Modeling solutions to Tanzania's physician workforce challenge.

BACKGROUND:There is a great need for physicians in Tanzania. In 2012, there were approximately 0.31 physicians per 10,000 individuals nationwide, with a lower ratio in the rural areas, where the majority of the population resides. In response, universities across Tanzania have greatly increased the enrollment of medical students. Yet evidence suggests high attrition of medical graduates to other professions and emigration from rural areas where they are most needed. OBJECTIVE:To estimate the future number of physicians practicing in Tanzania and the potential impact of interventions to improve retention, we built a model that tracks medical students from enrollment through clinical practice, from 1990 to 2025. DESIGN:We designed a Markov process with 92 potential states capturing the movement of 25,000 medical students and physicians from medical training through employment. Work possibilities included clinical practice (divided into rural or urban, public or private), non-clinical work, and emigration. We populated and calibrated the model using a national 2005/2006 physician mapping survey, as well as graduation records, graduate tracking surveys, and other available data. RESULTS:The model projects massive losses to clinical practice between 2016 and 2025, especially in rural areas. Approximately 56% of all medical school students enrolled between 2011 and 2020 will not be practicing medicine in Tanzania in 2025. Even with these losses, the model forecasts an increase in the physician-to-population ratio to 1.4 per 10,000 by 2025. Increasing the absorption of recent graduates into the public sector and/or developing a rural training track would ameliorate physician attrition in the most underserved areas. CONCLUSIONS:Tanzania is making significant investments in the training of physicians. Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized

Towards predicting biomechanical consequences of jaw reconstruction

Abstract — We are developing dynamic computer models of surgical jaw reconstructions in order to determine the effect of altered musculoskeletal structure on the biomechanics of mastication. We aim to predict post-reconstruction deficits in jaw motion and force production. To support these research goals we have extended our biomechanics simulation toolkit, ArtiSynth [1], with new methods relevant to surgical planning. The principle features of ArtiSynth include simulation of constrained rigid-bodies, volume-preserving finite-element methods for deformable bodies, contact between bodies, and muscle models. We are adding model editing capabilities and muscle activation optimization to facilitate progress on postsurgical simulation. Our software and research directions are focused on upper-airway and cranio-facial anatomy, however the toolset and methodology are applicable to other musculoskeletal systems. I

Field-Observed Angles of Repose for Stored Grain in the United States

Citation: Bhadra et al. (2016). Field-Observed Angles of Repose for Stored Grain in the United States. Applied Engineering in Agriculture, 33(1), 131-137. Doi:10.13031/aea.11894Bulk grain angle of repose (AoR) is a key parameter for inventorying grain, predicting flow characteristics, and designing bins and grain handling systems. The AoR is defined for two cases, piling (dynamic) or emptying (static), and usually varies with grain type. The objective of this study was to measure piling angles of repose for corn, sorghum, barley, soybeans, oats, and hard red winter (HRW) wheat in steel and concrete bins in the United States. Angles were measured in 182 bins and 7 outdoor piles. The piling AoR for corn ranged from 15.7° to 30.2° (median of 20.4° and standard deviation of 3.8°). Sorghum, barley, soybeans, oats, and HRW wheat also exhibited a range of AoR with median values of 24.6°, 21.0°, 23.9°, 25.7°, and 22.2°, respectively. Angles of repose measured for the seven outdoor piles were within the ranges measured for the grain bins. No significant correlation was observed between AoR and moisture content within the narrow range of observed moisture contents, unlike previous literature based on laboratory measurement of grain samples with wider ranges of moisture content. Overall, the average measured piling AoR were lower than typical values cited in MWPS-29, but higher than some laboratory measurements

Heat transport in model jammed solids

We calculate numerically the normal modes of vibrations in 3D jammed packings of soft spheres as a function of the packing fraction and obtain the energy diffusivity, a spectral measure of transport that controls sound propagation and thermal conductivity. The crossover frequency between weak and strong phonon scattering is controlled by the coordination and shifts to zero as the system is decompressed towards the critical packing fraction at which rigidity is lost. Below the crossover, the diffusivity displays a power-law divergence with inverse frequency, which suggests that the vibrational modes are primarily transverse waves, weakly scattered by disorder. Above it, a large number of modes appear whose diffusivity plateaus at a nearly constant value independent of the inter-particle potential, before dropping to zero above the Anderson localization frequency. The thermal conductivity of a marginally jammed solid just above the rigidity threshold is calculated and related to the one measured experimentally at room temperature for most glasses.Comment: 15 pages, 7 figure

