31 CFR 515.321 - United States; continental United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory of...

31 CFR 500.321 - United States; continental United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust territories...

31 CFR 535.321 - United States; continental United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory of...

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.

Impact of Medical Tourism on Cosmetic Surgery in the United States

Directory of Open Access Journals (Sweden)

Lauren E. Franzblau, BS

2013-10-01

Full Text Available Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

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.

Rapanos v. United States & Carabell v. United States

Science.gov (United States)

Documents associated with guidance for implementing the definition of waters of the United States under the Clean Water Act following the Rapanos v. United States, and Carabell v. United States Supreme Court decision.

American Society of Maxillofacial Surgeons 2006 to 2016: Another Decade of Excellence in Education and Research.

Science.gov (United States)

Doumit, Gaby; Totonchi, Ali; Wexler, Andy; Gosain, Arun K

2017-09-01

Over the past 10 years, the American Society of Maxillofacial Surgeons (ASMS) has continued to advance to meet its mission of being the premier organization to represent maxillofacial and pediatric plastic surgery in the United States. These advances are focused on education of its members, to include the American Society of Maxillofacial Surgeons basic course, the preconference symposium, the annual meeting, two basic maxillofacial courses per year, advanced maxillofacial courses, a boot camp for craniofacial fellows, a cleft course, quarterly webinars, sponsored fellowships, a visiting professorship, and the ASMS journal. In addition, the ASMS has continued to advance as the premier national organization representing maxillofacial and pediatric plastic surgery in the United States, thereby positioning the organization as a primary advocate for these surgical specialties. Outreach of the ASMS has grown over the past decade and now includes representatives to the American Society of Plastic Surgeons/Plastic Surgery Foundation, the American Board of Plastic Surgeons, the American Medical Association, and most recently a seat as a governor with the American College of Surgeons. The ASMS has also initiated an annual Summer Leadership Seminar to explore topics of relevance in a changing health care environment. The present report outlines the major initiatives of the ASMS over the past 10 years.

Cosmetic surgery growth and correlations with financial indices: a comparative study of the United Kingdom and United States from 2002-2011.

Science.gov (United States)

Nassab, Reza; Harris, Paul

2013-05-01

Over the past 10 years, there has been significant fluctuation in the yearly growth rates for cosmetic surgery procedures in both the United States and the United Kingdom. The authors compare cosmetic surgical procedure rates in the United Kingdom and United States with the macroeconomic climate of each region to determine whether there is a direct relationship between cosmetic surgery rates and economic health. The authors analyzed annual cosmetic surgery statistics from the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic Plastic Surgery for 2002-2011 against economic indices from both regions, including the gross domestic product (GDP), consumer prices indices (CPI), and stock market reports. There was a 285.9% increase in the United Kingdom and a 1.1% increase in the United States in the number of procedures performed between 2002 and 2011. There were significant positive correlations between the number of cosmetic procedures performed in the United Kingdom and both the GDP (r = 0.986, P failed to show a significant relationship with any indices. UK interest rates showed a significant negative correlation (r = -0.668, P indices are accurate indicators of numbers of procedures being performed in the United Kingdom, whereas rates in the United States seem independent of those factors.

Cataract surgery practices in the United States Veterans Health Administration.

Science.gov (United States)

Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy

2017-04-01

To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Supply and demand: Will we have enough vascular surgeons by 2030?

Science.gov (United States)

Williams, Katherine; Schneider, Brandon; Lajos, Paul; Marin, Michael; Faries, Peter

2016-08-01

The increase in prevalence of certain cardiovascular risk factors increases susceptibility to vascular disease, which may create demand for surgical intervention. In our study, data collected by the American Association of Medical Colleges Physician Specialty Databook of 2012, the United States Census Bureau, and other nationwide organizations were referenced to calculate future changes in vascular surgeon supply and prevalence of people at risk for vascular disease. In 2010, there were 2853 active vascular surgeons. By 2040, the workforce is expected to linearly rise to 3573. There will be an exponential rise in people with cardiovascular risk factors. Adding to concern, in 2030, an estimated 3333 vascular surgeons will be available for 180,000,000 people with at least one risk factor for peripheral arterial disease. The paucity of properly trained surgeons entering the workforce needs to be addressed before this shortage becomes a larger burden on healthcare providers and governmental spending. © The Author(s) 2015.

Trends in the United States in the treatment of distal radial fractures in the elderly.

Science.gov (United States)

Chung, Kevin C; Shauver, Melissa J; Birkmeyer, John D

2009-08-01

Traditionally, distal radial fractures in the elderly have been treated nonoperatively with casting. However, since the introduction of the volar locking plating system in 2000, there has been an interest in the use of more aggressive treatment methods. The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States. We evaluated a 5% sample of Medicare data from 1996 to 1997 and a 20% sample from 1998 to 2005. Information on four treatment methods (closed treatment, percutaneous pin fixation, internal fixation, and external fixation) was extracted from the dataset. Other available data were diagnosis, physician specialty, and patient age, sex, and race. We calculated frequencies and rates to compare the utilization of different treatments over time. Over the ten-year time period examined, the rate of internal fixation of distal radial fractures in the elderly increased fivefold, from 3% in 1996 to 16% in 2005. Closed treatment, however, remained the predominant method (used for 82% of the fractures in 1996 and 70% in 2005). Fractures in patients with an age of eighty-five years or more were significantly more likely to be treated in a closed fashion (p < 0.0001). There was a large variation among physician specialties with regard to the fixation methods that were used. Orthopaedic surgeons were significantly more likely to use closed treatment than hand surgeons were, whereas hand surgeons were significantly more likely to use internal fixation than orthopaedic surgeons were. Since 2000, although the majority of distal radial fractures are still treated nonoperatively, there has been an increase in the use of internal fixation and a concurrent decrease in the rate of closed treatment of distal radial fractures in the elderly in the United States.

NCI Statement on the U.S. Surgeon General's "Call to Action to Prevent Skin Cancer"

Science.gov (United States)

As the Federal Government's principal agency for cancer research and training, the National Cancer Institute (NCI) endorses the U.S. Surgeon General’s “Call to Action to Prevent Skin Cancer,” which provides a comprehensive evaluation of the current state of skin cancer prevention efforts in the United States and recommends actions for improvement in the future.

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

Science.gov (United States)

Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

2003-12-01

Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

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

Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017.

Science.gov (United States)

Graves, Janessa M; Mackelprang, Jessica L; Van Natta, Sara E; Holliday, Carrie

2018-06-01

To identify and compare state policies for suicide prevention training among health care professionals across the United States and benchmark state plan updates against national recommendations set by the surgeon general and the National Action Alliance for Suicide Prevention in 2012. We searched state legislation databases to identify policies, which we described and characterized by date of adoption, target audience, and duration and frequency of the training. We used descriptive statistics to summarize state-by-state variation in suicide education policies. In the United States, as of October 9, 2017, 10 (20%) states had passed legislation mandating health care professionals complete suicide prevention training, and 7 (14%) had policies encouraging training. The content and scope of policies varied substantially. Most states (n = 43) had a state suicide prevention plan that had been revised since 2012, but 7 lacked an updated plan. Considerable variation in suicide prevention training for health care professionals exists across the United States. There is a need for consistent polices in suicide prevention training across the nation to better equip health care providers to address the needs of patients who may be at risk for suicide.

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.

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.

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...

Distribution of specialized care centers in the United States.

Science.gov (United States)

Wang, Henry E; Yealy, Donald M

2012-11-01

As a recommended strategy for optimally managing critical illness, regionalization of care involves matching the needs of the target population with available hospital resources. The national supply and characteristics of hospitals providing specialized critical care services is currently unknown. We seek to characterize the current distribution of specialized care centers in the United States. Using public data linked with the American Hospital Association directory and US Census, we identified US general acute hospitals providing specialized care for ST-segment elevation myocardial infarction (STEMI) (≥40 annual primary percutaneous coronary interventions reported in Medicare Hospital Compare), stroke (The Joint Commission certified stroke centers), trauma (American College of Surgeons or state-designated, adult or pediatric, level I or II), and pediatric critical care (presence of a pediatric ICU) services. We determined the characteristics and state-level distribution and density of specialized care centers (centers per state and centers per state population). Among 4,931 acute care hospitals in the United States, 1,325 (26.9%) provided one of the 4 defined specialized care services, including 574 STEMI, 763 stroke, 508 trauma, and 457 pediatric critical care centers. Approximately half of the 1,325 hospitals provided 2 or more specialized services, and one fifth provided 3 or 4 specialized services. There was variation in the number of each type of specialized care center in each state: STEMI median 7 interquartile range (IQR 2 to 14), stroke 8 (IQR 3 to 17), trauma 6 (IQR 3 to 11), pediatric specialized care 6 (IQR 3 to 11). Similarly, there was variation in the number of each type of specialized care center per population: STEMI median 1 center per 585,135 persons (IQR 418,729 to 696,143), stroke 1 center per 412,188 persons (IQR 321,604 to 572,387), trauma 1 center per 610,589 persons (IQR 406,192 to 917,588), and pediatric critical care 1 center per 665

Social Media Use among United Kingdom Vascular Surgeons: A Cross-Sectional Study.

Science.gov (United States)

Cochrane, Andrew R; McDonald, James J; Brady, Richard R W

2016-05-01

Engagement with social media (SM) is increasing within the general population and medical professionals. Overall, SM engagement is divided between closed, private networks and open, public platforms, such as LinkedIn and Twitter. As engagement with SM is known to vary between specialties, this study was undertaken to evaluate the uptake of SM among vascular surgeons and to describe user demographics associated with SM engagement. Vascular surgeons were identified from the 2013 Vascular Society of Great Britain and Ireland Quality Improvement Project and cross-referenced with the General Medical Council registry. Identified individual surgeons were manually searched for on common SM platforms and via Google to identify both SM profiles and personal/partnership practice websites. In total, 472 surgeons (442 men, 93.6%) from 112 National Health Service Trusts were identified. Three hundred forty (63.7%) graduated from UK universities with a mean graduating year of 1987 (range 1969-2000). Cumulatively, they performed 36,300 procedures (mean 72/surgeon; range 3-257). Overall, SM engagement was 47.4%; 217 (46.0%) had LinkedIn accounts and 23 (4.8%) had Twitter profiles. LinkedIn users had a mean of 69 connections (range 0-500+) and had a mean graduating year of 1988 (range 1969-2000). Twitter users had a mean of 258 followers (range 2-2424) and had tweeted a mean of 450 times (range 0-2865); they graduated more recently than their non-Twitter engaged colleagues (mean graduation 1991 vs. 1987, P = 0.006). Overall, SM usage was associated with a more recent graduation (P = 0.038) and with working in the private sector (21.4% vs. 13.7%, P = 0.029). There were demographic differences between those who had LinkedIn and Twitter accounts. Twitter and LinkedIn engagement among vascular surgeons is higher than that of other surgical specialties. There is a significant link between the experience of the surgeon and with SM use. Copyright © 2016 Elsevier Inc. All rights

H-index and academic rank in general surgery and surgical specialties in the United States.

Science.gov (United States)

Ashfaq, Awais; Kalagara, Roshini; Wasif, Nabil

2018-09-01

H-index serves as an alternative to measure academic achievement. Our objective is to study the h-index as a measure of academic attainment in general surgery and surgical specialties. A database of all surgical programs in the United States was created. Publish or Perish software was used to determine surgeons h-index. A total of 134 hospitals and 3712 surgeons (79% male) were included. Overall, mean h-index was 14.9 ± 14.8. H-index increased linearly with academic rank: 6.8 ± 6.4 for assistant professors (n = 1557, 41.9%), 12.9 ± 9.3 for associate professors (n = 891, 24%), and 27.9 ± 17.4 for professors (n = 1170, 31.5%); P h-indices (18.7 ± 16.7 and 18.4 ± 17.6, respectively). Surgeons with additional postgraduate degrees, university affiliations and male had higher mean h-indices; P h-index and the number of publications (R2 = 0.817) and citations (R2 = 0.768). The h-index of academic surgeons correlates with academic rank and serves a potential tool to measure academic productivity. Copyright © 2018 Elsevier Inc. All rights reserved.

7 CFR 1220.615 - State and United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.615 Section 1220.615... CONSUMER INFORMATION Procedures To Request a Referendum Definitions § 1220.615 State and United States. State and United States include the 50 States of the United States of America, the District of Columbia...

7 CFR 1220.129 - State and United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.129 Section 1220.129... CONSUMER INFORMATION Soybean Promotion and Research Order Definitions § 1220.129 State and United States. The terms State and United States include the 50 States of the United States of America, the District...

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.

7 CFR 1209.21 - State and United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States of...

Management of patients taking antiplatelet or anticoagulant medication requiring invasive breast procedures: United Kingdom survey of radiologists' and surgeons' current practice

International Nuclear Information System (INIS)

Pritchard, M.G.; Townend, J.N.; Lester, W.A.; England, D.W.; Kearins, O.; Bradley, S.A.

2008-01-01

Aim: To determine the current practice in the UK National Health Service Breast Screening Programme for invasive diagnostic procedures and surgery in patients taking anticoagulant and antiplatelet medication. Materials and methods: Lead radiologists and surgeons at each breast screening service were surveyed to determine current practice. One hundred and five respondents provided information regarding their services, protocols, and willingness to proceed with combinations of procedures and anti-haemostatic medications. Results: Between units there was wide variation in practice. Within 21 services providing more than one response, 10 (48%) disagreed on whether protocols existed. Decisions to perform biopsies were unrelated to professional group. The taking of a drug history was variable. Surgeons reported more adverse effects than radiologists [21 (48%) versus 12 (26%)], but no difference in self-assessment of knowledge. Conclusion: Both radiologists and surgeons have expressed uncertainty about their understanding of anticoagulant and antiplatelet treatment. This is reflected in a wide range of practice. Guidance regarding the management of these patients is suggested

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.

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

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.

7 CFR 1160.104 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United States...

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.

Impact of surgeon and hospital experience on outcomes of abdominal aortic aneurysm repair in New York State.

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Meltzer, Andrew J; Connolly, Peter H; Schneider, Darren B; Sedrakyan, Art

2017-09-01

This study aimed to assess the impact of the surgeon's and hospital's experience on the outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) of intact and ruptured abdominal aortic aneurysms (AAAs) in New York State. New York Statewide Planning and Research Cooperative System data were used to identify patients undergoing AAA repair from 2000 to 2011. Characteristics of the provider and hospital were determined by linkage to the New York Office of Professions and National Provider Identification databases. Distinct hierarchical logistic regression models for EVAR and OSR for intact and ruptured AAAs were created to adjust for the patient's comorbidities and to evaluate the impact of the surgeon's and hospital's experience on outcomes. The provider's years since medical school graduation as well as annual volume of the facility and provider are examined in tertiles. Adjusted odds ratios and 95% confidence intervals are presented. A total of 18,842 patients underwent AAA repair by a vascular surgeon. For intact AAAs (n = 17,118), 26.2% of patients underwent OSR and 73.8% underwent EVAR. For ruptured AAAs (n = 1724), 63.9% underwent OSR and 36.1% underwent EVAR. After intact AAA repair, OSR adjusted outcomes were significantly influenced by the surgeon's annual volume but not by the facility's volume or the surgeon's age. The lowest volume providers (1-4 OSRs) had higher in-hospital mortality rates than high-volume (>11 OSRs) surgeons (adjusted odds ratio, 1.87 [95% confidence interval, 1.1-3.17]). Low-volume providers also had higher odds of major complications (1.23 [1-1.51]). For patients with intact AAA undergoing EVAR, mortality was higher at low-volume facilities (2.6 [1.3-5.3] and 2.7 [1.5-4.8] for 27 OSRs for ruptured AAA) centers (1.56 [1.02-2.39]), whereas low-volume physicians (<4 OSRs for ruptured AAA) had higher odds of major complications (1.58 [1.04-2.41]). In the case of EVAR for rupture, there were no characteristics of

Cardiac surgeons and the quality movement: the Michigan experience.

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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.

Motivators and barriers for dog and cat owners and veterinary surgeons in the United Kingdom to using preventative medicines.

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Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L

2018-06-01

Routine use of preventative medicines is advocated as part of responsible dog and cat ownership. However, it has been suggested that the number of owners in the United Kingdom (UK) using preventative medicines to protect their pets is in decline. The aim of this novel study was to use a qualitative methodology to explore the attitudes of pet owners and veterinary surgeons in the UK to using preventative medicine products in dogs and cats. Preventative medicine was defined as "a drug or any other preparation used to prevent disease, illness or injury." Semi-structured interviews were conducted by telephone with owners and veterinary surgeons who had recently participated in a preventative healthcare consultation. Thematic analysis of transcribed recordings of these interviews identified four themes. This paper reports the theme related to motivators and barriers to using preventative medicines. Owners' understanding varied widely about the importance of preventative medicines for pets, as did their confidence in the safety of prescription products. A good relationship with their veterinary surgeon or practice, seeing adverts on the television about specific diseases, advice from a breeder and having personally seen infected animals appeared to be motivators for owners to use preventative medicines. Concern about adverse events and uncertainty about the necessity of using preventative medicines were barriers. Owners who trusted their veterinary surgeons to advise them on preventative medicine products described little use of alternative information sources when making preventative medicine choices. However, owners who preferred to do their own research described reading online opinions, particular in relation to the safety of preventative medicines, which they found confusing. In contrast, veterinary surgeons described broad confidence in the safety and efficacy of prescription preventative medicines and described protection of pet health as a strong motivator for

Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

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Mayberry, John C; Ham, L Bruce; Schipper, Paul H; Ellis, Thomas J; Mullins, Richard J

2009-03-01

Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown. Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair. Two hundred thirty-eight trauma surgeons (TRS), 97 orthopedic trauma surgeons (OTS), and 70 THS completed the survey. Eighty-two percent of TRS, 66% of OTS, and 71% of THS thought that rib fracture repair was indicated in selected patients. A greater proportion of surgeons thought that sternal fracture repair was indicated in selected patients (89% of TRS, 85% of OTS, and 95% of THS). Chest wall defect/pulmonary hernia (58%) and sternal fracture nonunion (>6 weeks) (68%) were the only two indications accepted by a majority of respondents. Twenty-six percent of surgeons reported that they had performed or assisted on a chest wall fracture repair, whereas 22% of surgeons were familiar with published randomized trials of the surgical repair of flail chest. Of surgeons who thought rib fracture or sternal fracture repair was rarely, if ever, indicated, 91% and 95%, respectively, specified that a randomized trial confirming efficacy would be necessary to change their negative opinion. A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.

31 CFR 800.225 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 800.225 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.225 United States. The term United States or U.S. means the United States of America, the States of the United States, the District of Columbia, and any commonwealth...

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.

7 CFR 1150.106 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States. ...

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

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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.

Factors Associated With Financial Relationships Between Spine Surgeons and Industry: An Analysis of the Open Payments Database.

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

2017-09-15

A retrospective review of Centers for Medicare and Medicaid Services Database. Utilizing Open Payments data, we aimed to determine the prevalence of industry payments to orthopedic and neurospine surgeons, report the magnitude of those relationships, and help outline the surgeon demographic factors associated with industry relationships. Previous Open Payments data revealed that orthopedic surgeons receive the highest value of industry payments. No study has investigated the financial relationship between spine surgeons and industry using the most recent release of Open Payments data. A database of 5898 spine surgeons in the United States was derived from the Open Payments website. Demographic data were collected, including the type of residency training, years of experience, practice setting, type of medical degree, place of training, gender, and region of practice. Multivariate generalized linear mixed models were utilized to determine the relationship between demographics and industry payments. A total of 5898 spine surgeons met inclusion criteria. About 91.6% of surgeons reported at least one financial relationship with industry. The median total value of payments was $994.07. Surgeons receiving over $1,000,000 from industry during the reporting period represented 6.6% of the database and accounted for 83.5% of the total value exchanged. Orthopedic training (P regression analysis revealed a strong inverse relationship between years of experience and number of payments from industry (r = -0.967, P Financial relationships between spine surgeons and industry are highly prevalent. Surgeon demographics have a significant association with industry-surgeon financial relationships. Our reported value of payments did not include ownership or research payments and thus likely underestimates the magnitude of these financial relationships. 3.

