Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent.

Calcium carbonate scale impacts oil production in a large number of fields worldwide. This scale is generally managed by acid washing to removal the scale and/or by performing scale inhibition treatments. The choice between inhibition and regular stimulation is cost driven, with high cost operations generally selecting inhibition. However, even in wells where inhibition is planned, some scale can be deposited either prior to scale inhibitor deployment, or after the end of the scale inhibition treatment life. Consequently, stimulation treatments are required in many wells, in order to remove calcium carbonate scale. Combining scale inhibition with scale removal treatments offers several advantages. Firstly, in many operating areas, it would reduce the well intervention cost by making the operation a single intervention, offering significant economic benefits and a reduction in well intervention risk. Secondly, pumping a combined treatment not only reduces the risk of scale re-precipitation during the stimulation treatment, but it ensures that the zones that are stimulated are also inhibited. This directly protects value added by the scale removal treatment. This paper details the development of combined scale removal and inhibition treatments, from project initiation to readiness for field trials. The main challenges that need to be addressed in order to achieve an effective combined treatment are discussed. Data from a laboratory study, investigating the potential for combining scale inhibitors in hydrochloric acid, organic acid and scale dissolver systems are presented and the most effective combined systems are identified. Introduction Scale precipitation is a common cause of impaired well productivity, with calcium carbonate being the most common scale that is formed. Hydrochloric acid is frequently used for removal of carbonate scale,1–3 as it generally offers both the best performance and the lowest cost. Such acid treatments can be very effective in providing short term stimulation benefits to such wells, but the treatments are often short lived.3 For high temperature applications, organic acids have been used in preference to hydrochloric acid, due to corrosion concerns.4–5 The dissolution of calcium carbonate by chelating agents is also well known6–10. Treatments with chelating agents to remove calcium carbonate scale have been performed,6 but dissolution rates are generally lower than with acid and treatment economics tend to restrict their use. Calcium carbonate scale deposition can be effectively inhibited in most fields, with scale inhibitor squeeze treatments being widely used to prevent scale build-up11–13. In these squeeze treatments scale inhibitor is retained in the formation either via adsorption onto the rock surface14–16, or by precipitation (or phase separation) of the calcium salt of the inhibitor. Precipitation squeezes offer increased squeeze life17, but may have an associated risk of formation damage during treatment,18 especially in damage sensitive formations. Although scaling potential can be predicted19–21 and proactively treated, it is still common for scale to form in some wells, either before an inhibition treatment is pumped or after the end of the treatment life. This can occur if there is insufficient early warning of the onset of scale, or if limitations in well access or equipment availability delay a planned treatment. Consequently, even when inhibition is the scale management strategy, the need still arises for scale removal treatments. Conversely, when acid stimulation is the preferred scale management tool, there would be a benefit in reducing treatment frequency if the job life could be extended by simply adding an effective scale inhibitor to the acid system. Although the potential benefits of such combined treatments have been recognised, it has been reported that the post-acid treatment environment prevents scale inhibitors from performing effectively.22 The current approach to this problem, therefore, is to pump sequential scale removal and scale inhibition treatments.

Removal of near wellbore damage and implementation of sand control through the use of Frac Packs with Gravel Pack screen in the hole is well documented in the Gulf of Mexico. However, an alternate procedure utilizing resin coated sand and conventional frac technology without Gravel Pack screens is now available. This paper describes the flexibility of such completions where multiple zones are encountered and the initial completions can be set up for future thru-tubing recompletions.In addition, the success of Frac Pack workovers on wells which were currently producing but rate restricted due to sand production is presented.A discussion of well selection criteria, frac job design, gel systems, resin coated proppants, and field procedures is an integral part of the paper. Actual case histories are used to verify the success of the technique.Frac Pack completions without screens in the hole are simpler and more versatile than those employing screens. Wells which encounter multiple small intervals which would 183 not justify rig recompletions can be set up initially to facilitate future operations thru-tubing. By selecting the proper gel systems and resin coated proppants, formation damage removal, sand control, and stimulation can be realized without the use of screens.Field results back up screenless completions, recompletions, and workovers for small zones with less than thirty feet of perforated interval.

Low levels of CD2 have been described on subsets of monocytes, macrophages, and dendritic cells. CD2 is expressed on about one-third of circulating monocytes, at levels one-half log lower than on T or NK cells, representing 2–4% of PBMC. FACS analysis of CD2+ and CD2− monocytes revealed no significant difference in the expression of adhesion molecules (CD11a/b/c), class II Ags (HLA-DR, -DQ, -DP), myeloid Ags (CD13, CD14, CD33), or costimulatory molecules (CD80, CD86). Freshly isolated CD2+ and CD2− monocytes were morphologically indistinguishable by phase contrast microscopy. However, scanning electron microscopy revealed large prominent ruffles on CD2+ monocytes in contrast to small knob-like projections on CD2− monocytes. After 2 days of culture, the CD2+ monocytes largely lost CD14 expression and developed distinct dendrites, whereas the CD2− monocytes retained surface CD14 and remained round or oval. Freshly isolated CD2+ monocytes were more potent inducers of the allogeneic MLR and more efficiently induced proliferation of naive T cells in the presence of HIV-1 gp120 than did CD2− monocytes. After culture in the presence of GM/CSF and IL-4, CD2+ monocytes were up to 40-fold more potent than monocyte-derived dendritic cells or CD2− monocytes at inducing allogeneic T cell proliferation. These findings suggest that circulating CD2+ and CD2− monocytes are dendritic cells and the precursors of macrophages, respectively. Thus, dendritic cells are far more abundant in the blood than previously thought, and they and precursors of macrophages exist in the circulation as phenotypically, morphologically, and functionally distinct monocyte populations.

Completion methods used in the deep Anadarko Basin have varied a great deal over the past several years. Due to an active exploration program in the basin, Sohio Petroleum Co. formed a Springer task force group to evaluate past methods and to develop and refine deep completion techniques in the Morrow and Springer formations. This group formulated guidelines based upon published literature and past experience of the group members. The guidelines were implemented in the field and modified as more data and knowledge were obtained, resulting in a specific set of guidelines now used on all Morrow and Springer completions. There are a number of case histories that illustrate the evolution and reasons behind the specific guidelines, which will be listed.