The Ethics of Physician Migration and Their Implications for the United States

Currently, the United States trains only three quarters of the physicians it requires to fill its entry-level residency positions. The other quarter of residents employed by its hospitals is composed of immigrants who have been trained in other countries. This reliance of our healthcare system on foreign physicians puts a tremendous strain on the healthcare systems of developing nations. At the same time, by replacing American medical school graduates with graduates of foreign schools, the policy prevents a significant number of Americans who desire to practice medicine from doing so. An alarming shortage of physicians by the year 2020 has been forecasted. Discussion of how this shortage will be addressed is long overdue. The options are clear: either the United States can increase its dependence on foreign medical training programs or it can expand its own. It should choose the latter

An Experimental Study of the Near Field Region of a Free Jet with Passive Mixing Tabs

An experimental study was performed to determine the flow characteristics of a tabbed free jet. Results were acquired in the near field (nominally 2 tab widths upstream to 2 tab widths downstream of the exit plane) of a tabbed jet. Upstream pressure results showed static pressure distributions in both the x-and y-directions along the top surface of the tunnel. Hot-wire measurements showed rapid expansion of the core fluid into the ambient region. Two counter rotating regions of streamwise vorticity were shown on each side of the primary tab. An enhancement of the tabbed jet concept was proposed and tested. Specifically, two tabs, half the scale of the primary tab, were added to the primary tab to provide attachment surfaces for the normally occurring ejection of fluid. The secondary tabs caused a slight increase in the streamwise vorticity created from the upstream static pressure gradient while significantly increasing the re-oriented boundary layer vorticity. The combined pumping effect of the two counter rotating regions of vorticity caused a significant increase in the transport of the jet core fluid into the surrounding region

The Willed Body Donor Interview project: Medical student and donor expectations

The Anatomical Donations Program at the University of Michigan Medical School (UMMS) has begun a multiphase project wherein interviews of donors will be recorded and later shown to medical students who participate in the anatomical dissection course. The first phase of this project included surveys of both current UMMS medical students and donors concerning their perceptions of such a program. A five‐question survey administered via Qualtrics software was electronically mailed to all current medical students at UMMS, and a survey was mailed to registered and potential donors requesting information from the UMMS on anatomical donations. A total of 224 medical student responses (response rate 33%) and 54 donor responses (response rate 27%) were received. Seventy‐four percent of students and 81% of donors reported they would participate in this program if it existed. Students and donors supported the implementation of this program for varying reasons, though many felt strongly they would not want to participate in a donor interview program. These qualitative results support those of previous studies that show a majority of students desire a closer personal relationship with the donor, and these are the first results to be reported on donor perceptions of a donor interview program. Although many students and donors are in favor of instituting this program, others feel strongly that such an experience could be traumatic. The causes of these differing reactions need to be further explored, and the opinions of those who object to this study will be respected by maintaining voluntary participation in future phases of this study. Anat Sci Educ 6: 90–100. © 2012 American Association of Anatomists.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97164/1/1326_ftp.pd

Serendipitous Discovery of Light-Induced \u3cem\u3e(In Situ)\u3c/em\u3e Formation of An Azo-Bridged Dimeric Sulfonated Naphthol as a Potent PTP1B Inhibito

Background Protein tyrosine phosphatases (PTPs) like dual specificity phosphatase 5 (DUSP5) and protein tyrosine phosphatase 1B (PTP1B) are drug targets for diseases that include cancer, diabetes, and vascular disorders such as hemangiomas. The PTPs are also known to be notoriously difficult targets for designing inihibitors that become viable drug leads. Therefore, the pipeline for approved drugs in this class is minimal. Furthermore, drug screening for targets like PTPs often produce false positive and false negative results. Results Studies presented herein provide important insights into: (a) how to detect such artifacts, (b) the importance of compound re-synthesis and verification, and (c) how in situ chemical reactivity of compounds, when diagnosed and characterized, can actually lead to serendipitous discovery of valuable new lead molecules. Initial docking of compounds from the National Cancer Institute (NCI), followed by experimental testing in enzyme inhibition assays, identified an inhibitor of DUSP5. Subsequent control experiments revealed that this compound demonstrated time-dependent inhibition, and also a time-dependent change in color of the inhibitor that correlated with potency of inhibition. In addition, the compound activity varied depending on vendor source. We hypothesized, and then confirmed by synthesis of the compound, that the actual inhibitor of DUSP5 was a dimeric form of the original inhibitor compound, formed upon exposure to light and oxygen. This compound has an IC50 of 36 μM for DUSP5, and is a competitive inhibitor. Testing against PTP1B, for selectivity, demonstrated the dimeric compound was actually a more potent inhibitor of PTP1B, with an IC50 of 2.1 μM. The compound, an azo-bridged dimer of sulfonated naphthol rings, resembles previously reported PTP inhibitors, but with 18-fold selectivity for PTP1B versus DUSP5. Conclusion We report the identification of a potent PTP1B inhibitor that was initially identified in a screen for DUSP5, implying common mechanism of inhibitory action for these scaffolds

Ballistic Performance of Porous Ceramic Thermal Protection Systems at 9 km/s

Porous-ceramic, thermal-protection-systems are used heavily in current reentry vehicles like the Orbiter, and they are currently being proposed for the next generation of manned spacecraft, Orion. These materials insulate the structural components and sensitive electronic components of a spacecraft against the intense thermal environments of atmospheric reentry. Furthermore, these materials are also highly exposed to space environmental hazards like meteoroid and orbital debris impacts. This paper discusses recent impact testing up to 9 km/s on ceramic tiles similar to those used on the Orbiter. These tiles have a porous-batting of nominally 8 lb/cubic ft alumina-fiber-enhanced-thermal-barrier (AETB8) insulating material coated with a damage-resistant, toughened-unipiece-fibrous-insulation (TUFI) layer

