text:
Solaris Dentistryan Medical
www.fivevalleysurology.com Review:
http://solarisdentistryandmedical.com/w/www.fivevalleysurology.com.html
Missoula & Western Montana Urology and Prostate Care | Five Valleys Urology - Five Valleys Urology is dedicated to being the region's urologic provider of choice by providing the full continuum of urologic care in a patient centered
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http://www.fivevalleysurology.com/about/ About Us | Five Valleys Urology - Five Valleys Urology had yet to be formed when Dr. David Guth, one of our founding partners, struck out on his own in 1977 to form a solo practice in the newly
http://www.fivevalleysurology.com/about/kevin-kronner-md/ Kevin M. Kronner, MD | Five Valleys Urology - Special Interests: Laparascopic Robotic Surgery, Adult & Pediatric Urology, Laparascopic Surgery, Laser Surgery, No Scalpel Vasectomy, Vasectomy Reversal,
http://www.fivevalleysurology.com/about/garrick-simmons-md/ Garrick R. Simmons, MD | Five Valleys Urology - Special Interests: Laparascopic Robotic Surgery, Adult & Pediatric Urology, Laparascopic Surgery, Laser Surgery, Vasectomy, Clinical Research Hobbies/
http://www.fivevalleysurology.com/about/karl-westenfelder-md/ Karl R. Westenfelder, MD | Five Valleys Urology - Special Interests: Laparascopic Robotic Surgery, Urologic Oncology, Stone Disease, General Adult & Pediatric Urology, Laparascopic Surgery, Laser Surgery,
http://www.fivevalleysurology.com/about/christopher-wicher-md/ Christopher G. Wicher, MD | Five Valleys Urology - Special Interests: Laparoscopic Robotic Surgery, General Adult General Adult & Pediatric Urology, Urologic Oncology, Laprascopic Surgery, Laser Surgery,
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http://www.fivevalleysurology.com/about/whitney-martin-pac/ Whitney Martin, PA-C | Five Valleys Urology - SPECIAL INTERESTS: General Adult and Pediatric Urology, Female Urology including Incontinence, Recurrent Urinary Tract Infections, Interstitial Cystitis, OAB,
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Country: 192.124.249.3, North America, US
City: -97.822 , United States
bryce - Way better than expected for my short haired dogs!
I'll be honest.. I was not expecting this to really work, and it kinda looks like some sort of medevil torture device! I was up late one night after cleaning a ton that day, and I saw a clump of animal fur blow by in the kitchen.... seriously? how is there that much hair after vacuuming and sweeping and moping??? Granted there are 2 dogs and 2 cats in this house, but that is just ridiculous. Annoyed I went to play on facebook and there was an add for this brush. I wanted amazed at all the fur they were getting off of the animals.. Surely this was the answer to my prayers! I ordered it at 2 am in the morning!
D. McMahon - Okay, not perfect
we will overlook the fact that when you buy a $500 stroller you dont get any cup holders or storage..
Nina - Losin' my hair
I ordered this in the hopes it would help my hair grow longer quicker. After using it twice, I have decided to stop using it because more than my normal amount of hair fell out both times. I always have some hair fall out, but this was easily two to three times that amount.
Revolutionary; to compare it to the other 2 is futile.. - Revolutionary; to compare it to the other 2 is futile..
I've been an MA fan since '94. I own all three albums, as well as No Protection and the Singles Collection. Massive Attack, aside from being insanely talented, switch formulas from album to album, which is why it's pointless to compare the albums to each other. Moreover, many of the latecomers who think Mezzanine is MA's best are oblivious to the beauty and texture of "Protection" and "Blue Lines". (You can't get to C by ignoring A and B.)
Amazon Customer - A must have for the small business owner
The only issue I had was the importing of some items from Quickbooks. Partly due to Quickbooks chart of accounts not being configured correctly. beyond that, The ability to import your files directly, work the balance sheet, and work through all potential deductions was huge.
ArtistCPA - Additional charges apply
After I purchased this payroll product and used it for several months Intuit started charging our firm a monthly fee for processing, on top of the fee we paid for software. This is a new billing practice for them (I've been using their payroll for 4 years now and there have never been any additional charges) so be aware they have changed how they charge for payroll. They force you to provide a credit card number to activate the account.
© 2016 Solaris Dentistryan Medical. All Rights Reserved.


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Q: Hausdorff measure for Lebesgue measurable sets? As I never had a course which dealt with Hausdorff measures and every time I heard about Hausdorff measure I was only thinking using my intuition what that should be. So I decided to take a look at the definition, and try some typical examples. I am reading a chapter on Hausdorff measure of Real Analysis by Stein and Shakarchi.
I saw that they define the Hausdorff measure only for Borel measurable sets. My questions are:

*

*Can we define Hausdorff measure for Lebesgue measurable sets or not?

*If a set $E \subset \Bbb{R}^n$ has Lebesgue measure zero, then it's Hausdorff dimension is strictly smaller than $n$?

I am concerned about this since I sort of rushed out and 'proved' the following thing using Hausdorff measures:

If $E \subset \Bbb{R}^n$ has Lebesgue measure zero and $f :\Bbb{R}^n \to \Bbb{R}^n$ is Lipschitz continuous then  $f(E)$ also has Lebesgue measure zero.

and I don't think my proof is right.

A: Wikipedia has some useful information.
In $\mathbb{R}^d$, $d$-dimensional Hausdorff measure is equal to Lebesgue measure (up to scaling).  So once you have defined it for Borel sets, you can extend it to Lebesgue-measurable sets in the same way: any Lebesgue-measurable set is of the form $A = B \cup C$ where $B$ is Borel and $C$ is Lebesgue measurable with $m(C) = 0$, so define the Hausdorff measure of $A$ to be the Hausdorff measure of $B$. Just as with Lebesgue measure, this gives you a countably additive complete measure.
Wiki also gives a counterexample to your question 2: the image of a 2-dimensional Brownian motion has Hausdorff dimension 2 but its 2-dimensional Hausdorff measure (i.e. its Lebesgue measure) is zero (almost surely).

A: Hausdorff outer measure is defined for all sets, and then we use the definition of Caratheodory to restrict it to a subalgebra of "measurable" sets to get the Hausdorff measure.  In $\mathbb R^n$, the $n$-dimensional Hausdorff outer measure is the same (up to a constant factor) as $n$-dimensional Lebesgue outer measure, so they have the same measurable sets as well.
Another counterexample to 2.  In interval $[n,n+1]\;$ take a subset with Hausdorff dimension $1-1/n\;$.  The union of these sets has Hausdorff dimension 1 but Lebesgue measure zero.
So to prove your fact about Lipschitz functions, you cannot do it by considering only sets with Hausdorff dimension ${}\lt 1$, you have to consider Lebesgue measure itself, and use its definition.  Try it, it's not too hard!