Malaria Treatment (United States)

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... Providers, Emergency Consultations, and General Public. Contact Us Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

Directory of Open Access Journals (Sweden)

Ehsan Saadat

2014-12-01

Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

Do geography and resources influence the need for colostomy in Hirschsprung′s disease and anorectal malformations? A Canadian association of paediatric surgeons: Association of paediatric surgeons of Nigeria survey

Directory of Open Access Journals (Sweden)

Lukman O. Abdur-Rahman

2014-01-01

Full Text Available Background: This survey compared surgical management of Hirschsprung′s disease (HD and anorectal malformations (ARM in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS and the Association of Paediatric Surgeons of Nigeria (APSON. Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97. Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05 and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05. Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%. CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05. The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.

Burnout in the Plastic Surgeon: Implications and Interventions.

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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.

The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis.

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Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Hensley, Bradley J; Iannuzzi, James C; Noyes, Katia; Monson, John R T; Fleming, Fergal J

2016-11-01

Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal. The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000-2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission. Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1-15 colorectal resections/yr). High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal. Copyright © 2016

7 CFR 65.255 - United States.

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2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States. ...

7 CFR 1250.308 - United States.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia. ...

7 CFR 1205.23 - United States.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures ...

31 CFR 597.318 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597... General Definitions § 597.318 United States. The term United States means the United States, its territories, states, commonwealths, districts, and possessions, and all areas under the jurisdiction or...

7 CFR 1219.26 - United States.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District of...

7 CFR 1212.31 - United States.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States. ...

22 CFR 120.13 - United States.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia, the...

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation.

Science.gov (United States)

Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L

2018-01-18

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Directory of Open Access Journals (Sweden)

Zoe Belshaw

2018-01-01

Full Text Available Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Science.gov (United States)

Robinson, Natalie J.; Dean, Rachel S.

2018-01-01

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type. PMID:29346332

31 CFR 592.311 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States. ...

7 CFR 1205.313 - United States.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America. [31 FR 16758, Dec. 31, 1966. Redesignated at 56 FR 64472, Dec. 10, 1991] ...

Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines.

Science.gov (United States)

Grunebaum, Lisa Danielle; Reiter, David

2006-01-01

To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

31 CFR 542.310 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

31 CFR 548.310 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

31 CFR 546.310 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

31 CFR 586.318 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or authority...

31 CFR 537.318 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and possessions...

31 CFR 585.316 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States, its...

31 CFR 575.319 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and possessions...

31 CFR 539.312 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 539.312 United States. The term United States means the United States, its...

31 CFR 551.309 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and possessions...

31 CFR 587.310 - United States.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or authority...

31 CFR 547.310 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States, its...

Impact of the economic downturn on adult reconstruction surgery: a survey of the American Association of Hip and Knee Surgeons.

Science.gov (United States)

Iorio, Richard; Davis, Charles M; Healy, William L; Fehring, Thomas K; O'Connor, Mary I; York, Sally

2010-10-01

To evaluate the effects of the economic downturn on adult reconstruction surgery in the United States, a survey of the American Association of Hip and Knee Surgeons (AAHKS) membership was conducted. The survey evaluated surgical and patient volume, practice type, hospital relationship, total joint arthroplasty cost control, employee staffing, potential impact of Medicare reimbursement decreases, attitudes toward health care reform options and retirement planning. A surgical volume decrease was reported by 30.4%. An outpatient visit decrease was reported by 29.3%. A mean loss of 29.9% of retirement savings was reported. The planned retirement age increased to 65.3 years from 64.05 years. If Medicare surgeon reimbursement were to decrease up to 20%, 49% to 57% of AAHKS surgeons would be unable to provide care for Medicare patients, resulting in an unmet need of 92,650 to 160,818 total joint arthroplasty procedures among AAHKS surgeons alone. Decreases in funding for surgeons and inadequate support for subspecialty training will likely impact access and quality for Americans seeking adult reconstruction surgery. Copyright © 2010 Elsevier Inc. All rights reserved.

31 CFR 598.317 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories and...

31 CFR 596.312 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including its...

31 CFR 538.314 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 538.314 Section 538.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 538.314 United States. The term United States means the United States, its territories and possessions...

31 CFR 543.310 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories and...

31 CFR 594.313 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories and...

31 CFR 588.310 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories and...

31 CFR 536.315 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories and...

31 CFR 544.310 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States, its...

31 CFR 545.313 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories and...

31 CFR 595.314 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and possessions...

31 CFR 560.307 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories and...

31 CFR 593.311 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States, its...

31 CFR 541.310 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and possessions...

31 CFR 540.313 - United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States, its...

Academic versus Clinical Productivity of Cardiac Surgeons in the State of New York: Who Publishes More and Who Operates More.

Science.gov (United States)

Rosati, Carlo Maria; Gaudino, Mario; Vardas, Panos N; Weber, Daniel J; Blitzer, David; Hameedi, Fawad; Koniaris, Leonidas G; Girardi, Leonard N

2018-01-01

We investigated whether/how cardiac surgeons can be productive both academically and clinically. Using online resources (New York State Adult Cardiac Surgery database, SCOPUS), we collected individual clinical volumes (operations performed/year), academic metrics (ongoing publications, role as author), practice setting, and seniority for all cardiac surgeons in the State of New York from 1994 to 2011. Over time, individual clinical volumes decreased (median operations/year: 193 in 1995 vs 126 in 2010; P published more worked at hospitals with higher clinical volumes (Spearman's correlation coefficient: 0.16; P publishing at all; ∼45 per cent operating less, but publishing a little; ∼15 per cent clinically very productive (operating as much as the nonpublishers) and publishing a lot; and ∼1 per cent operating the least, but publishing the most.

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

OpenAIRE

Skedros John G; Hunt Kenneth J; Pitts Todd C

2007-01-01

Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anest...

7 CFR 1206.23 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States. ...

7 CFR 1215.20 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board ...

A day in the life of a paediatric surgeon: a PAPSA research study ...

African Journals Online (AJOL)

Objectives This study aimed to create a snapshot picture of the global workload of paediatric surgeons and identify differences between countries. Methods Surgeons from 13 paediatric surgical units in different countries across the world were asked to record the number and type of admissions to the paediatric surgery ...

7 CFR 1280.127 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia. ...

The attitude and perceptions of work-life balance: a comparison among women surgeons in Japan, USA, and Hong Kong China.

Science.gov (United States)

Kawase, Kazumi; Kwong, Ava; Yorozuya, Kyoko; Tomizawa, Yasuko; Numann, Patricia J; Sanfey, Hilary

2013-01-01

The objective of the present study was to explore how women surgeons manage their work-life balance in three environmental and cultural settings. Members of the Japan Association of Women Surgeons (JAWS), the United States of America (US) based Association of Women Surgeons (AWS), and the Women's Chapter of the College of Surgeons of Hong Kong (WCHK) were surveyed. Among 822 women surgeons contacted, 252 responded (response rate 31.8 %; 55.5 % JAWS, 28.2 % AWS, and 25.3 % WCHK). Japanese women surgeons think that work is the number one priority, whereas US and Hong Kong China (HK) respondents think the number one priority is home life. Work satisfaction level was generally high among women surgeons in all countries; however, 19 % of US surgeons are somewhat dissatisfied with their work and 76.1 % think that men are treated more favorably than women at work. Whereas 51.6 % of Japanese women surgeons think that men are treated more favorably than women at home, at the same time they placed more importance on the role of women in the family. More than half of Japanese women surgeons are "uncertain" about their career path in the future, whereas 55.2/87.1 % of US/HK respondents are optimistic. All surgeons recommended expanding support for child rearing or nursing care during work hours, promoting a flexible work schedule and changing some of the older conventional ideas about gender role. It is essential to address women surgeons' concerns to enable them to have a clearer vision and a challenging career, and to be more certain about their personal and professional goals.

7 CFR 1260.108 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and the...

7 CFR 1221.32 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth of...

7 CFR 1216.30 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto Rico...

7 CFR 1218.22 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto Rico...

7 CFR 1210.315 - United States.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1210.315 Section 1210.315 Agriculture... PLAN Watermelon Research and Promotion Plan Definitions § 1210.315 United States. United States means each of the several States and the District of Columbia. [60 FR 10797, Feb. 28, 1995] National...

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.

History of surface weather observations in the United States

Science.gov (United States)

Fiebrich, Christopher A.

2009-04-01

In this paper, the history of surface weather observations in the United States is reviewed. Local weather observations were first documented in the 17th Century along the East Coast. For many years, the progression of a weather observation from an initial reading to dissemination remained a slow and laborious process. The number of observers remained small and unorganized until agencies including the Surgeon General, Army, and General Land Office began to request regular observations at satellite locations in the 1800s. The Smithsonian was responsible for first organizing a large "network" of volunteer weather observers across the nation. These observers became the foundation for today's Cooperative Observer network. As applications of weather data continued to grow and users required the data with an ever-decreasing latency, automated weather networks saw rapid growth in the later part of the 20th century. Today, the number of weather observations across the U.S. totals in the tens of thousands due largely to privately-owned weather networks and amateur weather observers who submit observations over the internet.

Toll Facilities in the United States - Toll Facilities in the United States

Data.gov (United States)

Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

Access to paid parental leave for academic surgeons.

Science.gov (United States)

Itum, Dina S; Oltmann, Sarah C; Choti, Michael A; Piper, Hannah G

2018-01-31

Parental leave is linked to health benefits for both child and parent. It is unclear whether surgeons at academic centers have access to paid parental leave. The aim of this study was to determine parental leave policies at the top academic medical centers in the United States to identify trends among institutions. The top academic medical centers were identified (US News & World Report 2016). Institutional websites were reviewed, or human resource departments were contacted to determine parental leave policies. "Paid leave" was defined as leave without the mandated use of personal time off. Institutions were categorized based on geographical region, funding, and ranking to determine trends regarding availability and duration of paid parental leave. Among the top 91 ranked medical schools, 48 (53%) offer paid parental leave. Availability of a paid leave policy differed based on private versus public institutions (70% versus 38%, P leaves (>6 wk) than public institutions (67% versus 33%; P = 0.02). No difference in paid leave duration was noted based on region (P = 0.60) or rank (P = 0.81). Approximately, 50% of top academic medical centers offer paid parental leave. Private institutions are more likely to offer paid leave and leave of longer duration. There is considerable variability in access to paid parenteral leave for academic surgeons. Copyright © 2018 Elsevier Inc. All rights reserved.

Oil Vulnerabilities and United States Strategy

Science.gov (United States)

2007-02-08

Mazda, Mercedes - Benz , Ford, Mercury, and Nissan offer flexible fuel vehicles in the United States. Ethanol is currently produced in the United States...USAWC STRATEGY RESEARCH PROJECT OIL VULNERABILITIES AND UNITED STATES STRATEGY by Colonel Shawn P. Walsh...Colleges and Schools, 3624 Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on Higher Education is an institutional accrediting

31 CFR 596.313 - United States person.

Science.gov (United States)

2010-07-01

... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM LIST GOVERNMENTS SANCTIONS REGULATIONS General Definitions § 596.313 United States person. The term United States person means any United States...

Nuclear development in the United States

International Nuclear Information System (INIS)

Brewer, S.

1983-01-01

The history of the nuclear development in the United States has been one of international cooperation relations so far. The United States is to offer the technical information on atomic energy utilization to foreign countries in exchange for the guarantee that they never attempt to have or develop nuclear weapons. Actually, the United States has supplied the technologies on nuclear fuel cycle and other related fields to enable other countries to achieve economical and social progress. The Department of Energy clarified the public promise of the United States regarding the idea of international energy community. The ratio of nuclear power generation to total electric power supply in the United States exceeded 12%, and will exceed 20% by 1990. Since 1978, new nuclear power station has not been ordered, and some of the contracted power stations were canceled. The atomic energy industry in the United States prospered at the beginning of 1970s, but lost the spirit now, mainly due to the institutional problems rather than the technical ones. As the policy of the government to eliminate the obstacles, the improvement of the procedure for the permission and approval, the establishment of waste disposal capability, the verification of fast breeder reactor technology and the promotion of commercial fuel reprocessing were proposed. The re-establishment of the United States as the reliable supplier of atomic energy service is the final aim. (Kako, I.)

State laws prohibiting sales to minors and indoor use of electronic nicotine delivery systems--United States, November 2014.

Science.gov (United States)

Marynak, Kristy; Holmes, Carissa Baker; King, Brian A; Promoff, Gabbi; Bunnell, Rebecca; McAfee, Timothy

2014-12-12

Electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes) and other devices such as electronic hookahs, electronic cigars, and vape pens, are battery-powered devices capable of delivering aerosolized nicotine and additives to the user. Experimentation with and current use of e-cigarettes has risen sharply among youths and adults in the United States. Youth access to and use of ENDS is of particular concern given the potential adverse effects of nicotine on adolescent brain development. Additionally, ENDS use in public indoor areas might passively expose bystanders (e.g., children, pregnant women, and other nontobacco users) to nicotine and other potentially harmful constituents. ENDS use could have the potential to renormalize tobacco use and complicate enforcement of smoke-free policies. State governments can regulate the sales of ENDS and their use in indoor areas where nonusers might be involuntarily exposed to secondhand aerosol. To learn the current status of state laws regulating the sales and use of ENDS, CDC assessed state laws that prohibit ENDS sales to minors and laws that include ENDS use in conventional smoking prohibitions in indoor areas of private worksites, restaurants, and bars. Findings indicate that as of November 30, 2014, 40 states prohibited ENDS sales to minors, but only three states prohibited ENDS use in private worksites, restaurants, and bars. Of the 40 states that prohibited ENDS sales to minors, 21 did not prohibit ENDS use or conventional smoking in private worksites, restaurants, and bars. Three states had no statewide laws prohibiting ENDS sales to minors and no statewide laws prohibiting ENDS use or conventional smoking in private worksites, restaurants, and bars. According to the Surgeon General, ENDS have the potential for public health harm or public health benefit. The possibility of public health benefit from ENDS could arise only if 1) current smokers use these devices to switch completely

78 FR 70274 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

Science.gov (United States)

2013-11-25

... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade... the schedule and agenda for an open meeting of the United States Travel and Tourism Advisory Board...

78 FR 3398 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

Science.gov (United States)

2013-01-16

... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade... the schedule and agenda for an open meeting of the United States Travel and Tourism Advisory Board...

The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

Science.gov (United States)

Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

2013-03-01

The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective

"I Always Feel Like I Have to Rush…" Pet Owner and Small Animal Veterinary Surgeons' Reflections on Time during Preventative Healthcare Consultations in the United Kingdom.

Science.gov (United States)

Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L

2018-02-08

Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare.

Equal Pay for Equal Work: Medicare Procedure Volume and Reimbursement for Male and Female Surgeons Performing Total Knee and Total Hip Arthroplasty.

Science.gov (United States)

Holliday, Emma B; Brady, Christina; Pipkin, William C; Somerson, Jeremy S

2018-02-21

The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons. The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013. Data were extracted for each billing code per orthopaedic surgeon in the year 2013 for total claims, surgical claims, total knee arthroplasty (TKA) claims, and total hip arthroplasty (THA) claims. A total of 20,546 orthopaedic surgeons who treated traditional Medicare patients were included in the initial analysis. Claim volume and reimbursement received were approximately twofold higher for all claims and more than threefold higher for surgical claims for male surgeons when compared with female surgeons (p 10 TKAs and THAs, respectively, in 2013 for Medicare patients and were included in the subset analyses. Although male surgeons performed a higher mean number of TKAs than female surgeons (mean and standard deviation, 37 ± 33 compared with 26 ± 17, respectively, p men and women for TKA or THA ($1,135 ± $228 compared with $1,137 ± $184 for TKA, respectively, p = 0.380; $1,049 ± $226 compared with $1,043 ± $266 for THA, respectively, p = 0.310). Female surgeons had a lower number of total claims and reimbursements compared with male surgeons. However, among surgeons who performed >10 THAs and TKAs, there were no sex differences in the mean reimbursement payment per surgeon. The number of women in orthopaedics is rising, and there is much interest in how their productivity and compensation compare with their male counterparts.

Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

Directory of Open Access Journals (Sweden)

GD Taylor

1994-01-01

Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

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.

United States housing, 2012

Science.gov (United States)

Delton Alderman

2013-01-01

Provides current and historical information on housing market in the United States. Information includes trends for housing permits and starts, housing completions for single and multifamily units, and sales and construction. This report will be updated annually.

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.

Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa.

Science.gov (United States)

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2018-03-01

Previously, we studied the relative importance of different institutional interventions that the largest hospital in Iowa could take to grow the anesthesia department's outpatient surgical care. Most (>50%) patients having elective surgery had not previously had surgery at the hospital. Patient perioperative experience was unimportant for influencing total anesthesia workload and numbers of patients. More important was the availability of surgical clinic appointments within several days. These results would be generalizable if the median time from surgery to a patient's next surgical procedure was large (eg, >2 years), among all hospitals in Iowa with outpatient surgery, and without regard to the hospital where the next procedure was performed. There were 37,172 surgical cases at hospital outpatient departments of any of the 117 hospitals in Iowa from July 1, 2013, to September 30, 2013. Data extracted about each case included its intraoperative work relative value units. The 37,172 cases were matched to all inpatient and outpatient records for the next 2 years statewide using patient linkage identifiers; from these were determined whether the patient had surgery again within 2 years. Furthermore, the cases' 1820 surgeons were matched to the surgeon's next outpatient or inpatient case, both including and excluding other cases performed on the date of the original case. By patient, the median time to their next surgical case, either outpatient or inpatient, exceeded 2 years, tested with weighting by intraoperative relative value units and repeated when unweighted (both P 2 years for patients versus 1 day for surgeons. Thus, although patients' experiences are an important attribute of quality of care, surgeons' experiences are orders of magnitude more important from the vantage point of marketing and growth of an anesthesia practice.

31 CFR 500.520 - Payments from accounts of United States citizens in employ of United States in foreign countries...

Science.gov (United States)

2010-07-01

... States citizens in employ of United States in foreign countries and certain other persons. 500.520..., Authorizations and Statements of Licensing Policy § 500.520 Payments from accounts of United States citizens in employ of United States in foreign countries and certain other persons. (a) Banking institutions within...

31 CFR 515.520 - Payments from accounts of United States citizens in employ of United States in foreign countries...

Science.gov (United States)

2010-07-01

... States citizens in employ of United States in foreign countries and certain other persons. 515.520..., Authorizations, and Statements of Licensing Policy § 515.520 Payments from accounts of United States citizens in employ of United States in foreign countries and certain other persons. (a) Banking institutions within...

[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.

TRAINING OF THE STATE PRESIDENT'S UNIT

African Journals Online (AJOL)

The primary function of the State President's Unit is to protect the head of state - not his person as is generally believed, but his authority over the state. Ironically, the ceremonial performances of the State President's Unit lead people to believe that they are only capable of doing drill exer- cises. However, upon investigating.

An Assessment of Gender Differences in Plastic Surgery Patient Education and Information in the United States: Are We Neglecting Our Male Patients?

Science.gov (United States)

Sinno, Sammy; Lam, Gretl; Brownstone, Nicholas D; Steinbrech, Douglas S

2016-01-01

The number of total cosmetic procedures performed yearly has increased by more than 274% between 1997 and 2014, according to the American Society for Aesthetic Plastic Surgery. However, the vast majority of plastic surgery procedures are still targeted toward women, with little attention toward men. This study sought to quantify the extent of gender discrepancies observed in online plastic surgery marketing in this country. For the 48 contiguous United States, a systematic Google (Mountain View, CA) search was performed for "[state] plastic surgeon." The first 10 solo or group practice websites in each state were analyzed for the gender of the first 10 images featured, presence of a male services section, and which procedures were offered to men. The results were statistically analyzed using SPSS Software (IBM Corporation, Armonk, NY). A total of 453 websites were analyzed, as 5 states did not have 10 unique solo or group practice websites. Of the 4239 images reviewed, 94.1% were of females, 5.0% were of males, and 0.9% were of a male and female together. A male services page was present in 22% of websites. The most common procedures marketed toward men were gynecomastia reduction (58%), liposuction (17%), blepharoplasty (13%), and facelift (10%). Less than 10% of all websites offered other procedures to males, with a total of 15 other aesthetic procedures identified. Many plastic surgeons choose to ignore or minimize male patients in their online marketing efforts. However, as the number of men seeking cosmetic procedures continues to grow, plastic surgeons will benefit from incorporating male patients into their practice model. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

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.

Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons.

