Gunmen assassinate peasant leader in Paraguay












ASUNCION, Paraguay (AP) — Gunmen murdered one of the surviving leaders of a peasant movement whose land dispute with a powerful politician prompted the end of Fernando Lugo‘s presidency last June.


Vidal Vega, 48, was hit four times early Saturday by bullets from a 12-gauge shotgun and a .38-caliber revolver fired by two unidentified men who sped away on a motorcycle, according to an official report prepared at the police headquarters in the provincial capital of Curuguaty.












A friend, Mario Espinola, told The Associated Press that Vega was shot down when he stepped outside to feed his farm animals.


Vega was among the public faces of a commission of landless peasants from the settlement of Yby Pyta, which means Red Dirt in their native Guarani language.


He had lobbied the government for many years to redistribute some of the ranchland that Colorado Party Sen. Blas Riquelme began occupying in the 1960s.


By last May, the peasants finally lost patience and moved onto the land. A firefight during their eviction on June 15 killed 11 peasants and six police officers, prompting the Colorado Party and other leading parties to vote Lugo out of office for allegedly mismanaging the dispute.


Twelve suspects, nearly all of them peasants from Yby Pyta, have been jailed without formal charges since then on suspicion of murdering the officers, seizing property and resisting authority. The prosecutor had six months to develop the case and will present his findings Dec. 16.


Vega was expected to be a witness at the criminal trial, since he was among the few leaders who weren’t killed in the clash or jailed afterward.


He wasn’t charged because he was away getting supplies when the violence erupted at the settlement erected by the peasants inside Riquelme’s ranch, the Naranjaty Commission’s secretary, Martina Paredes, told the AP.


“We think he was assassinated by hit men who were sent, we don’t know by whom, perhaps to frighten us and frustrate our fight to recover the state lands that were illegally taken by Riquelme,” she said.


Riquelme, who died of natural causes about a month after the battle in June, occupied the land during the dictatorship of Alfredo Stroessner, whose government gave away land for free to anyone willing to put it to productive use.


A local court in Curuguaty upheld Riquelme’s claim to the land years later. Lugo’s government later sought to overturn the decision, but the case remains tied up in court.


Latin America News Headlines – Yahoo! News


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Jackson’s ‘Bad’ jacket, costumes sold at auction












LOS ANGELES (AP) — Costumes worn by Michael Jackson commanded hundreds of thousands of dollars at auction, and Lady Gaga was among the collectors.


Gaga tweeted Sunday that she bought 55 pieces in the sale administered by Julien’s Auctions and said she plans to keep the items “archived and expertly cared for in the spirit and love of Michael Jackson, his bravery and fans worldwide.”












Auctioneer Darren Julien said the jacket Jackson wore during his “Bad” tour fetched $ 240,000. Two of Jackson’s crystal-encrusted gloves sold for more than $ 100,000 each, as did other jackets and performance costumes.


The auction featuring the collection of Jackson’s longtime costume designers Dennis Tompkins and Michael Bush raised more than $ 5 million. Some proceeds benefited Guide Dogs of America and Nathan Adelson Hospice of Las Vegas.


___


Online:


www.juliensauctions.com


Entertainment News Headlines – Yahoo! News


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U.S. election, iPhone 5, Kardashian top Yahoo! 2012 searches












LOS ANGELES (Reuters) – The U.S. presidential election became the most-searched item and Kim Kardashian was the most-searched person on Yahoo! in a year when online searches were dominated by big news stories and pop culture obsessions, the search engine company said on Monday.


The search term “election” topped the list of searches, led not only by extensive media coverage but also widening conversation on online social media platforms.












The term “political polls” was No. 8 of the top 10 Yahoo! searches of the year.


“The 2012 elections dominated the online searches, which is amazing because if something is in the news, it’s already accessible … people were really saturated by it, but even so, that was a key word that people typed throughout the year,” Vera Chan, Yahoo!’s web trend analyst, said in a conference call.


Chan said only two other news stories have topped the list in the past decade, those being the death of Michael Jackson in 2009 and the BP oil spill in 2010.


“iPhone 5″ came in at No. 2, which Chan said was interesting “in a post-Steve Jobs era” because while Apple Inc’s iPhone has featured regularly in the top searches since the first generation emerged in 2007, this was the first time a specific model had appeared high on the list.


