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This study investigates the implications of cross-country differences in banking regulation and supervision for the international subsidiary locations and risk of U.S. bank holding companies (BHCs). We find that BHCs are more likely to operate subsidiaries in countries with weaker regulation and supervision and that such location decisions are associated with elevated BHC risk and higher contribution to systemic risk. The quality of BHCs' internal controls and risk management plays an important role in these location choices and risk outcomes. Overall, our study suggests that U.S. banking organizations engage in cross-country regulatory arbitrage, with potentially adverse consequences. [ABSTRACT FROM AUTHOR]

Continued competency is poorly defined in emergency medical services (EMS), with no established method for verifying continued competency at a national level. The objective of this project was to refine understanding of continued competency for EMS clinicians in the U.S. and establish priorities for developing competency assessments. A panel of EMS managers, educators, medical directors, and experts in competency assessment, simulation, and certification used a modified Delphi technique to address two questions: "What is the content for continued competency in EMS that should be assessed or verified?" (content) and "How should continued competency of EMS clinicians be demonstrated?" (process). The Delphi process was conducted through electronic conferencing and survey software over a 6-month period. In round one, panelists responded to open-ended prompts and their contributions were analyzed and categorized into themes by independent reviewers. In round two, the panel rated theme importance using five-point Likert-type scales. In round three, the panel ranked their top 10 themes, and in round four, the panel selected the most important themes for each of the two questions through consensus-building discussions. Descriptive statistics and thematic analyses were performed with Excel and STATA 16. Fourteen invited experts participated in all Delphi activities. The panel contributed 70 content and 35 process items from the original prompts. Following thematic analysis, these contributions were reduced to 21 and 14 unique themes, respectively. The final top five prioritized themes for content important for continued competency included (1) airway, respiration, and ventilation, (2) patient assessment, (3) pharmacology, (4) pediatrics, and (5) management of time critical disease progressions. The final top five prioritized themes for the processes for continued competency assessment included (1) assessments of evidence-based practice, (2) performance-based assessments, (3) combined knowledge and skill assessments, (4) performance improvement over time, and (5) frequent, short knowledge assessments. This modified Delphi process identified priorities for content and assessment, laying the groundwork for EMS continued competency at a national level. These findings can be leveraged by national task forces to develop transparent and consistent guidelines for systems that verify continued competency related to certification, licensure, and local credentialing. [ABSTRACT FROM AUTHOR]

An editorial is presented on child health care researchers and practitioners having a responsibility for ensuring the health of the pediatric population. Topics include offering an update on the NIH child health research portfolio and concluding an realign priorities for addressing new forms of childhood adversity; and NIH child health research portfolio defined as the total funds obligated for conducting or supporting pediatric research.

This study demonstrates that, among large U.S. bank holding companies (BHCs), the largest ones are exposed to more operational risk. Specifically, they have higher operational losses per dollar of total assets, a result largely driven by the BHCs' failure to meet professional obligations to clients and/or faulty product design. Operational risk at the largest institutions is also found to: (i) be persistent, (ii) have a countercyclical component, and (iii) materialize through more frequent tail risk events. We illustrate three plausible channels linking BHC size and operational risk—institutional complexity, moral hazard incentives arising from "too‐big‐to‐fail," and innovation. [ABSTRACT FROM AUTHOR]

Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14–24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth. [ABSTRACT FROM AUTHOR]

Background: In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. Methods: Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. Results: Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. Conclusions: Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula. [ABSTRACT FROM AUTHOR]

This article explores the views of abolitionist Thomas Wentworth Higginson toward the American Civil War. It includes an examination of the speech given during Decoration Day at Harvard University, the reaffirmation of the legacy of nineteenth-century emancipation, the expression of disillusion about the possibilities of nationalism, the perception of the war as a means of creating a sense of American nationalism, the admiration for soldier Rufus Saxton, and the belief in the degradation of the authority and power of the government.