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BM8251 Engineering Mechanics For Biomedical Engineers study materials for all 5 unit Syllabus Notes, question banks, 2 marks with answers (Part A), 15 marks questions (Part B & Part C), Previous year question papers, model question papers in pdf format have been provided.
Students can make use of the below table to access all study materials for BM8251 Engineering Mechanics For Biomedical Engineers in PDF as well as in word format. Students can also download Engineering Mechanics For Biomedical Engineers related PPT's and PDF's which they can use it to prepare for their exams as well as for their taking up their seminar during college hours.
Introduction – Units and Dimensions – Laws of Mechanics – Lami's theorem, Parallelogram and triangular Law of forces –– Vectorial representation of forces – Vector operations of forces -additions, subtraction, dot product, cross product – Coplanar Forces – rectangular components – Equilibrium of a particle – Forces in space – Equilibrium of a particle in space – Equivalent systems of forces – Principle of transmissibility.
Free body diagram – Types of supports –Action and reaction forces –stable equilibrium – Moments and Couples – Moment of a force about a point and about an axis – Vectorial representation of moments and couples – Scalar components of a moment – Varignon's theorem – Single equivalent force -Equilibrium of Rigid bodies in two dimensions – Equilibrium of Rigid bodies in three dimensions.
Rigid bodies and deformable solids – Tension, Compression and Shear Stresses – Deformation of rigid and non rigid bodies - Centroids and center of mass- Centroids of lines and areas - Rectangular, circular, triangular areas by integration –Principal moments of inertia of plane areas – Principal axes of inertia-Mass moment of inertia –mass moment of inertia for prismatic, cylindrical and spherical solids from first principle.
Fluids – density – pressure – blood pressure and gravity – buoyancy – moments of force and stability – movement in water –Newton's laws of viscosity – Definitions and simple problems on Newtonian fluid, Non-Newtonian fluid, Euler equations and Navier Stoke's equations,Visco elasticity, laminar flow, Couette flow, turbulent flow and Hagenpoiseuille equation.
Displacements, Velocity and acceleration, their relationship – Relative motion – Newton's laws of motion – Work Energy Equation– Friction force – Laws of sliding friction – equilibrium analysis of simple systems with sliding friction.


text:
News | Local
Apartment building in southeast Willmar heavily damaged in Wednesday afternoon fire
No one was injured Wednesday when a fire that reportedly started in a clothes dryer spread to other parts of a four-plex apartment building in southeast Willmar.
By West Central Tribune staff report
WILLMAR — A four-plex apartment building in southeast Willmar was heavily damaged by fire and smoke Wednesday afternoon.
No one was injured, and a cat was rescued, according to a news release.
The Willmar Fire Department was called to the building in the 2400 block of Fourth Avenue Southeast about 1:30 p.m. Wednesday.
More public safety news:
Montevideo man suffers life-threatening injuries in crash Friday near Clara City, Minnesota
A 19-year-old Montevideo man was taken to St. Cloud Hospital Friday morning following a crash in which he was a passenger.
By Jennifer Kotila
Willmar woman injured in crash with semi near Lake Lillian, Minnesota
A 19-year-old Willmar woman was transported to CentraCare — Rice Memorial Hospital after the vehicle she was driving crashed with a semi on Minnesota Highway 7 in East Lake Lillian Township.
Records published Jan. 28, 2023
The Tribune publishes Records as part of its obligation to inform readers about the business of public institutions and to serve as a keeper of the local historical record. All items are written by Tribune staff members based on information contained in public documents from the state court system and from law enforcement agencies. It is the Tribune's policy that this column contain a complete record. Requests for items to be withheld will not be granted.
Driver transported to hospital after being run off highway near Holloway in western Minnesota
A 22-year-old driver suffered non-life-threatening injuries after his car was run off the road by another vehicle on U.S. Highway 59, according to the Minnesota State Patrol.
Minnesota woman pleads guilty to cold case murder of newborn
A 50-year-old Red Wing woman has pleaded guilty to second-degree murder related to leaving her new born infant boy in the Lake Pepin as part of a plea deal.
By Mark Wasson
Teenage passenger injured in rollover crash north of Litchfield, Minnesota
A 15-year-old male suffered what are believed to be non-life threatening injuries after a crash reported Wednesday night to the Minnesota State Patrol. The driver, a 19-year-old male, was not injured.
Kandiyohi County issues warning about Green Lake ice conditions near Spicer's Saulsbury Beach
A hazardous ice warning has been issued for Green Lake near Saulsbury Beach ahead of Spicer Winterfest and Polar Plunge activities this weekend.
While on the way to the scene, the department was told that heavy black smoke was coming from a clothes dryer and out the door of the building.
When the department arrived, the smoke was getting thicker, and the fire appeared to have spread beyond the dryer, according to the news release from Fire Chief Frank Hanson.
Residents said that everyone was out of the building, but a cat was missing somewhere inside.
The fire had spread to other areas of the building through void spaces between the two floors, and it was difficult to reach, according to the release.
The department requested mutual aid from several other departments to assist with staffing. Fire crews were at the scene until about 6 p.m. Wednesday.
The apartment building and its contents were heavily damaged by smoke and fire.
The cause of the fire is currently under investigation by the Willmar Fire Department and the Minnesota State Fire Marshals Division.
CentraCare Emergency Medical Services-Willmar, Willmar Municipal Utilities, the Minnesota State Fire Marshal Division and the Pennock, Kandiyohi, and Spicer fire departments also responded to the scene.
Related Topics: MINNESOTAWILLMARWILLMAR FIRE DEPARTMENTFIRESPUBLIC SAFETY
Our newsroom occasionally reports stories under a byline of "West Central Tribune staff report." Often, the "West Central Tribune staff report" byline is used when rewriting basic news briefs that originate from official sources, such as a city press release about a road closure, and which require little or no reporting. At times, this byline is used when a news story includes numerous authors or when the story is formed by aggregating previously reported news from various sources. If outside sources are used, it is noted within the story.
The West Central Tribune newsroom can be reached via email:
news@wctrib.com or phone 320-235-1150.
Minneapolis artist Gregory Rose visits Ridgewater College to talk about trauma, community and art
Minneapolis artist Gregory Rose in a visit to Willmar shared how art can be a way to confront trauma, build community and look different at the world.
By Shelby Lindrud
Kandiyohi County catches attention of international hemp processor interested in possible expansion
A Netherlands-based business is looking to build a hemp processing facility in Kandiyohi County or the region. There could also be an opportunity for farmers to plant a hemp crop this season for the company.
Funeral service listing published Jan. 28, 2023
Area funerals scheduled through XX, 2023
Willmar Chamber President Ken Warner says he will miss working on community projects when he retires
Retiring president of the Willmar Lakes Area Chamber of Commerce Ken Warner says he has enjoyed his time working for the Willmar business community.
By Linda Vanderwerf

redpajama_set_name: RedPajamaCommonCrawl


YEC member company College Hunks Hauling and Moving was named a winner of the TINYpulse Raising the Bar Award for being one of the best places to work. Congratulations to YEC member Nick Friedman!
John also appeared on AccessHollywood Live to talk about his company.
Kelsey Meyer and John Hall's company, Influence & Co., currently has multiple full-time and intern-level positions open in their office. Click here to learn more.
Founder and CEO Dan Price is looking for someone to join Gravity Payments' Team Advocates Department. The position is Training Coordinator and the position is based in their Ballard, Seattle office. Go here to visit the career page.


