style guides provide good guidance for the command, control, communications, computers, and intelligence (C4I) domain, they do not necessarily represent the more unique requirements of the Army`s real time and near-real time (RT/NRT) weapon systems. The Office of the Director of Information for Command, Control, Communications, and Computers (DISC4), in conjunction with the Weapon Systems Technical Architecture Working Group (WSTAWG), recognized this need as part of their activities to revise the Army Technical Architecture (ATA). To address this need, DISC4 tasked the Pacific Northwest National Laboratory (PNNL) to develop an Army weapon systems unique HCI style guide. This document, the U.S. Army Weapon Systems Human-Computer Interface (WSHCI) Style Guide, represents the first version of that style guide. The purpose of this document is to provide HCI design guidance for RT/NRT Army systems across the weapon systems domains of ground, aviation, missile, and soldier systems. Each domain should customize and extend this guidance by developing their domain-specific style guides, which will be used to guide the development of future systems within their domains.

Nanotechnology Laboratory Collaborates with Army to Develop Botulism Vaccine | FNLCR

Science.gov (United States)

The Nanotechnology Characterization Laboratory (NCL) is collaborating with the Army to develop a candidate vaccine against botulism. Under a collaboration agreement between the National Cancer Institute and the U.S. Army Medical Research Institute of

Use of Computer Imaging in Rhinoplasty: A Survey of the Practices of Facial Plastic Surgeons.

Science.gov (United States)

Singh, Prabhjyot; Pearlman, Steven

2017-08-01

The objective of this study was to quantify the use of computer imaging by facial plastic surgeons. AAFPRS Facial plastic surgeons were surveyed about their use of computer imaging during rhinoplasty consultations. The survey collected information about surgeon demographics, practice settings, practice patterns, and rates of computer imaging (CI) for primary and revision rhinoplasty. For those surgeons who used CI, additional information was also collected, which included who performed the imaging and whether the patient was given the morphed images after the consultation. A total of 238 out of 1200 (19.8%) facial plastic surgeons responded to the survey. Out of those who responded, 195 surgeons (83%) were board certified by the American Board of Facial Plastic and Reconstructive Surgeons (ABFPRS). The majority of respondents (150 surgeons, 63%) used CI during rhinoplasty consultation. Of the surgeons who use CI, 92% performed the image morphing themselves. Approximately two-thirds of surgeons who use CI gave their patient a printout of the morphed images after the consultation. Computer imaging (CI) is a frequently utilized tool for facial plastic surgeons during cosmetic consultations with patients. Based on these results of this study, it can be suggested that the majority of facial plastic surgeons who use CI do so for both primary and revision rhinoplasty. As more sophisticated systems become available, it is possible that utilization of CI modalities will increase. This provides the surgeon with further tools to use at his or her disposal during discussion of aesthetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Can virtual reality simulators be a certification tool for bariatric surgeons?

Science.gov (United States)

Giannotti, Domenico; Patrizi, Gregorio; Casella, Giovanni; Di Rocco, Giorgio; Marchetti, Massimiliano; Frezzotti, Francesca; Bernieri, Maria Giulia; Vestri, Anna Rita; Redler, Adriano

2014-01-01

Construct validity of virtual laparoscopic simulators for basic laparoscopic skills has been proposed; however, it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. This study tested the ability of the Lap Mentor simulator to recognize the experience in advanced laparoscopic procedures and to assess its role in the certification of bariatric surgeons. Twenty surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery. The general group included 10 general surgeons performing between 75 and 100 nonbariatric laparoscopic procedures. The bariatric group included 10 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the simulator in one basic task (task 1: eye-hand coordination) and in two tasks of the gastric bypass module (task 2: creation of the gastric pouch; task 3: gastrojejunal anastomosis). Comparing the groups, no significant differences were found in task 1. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (21 vs. 48 cm(3)), in the percentage of fundus included in the pouch (8.4 vs. 29.4 %), in the complete dissection at the angle of His (10 vs. 3), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies. The Lap Mentor may be proposed as a certification tool for bariatric surgeons because it also recognizes their specific skills in the technical details of the procedure that affect long-term results. Furthermore, the possibility of analyzing the performance in detail can help define areas where the surgeon is lacking. These findings indicate a potential role of the Lap Mentor in tailoring the training to maximize improvement.