We find that small business credit scoring (SBCS) is associated with expanded quantities, higher average prices, and greater average risk levels for small business credits under $100,000, after controlling for bank size and other differences across banks. We also find that: (1) bank-specific and industry learning curves are important; (2) SBCS effects differ for banks that adhere to "rules" versus "discretion" in using the technology; and (3) SBCS effects differ for larger credits. The data do not support two alternative explanations of the main results under which the findings primarily represent statistical artifacts, rather than significant changes in lending behavior. [ABSTRACT FROM AUTHOR]

This paper examines the effect of credit scoring on small-business lending for a sample of large U.S. banking organizations. We find that credit scoring is associated with an 8.4 percent increase in the portfolio share of small-business loans, or $4 billion per institution. However, we fail to uncover any specific attributes of bank small-business credit-scoring programs that lead to this increased lending. Overall, we conclude that credit scoring lowers information costs between borrowers and lenders, thereby reducing the value of traditional, local bank lending relationships. [ABSTRACT FROM AUTHOR]

Abstract: Agency conflicts inherent in securitization are viewed as having been a key contributor to the recent financial crisis. A review of empirical research for the U.S. home mortgage market suggests that the problem may not have been securitization itself, but rather the origination and distribution of observably riskier loans. Low‐documentation mortgages, for which asymmetric information problems are acute, performed especially poorly during the crisis. Low‐documentation mortgages performed better when included in deals where issuers were affiliated with lenders or had reputational capital at stake. Investors priced low‐documentation loan risk via higher required equity tranches and security yields. [ABSTRACT FROM AUTHOR]

Objective: Mobile phones can replace traditional self-monitoring tools through cell phone-based ecological momentary assessment (CEMA) of lifestyle behaviours and camera phone-based images of meals, i.e. photographic food records (PFR). Adherence to mobile self-monitoring needs to be evaluated in real-world treatment settings. Towards this goal, we examine CEMA and PFR adherence to the use of a mobile app designed to help mothers self-monitor lifestyle behaviours and stress. Design/Setting In 2012, forty-two mothers recorded CEMA of diet quality, exercise, sleep, stress and mood four times daily and PFR during meals over 6 months in Los Angeles, California, USA.Subjects: A purposive sample of mothers from mixed ethnicities.Results: Adherence to recording CEMA at least once daily was higher compared with recording PFR at least once daily over the study period (74 v. 11 %); adherence to both types of reports decreased over time. Participants who recorded PFR for more than a day (n 31) were more likely to be obese v. normal- to overweight and to have higher blood pressure, on average (all P<0·05). Based on random-effects regression, CEMA and PFR adherence was highest during weekdays (both P<0·01). Additionally, PFR adherence was associated with older age (P=0·04). CEMA adherence was highest in the morning (P<0·01). PFR recordings occurred throughout the day.Conclusions: Variations in population and temporal characteristics should be considered for mobile assessment schedules. Neither CEMA nor PFR alone is ideal over extended periods. [ABSTRACT FROM AUTHOR]

Phenomenon. As one of the most common chronic disease affecting adults and children, obesity is a major contributor to noncommunicable diseases, both nationally and globally. Obesity adversely affects every organ system, and as such it is imperative that the United States Medical Licensing Examination (USMLE) adequately assesses students' knowledge about the science and practice of obesity management. The purpose of this study was to evaluate the coverage and distribution of obesity-related items on the three USMLE Step examinations.Approach. Examination items that included obesity-related keywords were identified by National Board of Medical Examiners (NBME) staff. A panel of 6 content experts evaluated all items and coded obesity-relevant items using the American Board of Obesity Medicine (ABOM) test outline rubric into 4 domains and 107 subdomains.Findings. There were 802 multiple-choice items containing obesity-related keywords identified by NBME, of which 289 (36%) were identified as being relevant to obesity and were coded into appropriate domains and subdomains. Among the individual domains, the Diagnosis & Evaluation domain comprised most of the items (174) for all 3 Step examinations. Fifty-eight percent of items were represented by 4 of 17 organ systems, and 80% of coded items were represented by 6 ABOM subdomains. The majority of obesity-coded items pertained to the diagnosis and management of obesity-related comorbid conditions rather than addressing the prevention, diagnosis, or management of obesity itself.Insights. The most important concepts of obesity prevention and treatment were not represented on the Step exams. Exam items primarily addressed the diagnosis and treatment of obesity-related comorbid conditions instead of obesity itself. The expert review panel identified numerous important obesity-related topics that were insufficiently addressed or entirely absent from the examinations. The reviewers recommend that the areas identified for improvement may promote a more balanced testing of knowledge in obesity. [ABSTRACT FROM PUBLISHER]

The article discusses the state of claims for bad faith failure to settle in Georgia; reports the decision of a court of appeal in the case 'United States Fidelity & Guaranty v. Evans,' concerning the issue; and discusses how a time-limited settlement demand may affect the insurer's duty.