Science.gov (United States)

Wang, Dean; Degen, Ryan M; Camp, Christopher L; McGraw, Michael H; Altchek, David W; Dines, Joshua S

2017-10-01

Much controversy exists regarding the optimal surgical intervention for lateral epicondylitis because of a multitude of options available and the lack of comparative studies. Knowledge of the current practice trends would help guide the design of comparative studies needed to determine which surgical technique results in the best outcome. To review the latest practice trends for the surgical treatment of lateral epicondylitis among newly trained surgeons in the United States utilizing the American Board of Orthopaedic Surgery (ABOS) database. Cross-sectional study; Level of evidence, 3. The ABOS database was utilized to identify surgical cases for lateral epicondylitis submitted by Part II board certification examination candidates from 2004 through 2013. Inclusion criteria were predetermined using a combination of International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Cases were organized by open and arthroscopic treatment groups and by fellowship training and were analyzed to determine differences in surgical techniques, complication rates, and concomitant procedures. In total, 1150 surgeons submitted 2106 surgical cases for the treatment of lateral epicondylitis. The number of surgical cases for lateral epicondylitis performed per 10,000 submitted cases significantly decreased from 26.7 in 2004 to 21.1 in 2013 ( P = .002). Among all cases, 92.2% were open and 7.8% were arthroscopic, with no change in the incidence of arthroscopic surgeries over the study period. Shoulder and elbow (18.1%) and sports medicine (11.4%) surgeons were more likely to perform surgery arthroscopically compared with hand surgeons (6.1%) ( P < .001). There was no difference in overall self-reported complication rates between open (4.4%) and arthroscopic (5.5%) procedures ( P = .666). Percutaneous tenotomy, debridement only, and debridement with tendon repair comprised 6.4%, 46.3%, and 47.3% of open treatment, respectively. Sports

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.

Disparities in access to emergency general surgery care in the United States.

Science.gov (United States)

Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

31 CFR 515.334 - United States national.

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2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States national. 515.334 Section 515.334 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... of the United States, and which has its principal place of business in the United States. [61 FR...

7 CFR 1212.32 - United States Customs Service.

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2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false United States Customs Service. 1212.32 Section 1212... § 1212.32 United States Customs Service. “United States Customs Service” or “Customs” means the United States Customs and Border Protection, an agency of the Department of Homeland Security. Honey Packers and...

Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week.

Science.gov (United States)

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2018-02-01

Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads. Observational cohort study. 116 hospitals in Iowa with inpatient or outpatient surgery from July 1, 2013 through June 30, 2015. Surgeons in Iowa, each with a unique identifier among hospitals. The independent variable was the number of inpatient and outpatient cases that each surgeon performed each week during the first fiscal year beginning July 1, 2013. The dependent variables were surgeons' number of inpatient and outpatient surgical cases, and intraoperative work relative value units (RVU's) for outpatient cases, during the second fiscal year. The average hospital in Iowa had less than half of its growth from year 1 to year 2 in numbers of cases among surgeons who performed >2 cases per week in the baseline year (23.0%±2.5% [SE], P2 cases per week at other hospitals in the state during that year (24.4%±2.6%, P<0.0001). Less than half the growth in RVU's was among those surgeons (21.3%±2.5%, P<0.0001). Most (≥50%) annual growth in surgery, both based on the number of total inpatient and outpatient surgical cases, and on the total outpatient RVU's, was attributable to surgeons who performed 2 or fewer cases per week at each hospital statewide during the preceding year. Therefore, the strategic priority should be to assure that the many low-caseload surgeons have access to convenient OR time (e.g., by allocating sufficient OR time, and assigning surgeon blocks, in a mathematically sound, evidence-based way). Although reducing turnover times and anesthesia-controlled times to promote growth will be beneficial for a few surgeons, the effect on total caseload will be small. Copyright © 2017 Elsevier Inc. All rights reserved.

Referral and Receipt of Treatment for Hepatocellular Carcinoma in United States Veterans: Effect of Patient and Non-Patient Factors

Science.gov (United States)

Davila, Jessica A.; Kramer, Jennifer R.; Duan, Zhigang; Richardson, Peter A.; Tyson, Gia L.; Sada, Yvonne H.; Kanwal, Fasiha; El-Serag, Hashem B.

2014-01-01

Background The delivery of treatment for hepatocellular carcinoma (HCC) could be influenced by place of HCC diagnosis (hospitalization vs. outpatient), subspecialty referral following diagnosis, as well as physician and facility factors. We conducted a study to examine the effect of patient and non-patient factors on the place of HCC diagnosis, referral, and treatment in Veterans Administration (VA) hospitals in the United States. Methods Using the VA Hepatitis C Clinical Case Registry, we identified HCV-infected patients who developed HCC during 1998–2006. All cases were verified and staged according to Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We examined factors related to these outcomes using hierarchical logistic regression. These factors included HCC stage, HCC surveillance, physician specialty, and facility factors, in addition to risk factors, co-morbidity, and liver disease indicators. Results Approximately 37.2% of the 1,296 patients with HCC were diagnosed during hospitalization, 31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being seen by a surgeon or oncologist was associated with surveillance (adjusted odds ratio (aOR)=1.47;95%CI:1.20–1.80) and varied by geography (1.74;1.09–2.77). Seeing a surgeon or oncologist was predictive of treatment (aOR=1.43;95%CI:1.24–1.66). There was a significant increase in treatment among patients who received surveillance (aOR=1.37; 95%CI:1.02–1.71), were seen by gastroenterology (1.65;1.21–2.24) or were diagnosed at a transplant facility (1.48;1.15–1.90). Conclusions Approximately 40% of patients were diagnosed during hospitalization. Most patients were not seen by a surgeon or oncologist for treatment evaluation and only 34% received treatment. Only receipt of HCC surveillance was associated with increased likelihood of outpatient diagnosis, being seen by a surgeon or

Nuclear power in the United States

International Nuclear Information System (INIS)

Johnston, J.B.

1985-01-01

All over the world except in the United States, nuclear energy is a low cost, secure, environmentally acceptable form of energy. In the United States, civilian nuclear power is dead. 112 nuclear power plants have been abandoned or cancelled in the last decade, and there has been no new order for nuclear plants since 1978. It will be fortunate to have 125 operating nuclear plants in the United States in the year 2000. There are almost 90 completed nuclear power plants and about 45 under construction in the United States, but several of those under construction will eventually be abandoned. About 20 % of the electricity in the United States will be generated by nuclear plants in 2000 as compared with 13 % supplied in the last year. Under the present regulatory and institutional arrangement, American electric utilities would not consider to order a new nuclear power plant. Post-TMI nuclear plants became very expensive, and there is also ideological opposition to nuclear power. Coal-firing plants are also in the similar situation. The uncertainty about electric power demand, the cost of money, the inflation of construction cost and regulation caused the situation. (Kako, I.)

What advice are oncologists and surgeons in the United Kingdom giving to breast cancer patients about physical activity?

Directory of Open Access Journals (Sweden)

Daley Amanda J

2008-09-01

Full Text Available Abstract Evidence has shown that physical activity may attenuate the negative physical, psychological and functional effects of treatment in women diagnosed with breast cancer. Physical activity levels also decline substantially during and after completion of treatment for cancer, highlighting the importance of strategies to promote participation in regular physical activity in this population. Oncologists and surgeons may serve as an influential source of motivation to be physically activity in cancer patients, by conveying the importance of a healthy lifestyle. The primary purpose of the present study was to investigate whether oncologists and surgeons routinely discuss physical activity with their breast cancer patients and to investigate the nature of any information/advice provided during consultations. A secondary aim was to examine whether physically active oncologists and surgeons were more likely to provide advice about physical activity to patients, than inactive oncologists and surgeons. A brief postal questionnaire was sent to 710 consultant breast cancer oncologists and surgeons throughout the UK and 102 responded (response rate = 14.4%. Of responders, most (55.9% did not routinely discuss physical activity with their patients. Amongst oncologists/surgeons (clinicians who did offer advice, most focussed on discussing the benefits of physical activity for physical and functional health gains and for facilitating weight control and maintenance. A number of clinicians indicated they advised patients that physical activity may decrease risk of recurrence and improve survival, despite the lack of evidence from RCTs to support this suggestion. There was no significant association between the physical activity status of oncologists/surgeons and the likelihood that they discussed physical activity with patients. Educational strategies aimed at encouraging clinicians to promote physical activity in consultations need to be targeted widely

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.

Teen Pregnancy in the United States

Science.gov (United States)

... United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. 2007;97(1):150-6. Lindberg LD, Santelli JS, Desai, S. Understanding the Decline in Adolescent Fertility in the United States, 2007–2012. J ...

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.

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.

Immigration Enforcement Within the United States

Science.gov (United States)

2006-04-06

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Policy Issues...Remained in the United States, (Washington: Center for Immigration Studies, May 2002). Immigration Enforcement Within the United States Introduction ...interior enforcement lack a border component. For example, fugitive taskforces, investigations of alien slavery and sweatshops , and employer sanctions do

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.

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.

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

United States advanced technologies

International Nuclear Information System (INIS)

Longenecker, J.R.

1985-01-01

In the United States, the advanced technologies have been applied to uranium enrichment as a means by which it can be assured that nuclear fuel cost will remain competitive in the future. The United States is strongly committed to the development of advanced enrichment technology, and has brought both advanced gas centrifuge (AGC) and atomic vapor laser isotope separation (AVLIS) programs to a point of significant technical refinement. The ability to deploy advanced technologies is the basis for the confidence in competitive future price. Unfortunately, the development of advanced technologies is capital intensive. The year 1985 is the key year for advanced technology development in the United States, since the decision on the primary enrichment technology for the future, AGC or AVLIS, will be made shortly. The background on the technology selection process, the highlights of AGC and AVLIS programs and the way to proceed after the process selection are described. The key objective is to maximize the sales volume and minimize the operating cost. This will help the utilities in other countries supply low cost energy on a reliable, long term basis. (Kako, I.)

The United States and the Arab Gulf Monarchies

International Nuclear Information System (INIS)

Kechichian, J.A.

1999-01-01

The United States has enduring strategic interests in the Persian Gulf region. To understand these interests and the Usa policy towards the Arab Gulf Monarchies, the french institute of international relations (IFRI) proposes this document. The following chapters are detailed: the United States and the Arab Gulf Monarchies, overview, Chief Unites States Objective: Access to oil, re-evaluating United States Foreign Policy in the Gulf, the second term (Usa strategy). (A.L.B.)

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.

78 FR 46686 - Privacy Act of 1974; Treasury/United States Mint .013-United States Mint National Electronic...

Science.gov (United States)

2013-08-01

... available publicly. FOR FURTHER INFORMATION CONTACT: For general questions and privacy issues, please... DEPARTMENT OF THE TREASURY Privacy Act of 1974; Treasury/United States Mint .013--United States... Privacy Act of 1974, as amended, 5 U.S.C. 552a, the Department of the Treasury (``Treasury'') and the...

39 CFR 221.1 - The United States Postal Service.

Science.gov (United States)

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false The United States Postal Service. 221.1 Section 221.1 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.1 The United States Postal Service. The United States Postal Service was established as an...

UNITED STATES DURING THE COLD WAR 1945-1990

Directory of Open Access Journals (Sweden)

Novita Mujiyati

2016-02-01

Full Text Available United States and the Soviet Union is a country on the part of allies who emerged as the winner during World War II. However, after reaching the Allied victory in the situation soon changed, man has become an opponent. United States and the Soviet Union are competing to expand the influence and power. To compete the United States strive continuously strengthen itself both in the economic and military by establishing a defense pact and aid agencies in the field of economy. During the Cold War the two are not fighting directly in one of the countries of the former Soviet Union and the United States. However, if understood, teradinya the Korean War and the Vietnam War is a result of tensions between the two countries and is a direct warfare conducted by the United States and the Soviet Union. Cold War ended in conflict with the collapse of the Soviet Union and the United States emerged as the winner of the country.

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.

78 FR 27857 - United States Standards for Wheat

Science.gov (United States)

2013-05-13

... RIN 0580-AB12 United States Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards... (GIPSA) is revising the United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change...

Tuberculosis along the United States-Mexico border, 1993-2001.

Science.gov (United States)

Schneider, Eileen; Laserson, Kayla F; Wells, Charles D; Moore, Marisa

2004-07-01

Tuberculosis (TB) is a leading public health problem and a recognized priority for the federal Governments of both Mexico and the United States of America. The objectives of this research, primarily for the four states in the United States that are along the border with Mexico, were to: (1) describe the epidemiological situation of TB, (2) identify TB risk factors, and (3) discuss tuberculosis program strategies. We analyzed tuberculosis case reports collected from 1993 through 2001 by the tuberculosis surveillance system of the United States. We used those data to compare TB cases mainly among three groups: (1) Mexican-born persons in the four United States border states (Arizona, California, New Mexico, and Texas), (2) persons in those four border states who had been born in the United States, and (3) Mexican-born persons in the 46 other states of the United States, which do not border Mexico. For the period from 1993 through 2001, of the 16 223 TB cases reported for Mexican-born persons in the United States, 12 450 of them (76.7%) were reported by Arizona, California, New Mexico, and Texas. In those four border states overall in 2001, tuberculosis case rates for Mexican-born persons were 5.0 times as high as the rates for persons born in the United States; those four states have 23 counties that directly border on Mexico, and the ratio in those counties was 5.8. HIV seropositivity, drug and alcohol use, unemployment, and incarceration were significantly less likely to be reported in Mexican-born TB patients from the four border states and the nonborder states than in patients born in the United States from the four border states (P pulmonary tuberculosis patients who were 18-64 years of age and residing in the four border states, the Mexican-born patients were 3.6 times as likely as the United States-born patients were to have resistance to at least isoniazid and rifampin (i. e., to have multidrug-resistant TB) and twice as likely to have isoniazid resistance

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

Science.gov (United States)

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

knee arthroplasty were lower. Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

Global Entrepreneurship and the United States

Science.gov (United States)

2010-09-01

Global Entrepreneurship and the United States by Zoltan J. Acs Laszlo Szerb Ruxton, MD 21204 for under contract number SBAHQ-09...SUBTITLE Global Entrepreneurship and the United States 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...3 2.1. Assessing Entrepreneurship ..................................................................................4 2.2. Stages of Development

75 FR 25925 - United States Mint

Science.gov (United States)

2010-05-10

... Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8... scheduled for May 25, 2010. Date: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801 9th Street, NW., Washington, DC 20220. Subject: Review and discuss obverse and...

31 CFR 515.330 - Person within the United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Person within the United States. 515... Definitions § 515.330 Person within the United States. (a) The term person within the United States, includes: (1) Any person, wheresoever located, who is a resident of the United States; (2) Any person actually...

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.

45 CFR 212.7 - Repayment to the United States.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Repayment to the United States. 212.7 Section 212... UNITED STATES CITIZENS RETURNED FROM FOREIGN COUNTRIES § 212.7 Repayment to the United States. (a) An..., any or all of the cost of such assistance to the United States, except insofar as it is determined...

20 CFR 416.215 - You leave the United States.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for 30...

37 CFR 1.412 - The United States Receiving Office.

Science.gov (United States)

2010-07-01

... Information § 1.412 The United States Receiving Office. (a) The United States Patent and Trademark Office is a Receiving Office only for applicants who are residents or nationals of the United States of America. (b) The... “United States Receiving Office” or by the abbreviation “RO/US.” (c) The major functions of the Receiving...

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 ...

Does Self-Citation Influence Quantitative Measures of Research Productivity Among Academic Oral and Maxillofacial Surgeons?

Science.gov (United States)

Susarla, Srinivas M; Swanson, Edward W; Lopez, Joseph; Peacock, Zachary S; Dodson, Thomas B

2015-10-01

Quantitative measures of research productivity depend on the citation frequency of a publication. Citation-based metrics, such as the h-index (total number of publications h that have at least h citations), can be susceptible to self-citation, resulting in an inflated measure of research productivity. The purpose of the present study was to estimate the effect of self-citation on the h-index among academic oral and maxillofacial surgeons (OMSs). The present study was a cross-sectional study of full-time academic OMSs in the United States. The predictor variable was the frequency of self-citation. The primary outcome of interest was the h-index. Other study variables included demographic factors and citation metrics. Descriptive, bivariate, and regression statistics were computed. The study sample consisted of 325 full-time academic OMSs. Most surgeons were men (88.3%); approximately 40% had medical degrees. The study subjects had an average of 23.5 ± 37.1 publications. The mean number of self-citations was 15 + 56. The sample's mean h-index was 6.6 ± 7.6 and was associated with self-citation (r = 0.71, P citations. After adjusting for PhD degree, total number of publications, and academic rank, an increasing self-citation rate influenced the h-index (r = 0.006, P citations were more likely to have their h-index influenced by self-citation. Self-citation among full-time academic OMSs does not substantially affect the h-index. Surgeons in the top quartile of self-citation rates are more likely to influence their h-index. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[Improving the surgeon's image: introduction].

Science.gov (United States)

Tajima, Tomoo

2004-05-01

-centered field. The Japanese Surgical Society appears to be the only medical society that is capable of leading a revolution in the health care system of this country with its autonomy and self-discipline. It is timely for the Japanese Surgical Society to consider a modification of its stated mission by adding "to improve the care of the surgical patient" as dictated by the American College of Surgeons.

The United States and the Kurds: Case Studies in United States Engagement

National Research Council Canada - National Science Library

Lambert, Peter

1997-01-01

..., between 1969- 1975, and 1990-1996. Both eras saw the United States able to influence events relating to the Kurds in support of a larger regional policy, only to find no easy solution to the Kurdish quest for autonomy...

A structured, extended training program to facilitate adoption of new techniques for practicing surgeons.

Science.gov (United States)

Greenberg, Jacob A; Jolles, Sally; Sullivan, Sarah; Quamme, Sudha Pavuluri; Funk, Luke M; Lidor, Anne O; Greenberg, Caprice; Pugh, Carla M

2018-01-01

Laparoscopic inguinal hernia repair has been shown to have significant benefits when compared to open inguinal hernia repair, yet remains underutilized in the United States. The traditional model of short, hands-on, cognitive courses to enhance the adoption of new techniques fails to lead to significant levels of practice implementation for most surgeons. We hypothesized that a comprehensive program would facilitate the adoption of laparoscopic inguinal hernia repair (TEP) for practicing surgeons. A team of experts in simulation, coaching, and hernia care created a comprehensive training program to facilitate the adoption of TEP. Three surgeons who routinely performed open inguinal hernia repair with greater than 50 cases annually were recruited to participate in the program. Coaches were selected based on their procedural expertise and underwent formal training in surgical coaching. Participants were required to evaluate all aspects of the educational program and were surveyed out to one year following completion of the program to assess for sustained adoption of TEP. All three participants successfully completed the first three steps of the seven-step program. Two participants completed the full course, while the third dropped out of the program due to time constraints and low case volume. Participant surgeons rated Orientation (4.7/5), GlovesOn training (5/5), and Preceptored Cases (5/5) as highly important training activities that contributed to advancing their knowledge and technical performance of the TEP procedure. At one year, both participants were performing TEPs for "most of their cases" and were confident in their ability to perform the procedure. The total cost of the program including all travel, personal coaching, and simulation was $8638.60 per participant. Our comprehensive educational program led to full and sustained adoption of TEP for those who completed the course. Time constraints, travel costs, and case volume are major considerations for

United States rejoin ITER

International Nuclear Information System (INIS)

Roberts, M.

2003-01-01

Upon pressure from the United States Congress, the US Department of Energy had to withdraw from further American participation in the ITER Engineering Design Activities after the end of its commitment to the EDA in July 1998. In the years since that time, changes have taken place in both the ITER activity and the US fusion community's position on burning plasma physics. Reflecting the interest in the United States in pursuing burning plasma physics, the DOE's Office of Science commissioned three studies as part of its examination of the option of entering the Negotiations on the Agreement on the Establishment of the International Fusion Energy Organization for the Joint Implementation of the ITER Project. These were a National Academy Review Panel Report supporting the burning plasma mission; a Fusion Energy Sciences Advisory Committee (FESAC) report confirming the role of ITER in achieving fusion power production, and The Lehman Review of the ITER project costing and project management processes (for the latter one, see ITER CTA Newsletter, no. 15, December 2002). All three studies have endorsed the US return to the ITER activities. This historical decision was announced by DOE Secretary Abraham during his remarks to employees of the Department's Princeton Plasma Physics Laboratory. The United States will be working with the other Participants in the ITER Negotiations on the Agreement and is preparing to participate in the ITA

A comparison of the teamwork attitudes and knowledge of Irish surgeons and U.S Naval aviators.