Educating for Innovation: Finding Balance in the Army’s Professional Military Education System

Science.gov (United States)

2016-06-10

house and senate by Secretary of the Army, John McHugh , and Chief of staff of the Army, General Raymond Odierno. Of particular interest is the chapter...Strategic Leader Education for the 21st-Century Army.” Parameters (Autumn 2001): 17-33. McHugh , John. 2014 Army Posture Statement. Presented 25 March 2014

Trauma surgeon personality and job satisfaction: results from a national survey.

Science.gov (United States)

Foulkrod, Kelli H; Field, Craig; Brown, Carlos V R

2010-04-01

Personality is correlated with job satisfaction, whereas job satisfaction is linked to performance. This study examines personality of practicing trauma surgeons in relation to their job satisfaction. The dominant theory in personality research is the five-factor model, which includes: extraversion, agreeableness, conscientiousness, emotional stability, and openness. The sample was identified from American Association for Surgery of Trauma, Eastern Association for Surgery of Trauma, and Western Trauma Association membership. A web-based survey of demographics and empirically supported measures was created. Four hundred and twelve trauma surgeons (49 +/- 14-years-old, 85% male) completed the survey. When comparing satisfied to unsatisfied trauma surgeons on personality variables, extraversion (5.0 +/- 1.6 vs 4.4 +/- 1.6, P = 0.014) and emotional stability (5.8 +/- 1.1 vs 5.4 +/- 1.2, P = 0.007) were significantly higher in satisfied surgeons. Moderate correlations were found for job satisfaction with emotional stability (r = 0.20, P personality variables highlighted the significance of emotional stability and extraversion in prediction of job satisfaction. Extraversion and emotional stability are the most significant personality factors to job satisfaction of trauma surgeons. These findings may have important implications for surgical resident recruitment, job performance, and retention.

British Gas marks progress in drive for global operations

International Nuclear Information System (INIS)

Kennedy, J.L.

1992-01-01

This paper reports that British Gas plc, London, is driving to boost the share of its business that comes form outside the U.K. Non-U.K. activities accounted for about 10% of the company's business last year. By the turn of the century earnings form British Gas's non-U.K. exploration and production activities are expected to be about in line with those form the U.K. core business. In addition, the company's global gas business unit-acquisitions, sales, of British Gas technology worldwide, and power generation form gas-will contribute significantly to overseas earnings

Educating for British Values: Kant's Philosophical Roadmap for Cosmopolitan Character Education

Science.gov (United States)

Hildebrand, Carl

2017-01-01

The UK's 2016 decision to exit the European Union and the discussion surrounding it indicate that public understanding of British identity has important consequences, one way or another. Defining British identity will be an important task in the years to come. The UK government not long ago provided some guidance on the matter of British identity…

Surgeons' work engagement: influencing factors and relations to job and life satisfaction.

Science.gov (United States)

Mache, Stefanie; Vitzthum, Karin; Klapp, Burghard F; Danzer, Gerhard

2014-08-01

Work engagement has become a topic of great interest in recent years. However, clinicians' work engagement has rarely been studied and relatively little is known about its predictors and consequences. Therefore the objective of this cross-sectional questionnaire study was to test a model of possible institutional and personal predictors and significant relations to job and life satisfaction. 123 clinicians specializing in Surgery Medicine participated in the study. Self-administered questionnaires, including the Copenhagen Psychosocial Questionnaire, the Utrecht Work Engagement Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism, were administered. Bivariate analyses and a stepwise regression analysis were performed. The whole sample of surgeons rated work engagement with a high mean of M = 4.38; SD = .91. Job satisfaction and perceived quality of life have been rated with moderate scores. The results show that job resources have a greater impact on surgeons' work engagement than their job demands. Significant correlations between surgeons' work engagement, their job satisfaction and quality of life were found. Moreover, work engagement mediated the relation between institutional factors and surgeons' job satisfaction. Our research suggests that strengthening surgeons' work engagement will contribute to a more sustainable workplace, in terms of both individual and hospital performance. Therefore, increasing work engagement among surgeons should be of concern for supervisors and hospital managers. Future research should focus on further predictors that may have an influence on health professionals' work engagement. Another field for future research is to study potential effects of interventions on work engagement. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Impact оf the First World War оn the Transformation of German Army

