Rural General Surgery: A Review of the Current Situation and Realities from a Rural Community Practice in Central Nebraska

Purpose: To examine the reasons fewer students and residents are entering general surgery, to educate residents about the realities of rural general surgery based on the experience of three general surgeons in central Nebraska, and to suggest a strategy for individual general surgeons and for residency programs to maintain the rural surgical workforce.Methods: A systematic literature review of surveys, review articles, and editorials through PUBMED was performed. Relevant studies were included in a review of the current literature on the rural general surgery workforce, general surgery residency, fellowship training, and rural surgery education. Findings: There is an insufficient supply of general surgeons in many parts of the country, particularly in rural settings. More general surgery residents are entering into subspecialty fellowship training and fewer are practicing general surgery than in the past. Residents may have inaccurate perceptions about rural general surgery practice. Those residency programs with dedicated rural and community surgery rotations have had more success in producing rural general surgeons.Conclusions: Although specialization in surgery has many positive effects, maintenance of a general surgical workforce in rural America is crucial to the health care of many citizens. Increasing the numbers of mentoring and training programs could provide medical students and general surgery residents with more educational opportunities that may lead to increased interest in rural surgery

Enhancing Cloud Security and Privacy: The Power and the Weakness of the Audit Trail

Winner of best paper award.Publisher PD

Enhancing Cloud Security and Privacy: The Cloud Audit Problem

Publisher PD

An alternate method for achieving temperature control in the -130 C to 75 C range

Thermal vacuum testing often requires temperature control of chamber shrouds and heat exchangers within the -130 C to 75 C range. There are two conventional methods which are normally employed to achieve control through this intermediate temperature range: (1) single-pass flow where control is achieved by alternately pulsing hot gaseous nitrogen (GN2) and cold LN2 into the feed line to yield the setpoint temperature; and (2) closed-loop circulation where control is achieved by either electrically heating or LN2 cooling the circulating GN2 to yield the setpoint temperature. A third method, using a mass flow ratio controller along with modulating control valves on GN2 and LN2 lines, provides excellent control but equipment for this method is expensive and cost-prohibitive for all but long-term continuous processes. The single-pass method provides marginal control and can result in unexpected overcooling of the test article from even a short pulse of LN2. The closed-loop circulation method provides excellent control but requires an expensive blower capable of operating at elevated pressures and cryogenic temperatures. Where precise control is needed (plus or minus 2 C), single-pass flow systems typically have not provided the precision required, primarily because of overcooling temperature excursions. Where several individual circuits are to be controlled at different temperatures, the use of expensive cryogenic blowers for each circuit is also cost-prohibitive, especially for short duration of one-of-a-kind tests. At JPL, a variant of the single-pass method was developed that was shown to provide precise temperature control in the -130 C to 75 C range while exhibiting minimal setpoint overshoot during temperature transitions. This alternate method uses a commercially available temperature controller along with a GN2/LN2 mixer to dampen the amplitude of cold temperature spikes caused by LN2 pulsing. The design of the GN2/LN2 mixer, the overall control system configuration, the operational procedure, and the prototype system test results are described

Organizational Design for Spill Containment in Deepwater Drilling Operations in the Gulf of Mexico: Assessment of the Marine Well Containment Company (MWCC)

The Deepwater Horizon oil spill in the Gulf of Mexico in April 2010 led to the deaths of 11 workers, a six-month moratorium on deepwater drilling in the Gulf, and nearly three months of massive engineering and logistics efforts to stop the spill. The series of failures before the well was finally capped and the spill contained revealed an inability to deal effectively with a well in deepwater and ultradeepwater. Ensuring that containment capabilities are adequate for drilling operations at these depths is therefore a salient challenge for government and industry. In this paper we assess the Marine Well Containment Company (MWCC), a consortium aimed at designing and building a system capable of containing future deepwater spills in the Gulf. We also consider alternatives for long-term readiness for deepwater spill containment. We focus on the roles of liability and regulation as determinants of readiness and the adequacy of incentives for technological innovation in oil spill containment technology to keep pace with advances in deepwater drilling capability. Liability and regulation can significantly influence the strength of these incentives. In addition, we discuss appropriate governance structure as a major determinant of the effectiveness of MWCC.oil spill, containment, industry R&D, liability, regulation, governance, innovation

The Ursinus Weekly, November 20, 1939

Gettysburg takes conference title by downing bears, 43-7 • Forum speaker is prominent writer • Dr. J. W. Meminger, director, dies at 80 • Winter scene will be setting for ball; critics praise Shadow and substance • Five from college on invalid list • Brotherhood of St. Paul hears talk on music by Roy Snyder • Rev. James C. Gilbert will conduct mission Dec. 4-8 • Y vespers conducted by West Chester college • Carter coaches coaches on oratorical objectives • Federation of women\u27s clubs will sponsor art exhibit here • Student opinion poll to be quarterly feature • Representatives of optical firm to give illustrated lecture • College students value wide cultural education • Audience of 350 hears musicians • IRC members hear talk on propaganda by Kramer • Fifty students attend \u27Y\u27 swim party at Norristown • Strange disappearance of Myrtle the turtle • Religion and its dogmas are discussed by Newman Club • French Club plans scavenger hunt for tonight\u27s meeting • Dawson receives R. W. Maxwell award for outstanding play in Drexel game • Perkiomen bows before unbeaten jayvees, 13-0 • Bakermen defeated by Gettysburg booters, 5-1https://digitalcommons.ursinus.edu/weekly/1827/thumbnail.jp

Breaking and Seating of Rigid Pavements

Breaking and seating has been utilized extensively in Kentucky to rehabilitate portland cement concrete pavements. Experience over three or four years with this type of design and construction are summarized and reported. Breaking to a range of nominal fragments is evaluated. Evaluation of two roller weights for seating is reported. The use of dynamic deflections to evaluate the effectiveness of the breaking and seating process and to measure the appropriateness of the asphaltic concrete overlay

Jewish Persecutions and Weather Shocks: 1100–1800

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137319/1/ecoj12331_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137319/2/ecoj12331-sup-0001-AppendixA-D.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137319/3/ecoj12331.pd

Photoluminescence modification by high-order photonic band with abnormal dispersion in ZnO inverse opal

We measured the angle- and polarization-resolved reflection and photoluminescence spectra of ZnO inverse opals. Significant enhancement of spontaneous emission is observed. The enhanced emission not only has good directionality but also can be linearly polarized. A detailed theoretical analysis and numerical simulation reveal that such enhancement is caused by the abnormal dispersion of a high-order photonic band. The frozen mode at a stationary inflection point of a dispersion curve can strongly modify the intensity, directionality and polarization of spontaneous emission.Comment: 22 pages, 11 figures, figures modified, references added, more explanation adde