The new princess on the block...well she was never offical called princess ingame.
Rosalina debuted in Super Mario Galaxy, seeking the aid of Mario. In an earlier event, Bowser attacked her observatory stealing the stars and Grand Stars. Rosalina later appeared to Mario after Peach is kidnapped. In order to aid Mario she gave him a Luma the same one seen with Peach at the Star Festival. After Mario collected enough stars to power the ship Rosalina flew the observatory to the center of the universe for the final confrontation with Bowser.
Rosalina's back-story is chronicled in a storybook told by her in the Comet Observatory's Library. Nine chapters are unlocked throughout the game, and the last is unlocked by completing the game.
Rosalina is also the first female character added into the Mario Kart series that wasn't Peach or Daisy (or a Toad...and is Birdo a girl?). Rosalina is also the first female heavyweight character and like Peach and Daisy she sports a new outfit for cycles.
Meh. I wasn't really touched by her little kid story in the Comet Observatory's Library, but I still like the way she was mysteriously portrayed in SMG. Makes her a lot more interesting than Peach in my book.
I look forward to using her in Mario Kart Wii when I get it on my birthday later this month.
She's fun to use in Mario Kart because she gets a little Luma to float around her.
Yep. She'll definitely be my main in Mario Kart Wii.
I hear she was originally meant to be a Assist Trophy in Brawl.
Yeah. I heard that too. I wonder what she would've done/what her attack would've been..
Hell, they could've had a uper Mario Galaxy level if they weren't gonna add the likes of Viewtiful Jow or Travis Touchdown as 3rd party characters.
I'm happy with Isle Delfino and all, but still.
IIRC, something said that she would use her wand to send a bunch of those little Luma Stars flying across the screen (probably like the unown from Melee and the Beedrill from SSB64).
Travis Touchdown (No More Heroes) came out too late for him to be added into Brawl and Viewiful Joe (Jow?) went onto the PS2 and thus betrayed Nintendo! Capcom does that a lot what with the likes of Resident Evil 4 suddenly popping up on the inferior PS2.
Now, who has pictures? Let's take another respectable woman of gaming and make her into a complete whore!
This is why I'm weary of Gamespot users sometimes.
It would be great if an anime was made using that picture of Peach, Daisy, and Rosalina.
Being able to control the Power Stars and Comet Observatory makes her quite powerful. Too bad I don't have Mario Kart Wii to see her greatness in that racing game; I don't even know if I'm gonna get it.


text:
Q: Code does not give any result and there is no syntax error I get no results.
This may be the answer you're looking for. If not, try removing or changing your filters to make them less specific."
SELECT
    COUNT(*) AS Cham_camera, DATE(t2.time) AS time2, t2.tagID
FROM
    sc_analytics.ugc_post_created AS t2
WHERE
    t2.content_src = "camera"
    AND t2.Composetype = "video"
    AND t2.Language = "Tamil"
    AND CAST(t2.userId AS INT64) IN (SELECT *
                                     FROM `maximal-furnace-783.sc_analytics`.championsId)
    AND CAST(DATE(t2.`time`) AS timestamp) BETWEEN CAST(DATE_ADD(DATE(current_timestamp), interval -2 day) AS timestamp)
                                               AND CAST(DATE(current_timestamp()) AS timestamp)
GROUP BY
    2, 3

"No results!
  This may be the answer you're looking for. If not, try removing or changing your filters to make them less specific."

I expect a table with time and tagID grouped champions camera content

A: Well that looks like no results from the filters you have used.
Try to run the below part of the query and see if you are getting any results:
 SELECT count(*) as Cham_camera, date(t2.time) as time2, t2.tagID from
 sc_analytics.ugc_post_created as t2

and then try adding the conditions as needed.


The Office of Sport is dedicated to researching the evidence-base into the value of sport, active recreation and physical activity towards improving the health and wellbeing of people in NSW.
In 2016 the Office of Sport and the University of Sydney Charles Perkins Centre established the SPRINTER (The Prevention Research Collaboration's Sport and Active Recreation Intervention & Epidemiology Research Group) research collaboration project.
The partnership is a three-year agreement for research into national and international practices and strategies that have proved successful in increasing participation in sport and active recreation.
SPRINTER unites wider agencies across the sector through intervention and epidemiology research and evaluation to inform policy and practice for increasing participation.
Develop best practice guidance on increasing population physical activity and participation rates.
For more information on SPRINTER please email Dr Lindsey Reece, Senior Research Fellow and Director, SPRINTER.


text:
Le tramway de Horlivka est le réseau de tramways de la ville de Horlivka, en Ukraine. Le réseau est composé de quatre lignes. Sa première ligne a été mise en service en 1932.

Réseau actuel

Aperçu général
Le réseau compte quatre lignes :