Directory of Open Access Journals (Sweden)

Evdokimova Tatyana

2014-11-01

Full Text Available Germany’s defeat in World War I and proclamation of the first German republic significantly influenced the change of the role of the army in the German state. At the stage of reorganization of the Kaiser’s army into the Reichswehr (1918–1921 the main result of this transformation became the creation of a new model of the German Army in which the principle of “distancing” the army from politics was replaced by new legislative and political realities that raised the question of inevitability of relationship between the army and the state. The Versailles Treaty and the Weimar constitution put forward the task of turning the German army into integral part of the state apparatus which led to losing its apoliticality. They also contributed to the emergence of Reich Ministry and the post of Reich Minister combined in one person the representative of the army and the state power. Besides, they helped to form a united German professional army and provided joint search of allies in the field of armaments by politicians and military men. The army tried to defend the old Prussian military traditions in terms of the German State called itself the Reich, and Weimar politicians sought to put the army under a parliamentary-presidential control. At the later stage of the Weimar Republic political generals will appear in the army, and important government positions will be taken by the representatives of the Generalitat. But the outcome of the force balance already at the stage of development of the temporary Reichswehr, when the real power in the army was in hands of the commander of the ground forces, and not of the Reich President and Reich Minister largely predetermined the strength of the conservative military elite in the future.

Role of the battalion surgeon in the Iraq and Afghanistan War.

Science.gov (United States)

Moawad, Fouad J; Wilson, Ramey; Kunar, Mathew T; Hartzell, Joshua D

2012-04-01

The battalion surgeon is an invaluable asset to a deploying unit. The primary role of a battalion surgeon is to provide basic primary care medicine and combat resuscitation. Other expectations include health care screening, vaccinations, supervision of medics, and being a medical advisor to the unit's commander. As many physicians who fill this role previously worked at medical treatment facilities or medical centers without prior deployment experience, the objective of this article is to highlight some of the challenges a battalion surgeon may encounter before, during, and following deployment.

Surgeon Scientists Are Disproportionately Affected by Declining NIH Funding Rates.

Science.gov (United States)

Narahari, Adishesh K; Mehaffey, J Hunter; Hawkins, Robert B; Charles, Eric J; Baderdinni, Pranav K; Chandrabhatla, Anirudha S; Kocan, Joseph W; Jones, R Scott; Upchurch, Gilbert R; Kron, Irving L; Kern, John A; Ailawadi, Gorav

2018-04-01

Obtaining National Institutes of Health (NIH) funding over the last 10 years has become increasingly difficult due to a decrease in the number of research grants funded and an increase in the number of NIH applications. National Institutes of Health funding amounts and success rates were compared for all disciplines using data from NIH, Federation of American Societies for Experimental Biology (FASEB), and Blue Ridge Medical Institute. Next, all NIH grants (2006 to 2016) with surgeons as principal investigators were identified using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results (NIH RePORTER), and a grant impact score was calculated for each grant based on the publication's impact factor per funding amount. Linear regression and one-way ANOVA were used for analysis. The number of NIH grant applications has increased by 18.7% (p = 0.0009), while the numbers of funded grants (p rate of funded grants with surgeons as principal investigators (16.4%) has been significantly lower than the mean NIH funding rate (19.2%) (p = 0.011). Despite receiving only 831 R01s during this time period, surgeon scientists were highly productive, with an average grant impact score of 4.9 per $100,000, which increased over the last 10 years (0.15 ± 0.05/year, p = 0.02). Additionally, the rate of conversion of surgeon scientist-mentored K awards to R01s from 2007 to 2012 was 46%. Despite declining funding over the last 10 years, surgeon scientists have demonstrated increasing productivity as measured by impactful publications and higher success rates in converting early investigator awards to R01s. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

US Army Research Office research in progress, July 1, 1991--June 30, 1992

Energy Technology Data Exchange (ETDEWEB)

1992-12-31

The US Army Research Office, under the US Army Materiel Command (AMC), is responsible for coordinating and supporting research in the physical and engineering sciences, in materials science, geosciences, biology, and mathematics. This report describes research directly supported by the Army Research Projects Agency, and several AMC and other Army commands. A separate section is devoted to the research program at the US Army Research, Development and Standardization Group - United Kingdom. The present volume includes the research program in physics, chemistry, biological sciences, mathematics, engineering sciences, metallurgy and materials science, geosciences, electronics, and the European Research Program. It covers the 12-month period from 1 July 1991 through 30 June 1992.

Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy for Women With Breast Cancer.

Science.gov (United States)

Katz, Steven J; Hawley, Sarah T; Hamilton, Ann S; Ward, Kevin C; Morrow, Monica; Jagsi, Reshma; Hofer, Timothy P

2018-01-01

Rates of contralateral prophylactic mastectomy (CPM) have markedly increased but we know little about the influence of surgeons on variability of the procedure in the community. To quantify the influence of the attending surgeon on rates of CPM and clinician attitudes that explained it. In this population-based survey study, we identified 7810 women with stages 0 to II breast cancer treated in 2013 to 2015 through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles County. Surveys were sent approximately 2 months after surgery. Surveys were also sent to 488 attending surgeons identified by the patients. We conducted multilevel analyses to examine the impact of surgeon influence on variations in patient receipt of CPM using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results data. A total of 5080 women responded to the survey (70% response rate), and 377 surgeons responded (77% response rate). The mean (SD) age of responding women was 61.9 (11) years; 28% had an increased risk of second primary cancer, and 16% received CPM. Half of surgeons (52%) practiced for more than 20 years and 30% treated more than 50 new patients with breast cancer annually. Attending surgeon explained a large amount (20%) of the variation in CPM, controlling for patient factors. The odds of a patient receiving CPM increased almost 3-fold (odds ratio, 2.8; 95% CI, 2.1-3.4) if she saw a surgeon with a practice approach 1 SD above a surgeon with the mean CPM rate (independent of age, diagnosis date, BRCA status, and risk of second primary). One-quarter (25%) of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM. The estimated rate of CPM was 34% for surgeons who least favored initial breast conservation and were least reluctant to perform CPM vs 4% for surgeons who most favored initial breast conservation and were most

Current practice patterns and knowledge among gynecologic surgeons of InterStim® programming after implantation.

Science.gov (United States)

Hobson, Deslyn T G; Gaskins, Jeremy T; Frazier, LaTisha; Francis, Sean L; Kinman, Casey L; Meriwether, Kate V

2017-10-03

The objective of this study was to describe surgeons' current practices in InterStim® programming after initial implantation and their knowledge of programming parameters. We hypothesized that surgeons performing their own reprogramming would have increased knowledge. We administered a written survey to attendees at the Society of Gynecologic Surgeons Scientific Meeting and analyzed those on which surgeons indicated they offer InterStim® care. The survey queried surgeon characteristics, experience with InterStim® implantation and programming, and clinical opinions regarding reprogramming and tested six knowledge-based questions about programming parameters. Correct response to all six questions was the primary outcome. One hundred and thirty-five of 407 (33%) attendees returned the survey, of which 99 met inclusion criteria. Most respondents (88 of 99; 89%) were between 36 and 60 years, 27 (73%) were women, 76 (77%) practiced in a university setting, and 76 (77%) were trained in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Surgeons who had InterStim® programming training were more likely to perform their own programming [15/46 (32%) vs 6/47 (13%), p = 0.03]. Most answered all knowledge-based questions correctly (62/90, 69%); no surgeon characteristics were significantly associated with this outcome. Most surgeons cited patient comfort (71/80, 89%) and symptom relief (64/80, 80%) as important factors when reprogramming, but no prevalent themes emerged on how and why surgeons change certain programming parameters. Surgeons who had formal InterStim® programming training are more likely to perform programming themselves. No surgeon characteristic was associated with improved programming knowledge. We found that surgeons prioritize patient comfort and symptoms when deciding to reprogram.

What factors influence attending surgeon decisions about resident autonomy in the operating room?