Science.gov (United States)

O'Connor, Paul; Ryan, Stephen; Keogh, Ivan

2012-10-01

Poor teamwork skills are contributors to poor performance and mishaps in high risk work settings, including the operating theatre. A questionnaire was used to assess the attitudes towards, and knowledge of, Irish surgeons (n = 72) towards the human factors that contribute to mishaps and poor teamwork in high risk environments. The responses were compared to those obtained from U.S. Naval aviators (n = 552 for the attitude questions, and n = 172 for the knowledge test). U.S. Naval aviators were found to be significantly more knowledgeable, and held attitudes that were significantly more positive towards effective teamworking than the surgeons. Moreover, 78.9% of Senior House Officers and Registrars stated that junior personnel were frequently afraid to speak-up (compared with 31.3% of Consultants). Only 7.3% of surgeons stated that an adequate pre-operative brief team brief was frequently conducted, and only 15% stated that an adequate post-operative team brief was frequently conducted. It is suggested that the human factors training currently provided to surgeons in Ireland is a positive first step. However, there is a need to stress the importance of assertiveness in juniors, listening in seniors, and more reinforcement of good teamworking behaviours in the operating theatre. Copyright © 2011 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

United States Stateplane Zones - NAD83

Data.gov (United States)

Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.

United States Stateplane Zones - NAD27

Data.gov (United States)

Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.

Present state of electric power business in United States and Europe

International Nuclear Information System (INIS)

Onishi, Kenichi

2011-01-01

This article reported present state of nuclear power and electric power business in United States and Europe after Fukushima Daiichi Accident. As for the trend of demand and supply of electric power and policy, the accident forced Germany possibly to proceed with phase-out of nuclear power, but France and United States to sustain nuclear power with no great change of energy policy at this moment. As for the trend of electric power market, there was not state in United States with liberalized retail market of electric power after rolling blackouts occurred in California State in the early 2000s. In Germany proceeding with renewable energy introduction, renewable electricity fed into the grid was paid for by the network operators at fixed tariffs and the costs passed on to electricity consumers were increasing. Renewable Portfolio Standards (RPS) in United States forced the state to introduction of renewable energy to some ratio, and Feed-in Tariff (FIT) introduced in EU in 1990s lead to introduction of a large amount of renewable electricity targeted in 2020. Huge amount of wind power introduction brought about several problems to solve such that excess electric power above domestic demand had bad effects on grids in neighboring region. Enforcement of power transmission lines was also needed with increase of maximum electric power as well as introduction of a large amount of renewable electricity. (T. Tanaka)

Complications of bariatric surgery--What the general surgeon needs to know.

Science.gov (United States)

Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

2016-04-01

Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K. the Department of Health report that 61.3% of people in the U.K. are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the U.K. and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Death in the United States, 2011

Science.gov (United States)

... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

31 CFR 103.39 - Person outside the United States.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Person outside the United States. 103... Person outside the United States. For the purposes of this subpart, a remittance or transfer of funds, or... the United States, shall be deemed to be a remittance or transfer to a person outside the United...

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.

Energy problems of the United States

International Nuclear Information System (INIS)

Pertuzio, A.

2006-01-01

The united states are the third world producer of oil which accounts for 440% of world production and 20 million barrels/day of which 60% are imported. That dependence on imports is likely to increase in the next decades. Such supplies and their security are therefore a fundamental factor of the United States foreign policy in combination with their political, economic and strategic objectives in a world both unsure and dangerous

Household pesticide usage in the United States.

Science.gov (United States)

Savage, E P; Keefe, T J; Wheeler, H W; Mounce, L; Helwic, L; Applehans, F; Goes, E; Goes, T; Mihlan, G; Rench, J; Taylor, D K

1981-01-01

A total of 10,000 U.S. households in 25 standard metropolitan statistical areas and 25 counties were included in the United States. More than 8,200 households granted an interview. Nine of every ten households in the United States used some types of pesticide in their house, garden, or yard. Households in the southeastern United States used the most pesticides. Although more than 500 different pesticide formulations were used by the sampled households, 15 pesticides accounted for 65.5% of all pesticides reported in this study. Thirteen of these 15 pesticides were insecticides, one was a herbicide, and one was a rodenticide.

Emergency surgeon-performed hepatobiliary ultrasonography.

LENUS (Irish Health Repository)

Kell, M R

2012-02-03

BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.

75 FR 13345 - Pricing for Certain United States Mint Products

Science.gov (United States)

2010-03-19

... DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of First Spouse Bronze Medals and 2010 First Spouse Bronze Medal Series: Four...

22 CFR 22.3 - Remittances in the United States.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2) money...

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.

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.

Transplant surgery fellow perceptions about training and the ensuing job market-are the right number of surgeons being trained?

Science.gov (United States)

Reich, D J; Magee, J C; Gifford, K; Merion, R M; Roberts, J P; Klintmalm, G B G; Stock, P G

2011-02-01

The American Society of Transplant Surgeons (ASTS) sought whether the right number of abdominal organ transplant surgeons are being trained in the United States. Data regarding fellowship training and the ensuing job market were obtained by surveying program directors and fellowship graduates from 2003 to 2005. Sixty-four ASTS-approved programs were surveyed, representing 139 fellowship positions in kidney, pancreas and/or liver transplantation. One-quarter of programs did not fill their positions. Forty-five fellows graduated annually. Most were male (86%), aged 31-35 years (57%), married (75%) and parents (62%). Upon graduation, 12% did not find transplant jobs (including 8% of Americans/Canadians), 14% did not get jobs for transplanting their preferred organ(s), 11% wished they focused more on transplantation and 27% changed jobs early. Half fellows were international medical graduates; 45% found US/Canadian transplant jobs, particularly 73% with US/Canadian residency training. Fellows reported adequate exposure to training volume, candidate selection, pre/postoperative care and organ procurement, but not to donor management/selection, outpatient care and core didactics. One-sixth noted insufficient 'mentoring/preparation for a transplantation career'. Currently, there seem to be enough trainees to fill entry-level positions. One-third program directors believe that there are too many trainees, given the current and foreseeable job market. ASTS is assessing the total workforce of transplant surgeons and evolving manpower needs. ©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

The effects of tenure and promotion on surgeon productivity.

Science.gov (United States)

Lam, Adam; Heslin, Martin J; Tzeng, Ching-Wei D; Chen, Herbert

2018-07-01

Studies investigating the impact of promotion and tenure on surgeon productivity are lacking. The aim of this study is to elucidate the relationship of promotion and tenure to surgeon productivity. We reviewed data for the Department of Surgery at our institution. Relative value units (RVUs) billed per year, publications per year, and grant funding per year were used to assess productivity from 2010 to 2016. We analyzed tenure-track (TT) and non-tenure-track (NT) surgeons and compared the productivity within these groups by rank: assistant professor (ASST), associate professor (ASSOC), and full professor (FULL). Kruskal-Wallis and Mann-Whitney U tests were used to assess significance and relationships between the groups. A TT faculty was promoted if they produced more research, with the highest publication rates in TT FULL. TT faculty publishing rates increased from ASST to ASSOC (1 versus 2, P = 0.006) and from ASSOC to FULL (2 versus 4, P production (RVUs) was highest between TT ASSOC and NT FULL. TT faculty increased productivity between ASST and ASSOC (7023 versus 8384, P = 0.001) and decreased between ASSOC and FULL (8384 versus 6877, P production and grant funding, whereas NT FULL has the highest clinical production. Copyright © 2018 Elsevier Inc. All rights reserved.

Collateral damage: the effect of patient complications on the surgeon's psyche.

Science.gov (United States)

Patel, Amit M; Ingalls, Nichole K; Mansour, M Ashraf; Sherman, Stanley; Davis, Alan T; Chung, Mathew H

2010-10-01

The effect of patient complications on physicians is not well understood. Our objective was to determine the impact of a surgeon's complication(s) on his/her emotional state and job performance. An anonymous survey was distributed to Midwest Surgical Society members and attending surgeons within the Grand Rapids, Michigan, community. There were 123 respondents (30.5% response rate). For the majority of participants, the first complication that had a significant emotional impact on them occurred during residency (51.2%). Most respondents reported this did not impair their professional functioning (77.2%). If a major complication was first experienced after residency, this had a greater likelihood of causing impairment (P < .05). Surgeons primarily dealt with the emotional impact by discussing it with a surgical partner (87.8%). Alcohol or other substance use increased in 6.5% of those surveyed. Most respondents (58.5%) felt it was difficult to handle the emotional effects of complications throughout their careers and this did not improve with experience. The majority of surgeons agreed that it was difficult to handle the emotional effects of complications throughout their careers. Efforts should be made to increase awareness of unrecognized emotional effects of patient complications and improve access to support systems for surgeons. Published by Mosby, Inc.

The United Kingdom: Issues for the United States

National Research Council Canada - National Science Library

Archick, Kristin

2007-01-01

...; and more recently, from the UK's strong support in countering terrorism and confronting Iraq. The United States and Britain also share a mutually beneficial trade and economic relationship, and are each other's biggest foreign direct investors...

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...

Radiation therapy facilities in the United States

International Nuclear Information System (INIS)

Ballas, Leslie K.; Elkin, Elena B.; Schrag, Deborah; Minsky, Bruce D.; Bach, Peter B.

2006-01-01

Purpose: About half of all cancer patients in the United States receive radiation therapy as a part of their cancer treatment. Little is known, however, about the facilities that currently deliver external beam radiation. Our goal was to construct a comprehensive database of all radiation therapy facilities in the United States that can be used for future health services research in radiation oncology. Methods and Materials: From each state's health department we obtained a list of all facilities that have a linear accelerator or provide radiation therapy. We merged these state lists with information from the American Hospital Association (AHA), as well as 2 organizations that audit the accuracy of radiation machines: the Radiologic Physics Center (RPC) and Radiation Dosimetry Services (RDS). The comprehensive database included all unique facilities listed in 1 or more of the 4 sources. Results: We identified 2,246 radiation therapy facilities operating in the United States as of 2004-2005. Of these, 448 (20%) facilities were identified through state health department records alone and were not listed in any other data source. Conclusions: Determining the location of the 2,246 radiation facilities in the United States is a first step in providing important information to radiation oncologists and policymakers concerned with access to radiation therapy services, the distribution of health care resources, and the quality of cancer care

75 FR 13345 - Pricing for Certain 2010 United States Mint Products

Science.gov (United States)

2010-03-19

... DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain 2010 United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint Presidential $1 Coin and First Spouse Medal...

Intergenerational educational mobility in Denmark and the United States

DEFF Research Database (Denmark)

Andrade, Stefan Bastholm; Thomsen, Jens-Peter

2018-01-01

An overall finding in comparative mobility studies is that intergenerational mobility is greater in Scandinavia than in liberal welfare-state countries like the United States and United Kingdom. However, in a recent study, Landersø and Heckman (L & H) (2017) argue that intergenerational educational...... mobility in Denmark and the United States is remarkably similar. L & H’s findings run contrary to widespread beliefs and have been echoed in academia and mass media on both sides of the Atlantic Ocean. In this article, we reanalyze educational mobility in Denmark and the United States using the same data...... sources as L & H. We apply several different methodological approaches from economics and sociology, and we consistently find that educational mobility is higher in Denmark than in the United States....

Toll Facilities in the United States

Data.gov (United States)

Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

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.

State nuclear initiatives in the United States

International Nuclear Information System (INIS)

Strauss, P.L.; Stoiber, C.R.

1977-01-01

The paper deals with State nuclear initiatives regarding the role of nuclear power in the energy future of the United States. The question of whether and under what circumstances nuclear facilities should be used to generate electricity was put to the popular vote in several States in 1976. Some general principles of Federal-State relations are discussed with specific reference to nuclear regulations. The initiative mechanism itself is described as well as its legal form and background. The parallel developments in the State and Federal legislative consideration of nuclear issues is reviewed and the suggested reasons for the defeat of the proposals in the seven States concerned are discussed. Finally, the author draws some conclusions on the effects of the 1976 initiatives on future decision-making in the US on energy policy in general and nuclear power in particular. (NEA) [fr

27 CFR 479.89 - Transfers to the United States.

Science.gov (United States)

2010-04-01

... Transfers to the United States. A firearm may be transferred to the United States or any department... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transfers to the United States. 479.89 Section 479.89 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO...

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.

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.

32 CFR 516.54 - Witnesses for the United States.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Witnesses for the United States. 516.54 Section..., Travel, and Expenses of Witnesses § 516.54 Witnesses for the United States. (a) Status of witness. A military member authorized to appear as a witness for the United States, including those authorized to...

32 CFR 150.21 - Appeals by the United States.

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Appeals by the United States. 150.21 Section 150... the United States. (a) Restricted filing. Only a representative of the government designated by the Judge Advocate General of the respective service may file an appeal by the United States under Article...

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.

United States housing, first quarter 2013

Science.gov (United States)

Delton Alderman

2014-01-01

Provides current and historical information on housing market in the United States. Information includes trends for housing permits and starts, housing under construction, and housing completions for single and multifamily units, and sales and construction. This report will be updated regularly.

Charles Bernard Puestow (1902-1973): American surgeon and commander of the 27th Evacuation Hospital during the Second World War.

Science.gov (United States)

Bosmia, Anand N; Christein, John D

2017-08-01

Dr. Charles Bernard Puestow (1902-1973) was an American surgeon who is well known for developing the longitudinal pancreaticojejunostomy, which is known as the "Puestow procedure" in his honor. Puestow served in the American military during the Second World War and commanded the 27th Evacuation Hospital, which provided medical and surgical services to wounded individuals in Europe and North Africa. In 1946, he founded the surgical residency training program at the Hines Veterans Hospital, which was the first such program in the United States based at a veterans hospital.

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.

An analysis of technical aspects of the arthroscopic Bankart procedure as performed in the United States.

Science.gov (United States)

Burks, Robert T; Presson, Angela P; Weng, Hsin-Yi

2014-10-01

variation in performance of the arthroscopic Bankart repair in the United States. Areas of concern include completeness of the diagnostic examination, the adequacy of capsulolabral mobilization, variation in the use of accessory portals, and inconsistent use of additional capsular or labral plication or fixation. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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.

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 ...

Arsenic in Ground Water of the United States

Science.gov (United States)

... Team More Information Arsenic in groundwater of the United States Arsenic in groundwater is largely the result of ... Gronberg (2011) for updated arsenic map. Featured publications United States Effects of human-induced alteration of groundwater flow ...

Case scheduling preferences of one Surgeon's cataract surgery patients.

Science.gov (United States)

Dexter, Franklin; Birchansky, Lee; Bernstein, James M; Wachtel, Ruth E

2009-02-01

The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery." The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon. The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.

Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications.

Science.gov (United States)

Mehta, Ambar; Xu, Tim; Hutfless, Susan; Makary, Martin A; Sinno, Abdulrahman K; Tanner, Edward J; Stone, Rebecca L; Wang, Karen; Fader, Amanda N

2017-05-01

Hysterectomy is among the most common major surgical procedures performed in women. Approximately 450,000 hysterectomy procedures are performed each year in the United States for benign indications. However, little is known regarding contemporary US hysterectomy trends for women with benign disease with respect to operative technique and perioperative complications, and the association between these 2 factors with patient, surgeon, and hospital characteristics. We sought to describe contemporary hysterectomy trends and explore associations between patient, surgeon, and hospital characteristics with surgical approach and perioperative complications. Hysterectomies performed for benign indications by general gynecologists from July 2012 through September 2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We excluded hysterectomies performed by gynecologic oncologists, reproductive endocrinologists, and female pelvic medicine and reconstructive surgeons. We included both open hysterectomies and those performed by minimally invasive surgery, which included vaginal hysterectomies. Perioperative complications were defined using the Agency for Healthcare Research and Quality patient safety indicators. Surgeon hysterectomy volume during the 2-year study period was analyzed (0-5 cases annually = very low, 6-10 = low, 11-20 = medium, and ≥21 = high). We utilized logistic regression and negative binomial regression to identify patient, surgeon, and hospital characteristics associated with minimally invasive surgery utilization and perioperative complications, respectively. A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; 38.5% underwent a minimally invasive surgery procedure (25.1% robotic, 46.6% laparoscopic, 28.3% vaginal). Most surgeons (68.2%) were very low- or low-volume surgeons. Factors associated with a lower likelihood of undergoing minimally

Physician preference items: what factors matter to surgeons? Does the vendor matter?

Directory of Open Access Journals (Sweden)

Burns LR

2018-01-01

Full Text Available Lawton R Burns,1 Michael G Housman,2 Robert E Booth,3 Aaron M Koenig4 1Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, 2Singularity University, Moffett Field, CA, 33B Orthopaedics, Langhorne, PA, 4Harvard Medical School, Massachusetts General Hospital, Wang Ambulatory Care Center, Boston, MA, USA Background: The USA devotes roughly $200 billion (6% of annual national health expenditures to medical devices. A substantial proportion of this spending occurs during orthopedic (eg, hip and knee arthroplasties – two high-volume hospital procedures. The implants used in these procedures are commonly known as physician preference items (PPIs, reflecting the physician’s choice of implant and vendor used. The foundations for this preference are not entirely clear. This study examines what implant and vendor characteristics, as evaluated by orthopedic surgeons, are associated with their preference. It also examines other factors (eg, financial relationships and vendor tenure that may contribute to implant preference. Methods: We surveyed all practicing orthopedic surgeons performing 12 or more implant procedures annually in the Commonwealth of Pennsylvania. The survey identified each surgeon’s preferred hip/knee vendor as well as the factors that surgeons state they use in selecting that primary vendor. We compared the surgeons’ evaluation of multiple characteristics of implants and vendors using analysis of variance techniques, controlling for surgeon characteristics, hospital characteristics, and surgeon–vendor ties that might influence these evaluations. Results: Physician’s preference is heavily influenced by technology/implant factors and sales/service factors. Other considerations such as vendor reputation, financial relationships with the vendor, and implant cost seem less important. These findings hold regardless of implant type (hip vs knee and specific vendor. Conclusion: Our

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians.

Science.gov (United States)

Skedros, John G; Hunt, Kenneth J; Pitts, Todd C

2007-07-06

Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1) fluorinated vs. non-fluorinated corticosteroids, 2) acetate vs. phosphate types, 3) patient age, and 4) adjustments for special considerations including young athletes and diabetics. 169 (64% response rate, RR) surveys were returned: 105/163 orthopaedic surgeons (64%RR), 44/77 PCSMs/PMRs (57%RR), 20/24 rheumatologists (83%RR). Although corticosteroid doses do not differ significantly between specialties (p > 0.3), anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol(R) (methylprednisolone acetate) and Kenalog(R) (triamcinolone acetonide) are most commonly used. More rheumatologists (80%) were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76%) and orthopaedists (60%). However, relatively fewer rheumatologists (25%) than PCSMs/PMRs (32%) or orthopaedists (32%) knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37% orthopaedists. Nearly 85% use the same

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

Directory of Open Access Journals (Sweden)

Skedros John G

2007-07-01

Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

Enrichment situation outside the United States

International Nuclear Information System (INIS)

Anon.

1979-01-01

Different enrichment technologies are briefly characterized which include gaseous diffusion, which is presently the production mainstay of the United States and France; the gaseous centrifuge which is the production plant for Urenco and the technology for future United States enrichment expansion; the aero-dynamic processes which include the jet nozzle (also known as the Becker process) and the fixed-wall centrifuge (also known as the Helikon process); chemical processes; laser isotope separation processes (also referred to in the literature as LIS); and plasma technology

Impact of Subspecialty Fellowship Training on Research Productivity Among Academic Plastic Surgery Faculty in the United States.

Science.gov (United States)

Sood, Aditya; Therattil, Paul J; Chung, Stella; Lee, Edward S

2015-01-01

The impact of subspecialty fellowship training on research productivity among academic plastic surgeons is unknown. The authors' aim of this study was to (1) describe the current fellowship representation in academic plastic surgery and (2) evaluate the relationship between h-index and subspecialty fellowship training by experience and type. Academic plastic surgery faculty (N = 590) were identified through an Internet-based search of all ACGME-accredited integrated and combined residency programs. Research output was measured by h-index from the Scopus database as well as a number of peer-reviewed publications. The Kruskal-Wallis test, with a subsequent Mann-Whitney U test, was used for statistical analysis to determine correlations. In the United States, 72% (n = 426) of academic plastic surgeons had trained in 1 or more subspecialty fellowship program. Within this cohort, the largest group had completed multiple fellowships (28%), followed by hand (23%), craniofacial (22%), microsurgery (15%), research (8%), cosmetic (3%), burn (2%), and wound healing (0.5%). Higher h-indices correlated with a research fellowship (12.5; P productivity compared with their colleagues. Craniofacial-trained physicians also demonstrated a higher marker for academic productivity than multiple other specialties. In this study, we show that the type and number of fellowships influence the h-index and further identification of such variables may help improve academic mentorship and productivity within academic plastic surgery.

