Search

Background: Fostering the success of surgical trainees from low- and middle-income countries (LMICs) plausibly addresses the existing workforce deficit in a sustainable manner, but it is unclear whether and how these trainees are targeted as strategic learners for educational exchanges. The purpose of this review was to assess the quality and outcomes of existing literature on exchanges of surgical trainees between high-income countries (HICs) and LMICs. Methods: We conducted a systematic review of reported instances of surgical training exchanges between HICs and LMICs. After database searching, 2 independent reviewers evaluated titles, abstracts and manuscripts. Selected studies were critically appraised with the use the Critical Assessment Skills Programme Qualitative Checklist and analyzed for trainee level, institutions, countries and subspecialties, as well as reported outcomes of the exchange. Results: Twenty-eight reports met the inclusion criteria and were analyzed. Most publications (18 [64%]) detailed North-to-South exchanges; 1 exchange was bidirectional. General surgery was the most common discipline identified, with 9 other subspecialties described involving learners at all phases of training. Reports were generally of good quality, although outcomes were reported variably, and most authors failed to acknowledge the ethical implications of their study. Conclusion: The articles identified described a variety of surgical exchanges across disciplines, learner types and host/home countries. Few of the exchanges prioritized the learning of surgical trainees from LMICs. There is an increasing need to formalize these exchanges via clear goals and objectives, as well as to prioritize the proper matching of educational goals with local clinical needs. Level of evidence: V - Evidence from systematic reviews of descriptive and qualitative studies. Contexte: Le soutien a la reussite des chirurgiens en formation des pays a revenu faible ou moyen (PRFM) pourrait concretement aider a remedier au manque d'effectifs actuel de facon durable. On ignore toutefois si ces apprenants sont cibles par les programmes d'echanges en tant que candidats strategiques et quelles sont les methodes de recrutement employees. La presente revue vise a evaluer la qualite et les resultats des publications sur les echanges entre pays a revenu eleve (PRE) et PRFM auxquels participent des chirurgiens en formation. Methodes: Nous avons procede a une revue systematique des cas rapportes d'echanges etudiants en chirurgie entre PRE et PRFM. Apres une recherche dans les bases de donnees, 2 evaluateurs independants ont passe en revue les titres, les resumes et les manuscrits retenus. Les etudes selectionnees ont fait l'objet d'une evaluation critique d'apres la liste de controle pour la recherche qualitative CASP (Critical Assessment Skills Programme Qualitative Checklist); les criteres d'analyse comprenaient le niveau de scolarite des apprenants, les etablisse-ments, les pays et les surspecialites, ainsi que les resultats rapportes pour l'echange. Resultats: Au total, 28 rapports repondaient aux criteres d'inclusion et ont donc ete analyses. La plupart d'entre eux (18 [64 %]) traitaient d'echanges du nord au sud; un echange etait bidirectionnel. La chirurgie generale etait la discipline la plus souvent recensee; on a aussi decrit la participation d'apprenants a differentes etapes de leur formation pour 9 autres surspecialites. Les rapports etaient en general de bonne qualite, mais la presentation des resultats variait, et la majorite des auteurs ont omis de rendre compte des considerations ethiques de leur etude. Conclusion: Les articles evalues decrivaient des echanges etudiants en chirurgie se rapportant a une multitude de disciplines, de types d'apprenants et de pays d'origine et d'accueil. Peu de programmes d'echanges priorisaient l'apprentissage des chirurgiens en formation issus des PRFM. Il est de plus en plus pressant de baliser les echanges etudiants en etablissant des buts et des objectifs clairs, et de faire une priorite de la juste correspondance des objectifs peda-gogiques et des besoins cliniques locaux. Niveau de preuve: V--Preuve issue de revues systematiques d'etudes descriptives et qualitatives., The delivery of surgical care to underresourced areas has been increasingly prioritized by health care providers and governing bodies, as evidenced by the efforts of the Lancet Commission on Global [...]