The Federal Reserve Bank of Atlanta's Center for Real Estate Analytics and the University of North Carolina at Charlotte's Center for Real Estate jointly sponsored a research conference held in Charlotte on December 5-6, 2013. The conference theme was 'Government Involvement in Residential Mortgage Markets' and included papers and discussions from an array of economists employed in academia, government, think tanks and the private sector. This special issue of Real Estate Economics is composed of seven of the ten papers presented at the conference. The research is concentrated on the recent U.S. housing boom and bust, with a particular focus on the role of government policy. [ABSTRACT FROM AUTHOR]

The imposition of federal conservatorships on September 6, 2008, at the Federal National Mortgage Association and the Federal Home Loan Mortgage Corporation-commonly known as Fannie Mae and Freddie Mac-was one of the most dramatic events of the financial crisis. These two government-sponsored enterprises play a central role in the US housing finance system, and at the start of their conservatorships held or guaranteed about $5.2 trillion of home mortgage debt. The two firms were often cited as shining examples of public-private partnerships-that is, the harnessing of private capital to advance the social goal of expanding homeownership. But in reality, the hybrid structures of Fannie Mae and Freddie Mac were destined to fail at some point, owing to their singular exposure to residential real estate and moral hazard incentives emanating from the implicit guarantee of their liabilities. We describe the financial distress experienced by the two firms, the events that led the federal government to take dramatic action in an effort to stabilize housing and financial markets, and the various resolution options available to US policymakers at the time; and we evaluate the success of the choice of conservatorship in terms of its effects on financial markets and financial stability, on mortgage supply, and on the financial position of the two firms themselves. Conservatorship achieved its key short-run goals of stabilizing mortgage markets and promoting financial stability during a period of extreme stress. However, conservatorship was intended to be a temporary fix, not a long-term solution, and more than six years later, Fannie Mae and Freddie Mac still remain in conservatorship. [ABSTRACT FROM AUTHOR]

The article presents information on Rev. Howard Thurman, a leader in civil rights movement of the African American and in U.S. Protestant. It explores life and theology of Thurman and describes both the Fellowship and its worship. It is stated that Thurman viewed arts as transformative and believed that Fellowship Church prays together but it requires other activities in order to stay together.

To address provider struggles to provide evidence-based, rational drug therapy to pregnant women, this third Conference was convened to highlight the current progress and research in the field. Speakers from academic centers, industry, and governmental institutions spoke about: the Food and Drug Administration's role in pregnancy pharmacology and the new labeling initiative; drug registries in pregnancy; the pharmacist's role in medication use in pregnancy; therapeutic areas such as preterm labor, gestational diabetes, nausea and vomiting in pregnancy, and hypertension; breast-feeding and medications; ethical challenges for consent in pregnancy drug studies; the potential for cord blood banks; and concerns about the fetus when studying drugs in pregnancy. The Conference highlighted several areas of collaboration within the current Obstetrics Pharmacology Research Units Network and hoped to educate providers, researchers, and agencies with the common goal to improve the ability to safely and effectively use individualized pharmacotherapy in pregnancy. Clin Trans Sci 2011; Volume 4: 204-209 [ABSTRACT FROM AUTHOR]

The heretofore obscure designer, silversmith, and jeweler Albert Feinauer played a notable role in bringing German avantgarde design to American silver during his thirty years in the United States beginning in 1925. The progressive ideas and production techniques discussed were derived from the artist's affiliation with leading Deutsche Werkbund designers as well as his Bauhaus experience and his time designing for Georg Jensen in Copenhagen and teaching at Henry van de Velde's arts and crafts school in Weimar. A sample of his tableware and jewelry creations illustrates the innovations that Feinauer brought to his International Silver Company and Gorham designs. [ABSTRACT FROM AUTHOR]

The Federal Home Loan Bank (FHLB) System is a large cooperatively owned government-sponsored liquidity facility that lends predominately to U.S. depository institutions. This paper documents the significant role played by the FHLB System at the outset of the recent financial crisis and provides evidence on the uses of FHLB funding by member banks and thrifts during that time. We then compare lending activity by the FHLB System and the Federal Reserve during 2007 and 2008, discuss the types of institutions seeking government-sponsored liquidity at various times, and identify the trade-offs faced by borrowers eligible to tap liquidity from both facilities. [ABSTRACT FROM AUTHOR]