Youth tobacco use in the United States--problem, progress, goals, and potential solutions.

Science.gov (United States)

Glynn, T J; Greenwald, P; Mills, S M; Manley, M W

1993-07-01

Efforts to control tobacco use and tobacco-related morbidity and mortality in the United States continue to be generally successful. In the quarter century since the publication of the first Surgeon General's Report on Tobacco and Health, adult smoking rates in the United States have been reduced by nearly 34%. Controlling tobacco use among our nation's youth, however, has not been as successful. Although there was considerable success in reducing adolescent tobacco use in the late 1970s and early 1980s, tobacco use among youth has remained essentially stable for the past decade. The health and economic burden of tobacco use, current knowledge about youth tobacco use, and youth-related national tobacco reduction goals for the Year 2000 are reviewed. Analysis of the research of the past two decades clearly indicates that there is no "magic bullet" in existence or in sight for the reduction of tobacco use, either among youth or among adults. This does not mean that opportunities for significant advances through, for example, pharmacological therapies or the broad application of media or policy strategies should not continue to be explored, but that for the moment no single approach appears to work best. Rather, a comprehensive approach that applies multiple prevention and cessation strategies simultaneously appears to be most effective in tobacco use control. Among youth, the combination of tobacco control strategies that may work best includes those that involve the family, primary care physicians, and other health professionals such as nurses and dentists; programs that are carried out in schools and/or through the media; and societal approaches such as access and advertising restrictions and increased taxes.

Leading Causes of Death in Females United States

Science.gov (United States)

... and Health Issues at Work Health Equity Leading Causes of Death in Females, United States Recommend on Facebook Tweet ... to current and previous listings for the leading causes of death in females in the United States. Please note ...

Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers.

Science.gov (United States)

O'Reilly, Eamon B; Johnson, Mark D; Rohrich, Rod J

2014-11-01

Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection. A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes. The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons. No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.

33 CFR 2.38 - Waters subject to the jurisdiction of the United States; waters over which the United States has...

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Waters subject to the jurisdiction of the United States; waters over which the United States has jurisdiction. 2.38 Section 2.38 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL JURISDICTION...

Unites States and the oil of the Middle-East

International Nuclear Information System (INIS)

Noel, P.

2005-08-01

The author discusses different aspects of the United States intervention and behavior in the Middle-East petroleum management. The Iraq and Iran potentials are largely under used. The Saudi Arabia defines its own oil policy, but benefits of the Unites States military help. The United States intervention is in the domain of the security of flux on the world market. (A.L.B.)

Food irradiation in the United States

International Nuclear Information System (INIS)

Pauli, G.H.

1991-01-01

Since 1963, some irradiated foods have been permitted for sale in the United States. Yet, at this time, commercial application has been limited to irradiation of a relatively small fraction of the spices and seasonings used as ingredients in other foods. The current situation regarding irradiated foods in the United States and how it developed is discussed. The author writes from experience gained as a Government regulator concerned primarily with ensuring safety of food and therefore this is stressed together with the crucial role played by consumers and industry. (author)

The medicolegal landscape of spine surgery: how do surgeons fare?

Science.gov (United States)

Makhni, Melvin C; Park, Paul J; Jimenez, Jesus; Saifi, Comron; Caldwell, Jon-Michael; Ha, Alex; Figueroa-Santana, Bianca; Lehman, Ronald A; Weidenbaum, Mark

2018-02-01

Because of the limited and confidential nature of most legal data, scarce literature is available to physicians about reasons for litigation in spine surgery. To optimally compensate patients while protecting physicians, further understanding of the medicolegal landscape is needed for high-risk procedures such as spine surgery. Based on these, surgeons can explore ways to better protect both their patients and themselves. To characterize the current medicolegal environment of spine surgery by analyzing a recent dataset of malpractice litigation. A retrospective study. All malpractice cases involving spine surgery available to public query between the years of 2010 and 2014. Case outcome for spine surgery malpractice cases between the years of 2010 and 2014. WestlawNext was used to analyze spine surgery malpractice cases at the state and federal level between the years 2010 and 2014. WestlawNext is a subscription-based, legal search engine that contains publicly available federal and state court records. All monetary values were inflation adjusted for 2016. One hundred three malpractice cases were categorized by case descriptors and outcome measures. Claims were categorized as either intraoperative complaints or preoperative complaints. Rulings in favor of the defendant (surgeon) were noted in 75% (77 of 103) of the cases. Lack of informed consent was cited in 34% of cases. For the 26 cases won by the plaintiff, the average amount in settlement was $2,384,775 versus $3,945,456 in cases brought before a jury. Cases involving consent averaged a compensation of $2,029,884, whereas cases involving only intraoperative complaints averaged a compensation of $3,667,530. A significant correlation was seen between increased compensation for plaintiffs and cases involving orthopedic surgeons (p=.020) or nerve injury (p=.005). Wrong-level surgery may be associated with lower plaintiff compensation (p=.055). The length of cases resulting in defense verdicts averaged 5.51 years

Job satisfaction among young board-certified surgeons at academic centers in Europe and North America.

Science.gov (United States)

Raptis, Dimitri Aristotle; Schlegel, Andrea; Tschuor, Christoph; Clavien, Pierre-Alain

2012-11-01

To identify independent factors influencing job satisfaction of academic surgeons within their first 10 years after board certification. Job satisfaction is increasingly recognized as a crucial factor for high performance of individuals and teams in most organizations. Sophisticated tools are now available to assess job satisfaction in medicine. A survey among 439 faculty surgeons from 16 European countries, United States, and Canada was conducted in 2011. Satisfaction at work was analyzed using the validated Global Job Satisfaction (GJS) instrument (score range, -36 to +36), modified to an extended version (eGJS) (score range, -87 to +87) covering additional personal and environmental factors. Independent factors were identified with multiple logistic regression analysis. Response rate was high at 59% (439/744). Median age of responders was 39 years, with 17% women. North American surgeons scored higher on the eGJS when compared with Europeans (median: 21 vs. 33, respectively, P job satisfaction included protected time for research (odds ratio [OR]: 9), good team relationship (OR: 7), female sex (OR: 5), having a partner (OR: 4), feeling enthusiastic about work (OR: 4), being pleased with life accomplishments (OR: 4), having the standard of living one deserves (OR: 3), and clinical autonomy (OR: 3). In contrast, independent predictors of poor job satisfaction were feeling frustrated by work (ie, a burnout item) (OR: 37), worrying about personal life at work (OR: 3), and having to work too many weekends (OR: 3). Satisfaction in young faculty members mostly relates to research opportunities, clinical autonomy, burnout, and lifestyle. Understanding satisfaction factors may improve productivity and competence.

Surgeons without borders: a brief history of surgery at Médecins Sans Frontières.

Science.gov (United States)

Chu, Kathryn; Rosseel, Peter; Trelles, Miguel; Gielis, Pierre

2010-03-01

Médecins Sans Frontières (MSF) is a humanitarian organization that performs emergency and elective surgical services in both conflict and non-conflict settings in over 70 countries. In 2006 MSF surgeons departed on approximately 125 missions, and over 64,000 surgical interventions were carried out in some 20 countries worldwide. Historically, the majority of MSF surgical projects began in response to conflicts or natural disasters. During an emergency response, MSF has resources to set up major operating facilities within 48 h in remote areas. One of MSF strengths is its supply chain. Large pre-packaged surgical kits, veritable "operating theatres to go," can be readied in enormous crates and quickly loaded onto planes. In more stable contexts, MSF has also strengthened the delivery of surgical services within a country's public health system. The MSF surgeon is the generalist in the broadest sense and performs vascular, obstetrical, orthopaedic, and other specialized surgical procedures. The organization aims to provide surgical services only temporarily. When there is a decrease in acute needs a program will be closed, or more importantly, turned over to the Ministry of Health or another non-governmental organization. The long-term solution to alleviating the global burden of surgical disease lies in building up a domestic surgical workforce capable of responding to the major causes of surgery-related morbidity and mortality. However, given that even countries with the resources of the United States suffer from an insufficiency of surgeons, the need for international emergency organizations to provide surgical assistance during acute emergencies will remain for the foreseeable future.

The State Geologic Map Compilation (SGMC) geodatabase of the conterminous United States

Science.gov (United States)

Horton, John D.; San Juan, Carma A.; Stoeser, Douglas B.

2017-06-30

The State Geologic Map Compilation (SGMC) geodatabase of the conterminous United States (https://doi. org/10.5066/F7WH2N65) represents a seamless, spatial database of 48 State geologic maps that range from 1:50,000 to 1:1,000,000 scale. A national digital geologic map database is essential in interpreting other datasets that support numerous types of national-scale studies and assessments, such as those that provide geochemistry, remote sensing, or geophysical data. The SGMC is a compilation of the individual U.S. Geological Survey releases of the Preliminary Integrated Geologic Map Databases for the United States. The SGMC geodatabase also contains updated data for seven States and seven entirely new State geologic maps that have been added since the preliminary databases were published. Numerous errors have been corrected and enhancements added to the preliminary datasets using thorough quality assurance/quality control procedures. The SGMC is not a truly integrated geologic map database because geologic units have not been reconciled across State boundaries. However, the geologic data contained in each State geologic map have been standardized to allow spatial analyses of lithology, age, and stratigraphy at a national scale.

Current Cigarette Smoking Among Adults - United States, 2016.

Science.gov (United States)

Jamal, Ahmed; Phillips, Elyse; Gentzke, Andrea S; Homa, David M; Babb, Stephen D; King, Brian A; Neff, Linda J

2018-01-19

The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products (1). Cigarettes are the most commonly used tobacco product among U.S. adults, and about 480,000 U.S. deaths per year are caused by cigarette smoking and secondhand smoke exposure (1). To assess progress toward the Healthy People 2020 target of reducing the proportion of U.S. adults aged ≥18 years who smoke cigarettes to ≤12.0% (objective TU-1.1),* CDC analyzed data from the 2016 National Health Interview Survey (NHIS). In 2016, the prevalence of current cigarette smoking among adults was 15.5%, which was a significant decline from 2005 (20.9%); however, no significant change has occurred since 2015 (15.1%). In 2016, the prevalence of cigarette smoking was higher among adults who were male, aged 25-64 years, American Indian/Alaska Native or multiracial, had a General Education Development (GED) certificate, lived below the federal poverty level, lived in the Midwest or South, were uninsured or insured through Medicaid, had a disability/limitation, were lesbian, gay, or bisexual (LGB), or had serious psychological distress. During 2005-2016, the percentage of ever smokers who quit smoking increased from 50.8% to 59.0%. Proven population-based interventions are critical to reducing the health and economic burden of smoking-related diseases among U.S. adults, particularly among subpopulations with the highest smoking prevalences (1,2).

Exporting Rambutan to United States: One Reality?

International Nuclear Information System (INIS)

Ahmad Zainuri Mohd Dzomir; Zainon Othman; Mohd Sidek Othman

2011-01-01

Rambutan is a one of commodity that are passed by United States of America authority to be market in that states. The main condition for the approval is the exporter must use irradiation technology as quarantine treatment to monitor the insects in there. United States of America's Agriculture Department (USDA-APHIS) has make early survey to the facilities involved in exporting process chain to overview Malaysia preparedness for this purpose. This paper work will discussed the possibility of this exporting implemented based on conditions rule by the USDA. (author)

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.

Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

Science.gov (United States)

Keller, Robert A; Moutzouros, Vasilios; Dines, Joshua S; Bush-Joseph, Charles A; Limpisvasti, Orr

Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States. Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery. Survey. Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis. Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation. Half of all sports medicine fellowship-trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol

Surgeon-tool force/torque signatures--evaluation of surgical skills in minimally invasive surgery.

Science.gov (United States)

Rosen, J; MacFarlane, M; Richards, C; Hannaford, B; Sinanan, M

1999-01-01

The best method of training for laparoscopic surgical skills is controversial. Some advocate observation in the operating room, while others promote animal and simulated models or a combination of surgical related tasks. The mode of proficiency evaluation common to all of these methods has been subjective evaluation by a skilled surgeon. In order to define an objective means of evaluating performance, an instrumented laparoscopic grasper was developed measuring the force/torque at the surgeon hand/tool interface. The measured database demonstrated substantial differences between experienced and novice surgeon groups. Analyzing forces and torques combined with the state transition during surgical procedures allows an objective measurement of skill in MIS. Teaching the novice surgeon to limit excessive loads and improve movement efficiency during surgical procedures can potentially result in less injury to soft tissues and less wasted time during laparoscopic surgery. Moreover the force/torque database measured in this study may be used for developing realistic virtual reality simulators and optimization of medical robots performance.

Wheat rusts in the United States in 2016

Science.gov (United States)

In 2016, wheat stripe rust caused by Puccinia striiformis f. sp. graminis was widespread throughout the United States. Cool temperatures and abundant rainfall in the southern Great Plains allowed stripe rust to become widely established and spread throughout the Great Plains and eastern United State...

Oral and maxillofacial surgeons' role in the first successful modified osteo-odonto-keratoprosthesis performed in the United States.

Science.gov (United States)

Sawatari, Yoh; Perez, Victor L; Parel, Jean-Marie; Alfonso, Eduardo; Falcinelli, Giancarlo; Falcinelli, Johnny; Marx, Robert E

2011-06-01

Corneal disease constitutes the second most common cause of blindness and often leads to corneal damage or scarring. Several corneal scarring is a complex and difficult condition for ophthalmologists to manage. In the most severe cases, the scarring is accompanied by excessive dryness and keratinization of the ocular surface. Certain etiologies, including Stevens-Johnson syndrome, cicatricial pemphigoid, Lyell's syndrome, and chemical trauma to the surface of the eye, are responsible for the most severe cases. Traditional allogeneic corneal transplantation is not effective because of the significant scarring and dryness of the eye. To allow light and images to be focused on the retina, a keratoprosthesis is required to position a lens on the surface of the eye. One of the oldest and most effective types of keratoprosthesis, the osteo-odonto-keratoprosthesis (OOKP), was first described and documented in 1963 by Strampelli and subsequently modified by Falcinelli et al. The modified OOKP (MOOKP) is a unique prosthesis consisting of a lens fabricated from a polymethylmethacrylate (PMMA) cylinder and cemented to an autogenous graft composed of tooth and bone, traditionally termed the osteo-odonto lamina. In this context, lamina refers to a thin rectangular plate of tooth and bone (Fig 1). The MOOKP involves 4 procedures performed in 3 surgical stages. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

United States National Seismographic Network

International Nuclear Information System (INIS)

Buland, R.

1993-09-01

The concept of a United States National Seismograph Network (USNSN) dates back nearly 30 years. The idea was revived several times over the decades. but never funded. For, example, a national network was proposed and discussed at great length in the so called Bolt Report (U. S. Earthquake Observatories: Recommendations for a New National Network, National Academy Press, Washington, D.C., 1980, 122 pp). From the beginning, a national network was viewed as augmenting and complementing the relatively dense, predominantly short-period vertical coverage of selected areas provided by the Regional Seismograph Networks (RSN's) with a sparse, well-distributed network of three-component, observatory quality, permanent stations. The opportunity finally to begin developing a national network arose in 1986 with discussions between the US Geological Survey (USGS) and the Nuclear Regulatory Commission (NRC). Under the agreement signed in 1987, the NRC has provided $5 M in new funding for capital equipment (over the period 1987-1992) and the USGS has provided personnel and facilities to develop. deploy, and operate the network. Because the NRC funding was earmarked for the eastern United States, new USNSN station deployments are mostly east of 105 degree W longitude while the network in the western United States is mostly made up of cooperating stations (stations meeting USNSN design goals, but deployed and operated by other institutions which provide a logical extension to the USNSN)

Structure, Process, and Culture of Intensive Care Units Treating Patients with Severe Traumatic Brain Injury: Survey of Centers Participating in the American College of Surgeons Trauma Quality Improvement Program.

Science.gov (United States)

Alali, Aziz S; McCredie, Victoria A; Mainprize, Todd G; Gomez, David; Nathens, Avery B

2017-10-01

Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI. One hundred forty-two TMDs (76%) completed the survey. Severe TBI patients are admitted to dedicated neurocritical care units in 52 hospitals (37%), trauma ICUs in 44 hospitals (31%), general ICUs in 34 hospitals (24%), and surgical ICUs in 11 hospitals (8%). Fifty-seven percent are closed units. Board-certified intensivists directed 89% of ICUs, whereas 17% were led by neurointensivists. Sixty percent of ICU directors were general surgeons. Thirty-nine percent of hospitals had critical care fellowships and 11% had neurocritical care fellowships. Fifty-nine percent of ICUs had standard order sets and 61% had standard protocols specific for TBI, with the most common protocol relating to intracranial pressure management (53%). Only 43% of TMDs were satisfied with the current level of neurosurgeons' engagement in the ICU management of TBI; 46% believed that neurosurgeons should be more engaged; 11% believed they should be less engaged. In the largest survey of North American ICUs caring for TBI patients, there is substantial variation in the current approaches to ICU care for TBI, highlighting multiple opportunities for comparative effectiveness research.

37 CFR 1.413 - The United States International Searching Authority.

Science.gov (United States)

2010-07-01

... Processing Provisions General Information § 1.413 The United States International Searching Authority. (a... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false The United States International Searching Authority. 1.413 Section 1.413 Patents, Trademarks, and Copyrights UNITED STATES PATENT...

United States Attorney Prosecutions

Science.gov (United States)

1993-10-01

property of CocaCola Bottling Company, Fayetteville, North Carolina, of a value in excess of $100.00, in violation of Title 18 United States Code, Section...another, to-wit: a Cocacola soft drink machine, the amount of damage to said personal property being more than $200.00, in violation of North Carolina

77 FR 48542 - United States

Science.gov (United States)

2012-08-14

... litigation.'' United States v. Armour and Co., 402 U.S. 673, 681 (1971). Section 5 of the Clayton Act... relief in consent judgment that contained recitals in which defendants asserted their innocence); Armour...

United States Strategy for Mexico

National Research Council Canada - National Science Library

Centner, Robert C

2005-01-01

The security and stability of Mexico is of national interest to the United States, and a strong, effective alliance between the two countries is pivotal to our national defense strategy and economic prosperity...

Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

International Nuclear Information System (INIS)

Jagsi, Reshma; Abrahamse, Paul; Morrow, Monica; Hamilton, Ann S.; Graff, John J.; Katz, Steven J.

2012-01-01

Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

Energy Technology Data Exchange (ETDEWEB)

Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Abrahamse, Paul [Department of Internal Medicine, University of Michigan, Ann Arbor, MI (United States); Morrow, Monica [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hamilton, Ann S. [Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA (United States); Graff, John J. [Department of Radiation Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Katz, Steven J. [Department of Internal Medicine, Division of General Medicine and Department of Health Management and Policy, School of Public Health, University of Michigan Health System, Ann Arbor, MI (United States)

2012-04-01

Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

Dr. Congeniality: Understanding the Importance of Surgeons' Nontechnical Skills Through 360° Feedback.

Science.gov (United States)

Lanz, Julie J; Gregory, Paul J; Menendez, Mariano E; Harmon, Larry

2018-01-17

Physician performance is a complex construct that is broadly defined by technical and nontechnical components. The primary aim of this study was to identify which Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, and emotional stability) in surgeons were related to patient satisfaction and teamwork performance in a surgical setting. A secondary aim of this study was to examine the specific perceptions of physician behavior related to patient satisfaction and teamwork performance. Orthopedic surgeons received anonymous multisource 360° feedback from managers, colleagues, nurses, technicians, and trainees. Personality traits were categorized with a modified Delphi Consensus technique using the Big Five framework. Patient satisfaction was measured using retrospective Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS) data. Teamwork performance was measured using the Quality PULSE 360 Teamwork Index. Research was performed at a large academic medical center in the northeastern United States. Participants in this study included a sample of 24 orthopedic surgeons. Backward stepwise regressions were used to determine which model with the most variance used the fewest explanatory variables. Personality traits acted as predictor variables in the regression models and patient satisfaction and teamwork performance were utilized as outcome variables. The higher the physicians' emotional stability, the higher patients' overall satisfaction (β = 0.41, p = 0.04) and willingness to recommend them to other patients (β = 0.45, p = 0.03). Furthermore, high emotional stability was related to effective surgical teams as rated by team members (β = -0.75, p = 0.00) such that the more emotionally stable physicians were, the higher their teamwork rating by colleagues. Both physicians-in-training and in-practice physicians may benefit from engaging in empathic and constructive behaviors with patients and team members

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.