Science.gov (United States)

Williams, Reed G; George, Brian C; Meyerson, Shari L; Bohnen, Jordan D; Dunnington, Gary L; Schuller, Mary C; Torbeck, Laura; Mullen, John T; Auyang, Edward; Chipman, Jeffrey G; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F; Mandell, Samuel; Meier, Andreas; Smink, Douglas S; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B; Lillemoe, Keith D; Fryer, Jonathan P

2017-12-01

Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors. Copyright © 2017 Elsevier Inc. All rights reserved.

The 1986/1987 Army Communications Objectives Measurement System. Supplementary Tabulations of Officer Markets

Science.gov (United States)

1988-08-01

assessments of advertising strategy efficiencies; (3) management of the advertising program; and (4) planning and development of new marketing strategies and...fashion; (2) To support Army assessments of advertising strategy in an integrated framework; and (3) To support Army advertising management and planning for...Army attain its annual recruiting goals. A second set of goals for ACOMS involved the use of ACOMS data to assess the Army’s advertising strategy . ACOMS

Problem Gambling Treatment within the British National Health Service

Science.gov (United States)

Rigbye, Jane; Griffiths, Mark D.

2011-01-01

According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study…

Separation of British Gas' transportation and storage business

International Nuclear Information System (INIS)

McGregor, G.

1992-12-01

In making his substantive reference of the transportation and storage business of British Gas to the Monopolies and Mergers Commission, the Director General of Gas Supply identified the following principal effects adverse to the public interest: ''The absence of provision for the establishment of an independent undertaking to operate the pipe-line system and other facilities used by British Gas for the conveyance and storage of gas which would not be subject to conflicting interests in securing (a) transparency of the prices charged, the costs incurred and the operating methods in respect of the conveyance and storage of gas; (b) proper allocation to various parts of the Gas Supply Business of costs incurred and returns by that business; and (c) protection of information relating to the conveyance and storage of gas from which British Gas might obtain unfair commercial advantage, and thereby avoid the restriction or distortion of competition between British Gas and other persons whose business consists of or includes the supply of gas''. This paper considers the structural issues associated with achieving effective competition and looks at how the relationship between the businesses of supply and transportation might be organised in the short and longer term. (Author)

International Affairs Programs: The Air Force Versus the Army

Science.gov (United States)

2015-10-01

individual tutoring programs . Additionally RAS personnel are offered regional enhancement studies opportunities at several facilities.48 RAS personnel...AU/ACSC/2015 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY INTERNATIONAL AFFAIRS PROGRAMS : THE AIR FORCE VERSUS THE ARMY by Robin L...5 COMPARISON: INTERNATIONAL AFFAIRS PROGRAMS AIR FORCE VERSUS ARMY 8

A systematic review of surgeon-patient communication: strengths and opportunities for improvement.

Science.gov (United States)

Levinson, Wendy; Hudak, Pamela; Tricco, Andrea C

2013-10-01

Effective communication is critical to patient satisfaction, outcomes of care and malpractice prevention. Surgeons need particularly effective communication skills to discuss complicated procedures and help patients make informed choices. We conducted a systematic review of the literature on surgeon-patient communication. Searches were conducted in MEDLINE, PsycINFO, and Sociological Abstract. Two reviewers screened citations and full-text articles. Quality was appraised using the Critical Appraisal Skills Program tool. Studies were categorized into content of communication, patient satisfaction, relationship of communication to malpractice, and duration of visits. 2794 citations and 74 full-text articles, 21 studies and 13 companion reports were included. Surgeons spent the majority of their time educating patients and helping them to make choices. Surgeons were generally thorough in providing details about surgical conditions and treatments. Surgeons often did not explore the emotions or concerns of patients. Potential areas of improvement included discussing some elements of informed decision making, and expressing empathy. Surgeons can enhance their communication skills, particularly in areas of relative deficiency. Studies in primary care demonstrate communication programs are effective in teaching these skills. These can be adapted to surgical training and ultimately lead to improved outcomes and satisfaction with care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The influence of surgeon personality factors on risk tolerance: a pilot study.

