What is the best method of surgical training?: A report of America's leading senior surgeons

OBJECTIVES: To characterize the career choices and developments made by leading senior surgeons in this country and to examine hypothetically whether application of a short tracking program would have hindered their career decisions. DESIGN: A survey pertaining to each surgeon's career, decisions, and opinions concerning surgical training. SETTING AND PARTICIPANTS: Senior surgeons of regional and national surgical societies. MAIN OUTCOME MEASURE: Survey responses. RESULTS: A total of 352 surveys (41.4%) were received. Respondents answered that the most common reasons for choosing a specialty were role models or mentors (56%), research (51%), and available patient population (23%). The 2 most common stages in a career at which the respondents became interested in a specialty, or an area of expertise, were at the junior residency level (when the specialty was chosen) and at the assistant professor level (when a more specific topic within the specialty was chosen). The most common stage at which the group believed they acquired their expertise was also at the assistant professor level. Seventy-one percent of respondents believed broad training was superior to a short tracking system, although none had participated in shortened surgical training. CONCLUSIONS: Most leading senior surgeons in this country still believe that broad surgical training is superior and should be maintained. Because career specialties in this surveyed group were generally chosen in early residency, a hypothetical application of the short tracking system would have still allowed for these important decisions to be made. Also, it seems likely that specialty and career development would not have been hindered because "expertization" mostly occurred after training was completed. Regardless of training method, a role model or mentor seems most important in career choices and developments.     

Tennessee's failed managed care program for mental health and substance abuse services

In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.     

Solid-state 2H NMR study of methyl-d3-cobalamin

A solid-state 2H NMR study of methyl-d3-cobalamin has been performed as a function of temperature to provide information concerning the character and energetics of the motion performed by this unique bioorganometallic methyl group. Analysis of the 2H NMR line shape indicates that the methyl group undergoes rapid three-fold rotation, and that the Co-C-2H angle lies between 105.9 and 109.5 degrees. Determination of the spin-lattice relaxation times T1 shows that the relaxation is anisotropic, consistent with a "jumping" motion of the methyl group rather than rotational diffusion. This also provides the activation energy to methyl jumps as 8.3 +/- 1.3 kJ/mol. It is proposed that this energetic barrier may be a useful probe of changes in the electronic character of the Co-C bond that accompany the biological role of this molecule in such enzymes as methionine synthase.     

Measurement of the peritectic phase composition in the Sn-Cd system through directional solidification techniques

Short Communication

Measurement of the peritectic phase composition in the Sn-Cd system through directional solidification techniques     

Creating corroborated crisis reports from social media data through formal concept analysis

During a crisis citizens reach for their smart phones to report, comment and explore information surrounding the crisis. These actions often involve social media and this data forms a large repository of real-time, crisis related information. Law enforcement agencies and other first responders see this information as having untapped potential. That is, it has the capacity extend their situational awareness beyond the scope of a usual command and control centre. Despite this potential, the sheer volume, the speed at which it arrives, and unstructured nature of social media means that making sense of this data is not a trivial task and one that is not yet satisfactorily solved; both in crisis management and beyond. Therefore we propose a multi-stage process to extract meaning from this data that will provide relevant and near real-time information to command and control to assist in decision support. This process begins with the capture of real-time social media data, the development of specific LEA and crisis focused taxonomies for categorisation and entity extraction, the application of formal concept analysis for aggregation and corroboration and the presentation of this data via map-based and other visualisations. We demonstrate that this novel use of formal concept analysis in combination with context-based entity extraction has the potential to inform law enforcement and/or humanitarian responders about on-going crisis events using social media data in the context of the 2015 Nepal earthquake.     

Practical considerations for high spatial and temporal resolution dynamic transmission electron microscopy

Although recent years have seen significant advances in the spatial resolution possible in the transmission electron microscope (TEM), the temporal resolution of most microscopes is limited to video rate at best. This lack of temporal resolution means that our understanding of dynamic processes in materials is extremely limited. High temporal resolution in the TEM can be achieved, however, by replacing the normal thermionic or field emission source with a photoemission source. In this case the temporal resolution is limited only by the ability to create a short pulse of photoexcited electrons in the source, and this can be as short as a few femtoseconds. The operation of the photo-emission source and the control of the subsequent pulse of electrons (containing as many as 5 x 10(7) electrons) create significant challenges for a standard microscope column that is designed to operate with a single electron in the column at any one time. In this paper, the generation and control of electron pulses in the TEM to obtain a temporal resolution <10(-6)s will be described and the effect of the pulse duration and current density on the spatial resolution of the instrument will be examined. The potential of these levels of temporal and spatial resolution for the study of dynamic materials processes will also be discussed.     