NCHS - Injury Mortality: United States

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset describes injury mortality in the United States beginning in 1999. Two concepts are included in the circumstances of an injury death: intent of injury...

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.

Both Europe's and the United States' electrification

International Nuclear Information System (INIS)

Matly, M.

2006-01-01

While the United States quickly had the largest electrical indus in the world, electrification in rural areas ended about thirty years after most European countries. Public intervention is a deciding factor in completing electrification, and the late involvement by the American authorities explains the gap. However it would be wrong to oppose in Europe and in the United States a motivated public sector and little involved private companies. In both continents indeed, major private and public urban distributors were almost not involved in rural electrification processes, where local players prevailed: local communities around Europe, small and medium size business in some European countries such as France, co-operative companies in the United States. Additionally, there is an essential difference between electrification in Europe and in the United States. The former does not provide much more than lighting and its success leaves few traces in popular memories; the latter includes many facilities and services, changes the lives of rural populations and is celebrated a such. Whereas the colonial venture keep European economies away from their domestic markets, while in the United States the urban market growth contents large companies, the American co-operative movement is right to believe in the existence of a large electrical equipment market among farmers then considered poor and behind. It even uses the market to complete a more profitable and less costly electrification. Electricity stories that offer food for the thoughts of Third World decision makers and power companies, when they entrust most rural electrification to their large urban companies and deny the existence of a real equipment market in their own rural world. (author)

Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State.

Science.gov (United States)

Kashanian, James A; Golan, Ron; Sun, Tianyi; Patel, Neal A; Lipsky, Michael J; Stahl, Peter J; Sedrakyan, Art

2018-02-01

Penile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade. To investigate trends in PP surgery and factors affecting the choice of different PPs in New York State. This study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study. Influence of patient demographics, surgeon volume, and hospital volume on type of PP inserted. Since 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection. During the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data. Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245-250. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Asian Immigration: The View from the United States.

Science.gov (United States)

Gardner, Robert W.

1992-01-01

Examines contemporary Asian immigration to the United States from a U.S. perspective. Analyzes immigration policies and data on recent immigration from Asia. Discusses impacts concerning the United States and the immigrants themselves and speculates on future immigration. The composition of Asian immigration might change, and the number might…

26 CFR 1.956-2 - Definition of United States property.

Science.gov (United States)

2010-04-01

..., which is— (i) Tangible property (real or personal) located in the United States; (ii) Stock of a... year ending June 30, 1964, R Corporation's increase in earnings invested in United States property for... United States property during its taxable year 1965, S Corporation's increase in earnings invested in...

Licensed pertussis vaccines in the United States: History and current state

OpenAIRE

Klein, Nicola P

2014-01-01

The United States switched from whole cell to acellular pertussis vaccines in the 1990s following global concerns with the safety of the whole cell vaccines. Despite high levels of acellular pertussis vaccine coverage, the United States and other countries are experiencing large pertussis outbreaks. The aim of this article is to describe the historical context which led to acellular pertussis vaccine development, focusing on vaccines currently licensed in the US, and to review evidence that w...

Nations United: The United Nations, the United States, and the Global Campaign Against Terrorism. A Curriculum Unit & Video for Secondary Schools.

Science.gov (United States)

Houlihan, Christina; McLeod, Shannon

This curriculum unit and 1-hour videotape are designed to help students understand the purpose and functions of the United Nations (UN) and explore the relationship between the United Nations and the United States. The UN's role in the global counterterrorism campaign serves as a case study for the unit. The students are asked to develop a basic…

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.

Estimated United States Transportation Energy Use 2005

Energy Technology Data Exchange (ETDEWEB)

Smith, C A; Simon, A J; Belles, R D

2011-11-09

A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.

United States of America National Report

International Nuclear Information System (INIS)

1992-01-01

The United States has produced this report as part of the preparations for the United Nations Conference on Environment and Development (UNCED) to be held in Brazil in June 1992. It summarizes this nation's efforts to protect and enhance the quality of the human environment in concert with its efforts to provide economic well-being during the two decades since the United Nations Conference on the Human Environment was held in Stockholm. The information presented in this report is primarily and deliberately retrospective. It is an attempt to portray the many human, economic and natural resources of the United States, to describe resource use and the principal national laws and programs established to protect these resources, and to analyze key issues on the agenda of UNCED. This analysis is presented in terms of past and present conditions and trends, measures of progress made in responding to the key issues, and a summary of government activities, underway or pending, to address ongoing or newly emerging national environmental and resource management problems

African Journals Online: United States Minor Outlying Islands

African Journals Online (AJOL)

African Journals Online: United States Minor Outlying Islands. Home > African Journals Online: United States Minor Outlying Islands. 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 ...

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.

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 ...

Refugee Status Required for Resettlement in the United States

Science.gov (United States)

2017-06-09

STATES REFUGEE ADMISSIONS PROGRAM FLOWCHART ...the American public’s concerns. 50 APPENDIX A UNITED STATES REFUGEE ADMISSIONS PROGRAM FLOWCHART Source: US Citizenship and Immigration...TITLE AND SUBTITLE Refugee Status Required for Resettlement in the United States 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT

Does Formal Research Training Lead to Academic Success in Plastic Surgery? A Comprehensive Analysis of U.S. Academic Plastic Surgeons.

Science.gov (United States)

Lopez, Joseph; Ameri, Afshin; Susarla, Srinivas M; Reddy, Sashank; Soni, Ashwin; Tong, J W; Amini, Neda; Ahmed, Rizwan; May, James W; Lee, W P Andrew; Dorafshar, Amir

2016-01-01

It is currently unknown whether formal research training has an influence on academic advancement in plastic surgery. The purpose of this study was to determine whether formal research training was associated with higher research productivity, academic rank, and procurement of extramural National Institutes of Health (NIH) funding in plastic surgery, comparing academic surgeons who completed said research training with those without. This was a cross-sectional study of full-time academic plastic surgeons in the United States. The main predictor variable was formal research training, defined as completion of a postdoctoral research fellowship or attainment of a Doctor of Philosophy (PhD). The primary outcome was scientific productivity measured by the Hirsh-index (h-index, the number of publications, h that have at least h citations each). The secondary outcomes were academic rank and NIH funding. Descriptive, bivariate, and multiple regression statistics were computed. A total of 607 academic surgeons were identified from 94 Accreditation Council for Graduate Medical Education-accredited plastic surgery training programs. In all, 179 (29.5%) surgeons completed formal research training. The mean h-index was 11.7 ± 9.9. And, 58 (9.6%) surgeons successfully procured NIH funding. The distribution of academic rank was the following: endowed professor (5.4%), professor (23.9%), associate professor (23.4%), assistant professor (46.0%), and instructor (1.3%). In a multiple regression analysis, completion of formal research training was significantly predictive of a higher h-index and successful procurement of NIH funding. Current evidence demonstrates that formal research training is associated with higher scientific productivity and increased likelihood of future NIH funding. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Predictors of Donor Heart Utilization for Transplantation in United States.

Science.gov (United States)

Trivedi, Jaimin R; Cheng, Allen; Gallo, Michele; Schumer, Erin M; Massey, H Todd; Slaughter, Mark S

2017-06-01

Optimum use of donor organs can increase the reach of the transplantation therapy to more patients on waiting list. The heart transplantation (HTx) has remained stagnant in United States over the past decade at approximately 2,500 HTx annually. With the use of the United Network of Organ Sharing (UNOS) deceased donor database (DCD) we aimed to evaluate donor factors predicting donor heart utilization. UNOS DCD was queried from 2005 to 2014 to identify total number of donors who had at least one of their organs donated. We then generated a multivariate logistic regression model using various demographic and clinical donor factors to predict donor heart use for HTx. Donor hearts not recovered due to consent or family issues or recovered for nontransplantation reasons were excluded from the analysis. During the study period there were 80,782 donors of which 23,606 (29%) were used for HTx, and 38,877 transplants (48%) were not used after obtaining consent because of poor organ function (37%), donor medical history (13%), and organ refused by all programs (5%). Of all, 22,791 donors with complete data were used for logistic regression (13,389 HTx, 9,402 no-HTx) which showed significant predictors of donor heart use for HTx. From this model we assigned probability of donor heart use and identified 3,070 donors with HTx-eligible unused hearts for reasons of poor organ function (28%), organ refused by all programs (15%), and recipient not located (9%). An objective system based on donor factors can predict donor heart use for HTx and may help increase availability of hearts for transplantation from existing donor pool. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Latin America and the United States: What Do United States History Textbooks Tell Us?

Science.gov (United States)

Fleming, Dan B.

1982-01-01

Evaluates how U.S.-Latin American relations are presented in high school U.S. history textbooks. An examination of 10 textbooks published between 1977-81 revealed inadequate coverage of Latin American cultural diversity and United States foreign policy from the Latin American perspective. (AM)

Preparation of School Psychologists in the United States

Science.gov (United States)

Joyce-Beaulieu, Diana; Rossen, Eric

2014-01-01

School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

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

An individual's face undergoes numerous changes throughout life. Since mid-face aesthetic units are key areas for rejuvenation procedures, their comprehensive assessment is essential for the development of any aesthetic management plan. Despite the availability of many evaluation criteria for treatment of mid-face ageing, there are discrepancies existing in both assessment and management approaches. The goal of this study was to determine if there are any identifiable profiles of clinical judgements and approaches related to the level of surgeon's experience. Forty seven standardised non-digital and not altered natural size photographic images of patients' faces (front and profile) were presented to eight senior board certified plastic surgeons, eight junior non-board certified plastic surgeons and eight plastic surgery residents from an independent program. Surveyed physicians were 'blinded' from each other and asked to assess five different major features characterising ageing mid-face. An interclass correlation data analysis was performed and the Cronbach coefficient alpha values were computed for each category. Responses obtained from senior plastic surgeons were consistently characterised by higher Cronbach coefficient alpha values indicating higher concordance. The highest agreement levels were obtained for the assessment of rhytids and jowls across all groups and the lowest agreement levels were obtained for the assessment and recommendation of upper lip management. This study illustrated that discrepancies in clinical assessments and surgical management exist among surgeons involved in the aesthetic surgery of the mid-face ageing. It appears that the level of surgeon's experience significantly impacts the inter-rater reliability and consensus in assessment and treatment of mid-face ageing. The most senior plastic surgeons' assessment and recommendations had the highest level of concordance while the junior non-board certified plastic surgeons and the

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.

United States position on severe accidents

International Nuclear Information System (INIS)

Ross, D.F.

1988-01-01

The United States policy on severe accidents was published in 1985 for both new plant applications and for existing plants. Implementation of this policy is in progress. This policy, aided by a related safety goal policy and by analysis capabilities emerging from improved understanding of accident phenomenology, is viewed as a logical development from the pioneering work in the WASH-1400 Reactor Safety Study published by the United States Nuclear Regulatory Commission (NRC) in 1975. This work provided an estimate of the probability and consequences of severe accidents which, prior to that time, had been mostly evaluated by somewhat arbitrary assumptions dating back 30 years. The early history of severe accident evaluation is briefly summarized for the period 1957-1979. Then, the galvanizing action of Three Mile Island Unit 2 (TMI-2) on severe accident analysis, experimentation and regulation is reviewed. Expressions of US policy in the form of rulemaking, severe accident policy, safety research, safety goal policy and court decisions (on adequacy of safety) are discussed. Finally, the NRC policy as of March 1988 is stated, along with a prospective look at the next few years. (author). 19 refs

Understanding human trafficking in the United States.

Science.gov (United States)

Logan, T K; Walker, Robert; Hunt, Gretchen

2009-01-01

The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.

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.

42 CFR 410.175 - Alien absent from the United States.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Alien absent from the United States. 410.175... Alien absent from the United States. (a) Medicare does not pay Part B benefits for services furnished to... during the first full calendar month the alien is back in the United States. [53 FR 6634, Mar. 2, 1988] ...

Project Muskan : Social responsibility of the plastic surgeon

Directory of Open Access Journals (Sweden)

Bhatt Yogesh

2008-01-01

Full Text Available Although exact statistics are not available, Indian plastic surgeons see around 7,00,000-8,00,000 burn admissions annually with around 10,00,000 cleft patients yet to be operated. In spite of this voluminous load, India does not have national health programs for the various deformities Indian plastic surgeons typically treat. As Plastic Surgeons, it is our social responsibility to treat these patients and bring ′ muskan ′ (smile in Hindi back into their lives. Project Muskan was initiated as an innovative model for targeting these patients and is probably one of its kind in the field of plastic surgery in our country. It is unique because it is a perfect collaboration of government institutions, a Non Government Organization (NGO, and cooperative sectors providing free health care at the doorstep. Identification of the patients was done with the help of the extensive milk dairy network in the state of Gujarat. Provision of transport and other facilities was done by the NGOs and quality health care provision was taken care of by the government hospital. Project Muskan started from a single village but now covers around 3000 villages and tribal areas of Gujarat. It is a system that can be easily reproducible in all hospitals and has reestablished the faith of the common man in government institutes.

Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume.

Science.gov (United States)

Saraidaridis, Julia T; Hashimoto, Daniel A; Chang, David C; Bordeianou, Liliana G; Kunitake, Hiroko

2018-03-01

General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume. The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models. Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p accounting for hospital and surgeon volume.

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position.

Science.gov (United States)

Youssef, Yassar; Lee, Gyusung; Godinez, Carlos; Sutton, Erica; Klein, Rosemary V; George, Ivan M; Seagull, F Jacob; Park, Adrian

2011-07-01

This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize. Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for

Inventory of power plants in the United States. [By state within standard Federal Regions, using county codes

Energy Technology Data Exchange (ETDEWEB)

None

1977-12-01

The purpose of this inventory of power plants is to provide a ready reference for planners whose focus is on the state, standard Federal region, and/or national level. Thus the inventory is compiled alphabetically by state within standard Federal regions. The units are listed alphabetically within electric utility systems which in turn are listed alphabetically within states. The locations are identified to county level according to the Federal Information Processing Standards Publication Counties and County Equivalents of the States of the United States. Data compiled include existing and projected electrical generation units, jointly owned units, and projected construction units.

Norovirus in the United States

Centers for Disease Control (CDC) Podcasts

2013-09-09

Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States.  Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/17/2013.

Fragmentation of Continental United States Forests

Science.gov (United States)

Kurt H. Riitters; James D. Wickham; Robert V. O' Neill; K. Bruce Jones; Elizabeth R. Smith; John W. Coulston; Timothy G. Wade; Jonathan H. Smith

2002-01-01

We report a multiple-scale analysis of forest fragmentation based on 30-m (0.09 ha pixel-1) land- cover maps for the conterminous United States. Each 0.09-ha unit of forest was classified according to fragmentation indexes measured within the surrounding landscape, for five landscape sizes including 2.25, 7.29, 65.61, 590.49, and 5314.41 ha....

Trial by jury in the United States

Directory of Open Access Journals (Sweden)

Lochhead Robert

2015-10-01

Full Text Available Th e Republic of Moldova is considering the adoption of trial by jury in select criminal cases. Th e following article is intended to contribute to the discussion of that proposal. Th e article will briefl y describe the history of juries under the English common law and as adopted by the United States. It will then outline some of the basic procedures in trials by jury as currently practiced in the United States federal court system.

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.

CEDAW in the Eyes of the United States

Directory of Open Access Journals (Sweden)

Al Shraideh Saleh

2017-12-01

Full Text Available Despite the large number of reservations registered by Member countries, making it one of the, if not the, most heavily reserved human rights treaties; the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW has managed to achieve a very high rate of states’ membership [1]. Currently, 187 countries out of the 193 United Nations Members are parties to CEDAW [2]. What is strange to digest, however, is the fact that the United States is one of the seven countries that are yet to ratify the Convention [3]. This article provides an insight into the position of the United States from the ratification of CEDAW. It examines the merits of arguments made for and against the ratification and their rationale to provide a better understanding that explains what is considered by many as a buzzling stand of the United States from the Convention.

Global context for the United States Forest Sector in 2030

Science.gov (United States)

James Turner; Joseph Buongiorno; Shushuai Zhu; Jeffrey P. Prestemon

2005-01-01

The purpose of this study was to identify markets for, and competitors to, the United States forest industries in the next 30 years. The Global Forest Products Model was used to make predictions of international demand, supply, trade, and prices, conditional on the last RPA Timber Assessment projections for the United States. It was found that the United States, Japan...

A functional intranet for the United States Coast Guard Unit

OpenAIRE

Hannah, Robert Todd.

1998-01-01

Approved for public release; distribution in unlimited. This thesis describes the complete development process of a friendly functional Intranet for an operational United States Coast Guard (USCG) electronic Support Unit (ESU) in Alameda, California. The final product is suitable for immediate use. It may also be used as a prototype for future Intranet development efforts. The methodology used to develop a finished, working product provides the core subject matter for this thesis. The disc...

Residency training in the United States: What foreign medical ...

African Journals Online (AJOL)

FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past ...

The state of amphibians in the United States

Science.gov (United States)

Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.

2012-01-01

More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.

Inventory of power plants in the United States, 1993

International Nuclear Information System (INIS)

1994-12-01

The Inventory of Power Plants in the United States is prepared annually by the Survey Management Division, Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA), U.S. Department of Energy (DOE). The purpose of this publication is to provide year-end statistics about electric generating units operated by electric utilities in the United States (the 50 States and the District of Columbia). The publication also provides a 10-year outlook of future generating unit additions. Data summarized in this report are useful to a wide audience including Congress, Federal and State agencies, the electric utility industry, and the general public. Data presented in this report were assembled and published by the EIA to fulfill its data collection and dissemination responsibilities as specified in the Federal Energy Administration Act of 1974 (Public Law 93-275) as amended

Inventory of power plants in the United States, 1993

Energy Technology Data Exchange (ETDEWEB)

1994-12-01

The Inventory of Power Plants in the United States is prepared annually by the Survey Management Division, Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA), U.S. Department of Energy (DOE). The purpose of this publication is to provide year-end statistics about electric generating units operated by electric utilities in the United States (the 50 States and the District of Columbia). The publication also provides a 10-year outlook of future generating unit additions. Data summarized in this report are useful to a wide audience including Congress, Federal and State agencies, the electric utility industry, and the general public. Data presented in this report were assembled and published by the EIA to fulfill its data collection and dissemination responsibilities as specified in the Federal Energy Administration Act of 1974 (Public Law 93-275) as amended.

Use of Internet Search Data to Monitor Rotavirus Vaccine Impact in the United States, United Kingdom, and Mexico.

Science.gov (United States)

Shah, Minesh P; Lopman, Benjamin A; Tate, Jacqueline E; Harris, John; Esparza-Aguilar, Marcelino; Sanchez-Uribe, Edgar; Richardson, Vesta; Steiner, Claudia A; Parashar, Umesh D

2018-02-19

Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine. We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions. There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction. Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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...

Licensed pertussis vaccines in the United States. History and current state.

Science.gov (United States)

Klein, Nicola P

2014-01-01

The United States switched from whole cell to acellular pertussis vaccines in the 1990s following global concerns with the safety of the whole cell vaccines. Despite high levels of acellular pertussis vaccine coverage, the United States and other countries are experiencing large pertussis outbreaks. The aim of this article is to describe the historical context which led to acellular pertussis vaccine development, focusing on vaccines currently licensed in the US, and to review evidence that waning protection following licensed acellular pertussis vaccines have been significant factors in the widespread reappearance of pertussis.

The United States initiative for international radioactive source management (ISRM)

International Nuclear Information System (INIS)

Naraine, N.; Karhnak, J.