Science.gov (United States)

Contessa, Jack; Suarez, Luis; Kyriakides, Tassos; Nadzam, Geoffrey

2013-01-01

This study attempts to assess the association between surgeon personality factors (measured by the Myers-Briggs Type Indicator personality inventory (MBTI(®))) and risk tolerance (measured by the Revised Physicians' Reactions to Uncertainty (PRU) and Physician Risk Attitude (PRA) scales). Instrument assessing surgeon personality profile (MBTI) and 2 questionnaires measuring surgeon risk tolerance and risk aversion (PRU and PRA). Saint Raphael campus of Yale New Haven Hospital in New Haven, Connecticut. Twenty categorical surgery residents and 7 surgical core faculty members. The following findings suggest there might be a relationship between surgeon personality factors and risk tolerance. In certain areas of risk assessment, it appears that surgeons with personality factors E (Extravert), T (Thinking), and P (Perception) demonstrated higher tolerance for risk. Conversely, as MBTI(®) dichotomies are complementary, surgeons with personality factors I (Introvert), F (Feeling), and J (Judgment) suggest risk aversion on these same measures. These findings are supported by at least 2 studies outside medicine demonstrating that personality factors E, N, T, and P are associated with risk taking. This preliminary research project represents an initial step in exploring what may be considered a fundamental component in a "successful" surgical personality. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric.

Science.gov (United States)

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2017-11-01

Percentage utilization of operating room (OR) time is not an appropriate endpoint for planning additional OR time for surgeons with high caseloads, and cannot be measured accurately for surgeons with low caseloads. Nonetheless, many OR directors claim that their hospitals make decisions based on individual surgeons' OR utilizations. This incongruity could be explained by the OR managers considering the earlier mathematical studies, performed using data from a few large teaching hospitals, as irrelevant to their hospitals. The important mathematical parameter for the prior observations is the percentage of surgeon lists of elective cases that include 1 or 2 cases; "list" meaning a combination of surgeon, hospital, and date. We measure the incidence among many hospitals. Observational cohort study. 117 hospitals in Iowa from July 2013 through September 2015. Surgeons with same identifier among hospitals. Surgeon lists of cases including at least one outpatient surgical case, so that Relative Value Units (RVU's) could be measured. Averaging among hospitals in Iowa, more than half of the surgeons' lists included 1 or 2 cases (77%; P<0.00001 vs. 50%). Approximately half had 1 case (54%; P=0.0012 vs. 50%). These percentages exceeded 50% even though nearly all the surgeons operated at just 1 hospital on days with at least 1 case (97.74%; P<0.00001 vs. 50%). The cases were not of long durations; among the 82,928 lists with 1 case, the median was 6 intraoperative RVUs (e.g., adult inguinal herniorrhaphy). Accurate confidence intervals for raw or adjusted utilizations are so wide for individual surgeons that decisions based on utilization are equivalent to decisions based on random error. The implication of the current study is generalizability of that finding from the largest teaching hospital in the state to the other hospitals in the state. Copyright © 2017 Elsevier Inc. All rights reserved.

Futures Seminar: The United States Army in 2025 and Beyond. A Compendium of U.S. Army War College Student Papers. Volume 1

Science.gov (United States)

2014-06-01

Beyond.A Compendium of U.S. Army War College Student Papers. Volume 1 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...is expected to result in considerable cost savings due to use of existing 31. Edward C. Cardon , “Moving to the Future,” Army Technology 1, iss. 2

Impact of surgeon subspecialty training on surgical outcomes in open globe injuries

Directory of Open Access Journals (Sweden)

Han IC

2015-09-01

Full Text Available Ian C Han,1 Sidharth Puri,1 Jiangxia Wang,2 Shameema Sikder1 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, 2Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Purpose: The purpose of this study was to evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries.Design: This study is a single-institution, retrospective case series.Methods: The charts of adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. Clinical findings at presentation were recorded, and details of initial repair and follow-up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared based on subspecialty training of the initial surgeon.Results: The charts of 282 adult patients were analyzed, and 193 eyes had at least 6 months of follow-up for analysis. Eighty-six eyes (44.6% required follow-up surgery within the first year, and 39 eyes (20.2% were enucleated. Eyes initially treated by a vitreoretinal (VR surgeon were 2.3 times (P=0.003 more likely to improve by one Ocular Trauma Score (OTS visual acuity category and 1.9 times (P=0.027 more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (P=0.004 and 0.016 for Zones I and II, respectively. There was no difference in visual acuity outcomes for eyes with posterior injuries (P=0.515 for Zone III.Conclusion: Eyes initially treated by a VR surgeon are more likely to improve by one OTS visual acuity category than those initially treated by a non-VR surgeon. However, patients initially treated by a VR surgeon also undergo more

