Is resident assistance equivalent to fellows during hepatectomy?

OBJECTIVE: Hepatectomy is a complex operative procedure frequently performed at academic institutions with trainee participation. The aim of this study was to determine the effect of assistant's training level on outcomes following hepatectomy. METHODS: A retrospective review of a prospective, single-institution ACS-NSQIP database was performed for patients that underwent hepatectomy (2013-2016). Patients were divided by trainee assistant level: hepatopancreatobiliary (HPB) fellow versus general surgery resident (PGY 4-5). Demographic, perioperative, and 30-day outcome variables were compared using Chi-Square/Fisher's exact, Mann-Whitney U test, and multivariable regression. Cases involving a senior-level general surgery resident or HPB fellow as first assistant were included (n = 352). Those with a second attending, junior-level resident, or no documented assistant were excluded (n = 39). RESULTS: Patients undergoing hepatectomy with an HPB fellow as primary assistant had more frequent preoperative biliary stenting, longer operative time, and more concomitant procedures including biliary reconstruction, resulting in a higher rate of post-hepatectomy liver failure (PHLF) (15% vs. 8%, P = 0.044). However, trainee level did not impact PHLF on multivariable analysis (OR 0.60, 95% CI [0.29-1.25], P = 0.173). Fellows assisted with proportionally more major hepatectomies (45% vs. 31%; P = 0.010) and resections for hepatobiliary cancers (31% vs. 19%, P = 0.014). On stratified analysis of major and minor hepatectomies, outcomes were similar between trainee groups. CONCLUSION: Fellows performed higher complexity cases with longer operative time. Despite these differences, outcomes were similar regardless of assistant training level. Resident and HPB fellow participation in operations requiring liver resection provide comparable quality of care.

Directly pumped 10 GHz microcomb modules from low-power diode lasers.

Soliton microcombs offer the prospect of advanced optical metrology and timing systems in compact form factors. In these applications, the pumping of microcombs directly from a semiconductor laser without amplification or triggering components is desirable to reduce system power and to simplify system design. At the same time, low-repetition-rate microcombs are required in many comb applications as an interface to detectors and electronics, but their increased mode volume makes them challenging to pump at low power. Here 10 GHz repetition rate soliton microcombs are directly pumped by low-power (<20 mW) diode lasers. High-Q silica microresonators are used for this low-power operation and are packaged into fiber-connectorized modules that feature temperature control for improved long-term frequency stability.

Travel distance affects rates and reasons for inpatient visits after pancreatectomy.

BACKGROUND: Centralization of complex surgical care leads to increased travel distances for patients. We sought to determine if increased travel distance to the index hospital altered inpatient Visit rates following pancreatectomy. METHODS: Pancreatectomies from 2013-2016 were reviewed retrospectively from a single high-volume institution. Travel distance for 936 patients was determined, and patients were grouped by 50-mile increments. Visits (Observations or Readmissions) and corresponding reasons were gathered. RESULTS: 222 patients (23.7%) had a Visit to any hospital (AH) within 90 days postoperative; 195 (87.8%) were to the index hospital (IH). The <50 miles group had the highest Visit rate to AH (28.6% vs. 17.8% vs. 24.6%; P = 0.008) and the IH (26.9% vs. 15.2% vs. 20.6%; P = 0.002) compared to 50-100 and > 100 miles. This trend was statistically significant for Observations, but not Readmissions. Gastrointestinal (GI) complaints alone led to 20.7% patients requiring Visits to AH at 90-days, mostly in <50miles group for Visits and Observations at AH and IH. CONCLUSIONS: Patients closest to the IH had the highest Visit and Observation rate following pancreatectomy without affecting Readmission rate, with GI complaints as a driving factor. Inpatient education and outpatient symptom management may reduce repeat hospitalization.

Mode-locked pulses from mid-infrared quantum cascade lasers.

In this study, we report the unequivocal demonstration of midinfrared mode-locked pulses from quantum cascade lasers. The train of short pulses was generated by actively modulating the current and hence the gain of an edge-emitting quantum cascade laser (QCL). Pulses with duration of about 3 ps at full-width-at-half-maxima and energy of 0.5 pJ were characterized using a second-order interferometric autocorrelation technique based on a nonlinear quantum well infrared photodetector. The mode-locking dynamics in the QCLs was modeled based on the Maxwell-Bloch equations in an open two-level system. Our model reproduces the overall shape of the measured autocorrelation traces and predicts that the short pulses are accompanied by substantial wings as a result of strong spatial hole burning. The range of parameters where short mode-locked pulses can be formed is found.

Authorship trends in the Journal of Orthopaedic Research: A bibliometric analysis.

Publications are an important tool to measure one's success and achievement in academia. They can help propel a career forward and move one into a position of leadership. The overall purpose of this study was to investigate changes in bibliometric variables, authorship, and collaboration trends in the Journal of Orthopaedic Research (JOR®), since its inception in 1983. A bibliometric analysis was completed for all manuscripts meeting the inclusion criteria (638), which were published throughout the inaugural year plus one representative year of each decade. Several parameters were investigated including numbers of manuscripts, authors, collaborating institutions/countries, references, pages, and citations; region of origin and gender of authors over time and by region were main focuses. Significant increases over time were observed in all bibliometric variables analyzed except in the number of pages and citations. There was an approximate 27% point increase for both female first and corresponding authors from 1983 to 2015. While this is most likely due to the increase in the number of women that have entered the field over time, similar increases in the percentage of women holding positions on the JOR editorial board or in leadership positions within in the field may have also contributed to improvements in gender parity. Understanding changes in publishing characteristics over time, by region, and by gender are critical, especially with the rising demands of publishing in academia. JOR has seen increase in most variables analyzed, including improvements in authorship by women in the field of orthopaedic research. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3071-3080, 2018.