1999-01-01

The United States takes seriously the potential problems from uncontrolled radioactive sources. To address these problems, the United States Department of State is leading the development of an initiative for International Radioactive Source Management (ISRM). The Department of State, through a number of Federal and state agencies, regulatory bodies and private industry, will endeavor to provide coordinated support to the international community, particularly through IAEA, to assist in the development and implementation of risk-based clearance levels to support import/export of radioactive contaminated metals and the tracking, management, identification, remediation, and disposition of 'lost sources' entering nation states and targeted industries. The United States believes that the international control of radioactive sources is critical in avoiding wide-spread contamination of the world metal supply. Thus the initiative has four objectives: (1) Protect sources from becoming lost (Tracking management); (2) Identify primary locations where sources have been lost (Stop future losses); (3) Locate lost sources (monitor and retrieve); and (4) Educate and train (deploy knowledge and technology). A number of efforts already underway in the United States support the overall initiative. The EPA has provided a grant to the Conference of Radiation Program Control Directors (CRCPD) to develop a nation-wide program for the disposition of orphaned radioactive sources. This program now has internet visibility and a toll-free telephone number to call for assistance in the disposal of sources. The Nuclear Regulatory Commission (NRC), the Department of Energy (DOE), and other government agencies as well as private companies are assisting CRCPD in this program. The NRC has begun a program to improve control of radioactive sources in the United States, and also intends to promulgate a regulation defining conditions for the release of materials from licensed facilities. The DOE is

Antiabortion violence in the United States.

Science.gov (United States)

Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

2012-11-01

This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

Masturbation in the United States.

Science.gov (United States)

Das, Aniruddha

2007-01-01

Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.

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.

Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care

Directory of Open Access Journals (Sweden)

Allison A. Vanderbilt

2013-03-01

Full Text Available Healthcare in the United States (US is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

Research on Anoplophora glabripennis in the United States

Science.gov (United States)

Robert A. Haack

2003-01-01

In the mid-1990s it was estimated that more than 400 exotic (non-native) forest insects had already become established in the United States (HAACK and BYLER, 1993; MATTSON et al., 1994; NIEMELA and MATTSON, 1996). This number has continued to grow with new exotics discovered annually in the United States (HAACK, 2002; HAACK and POLAND, 2001; HAACK et al., 2002). One...

Leading Causes of Death in Males United States, 2010

Science.gov (United States)

... What’s this? Submit What’s this? Submit Button Leading Causes of Death in Males and Females, United States Recommend on ... to current and previous listings for the leading causes of death for males and females in the United States. ...

76 FR 18198 - European Union-United States Atlantis Program

Science.gov (United States)

2011-04-01

... DEPARTMENT OF EDUCATION European Union-United States Atlantis Program AGENCY: Office of...)--Special Focus Competition: European Union-(EU) United States (U.S.) Atlantis Program Notice inviting... and Culture, European Commission for funding under a separate but parallel EU competition. Within this...

Development of Water Quality Modeling in the United States

Science.gov (United States)

This presentation describes historical trends in water quality model development in the United States, reviews current efforts, and projects promising future directions. Water quality modeling has a relatively long history in the United States. While its origins lie in the work...

Solar energy in the United States

International Nuclear Information System (INIS)

Ochoa, D.; Slaoui, A.; Soler, R.; Bermudez, V.

2009-01-01

Written by a group of five French experts who visited several research centres, innovating companies and solar power stations in the United States, this report first proposes an overview of solar energy in the United States, indicating and commenting the respective shares of different renewable energies in the production, focusing on the photovoltaic energy production and its RD sector. The second part presents industrial and research activities in the solar sector, and more specifically photovoltaic technologies (silicon and thin layer technology) and solar concentrators (thermal solar concentrators, photovoltaic concentrators). The last chapter presents the academic research activities in different universities (California Tech Beckman Institute, Stanford, National Renewable Energy Laboratory, Colorado School of Mines)

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.

75 FR 22551 - United States Standards for Grades of Frozen Blueberries

Science.gov (United States)

2010-04-29

...] United States Standards for Grades of Frozen Blueberries AGENCY: Agricultural Marketing Service, USDA... United States Standards for Grades of Frozen Blueberries. After considering the comments received... . The United States Standards for Grades of Frozen Blueberries are available by accessing the AMS Web...

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.

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.

The American Medical Association's Section on Surgery: The Beginnings of the Organization, Professionalization, and Specialization of Surgery in the United States.

Science.gov (United States)

Rutkow, Ira

2017-01-01

To explore the founding of the American Medical Association's Section on Surgery in 1859 and how it represented, on a national basis, the beginnings of organized surgery and the formal start of the professionalization and specialization of surgery in the United States. The broad social process of organization, professionalization, and specialization that began for various disciplines in America in the mid-19th century was a reaction to emerging economic, political, and scientific influences including industrialization, urbanization, and technology. For surgeons or, at least, those men who performed surgical operations, the efforts toward group organization provided a means to promote their skills and restrict competition. An analysis of the published literature, and unpublished documents relating to the creation of the American Medical Association's Section on Surgery. During the 1850s and through the 1870s, a time when surgery was still not considered a separate branch of medicine, the organization of the American Medical Association's Section on Surgery provided the much needed encouragement to surgeons in their quest for professional and specialty recognition. The establishment of the American Medical Association's Section on Surgery in 1859 helped shape the nationwide future of the craft, in particular, surgery's rise as a specialty and profession.

77 FR 64031 - United States-Peru Trade Promotion Agreement

Science.gov (United States)

2012-10-18

... Trade Promotion Agreement AGENCIES: U.S. Customs and Border Protection, Department of Homeland Security... tariff treatment and other customs-related provisions of the United States-Peru Trade Promotion Agreement... other customs-related provisions of the United States-Peru Trade Promotion Agreement (PTPA). Please...

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....

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom.

Science.gov (United States)

Sparer, Michael S; France, George; Clinton, Chelsea

2011-02-01

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.

THE UNITED STATES EDUCATIONAL SYSTEM

OpenAIRE

David Suriñach Fernández

2017-01-01

The United States educational system is very complex. Due to the fact a big number of agents take play of its regulation, the differences between the education from one State compared to the education from another, or even between school districts, might be considerable. The last two largest federal education initiatives, No Child Left Behind and Race to the Top, have had a huge impact on the American education system. The escalation of the standardized test throughout the whole country as a ...

Acute surgical unit: The consultant experience

Directory of Open Access Journals (Sweden)

Patrick J Stokes

2016-07-01

Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

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.

Inventory of Power Plants in the United States, October 1992

Energy Technology Data Exchange (ETDEWEB)

1993-10-27

The Inventory of Power Plants in the United States is prepared annually by the Survey Management Division, Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA), US Department of Energy (DOE). The purpose of this publication is to provide year-end statistics about electric generating units operated by electric utilities in the United States (the 50 States and the District of Columbia). The publication also provides a 10-year outlook of future generating unit additions. Data summarized in this report are useful to a wide audience including Congress, Federal and State agencies, the electric utility industry, and the general public. Data presented in this report were assembled and published by the EIA to fulfill its data collection and dissemination responsibilities as specified in the Federal Energy Administration Act of 1974 (Public Law 93-275) as amended. The report is organized into the following chapters: Year in Review, Operable Electric Generating Units, and Projected Electric Generating Unit Additions. Statistics presented in these chapters reflect the status of electric generating units as of December 31, 1992.

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.

78 FR 63052 - United States-Panama Trade Promotion Agreement

Science.gov (United States)

2013-10-23

...-Panama Trade Promotion Agreement AGENCY: U.S. Customs and Border Protection, Department of Homeland... Trade Promotion Agreement entered into by the United States and the Republic of Panama. DATES: Interim... and the Republic of Panama (the ``Parties'') signed the United States-Panama Trade Promotion Agreement...

United States Military in Central Asia: Beyond Operation Enduring Freedom

Science.gov (United States)

2009-10-23

Malinowski , advocacy director for Human Rights Watch, stated, “the United States is most effective in promoting liberty around the world when people...26 U.S. President, The National Security Strategy of the United States of America, page? 27 Thomas Malinowski , “Testimony

31 CFR Appendix D to Subpart A of... - United States Secret Service

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false United States Secret Service D...—United States Secret Service 1. In general. This appendix applies to the United States Secret Service. 2. Public reading room. The United States Secret Service will provide a room on an ad hoc basis when...

76 FR 68271 - To Modify the Harmonized Tariff Schedule of the United States

Science.gov (United States)

2011-11-03

... the Convention and do not run counter to the national economic interest of the United States. I have... United States obligations under the Convention and do not run counter to the national economic interest of the United States. 7. On June 6, 2003, the United States and Chile entered into the United States...

Human prion diseases in the United States.

Directory of Open Access Journals (Sweden)

Robert C Holman

Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.

Isn't it time to start speaking about "European surgeons"?

Directory of Open Access Journals (Sweden)

Lazzareschi Daniel

2009-07-01

Full Text Available Abstract Background Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specialization. However every emergency surgeon must have a good formation in General Surgery but exist huge disparities between different European surgical formative systems. Methods An analysis of the main problems of the European surgical formative system was conducted. Results This discrepancy between formative systems is absolutely unacceptable and presents a notable hazard for the European Union, considering that surgical certifications are reciprocally recognized between programs within all European Union states. Conclusion Considering the increasing possibilities to move inside the European Union, is necessary to improve the European surgical formative system to warrant an uniform formation for all surgeons.

A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil settings by different surgeons in phacoemulsification.

Science.gov (United States)

Chen, Ming; Sweeney, Henry W; Luke, Becky; Chen, Mindy; Brown, Mathew

2009-01-01

Cumulative dissipated energy (CDE) was used with Infiniti((R)) Vision System (Alcon Labs) as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti((R)) unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons.

Competitive Electricity Market Regulation in the United States: A Primer

Energy Technology Data Exchange (ETDEWEB)

Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Mackay [National Grid, Warwick (United Kingdom)

2016-12-01

The electricity system in the United States is a complex mechanism where different technologies, jurisdictions and regulatory designs interact. Today, two major models for electricity commercialization operate in the United States. One is the regulated monopoly model, in which vertically integrated electricity providers are regulated by state commissions. The other is the competitive model, in which power producers can openly access transmission infrastructure and participate in wholesale electricity markets. This paper describes the origins, evolution, and current status of the regulations that enable competitive markets in the United States.

Health, United States, 2012: Men's Health

Science.gov (United States)

... Mailing List Previous Reports Suggested Citation Related Sites Purchase Health, United States Behavioral Health Report Children’s ... with Internet Explorer may experience difficulties in directly accessing links to Excel files ...

Dengue Fever in the United States

Centers for Disease Control (CDC) Podcasts

Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.

15 CFR 971.209 - Processing outside the United States.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Processing outside the United States... THE ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR COMMERCIAL RECOVERY PERMITS Applications Contents § 971.209 Processing outside the United States. (a) Except as provided in this section...

Obesity: A United States Strategic Imperative

Science.gov (United States)

2013-04-01

States Department of Veterans Affairs 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) Dr. Thomas ...Army Ms. Karen Malebranche United States Department of Veterans Affairs Project Adviser Dr. Thomas Williams U.S. Army War...per American has increased by 57 pounds per year ( poultry representing 46 pounds).86 Surprisingly however, the percentage of calories from meat

Cholera in the United States

Centers for Disease Control (CDC) Podcasts

2011-11-08

Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola).  Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/8/2011.

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.

The United States

International Nuclear Information System (INIS)

Art, R.J.

1991-01-01

This paper reports that at least in the national security arena, the outcomes of bureaucratic infighting and domestic political struggles are not determined wholly by what goes on with the state. Rather struggles among contending groups are greatly affected by what is perceived to be happening outside the nation. Because external conditions give greater potency to some domestic forces over other, the external environment is never neutral in its domestic impact. The decisions of the period 1950-53 discussed above illustrate the point. But so too do the decisions of 1947, 1960-61 and 1969-72. In the 1947 case, Soviet intransigence provoked US nuclear rearmament. In the 1960-61 case, extended deterrent considerations pushed the United States to preserve its again newly discovered nuclear superiority. In the 1969-72 case, a Soviet determination to remain equal forced US acceptance of nuclear equality. And perhaps the best evidence of all, the perpetuation of parity ended the US inclination to resort to nuclear brinkmanship. In each instance, concerns about relative position heavily affected nuclear choice. Finally, the events of the past three years testify to the effects of international events on domestic choice. Under the terms of the 1987 INF Treaty, the two superpowers decided to dismantle and destroy an entire class of missiles of intermediate range (500-3000 kilometers) that both had deployed in Europe in the 1970s and 1980s, and in their June 1990 joint statement on strategic nuclear weapons, President Gorbachev and Brush agreed to cut the number of Soviet and US long range nuclear forces by 30 per cent. This agreement marks a watershed in US-Soviet strategic arm negotiations because for the first time the United States and the Soviet Union agreed in principals to reduce the number of weapons aimed at one another. Between 1985 and 1990 the cold war was brought to a close

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.

Malaria Surveillance - United States, 2015.

Science.gov (United States)

Mace, Kimberly E; Arguin, Paul M; Tan, Kathrine R

2018-05-04

Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to provide information on its occurrence (e.g., temporal, geographic, and demographic), guide prevention and treatment recommendations for travelers and patients, and facilitate transmission control measures if locally acquired cases are identified. This report summarizes confirmed malaria cases in persons with onset of illness in 2015 and summarizes trends in previous years. Malaria cases diagnosed by blood film microscopy, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff members. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS), the National Notifiable Diseases Surveillance System (NNDSS), or direct CDC consultations. CDC reference laboratories provide diagnostic assistance and conduct antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. This report summarizes data from the integration of all NMSS and NNDSS cases, CDC reference laboratory reports, and CDC clinical consultations. CDC received reports of 1,517 confirmed malaria cases, including one congenital case, with an onset of symptoms in 2015 among persons who received their diagnoses in the United States. Although the number of

Malaria Surveillance - United States, 2014.

Science.gov (United States)

Mace, Kimberly E; Arguin, Paul M

2017-05-26

Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. This report summarizes cases in persons with onset of illness in 2014 and trends during previous years. Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report. CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively

26 CFR 1.993-7 - Definition of United States.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Definition of United States. 1.993-7 Section 1.993-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Domestic International Sales Corporations § 1.993-7 Definition of United States...

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.

26 CFR 49.4261-5 - Payments made outside the United States.

Science.gov (United States)

2010-04-01

... travel under section 4262(b), the tax imposed by section 4261(b), shall not apply unless the... made outside the United States for one-way or round-trip transportation between a point within the United States and a point outside the United States. (b) Transportation between two or more points in the...

42 CFR 455.21 - Cooperation with State Medicaid fraud control units.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cooperation with State Medicaid fraud control units... Detection and Investigation Program § 455.21 Cooperation with State Medicaid fraud control units. In a State with a Medicaid fraud control unit established and certified under subpart C of this part, (a) The...

Low birth weight in the United States.

Science.gov (United States)

Goldenberg, Robert L; Culhane, Jennifer F

2007-02-01

Pregnancy outcomes in the United States and other developed countries are considerably better than those in many developing countries. However, adverse pregnancy outcomes are generally more common in the United States than in other developed countries. Low-birth-weight infants, born after a preterm birth or secondary to intrauterine growth restriction, account for much of the increased morbidity, mortality, and cost. Wide disparities exist in both preterm birth and growth restriction among different population groups. Poor and black women, for example, have twice the preterm birth rate and higher rates of growth restriction than do most other women. Low birth weight in general is thought to place the infant at greater risk of later adult chronic medical conditions, such as diabetes, hypertension, and heart disease. Of interest, maternal thinness is a strong predictor of both preterm birth and fetal growth restriction. However, in the United States, several nutritional interventions, including high-protein diets, caloric supplementation, calcium and iron supplementation, and various other vitamin and mineral supplementations, have not generally reduced preterm birth or growth restriction. Bacterial intrauterine infections play an important role in the etiology of the earliest preterm births, but, at least to date, antibiotic treatment either before labor for risk factors such as bacterial vaginosis or during preterm labor have not consistently reduced the preterm birth rate. Most interventions have failed to reduce preterm birth or growth restriction. The substantial improvement in newborn survival in the United States over the past several decades is mostly due to better access to improved neonatal care for low-birth-weight infants.

31 CFR 594.315 - United States person; U.S. person.

Science.gov (United States)

2010-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS General Definitions § 594.315 United States person; U.S. person. The term United States person or...

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.

Stigma and abortion complications in the United States.

Science.gov (United States)

Harris, Lisa H

2012-12-01

Abortion is highly stigmatized in the United States and elsewhere. As a result, many women who seek or undergo abortion keep their decision a secret. In many regions of the world, stigma is a recognized contributor to maternal morbidity and mortality from unsafe abortion, even when abortion is legal. Women may self-induce abortion in ways that are dangerous, or seek unsafe clandestine abortion from inadequately trained health care providers out of fear that their sexual activity, pregnancy, or abortion will be exposed if they present to a safe, licensed facility. However, unsafe abortion rarely occurs in the United States, and accordingly, stigma as a cause of unsafe abortion in the United States context has not been described. I consider the relationship of stigma to two serious abortion complications experienced by U.S. patients. Both patients wished to keep their abortion decision a secret from family and friends, and in both cases, their inability to disclose their abortion contributed to life-threatening complications. The experiences of these patients suggest that availability of legal abortion services in the United States may not be enough to keep all women safe. The cases also challenge the rhetoric that "abortion hurts women," suggesting instead that abortion stigma hurts women.

Vanadium recycling in the United States in 2004

Science.gov (United States)

Goonan, Thomas G.

2011-01-01

As one of a series of reports that describe the recycling of metal commodities in the United States, this report discusses the flow of vanadium in the U.S. economy in 2004. This report includes a description of vanadium supply and demand in the United States and illustrates the extent of vanadium recycling and recycling trends. In 2004, apparent vanadium consumption, by end use, in the United States was 3,820 metric tons (t) in steelmaking and 232 t in manufacturing, of which 17 t was for the production of superalloys and 215 t was for the production of other alloys, cast iron, catalysts, and chemicals. Vanadium use in steel is almost entirely dissipative because recovery of vanadium from steel scrap is chemically impeded under the oxidizing conditions in steelmaking furnaces. The greatest amount of vanadium recycling is in the superalloy, other-alloy, and catalyst sectors of the vanadium market. Vanadium-bearing catalysts are associated with hydrocarbon recovery and refining in the oil industry. In 2004, 2,850 t of vanadium contained in alloy scrap and spent catalysts was recycled, which amounted to about 44 percent of U.S. domestic production. About 94 percent of vanadium use in the United States was dissipative (3,820 t in steel/4,050 t in steel+fabricated products).

Orthopaedic Surgeons as Clinical Leaders in the National Health Service, United Kingdom (NHS UK): Can the World Learn From Us?

Science.gov (United States)

Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr

2015-07-01

This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction.

The voluntary safeguards offer of the United States

International Nuclear Information System (INIS)

Houck, F.S.

1985-01-01

During negotiations of the Treaty on the Non-Proliferation of Nuclear Weapons (NPT) concerns were expressed by non-nuclear-weapon States that their acceptance of Agency safeguards would put them at a disadvantage vis-a-vis the nuclear-weapon States. To allay these concerns, the United States and the United Kingdom in December 1967 made voluntary offers to accept Agency safeguards on their peaceful nuclear activities. Subsequently, France made a voluntary offer, the safeguards agreement for which was approved by the IAEA Board of Governors in February 1978, with a view to encouraging acceptance of Agency safeguards by additional States. More recently, in February 1985 the Board approved the safeguards agreement for the voluntary offer of the USSR, made inter alia to encourage further acceptance of Agency safeguards. These safeguards agreements with nuclear-weapon-States have two important features in common: Namely, they result from voluntary offers to accept safeguards rather than from multilateral or bilateral undertakings, and they give the Agency the right but generally not an obligation to apply its safeguards. The agreements differ in certain respects, the most noteworthy of which is the scope of the nuclear activities covered by each offer. The agreements of the United States and United Kingdom are the broadest, covering all peaceful nuclear activities in each country. The safeguards agreement for the US voluntary offer has been in force since December 1980. Now is an appropriate time to review the experience with the agreement's implementation during its first four years, as well as its history and salient features

United States Navy DL Perspective

Science.gov (United States)

2010-08-10

United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile

26 CFR 1.953-2 - Actual United States risks.

Science.gov (United States)

2010-04-01

... being the promotion of such sales to United States retail outlets by advertising in trade publications... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1.953-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX...

31 CFR 595.315 - United States person; U.S. person.

Science.gov (United States)

2010-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM SANCTIONS REGULATIONS General Definitions § 595.315 United States person; U.S. person. The term United States person or U.S...

United States Interagency Elevation Inventory (USIEI)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...