Reality star Kim Kardashian was the most-searched person on the website, coming in at No. 3 and leading six famous women in the top 10.


Chan said Kardashian’s “notoriety has kept her at the top,” citing her ongoing divorce saga with ex-husband Kris Humphries, her high-profile relationship with rapper Kanye West and her E! channel reality shows.


Sports Illustrated cover model Kate Upton, British royal Kate Middleton, late singer Whitney Houston, troubled former child star Lindsay Lohan and pop star and former “American Idol” judge Jennifer Lopez all featured in the top 10 after being in the news prominently throughout the year.


Middleton, who was followed eagerly by fans and critics in her first year as a royal married to Britain’s Prince William and being a staple at the London Olympics and the Queen’s Diamond Jubilee, also garnered the most-searched scandal of the year when a French magazine published photos of her topless.


“olympics” came in at No. 7 on the list, as many turned to online media to watch and keep tabs on the global sporting event held in London during the summer.


On Yahoo!’s separate list of top-searched obsessions, pop culture dominated this year, with “The Hunger Games,” reality star Honey Boo Boo, erotic novel “Fifty Shades of Grey,” British boy band One Direction, Carly Rae Jepsen’s hit song “Call Me Maybe” and Korean rapper Psy’s “Gangnam Style” featuring in the top 10.


Yahoo! Inc compiles its annual search lists based on aggregated visitor activity on the network and billions of consumer searches.


(Editing by Eric Walsh)


Internet News Headlines – Yahoo! News


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Report: At least three dead after Japan tunnel collapse

TOKYO (Reuters) - A tunnel on a major highway in central Japan collapsed on Sunday, killing at least three people and starting a blaze, Japanese media reported.


Attempts to rescue those still trapped inside the smashed tunnel, which began spewing smoke after concrete ceiling panels fell onto the road, have been interrupted for fear they might trigger another collapse.


Three bodies have been found so far, television networks Fuji and Asahi said.


The fire service earlier said at least seven people were unaccounted for in the 4.7 km (2.8-mile) tunnel in Yamanashi prefecture, about 80 km (50 miles) west of Tokyo on the Chou Expressway, a main road connecting the capital to western Japan.


"Dense smoke was coming out as if it covers the entire mountain," witness Kiyoko Toyomura told Japanese news agency Kyodo.


The fire service said the blaze was extinguished about 11 a.m. - some three hours after the accident occurred.


The operator of the highway, Central Nippon Expressway, said a 50-60 meters (165 feet) long section of ceiling panels fell to the road, and it was looking into the cause of the accident.


Motorists described narrow escapes from falling debris, and a long walk through the darkness after abandoning their cars.


"When I was driving in the tunnel, concrete pieces fell down suddenly from the ceiling," a man in his 30s told public broadcaster NHK. "I saw a crushed car catching fire. I was frightened, left my car and walked for about an hour to get out of the tunnel."


In 1996 a tunnel in Hokkaido, northern Japan, collapsed and falling rocks crushed cars and a bus, killing 20 people.


NHK reporter Yoshio Goto, caught in Sunday's accident, hit the accelerator and managed to drive out.


"But it was a bit too late and pieces of ceiling fell on my car. I kept pressing the pedal and managed to get out," he said. "Then when I looked around, I saw half of the car ceiling was crushed."


(Reporting by Hideyuki Sano; Editing by Daniel Magnowski)


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Asperger’s dropped from revised diagnosis manual












CHICAGO (AP) — The now familiar term “Asperger‘s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.


The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.












Full details of all the revisions will come next May when the American Psychiatric Association‘s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.


This diagnostic guide “defines what constellations of symptoms” doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it “shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care.”


Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association’s board of trustees.


The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.


One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger’s disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.


And some Asperger’s families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.


But the revision will not affect their education services, experts say.


The new manual adds the term “autism spectrum disorder,” which already is used by many experts in the field. Asperger’s disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don’t talk or interact, as well as those with milder forms.


Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger’s.


“To give it separate names never made sense to me,” Gibson said. “To me, my children all had autism.”


Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won’t affect those services, Gibson said. She also has a 3-year-old daughter without autism.


People with dyslexia also were closely watching for the new updated doctors’ guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won’t be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.


The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.