Active disks for large-scale data processing

As processor performance increases and memory cost decreases, system intelligence continues to move away from the CPU and into peripherals. Storage system designers use this trend toward excess computing power to perform more complex processing and optimizations inside storage devices. To date, such optimizations take place at relatively low levels of the storage protocol. Trends in storage density, mechanics, and electronics eliminate the hardware bottleneck and put pressure on interconnects and hosts to move data more efficiently. We propose using an active disk storage device that combines on-drive processing and memory with software downloadability to allow disks to execute application-level functions directly at the device. Moving portions of an application's processing to a storage device significantly reduces data traffic and leverages the parallelism already present in large systems, dramatically reducing the execution time for many basic data mining tasks     

Flexible Image-Based Photometric Reconstruction using Virtual Light Sources

Photometric reconstruction is the process of estimating the illumination and surface reflectance properties of an environment, given a geometric model of the scene and a set of photographs of its surfaces. For mixed-reality applications, such data is required if synthetic objects are to be correctly illuminated or if synthetic light sources are to be used to re-light the scene. Current methods of estimating such data are limited in the practical situations in which they can be applied, due to the fact that the geometric and radiometric models of the scene which are provided by the user must be complete, and that the position (and in some cases, intensity) of the light sources must also be specified a-priori. In this paper, a novel algorithm is presented which overcomes these constraints, and allows photometric data to be reconstructed in less restricted situations. This is achieved through the use of virtual light sources which mimic the effect of direct illumination from unknown luminaires, and indirect illumination reflected off unknown geometry. The intensity of these virtual light sources and the surface material properties are estimated using an iterative algorithm which attempts to match calculated radiance values to those observed in photographs. Results are presented for both synthetic and real scenes that show the quality of the reconstructed data and its use in off-line mixed-reality applications.     

Clustering categorical data: an approach based on dynamical systems

We describe a novel approach for clustering collections of sets, and its application to the analysis and mining of categorical data. By “categorical data,” we mean tables with fields that cannot be naturally ordered by a metric – e.g., the names of producers of automobiles, or the names of products offered by a manufacturer. Our approach is based on an iterative method for assigning and propagating weights on the categorical values in a table; this facilitates a type of similarity measure arising from the co-occurrence of values in the dataset. Our techniques can be studied analytically in terms of certain types of non-linear dynamical systems. Received February 15, 1999 / Accepted August 15, 1999     

An analysis of the mechanics of solid phase extrusion of polymers

An analysis is presented for the mechanics of the hydrostatic extrusion of polymers in the solid phase through a conical die. The analysis starts with the lower bound solution proposed by Hoffman and Sachs and includes the effects of strain, strain rate and pressure on the deformation behaviour. It is proposed that this involves knowledge of the tensile stress-strain-strain rate relationships for each polymer, and it is shown how such information for polyethylene and polyoxymethylene can be used to explain the observed behaviour of these materials in the solid-phase extrusion process.List of Symbols die cone semi-angle - normal stress coefficient of tensile flow stress - d ₀ initial diameter of billet - d _f die exit diameter - axial strain rate (plug flow) - _red shear strain (redundant strain) incurred on crossing die entry or exit boundary - _N In R _N=2ln (d ₀/d _f) nominal true strain in extrusion - _{f red}+ _N - L cot - normal stress coefficient of friction at die/billet interface - P experimental extrusion pressure=total work done per unit volume of material - P _F work done per unit volume against billet-die friction - P _I ideal deformation work done per unit volume of material - P _R total redundant work done per unit volume - P _W=P–P _I extra work required to overcome friction, pressure and redundant strain effects - r ₀ initial radius of billet - r _f die exit radius - r material radius at a point in the deformation zone - R _N=(r ₀/r _f)² nominal extrusion ratio - R=(r ₀/r)² extrusion ratio at a point in the deformation zone - ₀() axial tensile flow stress - _f() process flow stress path, related to die strain and strain rate fields - _h tensile haul-off stress - _x, _y die stresses in deformation zone - ₁, ₂ shear yield stress of material at die entry and exit boundaries, respectively - v _x axial velocity - v _f extrudate velocity at die exit