This perspective is a counterpoint to Dr. Brass' article, Basic biomedical sciences and the future of medical education: implications for internal medicine. The authors review development of the US medical education system as an introduction to a discussion of Dr. Brass' perspectives. The authors agree that sound scientific foundations and skill in critical thinking are important and that effective educational strategies to improve foundational science education should be implemented. Unfortunately, many students do not perceive the relevance of basic science education to clinical practice.The authors cite areas of disagreement. They believe it is unlikely that the importance of basic sciences will be diminished by contemporary directions in medical education and planned modifications of USMLE. Graduates' diminished interest in internal medicine is unlikely from changes in basic science education.Thoughtful changes in education provide the opportunity to improve understanding of fundamental sciences, the process of scientific inquiry, and translation of that knowledge to clinical practice. [ABSTRACT FROM AUTHOR]

Alternative fuels and technologies offer potential for reducing emissions in public transportation. These potentials were explored by determining emissions levels and fuel consumption from the U.S. transit bus fleet and comparison of hypothetical scenarios in which implementation of specific alternative fuels and technologies is considered. Impacts from current transit bus procurements were also evaluated. Emissions benefits above and beyond the natural course of transit bus procurements were examined for new diesel buses running on ULSD fuel, diesel-electric hybrid buses, gasoline-electric hybrid buses, compressed natural gas and biodiesel. According to the analysis, reductions in emissions of CO, NMHC, NOx, PM and CO2, as well as fuel consumption, may be attained, and diesel hybrid buses yield the largest reductions in CO2 emissions and are the only technology to reduce fuel consumption relative to the present fleet. Introducing diesel-electric hybrid buses in 15% of the U.S. transit bus fleet would reduce annual end-use emissions by nearly 1,800 tons of CO, 400 tons of NMHC, 4,400 tons of NOx, 200 tons of PM, 491,400 tons of CO2, and fuel consumption by 50.66 millions of diesel gallons. [ABSTRACT FROM AUTHOR]

Aim Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH. [ABSTRACT FROM AUTHOR]

The article presents information on the National Institutes of Health conference in the U.S., which focused on the prevention of fecal and urinary incontinence in adults. Fecal incontinence is a syndrome that involves unintentional loss of solid or liquid stool. In urinary incontinence, a person leaks urine unintentionally. It is stated that prevention of fecal and urinary incontinence has been hindered due to limited research and incomplete knowledge about the biological causes.

The article focuses on the liability of colleges and universities for incidents of on campus violence and crimes in the U.S. It states that once the school has certain knowledge about a particular student's potential to harm either oneself or others, a duty to protect their students may arise. It notes that a plaintiff engaging a negligence action against a college or university based on the student's violent actions may seek to establish, in which the school has a duty as a landowner, business owner or landlord. Further, it suggests that school administrators should implement effective strategies to prevent violent campus attacks.

ZIP models were used to detect reductions in drug abuse among young people living with HIV (YPLH) over 15 months when most young people abstain from use. YPLH (n = 171) aged 16 to 29 years were randomly assigned to an 18 session intervention or a delayed-intervention condition. The ZIP models showed significant reductions in abuse of multiple substances over time in the non-delayed intervention. Previous analyses did not find significant reductions. Intervention efficacy often cannot be detected if there are highly skewed distributions of outcomes, such as drug abuse. ZIP modeling offers an opportunity to more reliably detect behavioral changes. [ABSTRACT FROM AUTHOR]

This paper examines two forces that may soon increase competition in the U.S. secondary conforming mortgage market: (1) the Federal Home Loan Bank mortgage purchase programs, and (2) the adoption of revised risk-based capital requirements for large U.S. banks (Basel II). We argue that this competition is likely to reduce the growth and relative importance of Fannie Mae and Freddie Mac and hence reduce their charter values and effective capital. Such developments could, in turn, lead to more risky behaviors by these two companies. This last consequence warrants greater supervisory awareness and legal authorities. [ABSTRACT FROM AUTHOR]

The article focuses on Federal Home Loan Banks (FHLB) system in the U.S., which was established in 1932 as a collection of cooperatively owned wholesale banks. These banks primarily acted as a reliable provider of long-term funding to specialized mortgage lenders. The growth and profitability trends of FHLB have been further strengthened by the advances in information technology. It discusses some unique features of the FHLB system including ownership structure, equity market discipline and charter value.

Presents several benefits of information derived from organized wholesale market on electric industry in the U.S. Price discovery; Data for further resource planning and business decisions; Central information clearinghouse for market participants and regulators.