Notes et références

Voir aussi

Articles connexes
 Dniprodzerjynsk
 Liste des tramways en Europe

Horlivka
Horlivka

redpajama_set_name: RedPajamaWikipedia


text:
Featured Articles: Special Article
Mathis, Michael R. MD*; Schonberger, Robert B. MD, MHS†; Whitlock, Elizabeth L. MD, MSc‡; Vogt, Keith M. MD, PhD§; Lagorio, John E. MD, MBA∥; Jones, Keith A. MD¶; Conroy, Joanne M. MD#; Kheterpal, Sachin MD, MBA*
From the *Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
†Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
‡Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
§Departments of Anesthesiology & Perioperative Medicine and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
∥Department of Anesthesiology, Mercy Health, Muskegon, Michigan
¶Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
#Department of Anesthesiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
Published ahead of print March 08, 2021.
Accepted for publication January 5, 2021.
Funding: All work and partial funding attributed to the Department of Anesthesiology, University of Michigan Medical School (Ann Arbor, MI). The project was supported in part by the National Heart, Lung, and Blood Institute, Grant K01-HL141701-02, Bethesda, MD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of Interest: See Disclosures at the end of the article.
Address correspondence to Michael R. Mathis, MD, Department of Anesthesiology, University of Michigan, 1H247 UH, SPC 5048, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to [email protected].
Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field's health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology's public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone—rather than the complex psychosocial milieu—for pain management. Due to the often episodic nature of anesthesiologists' interactions with patients, it remains challenging for anesthesiologists to achieve their full potential for broad impact and leadership within increasingly integrated health systems. To unlock this potential, anesthesiologists should cultivate new clinical, research, and administrative roles within the health system—transcending traditional missions, seeking interdepartmental collaborations, and taking measures to elevate anesthesiologists as dynamic and trusted leaders.
This special article examines 3 core themes for how anesthesiologists can enhance their impact within the health care system and pursue new collaborative health missions with nonanesthesiologist clinicians, researchers, and administrative leaders. These themes include (1) reframing of traditional anesthesiologist missions toward a broader health system-wide context; (2) leveraging departmental and institutional support for professional career development; and (3) strategically prioritizing leadership attributes to enhance system-wide anesthesiologist contributions to improving overall patient health.
Amidst the massive disruptions to the clinical, administrative, and health research operations introduced by the coronavirus disease 2019 (COVID-19) pandemic, health care leaders who formerly may not have appreciated the dynamic skills of the anesthesiologist were given a unique glimpse of the skillset and value of a well-trained anesthesiologist workforce. These leaders witnessed firsthand the experience and ingenuity of anesthesiologists to maintain safe, reliable platforms for health delivery,1 their ability to innovate in response to unanticipated needs,2 and their willingness to deploy into nonstandard front-line roles as trusted physicians, committed to providing safe patient care.3
Coincident with this front-line work, anesthesiologist Surgeon General Jerome Adams, MD, MPH, FASA, demonstrated system-wide leadership in advocating for the evolving guidance of the Center of Disease Control and Prevention on social distancing and mask wearing amidst a highly politicized atmosphere,4 calling on anesthesiologists to be "physicians, not proceduralists"5 and recognizing anesthesiologists as bringing critical "innovations to the field of medicine, health care delivery, and health policy"6 during times of global strife. Additionally, in the 2020 Emery Rovenstine Lecture, Joanne Conroy, MD, advocated for anesthesiologists to embrace disruptive innovation to enhance value, explore gender equity in leadership roles, and serve as change leaders for promoting patient safety.7 During this fateful year, anesthesiologists rose to the occasion and faithfully worked to align COVID-19 patient care with the "Triple Aim" of the modern health system: to improve population health, reduce unnecessary utilization and cost, and enhance patients' subjective experience of care.8
Beyond the COVID-19 pandemic, the value proposition of the anesthesiologist has remained an important consideration for defining future directions. In regard to the "Triple Aim," this model has served as a foundational principle leading to the redesign of fee-for-service care delivery systems in favor of coordinated, interdisciplinary models guided by leaders capable of championing collaboration and integration. Such models seek to increase health care value through improving quality and outcomes while maintaining or lowering costs.9,10 In support of this collaborative approach, clinical and research organizations such as the American Board of Anesthesiology, the Foundation for Anesthesia Education and Research, and the International Anesthesia Research Society (IARS) promote core missions of advancing the highest standards of anesthesiology practice11 and disseminating state-of-the-art basic and clinical anesthesia research.12 Such overarching missions encompass opportunities for anesthesiologists to gain health systems leadership skills and collaborate with other health providers, researchers, and administrators to promote broad improvements in public health.
To fully realize anesthesiologist opportunities for health systems leadership, we first explore outside perspectives of anesthesiologists, followed by critically evaluating clinical, research, and administrative strengths of the field. Building on this framework, the objectives of this article are to explore 3 core themes anesthesiologists can consider, when seeking opportunities to enhance impact within an increasingly value-driven, team-based health system. These include
Core theme no. 1: Anesthesiologists can reframe traditional health care missions toward a broader system-wide context.
Core theme no. 2: Anesthesiologists can seek career development opportunities which enable candidacy for newly emerging health systems leadership roles.
Core theme no. 3: Anesthesiologists can cultivate a positive culture in the workplace, by anchoring to a set of leadership attributes which may in turn enhance anesthesiologist contributions to public health.
Outside Perspectives of Anesthesiologists
Despite the well-defined missions of anesthesiology clinical and research organizations, the roles and training of anesthesiologists are largely misunderstood by the lay public13–15 and often other health care providers. Anesthesiologists are recognized as leaders in patient safety,16 trusted authorities in emergency, trauma, and critical care,17 and expert consultants in pain management.18,19 However, anesthesiologists have also been confronted with questions of whether the specialty is fully aligned with value-based care, and separately, whether they are able to provide care and leadership beyond the individualized patient encounter to have a sustained public health impact.20
Through a systematic approach to improving intraoperative care, many complications of anesthesia have been reduced to "almost never" events.21 Although such an accomplishment once served as a testimonial to the utility of anesthesiologists within a health system, this standard of care is now largely perceived to be a solved problem, aided by continued advances in engineering safety design and systems-based practice.22 In the modern health system, a safe and efficient intraoperative period—as is a standard expectation of the potentially commoditized anesthesiology team—may be regarded as a health care resource-intensive, yet ephemeral event. Furthermore, when considering the longitudinal management of chronic health conditions over a patient's lifetime, intraoperative care by an anesthesiology team may be perceived as having limited impact on long-term patient health trajectories and limited value relative to the surgical intervention itself.23 Finally, in the context of pain management, anesthesiologist-administered medical and procedural interventions are no longer the central component: rather, analgesia is a facet of a multidisciplinary approach toward confronting pain in its psychosocial context, a challenge that has become increasingly relevant to nonanesthesia providers amidst the opioid epidemic.
Introspection: Relative Professional Strengths of Anesthesiologists
In an era of value-driven health care, integrated health systems leadership opportunities for anesthesiologists are ripe and well worth pursuing. By tackling these opportunities, anesthesiologists can leverage their field's relative strengths to make high-impact contributions to public health in collaboration with providers outside the specialty. To sustain collaboration opportunities, anesthesiologists must focus on sources of underrecognized value, leveraging clinical, operational, and research strengths of the anesthesiology specialty.24
Clinical strengths of anesthesiologists are driven by expertise in cardiovascular, pulmonary, and neurophysiologic systems, with an emphasis on evaluating results from interventions at reliable intervals, followed by rapid escalation and crisis management as needed. Anesthesiologists leveraging this expertise to achieve impact beyond the specialty have included Dr Paul Barash in cardiovascular medicine, who served as chair of the Multicenter Study of Perioperative Ischemia Groups25,26 and later served as consultant to the National Aeronautics and Space Administration on the Perioperative Medicine for Manned Space Flight Working Group.27 Additionally, Dr Virginia Apgar whose work in the assessment of a neonate's first expressions of essential neurological and cardiovascular function28 led to a transformation in neonatal medicine that impacts every infant born today in the hospital setting.
Operational strengths of anesthesiologists are driven by experience designing safe, highly reliable workflow platforms, and serving as impartial arbiters of scarce operating room and intensive care unit resources. Anesthesiologists exemplifying operational excellence have included Drs Peter Pronovost and John Eichorn, whose respective work in reducing medical errors29 and establishing standards of patient monitoring under anesthesia30 laid the foundations for anesthesiologists as leaders in patient safety. Beyond patient safety, the familiarity of anesthesiologists with a wide variety of medical specialties has enabled opportunities for impact on national and global levels, via positions with the US congress,31 the Office of the Surgeon General,32 and the Chief Medical Officer for the Centers for Medicare and Medicaid.33
Finally, research strengths of anesthesiologists include a data-driven focus on outcomes arising from novel pharmaceuticals, medical devices, and technologies implemented in highly monitored health care settings, as well as a basic science focus on neurophysiological mechanisms of pain, consciousness, and cognitive function. Anesthesiologists with notable research contributions extending beyond the specialty have included Dr Elmer McKesson who was able to achieve transformational advances in patient safety by advocating for quantitative assessments of pulse, respirations, and blood pressure.34 Additionally, Drs Max Kelz and Emery Brown, whose work have advanced the understanding of neurobiologic mechanisms of unconsciousness,35,36 exemplified how anesthesiologists can play key roles in cross-disciplinary research initiatives aimed at revolutionizing the understanding of the human brain.