The revised guidebook “represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders,” Dr. David Fassler, the group’s treasurer and a University of Vermont psychiatry professor, said after the vote.


The shorthand name for the new edition, the organization’s fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won’t be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.


Olfson said the manual “seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 … there have been important advances in our understanding of the nature of psychiatric disorders.”


Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group’s autism task force, said anyone who met criteria for Asperger’s in the old manual would be included in the new diagnosis.


One reason for the change is that some states and school systems don’t provide services for children and adults with Asperger’s, or provide fewer services than those given an autism diagnosis, she said.


Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don’t lose services.


Other changes include:


—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids’ who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.


—Eliminating the term “gender identity disorder.” It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn’t a disorder and say calling it one is stigmatizing. The term would be replaced with “gender dysphoria,” which means emotional distress over one’s gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .


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Italy votes for center-left candidate for premier












ROME (AP) — Italians are choosing a center-left candidate for premier for elections early next year, an important primary runoff given the main party is ahead in the polls against a center-right camp in utter chaos over whether Silvio Berlusconi will run again.


Sunday’s runoff pits a veteran center-left leader, Pier Luigi Bersani, 61, against the 37-year-old mayor of Florence, Matteo Renzi, who has campaigned on an Obama-style “Let’s change Italy now” mantra.












Nearly all polls show Bersani winning the primary, after he won the first round of balloting Nov. 25 with 44.9 percent of the vote. Since he didn’t get an absolute majority, he was forced into a runoff with Renzi, who garnered 35.5 percent.


After battling all week to get more voters to the polling stations for round two, Renzi seemed almost resigned to a Bersani win by Sunday, saying he hoped that by Monday “we can all work together.”


Bersani, a former transport and industry minister, seemed confident of victory as well, joking about Berlusconi’s flip-flopping political ambitions by asking “What time did he say it?” when told that the media mogul had purportedly decided against running.


Next year’s general election will largely decide how and whether Italy continues on the path to financial health charted by Premier Mario Monti, appointed last year to save Italy from a Greek-style debt crisis.


The former European commissioner was named to head a technical government after international markets lost confidence in then-Premier Berlusconi’s ability to reign in Italy’s public debt and push through sorely needed structural reforms.


Berlusconi has largely stayed out of the public spotlight for the past year, but he returned with force in recent weeks, announcing he was thinking about running again, then changing his mind, then threatening to bring down Monti’s government, and most recently staying silent about his political plans.


His waffling has thrown his People of Freedom party into disarray and disrupted its own plans for a primary — all of which has only seemed to bolster the impression of order, stability and organization within the center-left camp.


A poll published Friday gave the Democratic Party 30 percent of the vote if the election were held now, compared with some 19.5 percent for the upstart populist movement of comic Beppe Grillo, and Berlusconi’s People of Freedom party in third with 14.3 percent. The poll, by the SWG firm for state-run RAI 3, surveyed 5,000 voting-age adults by telephone between Nov. 26 and 28. It had a margin of error of plus or minus 1.36 percentage points.


It’s quite a turnabout for Berlusconi’s once-dominant movement, and a similarly remarkable shift in fortunes for the Democratic Party, which had been in shambles for years, unable to capitalize on Berlusconi’s professional and personal failings while he was premier.


But Berlusconi’s 2011 downfall and a series of recent political party funding scandals that have targeted mostly center-right politicians have contributed to the party’s rise as Italy struggles through a grinding recession and near-record high unemployment.


Angelino Alfano, Berlusconi’s hand-picked political heir, seemed again exasperated Sunday after a long meeting with his patron over Berlusconi’s plans. News reports have suggested Berlusconi might split the party in two and re-launch the Forza Italia party that brought him to political power for the first time in 1994.


“We have to work to reconstruct the center-right, and reconstructing it means having a big center-right party,” not a divided one, Alfano said.


He added that Berlusconi didn’t say one way or another if he would run himself. “It’s his choice,” he said. “If there are any decisions in this regard, he’ll be the one to say so.”


___


Follow Nicole Winfield at www.twitter.com/nwinfield


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Judge who named Starr to probe Clinton to retire












WASHINGTON (Reuters) – The conservative U.S. federal judge who helped to appoint Kenneth Starr as an independent counsel to investigate President Bill Clinton, prompting first lady Hillary Clinton to complain of a “vast right-wing conspiracy,” is planning a partial retirement in February.