Induction of Colonic Aberrant Crypts in Mice by Feeding Apparent N-Nitroso Compounds Derived From Hot Dogs

Nitrite-preserved meats (e.g., hot dogs) may help cause colon cancer because they contain N-nitroso compounds. We tested whether purified hot-dog-derived total apparent N-nitroso compounds (ANC) could induce colonic aberrant crypts, which are putative precursors of colon cancer. We purified ANC precursors in hot dogs and nitrosated them to produce ANC. In preliminary tests, CF1 mice received 1 or 3 i.p. injections of 5mg azoxymethane (AOM)/kg. In Experiments 1 and 2, female A/J mice received ANC in diet. In Experiment 1, ANC dose initially dropped sharply because the ANC precursors had mostly decomposed but, later in Experiment 1 and throughout Experiment 2, ANC remained at 85 nmol/g diet. Mice were killed after 8 (AOM tests) or 17–34 (ANC tests) wk.Median numbers of aberrant crypts in the distal 2 cm of the colon for 1 and 3 AOMinjections, CF1 controls, ANC (Experiment 1), ANC (Experiment 2),and untreated A/J mice were 31, 74, 12, 20, 12, and 5–6, with P < 0.01 for both ANC tests. Experiment 2 showed somewhat increased numbers of colonic mucin-depleted foci in the ANC-treated group. We conclude that hot-dog-derived ANC induced significant numbers of aberrant crypts in the mouse colon

Updated Information on the Local Group

The present note updates the information published in my recent monograph on \underline{The Galaxies of the Local Group}. Highlights include (1) the addition of the newly discovered Cetus dwarf spheroidal as a certain member of the Local Group, (2) an improved distance for SagDIG, which now places this object very close to the edge of the Local Group zero-velocity surface, (3) more information on the evolutionary histories of some individual Local Group members, and (4) improved distance determinations to, and luminosities for, a number of Local Group members. These data increase the number of certain (or probable) Local Group members to 36. The spatial distribution of these galaxies supports Hubble's claim that the Local Group ``is isolated in the general field.'' Presently available evidence suggests that star formation continued much longer in many dwarf spheroidals than it did in the main body of the Galactic halo. It is suggested that ``young'' globular clusters, such as Ruprecht 106, might have formed in now defunct dwarf spheroidals. Assuming SagDIG, which is the most remote Local Group galaxy, to lie on, or just inside, the zero-velocity surface of the Local Group yields a dynamical age \gtrsim 17.9 \pm 2.7 Gyr.Comment: 19 pages, 1 figure, to be published in the April 2000 issue of PAS

Who Treats Patients with Diabetes and Compensated Cirrhosis

Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis

Catalysts for long-life closed-cycle CO2 lasers

Long-life, closed-cycle operation of pulsed CO2 lasers requires catalytic CO-O2 recombination both to remove O2, which is formed by discharge-induced CO2 decomposition, and to regenerate CO2. Platinum metal on a tin (IV) oxide substrate (Pt/SnO2) has been found to be an effective catalyst for such recombination in the desired temperature range of 25 to 100 C. This paper presents a description of ongoing research at NASA-LaRC on Pt/SnO2 catalyzed CO-O2 recombination. Included are studies with rare-isotope gases since rare-isotope CO2 is desirable as a laser gas for enhanced atmospheric transmission. Results presented include: (1) achievement of 98% to 100% conversion of a stoichiometric mixture of CO and O2 to CO2 for 318 hours (greater than 1 x 10 to the 6th power seconds), continuous, at a catalyst temperature of 60 C, and (2) development of a technique verified in a 30-hour test, to prevent isotopic scrambling when CO-18 and O-18(2) are reacted in the presence of a common-isotope Pt/Sn O-16(2) catalyst