Throughout the remainder of this article, we explore core themes that guide how anesthesiologists may answer calls to action for enhancing their scope of care and overall health care value. As aided by career development and leadership training, anesthesiologists may leverage clinical, operational, and research strengths to become leaders and disruptors, developing new collaborations with nonanesthesiologist health professionals to achieve greater public health impact.
CORE THEMES FOR ENHANCING ANESTHESIOLOGIST IMPACT
Core Theme No. 1: Reframing and Intelligent Branding of Anesthesiologist-Led Patient Care
Despite scores of anesthesiologists having successfully transcended traditional roles and impacted health care delivery more broadly, far too often anesthesiologists today have alternatively chosen to narrowly scope daily work. Anesthesiologists may be hesitant to seek broader responsibility due to concerns of liability, insecurity of expertise, or perhaps simply that fee-for-service reimbursement focuses efforts on predefined tasks that prioritize volume over long-lasting value. Furthermore, anesthesiologists may not be selected for leadership roles at the institutional level due to relatively higher salary costs incurred for purchasing nonclinical effort, compared to other medical specialties.
There are, however, significant cost savings, indirect revenues, and value-based incentives offsetting such costs that anesthesiologists can influence in addition to the patient benefits directly derived by anesthesiologist efforts.37 Pursuant to the "Triple Aim" of the modern health system, institutions have increasingly recognized that leadership positions should not be filled by the least costly physician but rather by who will provide the most value. Integrated health systems have begun to consider approaches aligning with the value added by anesthesiologists, such as an emphasis on safety and reliability when performing high-risk tasks in an operationally efficient manner (ie, high-reliability organizations),38 and a focus on the capacity to work in teams within a resource and revenue intensive environment.39 Progressive and successful anesthesiology departments and practices have begun to navigate this new paradigm, overcoming prejudices against anesthesiologists as having limited leadership vision beyond increasing operating room revenue. Such innovative paradigms will likely prove critical to the security of academic and private anesthesiology environments alike.
In recognition of newly developing health care paradigms, anesthesiologists may consider how clinical care models traditionally adopted within an anesthesiology department can be reframed to more broadly integrate across an entire health system, and what partnerships across disciplines would be reinforced in doing so. For example, in the operating room, anesthesiologists provide expert judgments to maintain hemodynamic stability in the face of anesthetic- and surgical-induced cardiovascular stressors, through the titration of potent medications while considering a patient's comorbidities and surgical goals. In doing so, anesthesiologists work to optimize end-organ perfusion, provide optimal surgical conditions, and minimize the risk of major adverse cardiac events. Similarly, in the preoperative clinic, anesthesiologists work to optimize a patient's preexisting cardiovascular conditions to decrease perioperative risk.40 However, if such principles were applied more broadly across the longitudinal health timeline of patients undergoing surgical procedures, anesthesiologists may establish a perioperative paradigm for the identification and primary care follow-up of patients with undiagnosed or undertreated hypertension,41,42 hyperlipidemia,43 or heart failure.44 This reframing of anesthesiologists as physicians who are engaged with improving the longitudinal cardiovascular care of their patients—in collaboration with primary care physicians and cardiologists—provides an opportunity to improve the health trajectories of surgical patients beyond the day of surgery and may significantly enhance the public health impact of the anesthesiologist and operative episode.45
Table 1. - Reframing of Anesthesiologist-Led Clinical Care and Research—Expanded Horizons
Traditional anesthesiologist clinical theme
Traditional anesthesiologist research theme
Theme expanded toward an interdisciplinary orientation with population health relevance
Maintain hemodynamic stability in the operating room and intensive care unit Define targets for reduced morbidity (eg, perioperative major adverse cardiac events, acute kidney injury) Collaborate with primary care physicians and cardiologists to identify poorly controlled chronic conditions such as hypertension41,46 or heart failure44; implement efficient and effective referral strategies
Reduce rates of postoperative cognitive dysfunction in older adults Identify which medications at what doses enable the safest perioperative experience for older adults Use perioperative and pain clinic encounters as an opportunity to identify occult mild cognitive impairment or dementia; collaborate with geriatricians to provide cognition-centered perioperative counseling, goal-setting, and/or care47
Treat acute and chronic pain Study the effectiveness of enhanced recovery after surgery protocols Lead multidisciplinary clinical and research efforts to prevent the transition from acute to chronic pain48; collaborate with health policy experts and community leaders to address the opioid abuse epidemic49
Provide critical care to patients with major organ system dysfunction Understand ideal care modalities to promote critical care recovery Collaborate with health system leaders to provide critical care surge capacity during natural disasters/global pandemic (eg, COVID-19)3; work with palliative care colleagues to elicit valued activities and define care goals for critically ill patients, and promote a philosophy of goal-focused treatment into critical care50
Limit exposure to potentially neurotoxic anesthetic agents in children Study neurotoxicity of anesthetic agents and potentially safer alternatives Use surgery as an index opportunity to obtain toxin levels (eg, lead) in pediatric patients; and collaborate with pediatricians to provide referral for the estimated 5% of neurotoxic lead levels
Develop anesthetic plans with attention to pulmonary status and risk factors for postoperative pulmonary complications Define lung-protective care modalities, particularly for patients with preexisting pulmonary disease Collaborate with primary care providers, psychologists, and pulmonologists, using perioperative period as a teachable moment to encourage smoking cessation and physical activity51
Reduce hospital-acquired infections Study and define optimal preoperative antibiotic coverage and ventilator-associated pneumonia/central line-associated bloodstream infection bundles Work with Infection Prevention and Facility teams to identify and address Environment of Care issues impacting infection risk52
Work with primary care, endocrinologists, and laboratory medicine physicians to address preoperative anemia and diabetes and lessen perioperative transfusions and blood sugar perturbations53
Manage anesthetic implications of alcohol and drug abuse Study the hemodynamic and cognitive effects of alcohol and drug abuse in the perioperative period Collaborate with primary care and mental health providers, using perioperative period as a teachable moment to encourage abuse recovery54
Provide consultation and management of difficult airways Study and define risk factors for difficult airways Work in hospital leadership roles to develop protocols and educate nonanesthesia providers in safe airway management55
Provide lecture-based education for anesthesiology residents on anesthetic pharmacology and pain mechanisms Study the impact of anesthesiology educational interventions on learning outcomes Develop a novel educational curriculum that enhances anesthesiology provider communication with patients, staff, and colleagues
Participate in or support global surgical initiatives Study limitations in access to safe and reliable anesthesiology care Collaborate with diversity, equity, and inclusion experts to characterize disparities in access to anesthesiology, critical care, and pain management interventions
Abbreviation: COVID-19, coronavirus disease 2019.
Table 2. - Reframing of Anesthesiologist-Led Operational Management and Research—Expanded Horizons
Traditional anesthesiologist operational management theme
Manage tradeoffs guiding which surgery is performed in a capacity-constrained operating room environment with in-house call for obstetrics, level 1 traumas, and emergency surgery Study and predict operating room case duration; study the impact of attending provider case concurrency and clinical handovers Collaborate with hospital administrators to develop a triaging system based on patient acuity, risk assessment, health system-wide operational impact, and evidence integration56
Determine optimal staffing across multiple provider training levels (CRNA, resident, faculty) to achieve correct financial and clinical infrastructure enabling urgent surgeries to be performed
Determine safe and effective anesthetic medication alternatives during drug shortages Study the impact of alternative anesthetic medication choices on long-term outcomes Consult and collaborate with sustainability scientists to understand environmental implications of operating room choices57
Work with facility pharmacists to help manage both cost and accessibility throughout the perioperative continuum
Provide safe anesthetics and perioperative care Characterize and identify risk factors for perioperative adverse events Partnering with hospitals to assist in certain hospital pay for performance initiatives, including mortality, readmissions, and other quality measures
Provide traditional payer contracting Perform cost-effectiveness analyses in the ambulatory surgical setting Collaborate with hospital and facility partners on direct to employer health care contracting initiatives
Abbreviation: CRNA, certified registered nurse anesthetist.
In Tables 1 and 2, we provide a noncomprehensive list of additional examples, spanning perioperative, critical care and pain medicine domains, and illustrating how clinical, research, and operational collaborations outside of the anesthesiology department may develop and evolve. To fully realize any collaboration, however, an approach coordinating top-down strategic anesthesiology departmental sponsorship, with bottom up buy-in of clinician and researcher stakeholders must be carefully planned and implemented.
Core Theme No. 2: Anesthesiologist Career Development for Collaboration and Impact
Producing an anesthesiologist workforce that is prepared to lead new interdepartmental collaborations requires strategic professional and organizational development that may benefit from extending beyond traditional pathways of career advancement. As with any change management process, most success comes from small, deliberate, and consistent decisions made over years, rather than radical decisions implemented en bloc. This kaizen approach, a Japanese business philosophy of continuous improvement,58 can be applied at both individual and departmental levels and requires having a strategic long-term vision of success and the tools required to achieve it to guide decisions made at each next immediate step.