Force Structure: Capabilities and Cost of Army Modular Force Remain Uncertain

National Research Council Canada - National Science Library

2006-01-01

.... The Army's goals for increasing combat power while introducing predictability in deployments for its soldiers are important, and the Army leadership in headquarters, military and civilian staffs...

Increasing Army Retention Through Incentives

National Research Council Canada - National Science Library

Beerman, Kevin

2006-01-01

.... If the Army fails to address the enlisted retention issue in the near future departures of experienced NCOs will have a detrimental impact our military's ability to provide for our nation's security...

The Genesis of Public Relations in British Colonial Practice.

Science.gov (United States)

Smyth, Rosaleen

2001-01-01

Demonstrates how the British Colonial Office employed public relations strategies as they administered the British colony of Northern Rhodesia before, during, and after World War II. Demonstrates how civil servants in London and colonial officials implemented public relations policies, strategies, and tactics on an ad hoc basis, covering political…

Precocious albion: A new interpretation of the British Industrial Revolution

OpenAIRE

Kelly, Morgan; Mokyr, Joel; Ó Gráda, Cormac

2013-01-01

Many explanations have been offered for the British Industrial Revolution. This article points to the importance of human capital (broadly defined) and the quality of the British labor force on the eve of the Industrial Revolution. It shows that in terms of both physical quality and mechanical skills, British workers around 1750 were at a much higher level than their continental counterparts. As a result, new inventions—no matter where they originated—were adopted earlier, faster, and on a la...

Glocal routes in British Asian drama: Between adaptation and tradaptation

OpenAIRE

Buonanno, Giovanna; Sams, Victoria; Schlote, Christiane

2011-01-01

In the context of British Asian theatre and the search for a diasporic theatre aesthetics the practice of adaptation has emerged as a recurring feature. Over the last decades, British Asian theatre has sought to create a language of the theatre that can reflect the cultural heritage of Asians in Britain; this search has taken different directions testified also by the plurality of voices that today make up British Asian theatre and has responded to the need to challenge the conceptual binary ...

Submission to the British Columbia government on the Kyoto Protocol

International Nuclear Information System (INIS)

2002-09-01

The Business Council provided its comments concerning the Kyoto Protocol and climate change to the government of British Columbia, recommending that a clear position be established quickly on the matter. The adopted position should also be disseminated broadly to allow stake holders sufficient time to prepare for the upcoming meetings of the Joint Ministers and First Ministers. The federal government has announced that the decision on whether to ratify the Kyoto Protocol will be made before the end of 2002, and this decision will have numerous effects on the people of British Columbia, businesses, workers, and consumers alike. The Business Council of British Columbia believes that the unique interests of the province can best be protected by a proactive approach. Actions plans are being prepared by several of the other provinces and territories, who have already stated their position concerning the Kyoto Protocol. The long-term risks of climate change for British Columbia have not been determined nor have the elements of a provincial approach. The following elements should be included in British Columbia's position on the Kyoto Protocol, according to the Business Council of British Columbia: (1) a credible and cost-effective implementation plan that does not unduly burden the province and other jurisdictions must be developed before Canada decides to ratify the Protocol. British Columbia should go on the record stating it does not support the ratification of the Kyoto Protocol in its present form. (2) the province should advocate for a national approach to climate change that can be achieved within a reasonable time frame, reflects the long-term nature of the problem, and is in agreement with the economic development objectives of British Columbia, (3) a plan detailing how the province intends to deal with the growth of greenhouse gas emissions should supplement and support the position of the province on the Kyoto Protocol. Consumers and business should be engaged

Postoperative electrolyte management: Current practice patterns of surgeons and residents.

Science.gov (United States)

Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

2015-07-01

Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Army ROTC: A Strategy for Developing Tomorrow's Army Leadership in an Era of Diminishing Resources