The decision by Judge David Sentelle, an anchor of the conservative side of the federal judiciary, will open a fourth vacancy on a Washington, D.C., appeals court considered second in influence to the U.S. Supreme Court.












His semi-retirement, known as “senior status,” was disclosed on a judiciary website that monitors future vacancies.


President Barack Obama has faced difficulty persuading the Senate to confirm his nominees for the 11-judge U.S. Court of Appeals for the District of Columbia Circuit, which hears many cases arising from federal agencies.


Sentelle, who turns 70 next year, was a federal prosecutor and judge in North Carolina before President Ronald Reagan appointed him to the appeals court in 1987.


He was chief of a three-judge panel that in 1994 appointed Starr – a former appeals court judge – as the one to investigate President Bill Clinton over a real estate investment and other matters.


Starr’s investigation widened to include Clinton’s relationship with White House intern Monica Lewinsky, and led to Clinton’s impeachment by the House of Representatives.


Without mentioning Sentelle’s name, Hillary Clinton noted the judge’s ties to Republican senators in a 1998 national television interview in which she spoke about a conspiracy against her husband.


Starr released a statement calling her comments “nonsense.”


Known for direct, colorful questions to lawyers, Sentelle wrote a book, “Judge Dave and the Rainbow People,” based on his handling of a court case involving a gathering of hippies in the North Carolina mountains.


He did not immediately return a call to his chambers on Friday.


(Reporting by David Ingram; Editing by Howard Goller and David Storey)


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6 Futuristic Fireplaces to Keep You Warm This Winter












Who would have guessed — the futuristic-looking luxury fireplace industry is booming. Surprisingly, if you can dream it, it can be built. But, most of the time, it’ll cost you.


It seems we’re no longer just content to view the crackling Yule Log on our TVs. These fireplaces even move past the traditional stone and brick models commonly seen today. They run on gas and have controllers to turn them on or off. Some can even be operated from smartphone apps.












[More from Mashable: For Sale: Space Shuttle Xing Sign]


Check out the gallery and tell us which one is most appealing to you.


Uni Flame


The Uni Flame indoor or outdoor fireplace comes from modern home goods company Radius.


[More from Mashable: Portland Toymakers Create Ten-Legged Bamboo Companion [VIDEO]]


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Photo courtesy of iStockphoto, dszc


This story originally published on Mashable here.


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Why Obama is pushing for stimulus in 'fiscal cliff' deal

How about a little government economic stimulus?


That may sound incongruous considering the budget deficit and the push from Republicans to cut government spending.


But President Obama’s first offer to avoid going over the "fiscal cliff" holds out the hope of at least some stimulus. This would include extending the 2 percentage point Social Security payroll tax cut, boosting a tax incentive to businesses, establishing a $50 billion bank for long-term infrastructure projects, and extending unemployment benefits.


RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered


The total bill: about $255 billion out of the federal government's pocket – an amount the GOP would likely say needs to be offset by spending cuts elsewhere.


The argument in favor of such stimulus? The tax measures, at least, could minimize the drag on the economy from Mr. Obama's proposed tax increases on the wealthy.


“The increases in the top two income tax brackets would put a drag on consumption, so I think, from the Obama point of view, the spending or tax cuts are designed to offset that drag to consumption,” says Michael Brown, an economist at Wells Fargo Securities in Charlotte, N.C.


But to some budget experts, Obama’s list seems more like an opening round of negotiations, where he has asked for a lot more than he will get.


“It looks to me like these are bargaining chips,” says Pete Davis of Davis Capital Ideas, which advises Wall Street firms. “Even most Democrats had given up on the prospect of getting the payroll tax cut extended.”


Mr. Davis considers the odds of most of the stimulus proposals passing Congress “very low.”


What's needed most, say others, is just buckling down and negotiating an end to the fiscal cliff. “Cancelling the fiscal cliff is economic stimulus,” says Stan Collender, a budget expert and partner at Qorvis Communications in Washington.


If Obama's stimulus were passed, however, here is a look at the impact the four elements might have.