However, it is not a trivial problem for busy anesthesiologist clinicians, researchers, and administrators inundated with tasks to find the time to invest in skills and activities that support innovative collaborative efforts. In this regard, the operative volume-dependent nature of an anesthesiology department's daily work schedule may offer opportunities amidst the staffing challenge. If appropriate staffing for clinical coverage is in place to accommodate surges in operative and critical care patient volume, the prepared anesthesiology team may find increased opportunities to advance nonclinical activities of team members including career development using novel flexible staffing models. Alternatively, a tendency to staff operating rooms according to schedule nadirs or even average utilization, and then strain to the peaks by working postcall, on vacation, or stretching care team concurrency, squanders a potentially valuable resource. As department revenues become relatively less dependent on direct fee-for-service care and increasingly incorporate indirect and value-based streams, it creates opportunity for anesthesiology departments to staff to surge capacity, yet have value-generating nonpatient care work to maintain productivity during off-peak times. This creates a valuable flexibility to both the facility and anesthesiology group.
As an illustration of the flexibility that capitated and other similar payer/provider arrangements can provide, one only needs to recall the heights of the COVID-19 pandemic when such arrangements, which were previously thought of as ways for payers to share risk with providers, suddenly became an important hedge against an alternative risk—namely against major, system-wide declines in demand for elective surgical care in response to pandemic operations. The necessity to remain agile as a leader in perioperative care demands the skills to rapidly recruit team members when a critical need arises and being available to assist others when in steady-state. These essential skills of the anesthesiologist can be translated to recruiting or assisting others for nonclinical tasks such as teaching, research, administrative duties, or career development. Such creative and dynamic allocation relies on a foundation of team-based care where members see the value in others' advancement. A foundation of trustworthiness, as described in the following core theme, is an absolute necessity for such team-oriented behavior.
Despite an opportunity to capitalize on creative approaches for career development activities during nonsurge periods, finding time for the extended career development efforts inevitably necessitates the availability of sponsorship, training, and a robust support network. Sponsorship is necessary for activities requiring an investment of time or buy-in from a larger group of stakeholders and can occur at both the departmental and health system level, each offering unique advantages. At a departmental level, sponsorship is more likely to directly translate into protected time for an anesthesiologist, given the greater control of departmental leadership on the day-to-day schedules of its members. However, at a health system level, sponsorship more naturally translates into positive acceptance of interdisciplinary efforts given the broad investment that has been made in an individual beyond the anesthesiology department.
Training for an expanded, interdisciplinary focus in anesthesiology may occur in many forms, often tailored to the clinical, operations, or research strengths of an individual, and should include consideration of interdisciplinary activities that extend beyond traditional paths. Opportunities for participation in professional or scientific communities are broad, and for the anesthesiologist looking to expand the scope of the specialty, opportunities can extend beyond traditional national society service. Participation in professional meetings outside the standard purview of anesthesiologists (eg, the American College of Cardiology or the American Geriatric Society) may require peer support via networking or sponsorship from local leaders in those fields. The challenge to enter the national conversation in one's own field itself requires careful mentorship, and this need is further underscored when one's vision stretches beyond existing departmental mentoring networks. While a traditional perspective would hold that attendance at the American Society of Anesthesiologists (ASA), the IARS, or anesthesiology subspecialty meetings and participation in professional society committees are among the centerpieces of an academic anesthesiology career trajectory, an expanded role may incorporate other nonanesthesiologist professional society meetings as well.
Regarding formal degree and professional certificate programs, academic institutions—when affiliated with an anesthesiologist's health care system—provide many opportunities for professional training, sometimes in the context of hybrid programs focused on administration, education, or research specifically relevant to health care leadership and expanding beyond MPH or MBA pathways. Although traditional degree programs provide broad flexibility in training, hybrid professional programs include collaborations between experts in business leadership and health services research.59 Another route for such interdisciplinary training may be found in military training where emerging concepts of multidomain operations are increasingly a cornerstone of strategy.60 Less time-intensive options for health care leadership development—targeting of both academic- and community-based anesthesiologists—are also available and enable interdisciplinary networking via robust and intensive leadership academy programs.61–63
Still, innovative interdisciplinary programs may be ahead of academia itself. For example, most academic institutions continue to rely on promotion criteria that emphasize first and senior author positions on scholarly work to the potential detriment of team science, and a team science perspective will require cultural shifts that are not yet evidenced in many parts of the academic world. It is perhaps instructive that the guidelines for authorship promulgated by the International Committee of Medical Journal Editors (ICMJE) are often cited by existing leadership to emphasize the need to exclude inappropriate authors.64 Yet these same citations often completely ignore the ICMJE exhortation that any collaborators who participated in conception, design, acquisition, or analysis of data must be given the opportunity to fulfill all the other authorship criteria.65 The overarching lesson is that expanding beyond the anesthesiology department requires not just academic department reorientation but may hinge on a rethinking of promotional criteria at the level of the medical school and university. Perhaps part of the challenge is that such a reorientation will depend on change agents who are prepared to redefine the culture from which they emerged. In response to this call to action, innovative groups have sought approaches to deemphasize first- and senior-authored manuscript publications, and instead emphasize promotion criteria to accommodate variation in roles, contributions, and professional interests of team members—especially for clinical- and operations-oriented faculty whose contributions are primarily to uphold safe, reliable, and efficient clinical care for patients.66,67 Elevated roles of clinical- and operations-oriented faculty have more recently become promoted through the expansion of nontraditional Chief or Vice Chairperson positions, including the Chief/Chair of Strategic Planning68; the Chief/Chair of Diversity, Equity, and Inclusion69; and the Chief/Chair for Culture and Wellness.70
Outside of academics, private practice anesthesiologists may become similarly involved in leadership and career development opportunities in a variety of ways. Community-based hospitals often have tremendous opportunities for collaborative work among specialties, alignment of hospital and medical staff goals, and operational governance. Many institutions have internal leadership pathways available through their medical staff offices or mentorships or may sponsor medical leaders to engage in outside leadership learning activities. Such activities have been recently promoted by the ASA, through web-based resources for leadership development,71 and through collaborations with the American College of Healthcare Executives as a means for establishing a culture of patient safety.72 Often such activities create an ability for a multidisciplinary team from a hospital to learn together, building rapport, and developing solutions to real-time issues.
In addition, many private groups understand the need for at least some of their physicians to be knowledgeable in administrative and leadership activity. This can be crucial for a group to be successful at its core business, but also to engage facility administration and medical colleagues in providing value beyond intraoperative care. This may include operational administrative assistance, improved payer contracting, or tackling clinical issues such as resource utilization, infections, falls, or injuries. Private groups are wise to develop internal leaders in these areas, and do so by sponsoring interested members to (1) pursue training either through advanced degree or certificate programs or (2) simply become knowledgeable in the challenges of health care delivery beyond anesthesiology.
Table 3. - Opportunities for Expanded Career Development, Promotion, and Scholarship Pathways
Traditional career development, promotion, and scholarship pathways
Expanded pathways with interdisciplinary focus
Anesthesiology society meetings (IARS, ASA) Allied society meetings and participation (eg, American College of Surgeons)
Anesthesiology specialty society Meetings (SCA, SNACC, SPA, SOAP, SOCCA, ASRA) Involvement in interdepartmental specialty society meetings (eg, American Geriatric Society, American Cancer Society, American College of Cardiology)
Graduate training programs in public health or business management (eg, MPH, MBA) Hybrid graduate programs tailored to health care leadership63,73
Certificate programs in process improvement, management, and leadership74,75
Academic promotion places exclusive emphasis on first author and senior author publications Considerations for promotion expanded to appreciate "team science" and the need for large collaborations in which "middle authors" and nonauthor contributors ("collaborators") are recognized as essential; development of promotional criteria oriented toward nonpublication contributions of clinical-track faculty67
Siloes of specialists within existing professional schools (eg, departmental or section defined specialist groups) Interdisciplinary organizations that extend beyond traditional university or organizational borders (eg, Institute for Healthcare Policy and Innovation; US Department of Veterans Affairs Center for Health Equity Research and Promotion; US Department of Veterans Affairs Pain Research, Informatics, Multi-morbidities, and Education [PRIME] Center)
Principal investigator-driven research program focused on National Institutes of Health funding Multicenter and multidisciplinary collaborations, sourced from a variety of governmental, private-sector, or nontraditional funding entities (eg, the Michigan Surgical Quality Collaborative)