Objectives: To investigate incidence, mortality and case survival trends for cancer of unknown primary site (CUP) and consider clinical implications. Method: South Australian Cancer Registry data were used to calculate age-standardised incidence and mortality rates from 1977 to 2004. Disease-specific survivals, socio-demographic, histological and secular predictors of CUP, compared with cancers of known primary site, and of CUP histological types, using multivariable logistic regression were investigated. Results: Incidence and mortality rates increased approximately 60% between 1977-80 and 1981-84. Rates peaked in 1993-96. Male to female incidence and mortality rate ratios approximated 1.3:1. Incidence and mortality rates increased with age. The odds of unspecified histological type, compared with the more common adenocarcinomas, were higher for males than females, non-metropolitan residents, low socio-economic areas, and for 1977-88 than subsequent diagnostic periods. CUP represented a higher proportion of cancers in Indigenous patients. Case survival was 7% at 10 years from diagnosis. Factors predictive of lower case survival included older age, male sex, Indigenous status, lower socio-economic status, and unspecified histology type. Conclusion: Results point to poor CUP outcomes, but with a modest improvement in survival. The study identifies socio-demographic groups at elevated risk of CUP and of worse treatment outcomes where increased research and clinical attention are required. Keywords: Cancer unknown primary; incidence; mortality; survival. doi: 10.1111/j.1753-6405.2008.00260.x

The effect of dilution of tunable ferroelectric with linear materials are theoretically addressed. The main impact of the dilution on the main dielectric parameters of the material is shown to be very sensitive to the composite type.

Estimates of incidental marine mammal, sea turtle, and seabird mortality in the California drift gillnet fishery for broadbill swordfish, Xiphias gladius, and common thresher shark, Alopias vulpinus, are summarized for the 7-year period, 1996 to 2002. Fishery observer coverage was 19% over the period (3,369 days observed/17,649 days fished). An experiment to test the effectiveness of acoustic pingers on reducing marine mammal entanglements in this fishery began in 1996 and resulted in statistically significant reductions in marine mammal bycatch. The mast commonly entangled marine mammal species were the short-beaked common dolphin, Delphinus delphis; California sea lion, Zalophus californianus; and northern right whale dolphin, Lissodelphis borealis. Estimated mortality by species (CV and observed mortality in parentheses) from 1996 to 2002 is 861 (0.11, 133) short-beaked common dolphins; 553 (0.16, 103) California sea lions; 151 (0.25, 31) northern right whale dolphins; 150 (0.21, 27) northern elephant seals, Mirounga angustirostris; 54 (0.41, 10) long-beaked common dolphins, Delphinus capensis; 44 (0.53, 6) Dali's porpoise, Phocoenoides dalli; 19 (0.60, 5) Risso's dolphins, Grampus griseus; 11 (0.71, 2) gray whales, Eschrichtius robustus; 7 (0.83, 2) sperm whales, Physeter macrocephalus; 7 (0.96, 1) short-finned pilot whales, Globicephala macrorhychus; 12 (1.06, 1) minke whales, Balaenoptera acutorostrata; 5 (1.05, 1) fin whales, Balaenoptera physalus; 11 (0.68, 2) unidentified pinnipeds; 33 (0.52, 4) leatherback turtles, Dermochelys coriacea; 18 (0.57, 3) loggerhead turtles, Caretta caretta; 13 (0.73, 3) northern fulmars, Fulmarus glacialis; and 6 (0.86, 2) unidentified birds., Introduction The California drift gillnet fishery for broadbill swordfish, Xiphias gladius, and common thresher shark, Alopias vulpinus, developed in the late 1970's when incidental catches of pelagic sharks in small-mesh [...]

The fabrication of new six-layer perovskite-related structure [Ba.sub.6][Na.sub.2][Nb.sub.2][M.sub.2][O.sub.17] (M = P, V), which consists of cubic (c) Ba[O.sub.3] layers and oxygen-deficient pseudocubic (c') Ba[O.sub.2] layers stacked in the sequence c'ccccc, is presented. Both oxides are obtained from the 2:1 ordered perovskite structure by ordered removal of O atoms in every sixth Ba[O.sub.3] layer.