Fatigue is a frequent problem after surgical treatment of solid tumours. Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients. Therefore, we compared the effect of the two therapies on fatigue in a randomised controlled study. Seventy-two patients who underwent surgery for lung (n=27) or gastrointestinal tumours (n=42) were assigned to an aerobic exercise group (stationary biking 30 min five times weekly) or a progressive relaxation training group (45 min three times per week). Both interventions were carried out for 3 weeks. At the beginning and the end of the study, we evaluated physical, cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC-QLQ-30) questionnaire, and maximal physical performance with an ergometric stress test. Physical performance of the training group improved significantly during the programme (9.4+/-20 watts, p=0.01) but remained unchanged in the relaxation group (1.5+/-14.8 watts, p=0.37). Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all< or =0.01); however, there was no significant difference between changes in the scores of both groups (p=0.67). We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours. However, exercise is not better than progressive relaxation training for the treatment of fatigue in this setting.

IMPORTANCE Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric.OBJECTIVE To describe changes in US military general surgeon procedural volume and readiness using the KSA metric.DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product. MAIN OUTCOMES AND MEASURESThe main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold. RESULTSThe number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019. CONCLUSIONS AND RELEVANCEThis study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.

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The Tahiti field is a recent major development in the deepwater Gulf of Mexico. The field’s prolific Miocene reservoir section lies below a thick salt canopy with structural dips as high as 80 degrees, adjacent to a near-vertical salt root. Successful appraisal and initial development was enabled by interpretation of proprietary depth imaging products generated from narrow-azimuth seismic data. However, reservoir-scale mapping and fault definition remained problematic due to seismic imaging and illumination challenges. In 2009–2010, the Tahiti partnership initiated a reimaging project using multiclient wide-azimuth seismic data. The project employed current technologies for multiple attenuation, tilted transverse isotropy velocity modeling, and migration. Increased azimuthal coverage and inherent multiple suppression provided by wide azimuth acquisition delivered significant imaging enhancements. Advanced noise and multiple attenuation techniques provided cleaner data with improved signal-to-noise. Earth models representing multiazimuth subsurface velocities and anisotropy parameters calibrated to well control with detailed salt interpretation resulted in higher confidence structural imaging. Comparison of Gaussian beam, one-way wave equation, and reverse time migration algorithms shows that reverse time migration generally provides superior subsalt and salt-body data quality, with improved event positioning, higher resolution, and enhanced steep dip imaging. The resulting seismic volumes enable accurate mapping of reservoir horizons and faulting. This will improve resource determination and future well placement in the next phase of field development.