Anesthesiology resident tracks at society meetings (IARS, ASA) focused on traditional anesthesiology research, clinical training, and resident advocacy Early Stage Anesthesiology Scholars program at society meetings (IARS, ASA) focused on broadly integrative research training, cross-disciplinary team science, and leadership development76
Abbreviations: ASA, American Society of Anesthesiologists; ASRA, American Society of Regional Anesthesia and Pain Medicine; IARS, International Anesthesia Research Society; SCA, Society of Cardiovascular Anesthesiologists; SNACC, Society of Neuroscience in Anesthesiology and Critical Care; SOAP, Society for Obstetric Anesthesia and Perinatology; SOCCA, Society of Critical Care Anesthesiologists; SPA, Society for Pediatric Anesthesia.
In Table 3, we provide a noncomprehensive list of innovative expanded pathways for anesthesiologist career development, to be encouraged by institutional and anesthesiology departmental heads of practice and pursued by anesthesiologists, spanning multiple dimensions as suited to individual interests and strengths. With consistent and dedicated efforts over time to address these expanded dimensions of career development, anesthesiologists may be poised to "swim outside their lane," by taking on multidisciplinary health systems leadership roles and developing high-impact collaborations.
Core Theme No. 3: Prioritizing Qualities for Trusted Leadership
Through reframing of missions to public health and purposeful career development activities, anesthesiologists may better position themselves as leaders within their health system. Beyond the specific activities and career development which enable leadership opportunities, conceptual models for effective leadership can be considered, to maximize the potential for health impact. One such model centers on trust—an essential prerequisite for strong and enduring leadership.77 In a work developed by professional leadership consultants, trustworthiness can be described by 4 attributes: credibility, reliability, intimacy, and self-orientation (Figure).78
The "Trust Quotient." Adapted from Maister et al.78
Within this conceptual model comprised by 4 attributes, credibility fundamentally refers to the spoken or written words of an individual and how believable they are to others. Credibility can be built slowly over time and comes through developing a mastery of a specific skill or practice. For anesthesiologists, tangible measures of credibility come from credentialing, degree training, board certification, and demonstrations of expertise including upholding excellent patient care, providing service as administrative leaders, and developing scholarly work. Reliability refers to the actions of an individual and how dependable they are perceived to be by others. Reliability is built through consistently delivering on key roles and promises, most notably when it is not convenient or when an individual could have otherwise not. For anesthesiologists recognized as leaders in patient safety, reliability—as demonstrated by the consistent delivery of safe and effective perioperative patient care—often comes naturally but must not be overlooked. The third attribute of trust—intimacy—refers to how comfortable others feel with sharing thoughts and opinions with an individual. In anesthesiology, intimacy can be built through a patient-centered approach, and deepening connections with both patients and health care team members through the telling of stories as well as meeting in-person. Finally, a fourth attribute, self-orientation, which is inversely related to trust, refers to the personal focus on an individual's interests versus interests of others. For anesthesiologists to limit self-orientation, a core component is the understanding of being part of a larger health care team, which transcends any degree training or past experiences. Counterintuitive in some ways, strong leadership frequently avoids the use of "command and control," that is, an externalized and often rigid, coercive, and noncollaborative leadership style,79 to limit self-orientation and maintain trust. This deemphasis of self and ambivalence toward recognition, as learned through collaborating across specialties to safely enable complex and invasive procedural interventions, has been described as perhaps the strongest trustworthiness trait of anesthesiologists.3
By the nature of anesthesiologists' clinical work, key attributes for establishing and maintaining trust are continually reinforced, suggesting that our specialty is well-positioned to internalize this model of trustworthiness. Anesthesiologists are trained, positioned, and experienced in modeling trust-centered leadership, and such qualities should be leveraged to ensure successful leadership and collaboration with other professional domains.
SUMMARY AND CONCLUSIONS
For anesthesiologists to take full advantage of opportunities for enhanced impact across a rapidly evolving landscape of health care delivery, the profession can consider reimagining new roles which invoke collaborations with nonanesthesiologists, but which are, as exemplified in this article, grounded in some of the great forebearers of the specialty. These roles, requiring both sponsorship from local leaders and buy-in from anesthesiologist team members, can be aided by carefully planned career development and leadership training extending beyond traditional venues. The success of these pathways will both enhance and rely on cultural shifts that promote teamwork and innovation. Through these measures, anesthesiologists may follow in the footsteps of earlier vanguards and promote the Triple Aim of modern health care, enabling a path to sustained, impactful, and transformational change across the health care system as a whole.
Name: Michael R. Mathis, MD.
Contribution: This author helped with the conception and design of the work; developing first and final drafts of the work; and the assimilation of intellectual content from all coauthors.
Conflicts of Interest: M. R. Mathis reports grants from US National Institute of Health (NHLBI, K01-HL141701) during the conduct of the study.
Name: Robert B. Schonberger, MD, MHS.
Contribution: This author helped edit and develop the drafts of the work.
Conflicts of Interest: R. B. Schonberger reports grant support from US National Institute of Health (NIA, R01AG059607 and NLM T15LM007056-32S1M) during the conduct of this study. Dr. Schonberger reports involvement in a study in which Yale receives support from Merck, Inc. Dr Schonberger reports owning stock in Johnson & Johnson.
Name: Elizabeth L. Whitlock, MD, MSc.
Conflicts of Interest: E. L. Whitlock reports a grant from the US National Institutes of Health (NCATS, KL2-TR001879) during the conduct of the study.
Name: Keith M. Vogt, MD, PhD.
Conflicts of Interest: K. M. Vogt reports a grant from US National Institutes of Health (NIGMS, K23-GM132755) during the conduct of the study.
Name: John E. Lagorio, MD, MBA.
Name: Keith A. Jones, MD.
Contribution: This author helped with the conception and design of the work.
Name: Joanne M. Conroy, MD.
Name: Sachin Kheterpal, MD, MBA.
Contribution: This author helped with the conception and design of the work and developing final drafts of the work.
This manuscript was handled by: Jean-Francois Pittet, MD.
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Roles for Anesthesiologists in the Future of Medicine in the United States
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Articles in PubMed by Michael R. Mathis, MD
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AB de Villiers feeling 'in some of the best form of my career' as he joins Brisbane Heat
9dAndrew McGlashan
AB de Villiers has arrived for his stint with the Brisbane Heat Getty Images
Andrew McGlashanDeputy editor, ESPNcricinfo
Deputy Editor Andrew arrived at ESPNcricinfo via Manchester and Cape Town, after finding the assistant editor at a weak moment as he watched England's batting collapse in the Newlands Test. Andrew began his cricket writing as a freelance covering Lancashire during 2004 when they were relegated in the County Championship. In fact, they were top of the table when he began reporting on them but things went dramatically downhill. He likes to let people know that he is a supporter of county cricket, a fact his colleagues will testify to and bemoan in equal quantities.
AB de Villiers has arrived in Australia for his long-awaited Big Bash stint with the Brisbane Heat feeling in some of the best form of his career and ready for the "big role" he has to play on and off the field.
De Villiers replaces Tom Banton for the latter stages of the tournament with the Heat currently fifth in the table, having four wins and four defeats from their eight matches.
It was a lengthy process to bring de Villiers to Australia with the chances of the signing having seemingly slipped away until the deal the was agreed in early October.
De Villiers joins on the back of 325 runs at 46.42 and a strike-rate of 152.58 in the Mzansi Super League for Tshwane Spartans, who finished runner's up.
"I had a fantastic tournament in South Africa, had a few good knocks, felt in some of the best form of my career so hopefully we'll see more of that in this tournament," he said the morning after arriving in Brisbane ahead of his first match against the Adelaide Strikers on Tuesday.
Even with so many matches behind him - 304 in all T20s - de Villiers admitted he still gets butterflies but believes that is a good thing and is ready to embrace a broader role with the Heat.
"I've said it many times before, wherever I play around the world, whether it's a club game or a World Cup semi-final, I feel the same pressure when I go out to bat," he said. "I've always got that pressure I put on myself to perform at the best of my ability. I've done it so many times, it doesn't guarantee success but I know what to expect, I know the butterflies are a good sign generally.
"All I can do is go out and enjoy myself, make sure I have a good influence on my team-mates and make sure I have an impact on the game with bat in hand. Then there's the fielding and the off-field stuff, I have big role to play as an individual and not just a cricketer."
The Heat captain Chris Lynn has urged team-mates to make use of every moment de Villiers is with them as they hunt for a place in the knockouts in what has so far been a topsy-turvy tournament.
"Experience is everything, there were a couple of games where we needed that experience so to have him is just gold," Lynn said. "We've got a young team and the guys are mad if they aren't like a sponge over the next few weeks."
"It's a natural role for me," de Villiers said. "I'm 35 and have played quite a bit of cricket around the world. I'd hate to think that I won't have that kind of role. I had a similar role in South Africa. I enjoy guys asking me questions about my batting. Like to think we'll help some of the youngsters understand what's needed to achieve success."
Where de Villiers bats is yet to be determined with the Heat needing to reshape the order now that Banton has departed, but it is likely to be at No. 3 or 4. All eyes will be on the team if de Villiers and Lynn are at the crease together for any length of time. "It could be interesting," de Villiers said. "I don't know what to expect to be honest. I've a feeling it's going to work and will be nice to watch."
Lynn, who was a key part in long project to get de Villiers to the Heat, was in no doubt of his standing. "In my opinion he's probably the No. 1 entertaining batsman in the world. When he gets going he hits the ball 360 degrees whenever he wants. I believe he's two steps ahead of the game compared to everyone else. I think he's the best in the game and the way he thinks is totally different to other batters around the world."