Medical Comorbidities and Functional Dependent Living Are Independent Risk Factors for Short-Term Complications Following Osteotomy Procedures about the Knee

© The Author(s) 2018. Objective: To characterize rates and risk factors for adverse events following distal femoral osteotomy (DFO), high tibial osteotomy (HTO), and tibial tubercle osteotomy (TTO) procedures. Design: Patients undergoing DFO, HTO, or TTO procedures during 2005 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Rates of adverse events were characterized for each procedure. Demographic, comorbidity, and procedural factors were tested for association with occurrence of any adverse events. Results: A total of 1,083 patients were identified. Of these, 305 (28%) underwent DFO, 273 (25%) underwent HTO, and 505 (47%) underwent TTO. Mean ages for patients undergoing each procedure were the following: DFO, 51 ± 23 years; HTO, 40 ± 13 years; and TTO, 31 ± 11 years. The most common comorbidities for DFO were hypertension (34%) and smoking (17%); for HTO, hypertension (22%) and smoking (21%); and for TTO, smoking (20%) and hypertension (11%). Independent risk factors for occurrence of any adverse event were age ⩾45 years for DFO (odds ratio [OR] = 3.1, P \u3c 0.001) and HTO (OR = 2.3, P = 0.029), and body mass index \u3e30 for HTO (OR = 2.5, 95% confidence interval = 1.1-5.7, P = 0.031). When all osteotomy procedures were analyzed collectively, additional variables including diabetes mellitus (OR = 2.2, P = 0.017), chronic obstructive pulmonary disease (OR = 5.5, P = 0.003), and dependent functional status (OR = 3.0, P = 0.004) were associated with adverse events. Conclusions: The total rate of adverse events was not independently associated with the type of osteotomy procedure. In addition, patients with age \u3e45, diabetes mellitus, chronic obstructive pulmonary disease, and dependent functional status have greater odds for adverse events and should be counseled and monitored accordingly

Ballistic Performance of Porous-Ceramic, Thermal Protection Systems to 9 km/s

Porous-ceramic, thermal protection systems are used heavily in current reentry vehicles like the Orbiter, and they are currently being proposed for the next generation of US manned spacecraft, Orion. These materials insulate the structural components and sensitive components of a spacecraft against the intense thermal environments of atmospheric reentry. These materials are also highly exposed to solid particle space environment hazards. This paper discusses recent impact testing up to 9.65 km/s on ceramic tiles similar to those used on the Orbiter. These tiles are a porous-ceramic insulator of nominally 8 lb/ft(exp 3) alumina-fiber-enhanced-thermal-barrier (AETB8) coated with a damage-resistant, toughened-unipiece-fibrous-insulation/reaction-cured-glass layer (TUFI/RCG)

Curvature-direction measures of self-similar sets

We obtain fractal Lipschitz-Killing curvature-direction measures for a large class of self-similar sets F in R^d. Such measures jointly describe the distribution of normal vectors and localize curvature by analogues of the higher order mean curvatures of differentiable submanifolds. They decouple as independent products of the unit Hausdorff measure on F and a self-similar fibre measure on the sphere, which can be computed by an integral formula. The corresponding local density approach uses an ergodic dynamical system formed by extending the code space shift by a subgroup of the orthogonal group. We then give a remarkably simple proof for the resulting measure version under minimal assumptions.Comment: 17 pages, 2 figures. Update for author's name chang

Measurements of the LHC longitudinal resistive impedance with beam

The resistive part of the longitudinal impedance contributes to the heat deposition on different elements in the LHC ring including the beam screens, where it has to be absorbed by the cryogenic system and can be a practical limitation for the maximum beam intensity. In this paper, we present the first measurements of the LHC longitudinal resistive impedance with beam, done through synchronous phase shift measurements duringMachine Development sessions in 2012. Synchronous phase shift is measured for different bunch intensities and lengths using the high-precision LHC Beam Phase Module and then data are post-processed to further increase the accuracy. The dependence of the energy loss per particle on bunch length is then obtained and compared with the expected values found using the LHC impedance model

Proton acceleration by irradiation of isolated spheres with an intense laser pulse

We report on experiments irradiating isolated plastic spheres with a peak laser intensity of 2-3 x 10(20) W cm(-2). With a laser focal spot size of 10 mu m full width half maximum (FWHM) the sphere diameter was varied between 520 nm and 19.3 mu m. Maximum proton energies of similar to 25 MeV are achieved for targets matching the focal spot size of 10 mu m in diameter or being slightly smaller. For smaller spheres the kinetic energy distributions of protons become nonmonotonic, indicating a change in the accelerating mechanism from ambipolar expansion towards a regime dominated by effects caused by Coulomb repulsion of ions. The energy conversion efficiency from laser energy to proton kinetic energy is optimized when the target diameter matches the laser focal spot size with efficiencies reaching the percent level. The change of proton acceleration efficiency with target size can be attributed to the reduced cross-sectional overlap of subfocus targets with the laser. Reported experimental observations are in line with 3D3V particle in cell simulations. They make use of well-defined targets and point out pathways for future applications and experiments.DFG via the Cluster of Excellence Munich-Centre for Advanced Photonics (MAP) Transregio SFB TR18NNSA DE-NA0002008Super-MUC pr48meIvo CermakCGC Instruments in design and realization of the Paul trap systemIMPRS-APSLMUexcellent Junior Research FundDAAD|ToIFEEuropean Union's Horizon research and innovation programme 633053Physic