SOCIAL SECURITY PAYROLL TAX CUT


The largest chunk of the Obama plan is the extension of the payroll tax cut. This is the money that comes out of an individual’s paycheck as a contribution to Social Security. Two years ago, in an effort to stimulate the economy, Congress decreased the individual contribution from 6.2 percent to 4.2 percent. The employer’s contribution of 6.2 percent remained unchanged.


The Obama administration estimates extending the cuts would cost the government as much as $115 billion in revenue.


The argument for extending the tax cut is that it helps lower-income workers who live paycheck to paycheck. “The difference in the paycheck might be the ability to pay the electric bill for someone or the chance to go to a sit-down restaurant once a month,” says Chris Christopher, an economist at IHS in Lexington, Mass.


The argument against continuing the cut is that it is weakening the Social Security Trust Fund. In order to make up for the loss of contributions, the government taps the general tax revenues, says Pamela Tainter-Causey, a spokeswoman for the National Committee to Preserve Social Security and Medicare.


“It sets up Social Security to compete for funding from the general fund,” she says. “It’s a perfect set up for people who are gunning for the program and claim we can’t afford it now.”


BUSINESS TAX INCENTIVE


The second largest program proposed by Obama would be the extension of accelerated depreciation for business, which would cost the US Treasury about $65 billion in fiscal year 2013, according to the Congressional Budget Office.


Two years ago, business was allowed to accelerate the write-off of 100 percent of its spending on certain capital equipment. Capital spending on equipment and computer software soared by 18.3 percent in 2011.


Then, this year, the benefit to business was cut in half to 50 percent. Capital spending sank in the third quarter by 2.7 percent compared with the same quarter the prior year. With business interest in using the tax break diminishing, economist Gregory Daco of IHS says “it’s a goner.”


INFRASTRUCTURE BANK


Obama has also proposed a $50 billion infrastructure bank. The idea is to fund roads, bridges, tunnels and other large projects that last for a long period of time. “At the moment the funding is done on a cash basis – you have to pay for it as you build it,” says Mr. Collender.


Democrats have been trying to get Congress to fund the bank for the past 10 years, he says. “It does not have a chance of getting through the House," which is controlled by the Republicans, says Mr. Collender.


UNEMPLOYMENT BENEFITS


And, finally, Obama wants to extend unemployment benefits, which would cost about $30 billion.


Under current law, if Congress does nothing, the maximum number of weeks in which an individual could receive jobless will drop to 26 from the current 73 weeks for states with unemployment over 9 percent and 63 weeks for states with unemployment over 7 percent.


If Congress does nothing about the program during the lame-duck session, some 2.1 million jobless will lose their benefits in the first week of January, says Judy Conti, a federal advocacy coordinator at the National Employment Law Project (NELP) in Washington. By the end of the March, she says, another 900,000 people will lose their benefits.


“Forty percent of the unemployed are long term unemployed,” she says. “They have been out of the workforce for over six months.”


RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered



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The Economy of Surgery












When I was twelve, my sister and I accompanied my grandparents to their annual yoga retreat in the hilly ranges of southern India. We had never been before, but the summer heat was particularly blistering that year, so we persuaded our grandparents to take us along. I envisioned a blissful two-week vacation in a photogenic little hamlet, nestled among tea plantations, in temperatures that were thirty degrees cooler than on the mainland. It was just that, and yet, it was even less complicated than that.The mean age of folk at the retreat was 67. Bells sounded every morning at 3:30am, and everyone filed out of their cabins and to a little gymnasium in the center of the dwelling, where we all meditated for two hours to the sounds of sitar music and transcendental humming. Meals were served at strict hours three times a day, and consisted of boiled vegetables and grains, with not a lick of salt or spice. The library in the middle of this utopian dwelling held only spiritual and philosophical texts, not the Nancy Drew or Hardy Boys I hoped for. In the afternoons, there were a variety of classes offered – cooking lessons, devotional classes, music and instrumental classes, and yoga. My sister and I stopped by the latter occasionally, and were always put to shame by octogenarians holding themselves up in impossible poses, such as balancing their entire habitus on the tips of their fingers. I journaled in the evenings, writing each day about a new facet of human life that I’d observed. In the absence of stimulus, my dreams grew vivid and exceedingly detailed.Over the course of the two weeks, my sister and I grew quiet and reflective. It was then that we began an important switch in our minds, something that has lasted to this day. We began to see value in living leanly, economically, functionally. We began to separate needs from wants, and to discard the ornamentation.*Third year of medical school has finally brought me around to my surgery rotation: three months of waking up at 4am, stuffing my white coat pockets to the brim with gauze and tape, retracting skin and fat during long abdominal surgeries, and practicing suturing techniques on pig’s feet procured at the local Stop&Shop grocery market. It’s fast and exhilarating, and deeply satisfying. I was skeptical when I first heard that my preceptor’s favorite procedure of all time was draining a deep-seated abscess. But when I saw it being done in clinic, how a single stab of the thing blade led to the gushing of what felt like liters of pus, I couldn’t help but agree. What a joy to just go in and fix a problem so dramatically, reconstruct a failing human body in a matter of hours!During orientation on the first day of the rotation, two residents sat down and gave my classmates and me some hard advice. Surgery is a demanding rotation, they said, and it reflects the demanding residency ahead that awaits the select few. We could expect to go in while it is still dark out, and leave after the sun had set, almost every day. Residents and attendings can be rough around the edges, and may be gruff with you, even kick you out of their operating room if they feel like it, but it’s not personal. Or even if it is, we’ve got to shrug it off and keep it moving. Gone are the days of noon conferences and luxurious afternoon didactics, with their promise of free lunches and coffee. We were to eat when we can, sit when we can, sleep when we can.After an hour of such grim prognostications, my classmates and I took a break and debriefed our feelings with each other outside the bathrooms. Some were giggling nervously with panicked eyes, but most looked inspired. I too felt like I had voluntarily signed up for a warrior training program, and was feeling pretty zen about it. I saw it as a character-building experience: surgery was the time to cut out the silly frills, and embrace a leaner, meaner way of living. It was time to lose the pretty business casual outfits and fancy footwear of internal medicine, and trade them in for utilitarian scrubs and clogs. It promised to be a time of talking less and getting things done.*During a recent health management class, my classmates and I discussed the case of a medical center based in Seattle that benefited from industry principles gleaned from, of all places, the Toyota car manufacturing company. Toyota’s revolution as a manufacturing miracle began in the supply-scarce post-WWII Japan, when management was confronted with the challenge of meeting customer needs in the face of little spare capital to hold inventory as a buffer to fluctuating demand. The company then developed a set of principles focused on cutting muda or waste, while pursuing kaizen, or continuous self -improvement by way of complete intolerance for redundancy. Toyota integrated these principles into every step of production and management.For instance, Toyota emphasizes innovation on the shop floor by frontline workers to solve problems in production in real time. If a problem is discovered that cannot be fixed within the production cycle time, workers pull a cord that halts the entire assembly line and brings a senior supervisor to the scene. The management aggressively seeks ideas for improvement from employees, resulting in an average yield of close to a million ideas annually, 90% of which go on to be implemented.Analysts attribute Toyota’s success to its emphatic optimization of flow – information flow, physical flow of parts, and overall production flow, via standardized processes and continuous improvement. Standardized processes are ones that are streamlined to eliminate aberrations and unplanned redundancies. Waste, measured even in the seconds, is simply not tolerated, forcing a redesign of processes, again and again, which any employee can take on.In 2004, Toyota surpassed Ford Motors to become the world’s second-largest manufacturer of cars and trucks, surpassing the latter consistently in quality, dependability and value assessments. In turn, Ford began to take cues from Toyota, transforming its assembly-line system to similarly cut out waste.*There are two kinds of people in the world: surgeons, and everyone else.Really, what does it mean to live leanly? I rediscovered it in this rotation. A life in surgery isn’t for everyone, but such an experience is something I truly feel everyone should have. These past 6 weeks have been teaching me to think fast, move fast. They’ve been teaching me to suffice with less, be it food, sleep, or words of appreciation. They’ve been teaching me to appreciate the vulnerabilities of the human body – for no matter how exhausted or sleep-deprived I may feel, actually laying hands on the more tangible deficits of another’s is always startling and humbling. The end result is a beautiful dance, for surgeons and their assistants, working with their hands, rediscovering the grace of human movement, bring art back into medicine.I never leave the OR thinking that more is better. I watch instruments fly, I watch the players push and pull, cut and stitch, wash and dry, and I think about things like symmetry, precision, and above all, the beauty of economy.


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