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Tokyo Olympic gold medallist Neeraj Chopra launches YouTube channel
The Javelin thrower will share glimpses from his life in the form of short and long-format videos on his sport and fitness
In a bid to provide guidance to the next generation of Indian athletes, Olympic gold medallist Neeraj Chopra launched his own YouTube channel, on Monday.
The Javelin thrower will share glimpses from his life in the form of short and long-format videos on his sport and fitness.
"I am now excited to start my own channel with the hope of helping the next generation of Indian athletes. Through my channel, I will aim to give a glimpse of my fitness and training regimen to followers, while also putting out interesting content from my life and travels as an athlete," said Chopra.
Neeraj took to his social media handles on Sunday to inform his seven million fans about his entry to the platform where they can follow his journey on the road and the several tournaments that he competes in.
"I have a special connection with YouTube since I followed all the javelin greats from across the world on the platform as a young javelin thrower. I continue to learn a lot by watching videos on the platform, both for my sport and for entertainment in between training sessions," he added.
Since the launch on Sunday, over 10,000 fans have already subscribed to the channel and his videos have recorded over one lakh views as of Tuesday.
The javelin thrower from Khandra in Haryana shot to national limelight after his historic Gold medal winning throw on August 7, 2021 which saw him become the first Indian to win a Track and Field Olympic Gold medal.
Since then, he has become a national sensation, appearing on magazine covers, and TV shows, while subsequently signing multiple brand associations and amassing millions of followers on social media. He was also one of the most searched personalities on Google from India and was conferred with the Khel Ratna and Padma Shri by the Indian Government.
Despite all of this, he has continued to stay focused on his training and his goals as an athlete ahead of an important 2022 season that includes major events such as the Athletics World Championships, the Commonwealth Games and the Asian Games.
Also Read: YouTube Vanced to shut down 'due to legal reasons'
Olympic gold medallist