China's international trade and air pollution in the United States.

Science.gov (United States)

Lin, Jintai; Pan, Da; Davis, Steven J; Zhang, Qiang; He, Kebin; Wang, Can; Streets, David G; Wuebbles, Donald J; Guan, Dabo

2014-02-04

China is the world's largest emitter of anthropogenic air pollutants, and measurable amounts of Chinese pollution are transported via the atmosphere to other countries, including the United States. However, a large fraction of Chinese emissions is due to manufacture of goods for foreign consumption. Here, we analyze the impacts of trade-related Chinese air pollutant emissions on the global atmospheric environment, linking an economic-emission analysis and atmospheric chemical transport modeling. We find that in 2006, 36% of anthropogenic sulfur dioxide, 27% of nitrogen oxides, 22% of carbon monoxide, and 17% of black carbon emitted in China were associated with production of goods for export. For each of these pollutants, about 21% of export-related Chinese emissions were attributed to China-to-US export. Atmospheric modeling shows that transport of the export-related Chinese pollution contributed 3-10% of annual mean surface sulfate concentrations and 0.5-1.5% of ozone over the western United States in 2006. This Chinese pollution also resulted in one extra day or more of noncompliance with the US ozone standard in 2006 over the Los Angeles area and many regions in the eastern United States. On a daily basis, the export-related Chinese pollution contributed, at a maximum, 12-24% of sulfate concentrations over the western United States. As the United States outsourced manufacturing to China, sulfate pollution in 2006 increased in the western United States but decreased in the eastern United States, reflecting the competing effect between enhanced transport of Chinese pollution and reduced US emissions. Our findings are relevant to international efforts to reduce transboundary air pollution.

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.

19 CFR 10.46 - Articles for the United States.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles for the United States. 10.46 Section 10... THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. General Provisions Articles for Institutions § 10.46 Articles for the United States. Pursuant to subheadings 9808.00.10 and 9808...

A survey on surgeons' perceived quality of the informed consent process in a Swiss paediatric surgery unit.

Science.gov (United States)

Guinand, Julie; Gapany, Christophe; Simon, Jeanne-Pascale; Wasserfallen, Jean-Blaise; Joseph, Jean-Marc

2015-01-01

To evaluate the levels of satisfaction and opinions on the usefulness of the informed consent form currently in use in our Paediatric Surgery Department. Qualitative study carried out via interviews of senior paediatric surgeons, based on a questionnaire built up from reference criteria in the literature and public health law. Physicians with between 2 and 35 years experience of paediatric surgery, with a participation rate of 92 %, agreed on the definition of an informed consent form, were satisfied with the form in use and did not wish to modify its structure. The study revealed that signing the form was viewed as mandatory, but meant different things to different participants, who diverged over whom that signature protected. Finally, all respondents were in agreement over what information was necessary for parents of children requiring surgery. Paediatric surgeons seemed to be satisfied with the informed consent form in use. Most of them did not identify that the first aim of the informed consent form is to give the patient adequate information to allow him to base his consent, which is a legal obligation, the protection of physicians by the formalisation and proof of the informed consent being secondary. Few surgeons brought up the fact that the foremost stakeholder in paediatric surgery are the children themselves and that their opinions are not always sought. In the future, moving from informed consent process to shared decision-making, a more active bidirectional exchange may be strongly considered. Involving children in such vital decisions should become the norm while keeping in mind their level of maturity.

26 CFR 1.864-2 - Trade or business within the United States.

Science.gov (United States)

2010-04-01

... States, as his agent to effect transactions in the United States in stocks and securities for the account... A ordinarily effects transactions in the United States in stocks or securities. Under the agency..., effects transactions in the United States in stocks or securities for the partnership's own account or...

Civil Surgeon Tuberculosis Evaluations for Foreign-Born Persons Seeking Permanent U.S. Residence.

Science.gov (United States)

Bemis, Kelley; Thornton, Andrew; Rodriguez-Lainz, Alfonso; Lowenthal, Phil; Escobedo, Miguel; Sosa, Lynn E; Tibbs, Andrew; Sharnprapai, Sharon; Moser, Kathleen S; Cochran, Jennifer; Lobato, Mark N

2016-04-01

Foreign-born persons in the United States seeking to adjust their status to permanent resident must undergo screening for tuberculosis (TB) disease. Screening is performed by civil surgeons (CS) following technical instructions by the Centers for Disease Control and Prevention. From 2011 to 2012, 1,369 practicing CS in California, Texas, and New England were surveyed to investigate adherence to the instructions. A descriptive analysis was conducted on 907 (66%) respondents. Of 907 respondents, 739 (83%) had read the instructions and 565 (63%) understood that a chest radiograph is required for status adjustors with TB symptoms; however, only 326 (36%) knew that a chest radiograph is required for immunosuppressed status adjustors. When suspecting TB disease, 105 (12%) would neither report nor refer status adjustors to the health department; 91 (10%) would neither start treatment nor refer for TB infection. Most CS followed aspects of the technical instructions; however, educational opportunities are warranted to ensure positive patient outcomes.

Taxation of United States general aviation

Science.gov (United States)

Sobieralski, Joseph Bernard

General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and

Analysis of United States' Broadband Policy

National Research Council Canada - National Science Library

Uzarski, Joel S

2007-01-01

.... With every month that passes, the United States fails to close the gap in the digital divide both inside its borders as well as among the other countries that lead the world in broadband penetration...

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.

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.

Anti-Terrorism Authority Under the Laws of the United Kingdom and the United States

National Research Council Canada - National Science Library

Feikert, Clare; Doyle, Charles

2006-01-01

This is a comparison of the laws of the United Kingdom and of the United States that govern criminal and intelligence investigations of terrorist activities Both systems rely upon a series of statutory authorizations...

76 FR 38700 - United States, et al.

Science.gov (United States)

2011-07-01

... prices in advertisements, in-store displays, and online. Consumer World believes these rules should be... has ruled on that motion. I. Procedural History The United States and seven Plaintiff States filed the... Restraints result in higher merchant costs, and merchants generally pass costs on to consumers, retail prices...

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.

75 FR 10561 - Pricing for 2010 United States Mint America the Beautiful QuartersTM

Science.gov (United States)

2010-03-08

... DEPARTMENT OF THE TREASURY United States Mint Pricing for 2010 United States Mint America the Beautiful Quarters\\TM\\ Two-Roll Set, etc. AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint America...

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.

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.

78 FR 77103 - United States Travel and Tourism Advisory Board

Science.gov (United States)

2013-12-20

... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism... extended deadline for application for membership on the United States Travel and Tourism Advisory Board... Travel and Tourism Advisory Board (Board). The November 25, 2013 notice provided that all applications...

State of pine decline in the southeastern United States

Science.gov (United States)

Lori Eckhardt; Mary Anne Sword Sayer; Don Imm

2010-01-01

Pine decline is an emerging forest health issue in the southeastern United States. Observations suggest pine decline is caused by environmental stress arising from competition, weather, insects and fungi, anthropogenic disturbances, and previous management. The problem is most severe for loblolly pine on sites that historically supported longleaf pine, are highly...

78 FR 53426 - United States Travel and Tourism Advisory Board Charter Renewal

Science.gov (United States)

2013-08-29

... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism... for the United States Travel and Tourism Advisory Board on August 19, 2013. DATES: The Charter for the United States Travel and Tourism Advisory Board was renewed on August 19, 2013. FOR FURTHER INFORMATION...

Surgeon-level reporting presented by funnel plot is understood by doctors but inaccurately interpreted by members of the public.

Science.gov (United States)

Bhalla, Ashish; Mehrotra, Prerna; Amawi, Falah; Lund, Jonathan N

2015-01-01

Risk-adjusted outcome data for general surgeons practicing in the United Kingdom were published for the first time in 2013 with the aim of increasing transparency, improving standards, and providing the public with information to aid decision making. Most specialties used funnel plots to present their data. We assess the ability of members of the public (MoP), medical students, nonsurgical doctors (NSD), and surgeons to understand risk-adjusted surgical outcome data. A fictitious outcome dataset was created and presented in the form of a funnel plot to 10 participants from each of the aforementioned group. Standard explanatory text was provided. Each participant was given 5 minutes to review the funnel plot and complete a questionnaire. For each question, there was only 1 correct answer. Completion rate was 100% (n = 40). No difference existed between NSD and surgeons. A significant difference for identification of the "worst performing surgeon" was noted between surgeons and MoP (p plot significantly "more difficult" to interpret than surgeons did (p < 0.01) and NSD (p < 0.01). MoP found these data significantly more "difficult to understand" and were less likely to both spot "outliers" and use this data to inform decisions than doctors. Surgeons should be aware that outcome data may require an alternative method of presentation to be understood by MoP. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice.

Science.gov (United States)

Mitura, Kryspin; Dąbrowiecki, Stanisław; Śmietański, Maciej; Matyja, Andrzej

2017-01-01

In 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures. To determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice. The data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants' smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey. 19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh. The skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

Summary of Notifiable Diseases, United States. Volume 45, Number 53.

Science.gov (United States)

1997-10-31

Trichinosis Tuberculosis Typhoid fever Yellow fever NOTE: Although varicella is not a nationally notifiable disease, the Council of State and...plague among humans, two of which were fatal, were re- ported in the United States (two cases in Arizona, one in Colorado, and two in New Mexico ). Both...13 cases per year) were reported in the United States. Of these cases, 80% occurred in the southwestern states of New Mexico , Arizona, and

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...

Forest carbon management in the United States: 1600-2100

Science.gov (United States)

Richard A. Birdsey; Kurt Pregitzer; Alan Lucier

2006-01-01

This paper reviews the effects of past forest management on carbon stocks in the United States, and the challenges for managing forest carbon resources in the 21st century. Forests in the United States were in approximate carbon balance with the atmosphere from 1600-1800. Utilization and land clearing caused a large pulse of forest carbon emissions during the 19th...

NCHS - Births and General Fertility Rates: United States

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset includes crude birth rates and general fertility rates in the United States since 1909. The number of states in the reporting area differ historically....

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...

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

The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team?

Science.gov (United States)

Chohan, P; Elledge, R; Virdi, M K; Walton, G M

2018-02-01

Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. The first part was a prospective audit of practice within the University Hospital Coventry. This was followed by a telephone survey of oral and maxillofacial surgery units throughout the UK. In the intensive care unit at University Hospital Coventry, of 39 referrals, 21 (53.8%) were delayed beyond 24 hours. There was a mean (standard deviation) time to delay of 2.2 days (0.9 days) and the most common cause of delay was surgeon decision, accounting for 13 (61.9%) delays. From a telephone survey of 140 units nationwide, 40 (28.4%) were regularly involved in the provision of surgical tracheostomies for intensive care and 17 (42.5%) experienced delays beyond 24 hours, owing to a combination of theatre availability (76.5%) and surgeon availability (47.1%). There is case for having a dedicated tracheostomy team and provisional theatre slot to optimise patient outcomes and reduce delays. We aim to implement such a move within our unit and audit the outcomes prospectively following this change.

Green electricity policies in the United States: case study

International Nuclear Information System (INIS)

Menz, Fredric C.

2005-01-01

While there has been interest in promoting the use of renewable energy in electricity production for a number of years in the United States, the market share of non-hydro renewable energy sources in electricity production has remained at about 2 percent over the past decade. The paper reviews the principal energy resources used for electricity production, considers the changing regulatory environment for the electricity industry, and describes government policies that have been used to promote green electricity in the United States, with an emphasis on measures adopted by state governments. Factors influencing the development of green power markets are also discussed, including underlying economic issues, public policy measures, the regulatory environment, external costs, and subsidies. Without significant increases in fossil fuel prices, much more stringent environmental regulations, or significant changes in electricity customer preferences, green electricity markets are likely to develop slowly in the United States

78 FR 70275 - United States Travel and Tourism Advisory Board

Science.gov (United States)

2013-11-25

... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism... an opportunity to apply for membership on the United States Travel and Tourism Advisory Board... Travel and Tourism Advisory Board (Board). The purpose of the Board is to advise the Secretary of...

Veterinary Fusarioses within the United States

Science.gov (United States)

Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...

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. ...

Low-level radioactive waste disposal technologies used outside the United States

International Nuclear Information System (INIS)

Templeton, K.J.; Mitchell, S.J.; Molton, P.M.; Leigh, I.W.

1994-01-01

Low-level radioactive waste (LLW) disposal technologies are an integral part of the waste management process. In the United States, commercial LLW disposal is the responsibility of the State or groups of States (compact regions). The United States defines LLW as all radioactive waste that is not classified as spent nuclear fuel, high- level radioactive waste, transuranic waste, or by-product material as defined in Section II(e)(2) of the Atomic Energy Act. LLW may contain some long-lived components in very low concentrations. Countries outside the United States, however, may define LLW differently and may use different disposal technologies. This paper outlines the LLW disposal technologies that are planned or being used in Canada, China, Finland, France, Germany, Japan, Sweden, Taiwan, and the United Kingdom (UK)

Pakistan: Can the United States Secure an Insecure State?

Science.gov (United States)

2010-01-01

do not have female staff; the male-to-female staff ratio in the health field is 7 to 1.130 More nurses and female staff are needed, especially to...exercise was rescheduled for 2009. 9 Interview with Ninth Air Force personnel, September 12, 2008. 200 Pakistan: Can the United States Secure an Insecure

The hydroelectric power market in the United States

International Nuclear Information System (INIS)

2002-01-01

The second-largest producer of hydroelectric power in the world is the United States, right after Canada. In the United States, 7.1 per cent of net electricity generation was attributed to hydroelectric power in 2000, which totalled 269 terawatt hours (TWh). Aging facilities, outdated technology in some facilities, a cumbersome licensing process, and increasing environmental demands from interest groups for the preservation of river systems and surrounding wildlife challenge the industry. Pacific Coast states, especially California, were faced with electric power shortages during the summer of 2001, due to low market prices, high power usage among consumers and drought. The problems with the deregulation of the electricity market were brought to light by these shortages. Legislation to restructure the electric power industry in 25 states had not been enacted as of January 2002. The purchase of more power from both Canada and the Mexico is being considered by the government of the United States, as is the creation of a national power grid to allow for power transmission throughout the country. The Canada-United States energy trade might be affected by such a move, and result in project construction opportunities for Canadian companies. Renewable energy sources must be responsible for the generation of 10 per cent of power generation levels by 2020, on a gradual basis as mandated by law. By 2005, New York City must purchase 10 per cent of its power from renewable energy sources, reaching 20 per cent by 2010. The repair and replacement of aging dam equipment, the development of advanced turbine technology to protect fish stocks and water quality, dam removal, the construction of power lines are all opportunities open to Canadian companies. 60 refs., 5 tabs

Making of a burn unit: SOA burn center

Directory of Open Access Journals (Sweden)

Jayant Kumar Dash

2016-01-01

Full Text Available Each year in India, burn injuries account for more than 6 million hospital emergency department visits; of which many require hospitalization and are referred to specialized burn centers. There are few burn surgeons and very few burn centers in India. In our state, Odisha, there are only two burn centers to cater to more than 5000 burn victims per year. This article is an attempt to share the knowledge that I acquired while setting up a new burn unit in a private medical college of Odisha.

Research and photovoltaic industry at the United States

International Nuclear Information System (INIS)

Lerouge, Ch.; Herino, R.; Delville, R.; Allegre, R.

2006-06-01

For a big country as the United States, the solar energy can be a solution for the air quality improvement, the greenhouse gases fight and the reduction of the dependence to the imported petroleum and also for the economic growth by the increase of the employment in the solar industry sector. This document takes stock on the photovoltaic in the United States in the industrial and research domains. The american photovoltaic industry is the third behind the Japan and the Germany. (A.L.B.)

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

State cigarette minimum price laws - United States, 2009.

Science.gov (United States)

2010-04-09

Cigarette price increases reduce the demand for cigarettes and thereby reduce smoking prevalence, cigarette consumption, and youth initiation of smoking. Excise tax increases are the most effective government intervention to increase the price of cigarettes, but cigarette manufacturers use trade discounts, coupons, and other promotions to counteract the effects of these tax increases and appeal to price-sensitive smokers. State cigarette minimum price laws, initiated by states in the 1940s and 1950s to protect tobacco retailers from predatory business practices, typically require a minimum percentage markup to be added to the wholesale and/or retail price. If a statute prohibits trade discounts from the minimum price calculation, these laws have the potential to counteract discounting by cigarette manufacturers. To assess the status of cigarette minimum price laws in the United States, CDC surveyed state statutes and identified those states with minimum price laws in effect as of December 31, 2009. This report summarizes the results of that survey, which determined that 25 states had minimum price laws for cigarettes (median wholesale markup: 4.00%; median retail markup: 8.00%), and seven of those states also expressly prohibited the use of trade discounts in the minimum retail price calculation. Minimum price laws can help prevent trade discounting from eroding the positive effects of state excise tax increases and higher cigarette prices on public health.

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

75 FR 78338 - Meeting of the United States-Oman Joint Forum on Environmental Cooperation Pursuant to the United...

Science.gov (United States)

2010-12-15

... DEPARTMENT OF STATE [Public Notice 7261] Meeting of the United States-Oman Joint Forum on Environmental Cooperation Pursuant to the United States-Oman Memorandum of Understanding on Environmental Cooperation ACTION: Notice of the meeting of the U.S.-Oman Joint Forum on Environmental Cooperation and...

The veterinary surgeon in natural disasters: Italian legislation in force.

Science.gov (United States)

Passantino, A; Di Pietro, C; Fenga, C; Passantino, M

2003-12-01

Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection.

77 FR 27669 - Modifications to Definition of United States Property

Science.gov (United States)

2012-05-11

... contracts. The temporary regulations provide that certain obligations of United States persons arising from upfront payments made by controlled foreign corporations pursuant to contracts that are cleared by a... the meaning of section 956(c)) for obligations of United States persons arising from certain upfront...

Contemporary United States Foreign Policy Towards Indonesia

National Research Council Canada - National Science Library

McAslan, Hugh

2004-01-01

United States national interests in Indonesia have traditionally being based on strategic security requirements given Indonesia's geographic location between the Indian and Pacific Oceans, and strong...

Employers mexican migrants in the United States

Directory of Open Access Journals (Sweden)

Eduardo Fernández Guzmán

2013-09-01

Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.

A retrospective randomized study to compare the energy delivered using CDE with different techniques and OZil® settings by different surgeons in phacoemulsification

Science.gov (United States)

Chen, Ming; Sweeney, Henry W; Luke, Becky; Chen, Mindy; Brown, Mathew

2009-01-01

Cumulative dissipated energy (CDE) was used with Infiniti® Vision System (Alcon Labs) as an energy delivery guide to compare four different phaco techniques and phaco settings. The supracapsular phaco technique and burst mode is known for efficiency and surgery is faster compared with the old phaco unit. In this study, we found that supracapsular phaco with burst mode had the least CDE in both cataract and nuclear sclerosis cataract with the new Infiniti® unit. We suggest that CDE can be used as one of the references to modify technique and setting to improve outcome for surgeons, especially for new surgeons. PMID:19688027

Motorcycle trends in the United States

Science.gov (United States)

2009-05-01

During the last decade there has been a significant increase in the number of motorcycle sales and registrations in the United States. At the same time there has been a shift in the demographics of motorcycle users and increased focus on motorcycle s...

THE UNITED STATES AND NIGERIAN RELATIONS:

African Journals Online (AJOL)

Mrs. I.D

2009-12-25

Dec 25, 2009 ... response from the Nigerian government. ... domestic crises that negatively impacts state stability, the US government ... Harrison C. Ajebon, Department of Political Science, University of Calabar, ..... Sweden. United Kingdom. Switzerland. Asia & far East. Japan ..... case Study of Nigeria, in Ikonnechidi and.

37 CFR 1.416 - The United States International Preliminary Examining Authority.

Science.gov (United States)

2010-07-01

... STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES International Processing Provisions General Information § 1.416 The United States International Preliminary... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false The United States...

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...

31 CFR Appendix C to Subpart C of... - United States Customs Service

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false United States Customs Service C... Customs Service 1. In general. This appendix applies to the United States Customs Service. It sets forth... records and accounting of disclosures. (a) For records which are maintained at the United States Customs...

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.

The State of Homeless Children in the United States

Science.gov (United States)

Kabler, Brenda; Weinstein, Elana

2009-01-01

Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…

78 FR 53478 - Proposed Information Collection; United States Park Police Personal History Statement