This study reports the results of a survey as to whether NCATE accredited institutions throughout the United States made changes in professional education and/or teaching field coursework, in either elementary and/or secondary areas, because of the No Child Left Behind Act (NCLB). Two hundred forty eight of the 550 institutions surveyed (45.09%) responded that changes had been made because of NCLB. Areas of change included increasing hours in professional education and teaching field courses, and expanding alternative certification/licensure programs. There was also increased articulation/dialogue between Schools, Colleges, and Departments of Education (SCDEs) and Colleges of Arts and Sciences as well as increased articulation between SCDEs and local schools/school districts. The percentages of SCDEs making changes were nearly uniform across all sizes of institutions. Changes were made in both private and public SCDEs. [ABSTRACT FROM AUTHOR]

This article offers a generalist's guide to the functions that the Federal National Mortgage Association (Fannie Mae) and Federal Home Loan Mortgage Corp. (Freddie Mac) perform in the residential mortgage financial markets and the controversies that swirl around them. In essence, Fannie Mae and Freddie Mac are providing insurance to holders of mortgage-backed securities against default risk on the underlying mortgages and are thus bearing that risk themselves. This securitization activity illustrates one of their two core businesses: mortgage credit guarantees. The other core business of Fannie Mae and Freddie Mac is their investment portfolios. As of year-end 2003, Fannie Mae had $1,010 billion in assets and Freddie Mac had $803 billion in assets, making them the second- and third-largest U.S. companies, respectively, on this basis. Fannie Mae and Freddie Mac differ from other U.S. corporations in that they were created by Congress and maintain exclusive federal charters. By law, securities of Fannie Mae and Freddie Mac are required to include language that they are not guaranteed by, or otherwise an obligation of, the federal government. The federal charters for Fannie Mae and Freddie Mac, and particularly the implied federal guarantee of their financial obligations, raise the central policy issue. Safety-and-soundness regulatory oversight is one way to deal with insufficient market monitoring and discipline. However, in the case of Fannie Mae and Freddie Mac, the case for such regulation must be more nuanced.

A high-resolution, regional passive seismic experiment in the Rio Grande rift region of the southwestern United States has produced new images of upper-mantle velocity structure and crust-mantle topography. Synthesizing these results with geochemical and other geophysical evidence reveals highly symmetric lower-crustal and upper-mantle lithosphere extensional deformation, suggesting a pure-shear rifting mechanism for the Rio Grande rift. Extension in the lower crust is distributed over a region four times the width of the rift's surface expression. Here we propose that the laterally distributed, pure shear extension is a combined effect of low strain rate and a regionally elevated geotherm, possibly abetted by pre-existing lithospheric structures, at the time of rift initiation. Distributed extension in the lower crust and mantle has induced less concentrated vertical mantle upwelling and less vigorous small-scale convection than would have arisen from more localized deformation. This lack of highly focused mantle upwelling may explain a deficit of rift-related volcanics in the Rio Grande rift compared to other major rift systems such as the Kenya rift. [ABSTRACT FROM AUTHOR]

Discusses the institutional structure and authorities of housing government-sponsored enterprises (GSE) in the U.S. Regulatory structure for the housing GSE; Institutional authorities of the Federal Housing Enterprise Supervisory Agency; Evaluation of the changes to housing GSE oversight. INSET: Recent Events.

The almost complete disappearance of benign gastric ulcer disease has led to the perception that there may be an insufficient gastric surgery experience for surgery residents. This study analyzed resident-reported gastric procedure experience by chief residents from U.S. programs. The Resident Statistic Summaries (Report C) for 1990-2001 were compiled and analyzed. Results are expressed as the average number of operations performed per resident, standard deviation (SD), and the percentage (%) of total gastric operative cases. For all gastric-related surgery, the average reported cases per chief resident ranged from 9.8-12.4 with a peak in 1990 and a nadir in 1999; in 2001 the reported case average was 11.3 (SD ranged from 6-8). Over the same interval, vagotomy decreased from 24% in 1990 to 7% in 2001, whereas gastric-reduction operations increased from 5%-34%. Total gastrectomy remained a constant less than 1.0 per chief resident (range 0.6-0.8), whereas partial gastric resection (PGR) was unchanged. The percentage of all types of gastric resections slightly diminished from 34% in 1990 to 29% in 2001. U.S. surgical chief residents report a widely variable experience in gastric surgery over the period analyzed. However, their overall experience has not significantly diminished since 1990 although specific procedural volume has varied. [ABSTRACT FROM AUTHOR]