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Fahl C, Alexis D, Higginbotham EJ, Xu C, Aysola J. Asserting Accountability to Address Diversity: Report Card as a System of Measurement. Health Equity 2023; 7:116-125. [PMID: 36876235 PMCID: PMC9982139 DOI: 10.1089/heq.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 02/23/2023] Open
Abstract
Problem To the best of our knowledge, there are no standard accountability measures for diversity efforts at the departmental level. Therefore, the purpose of this study is to evaluate a multiprong report card as a structure for evaluation, tracking, and reporting as well as to examine any relationships between expenditures and outcomes. Approach We instituted an intervention that offered leadership a report card of metrics related to diversity efforts. Included are diversity expenditures, benchmark demographic and departmental data, applications to support faculty salaries, participation in clerkship programs focused on attracting diverse candidates, and requests for candidate lists. The purpose of this analysis is to demonstrate the impact of the intervention. Outcomes A significant relationship was found between faculty funding applications and under-represented minority (URM) representation in a department (0.19; confidence interval [95% CI] 0.17-0.21; p<0.001). An association was also found between total expenditures and URM representation in a department (0.002; 95% CI 0.002-0.003; p<0.001). Other outcomes include the following: (1) women, URM, and minority faculty have all increased in representation since tracking began; (2) diversity expenditures and faculty opportunity fund and presidential professorship applications have increased over time; and (3) a steady decline in departments with zero URM representation after the tracking of diversity expenditures in both clinical and basic science departments. Next Steps Our findings suggest that standardized metrics for inclusion and diversity initiatives promote accountability and buy-in from executive leadership. Departmental detail enables tracking of progress longitudinally. Future work will continue to evaluate the downstream effects of diversity expenditures.
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Affiliation(s)
- Corrinne Fahl
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominique Alexis
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eve J Higginbotham
- Office of Inclusion, Diversity, and Equity, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chang Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jaya Aysola
- Division of General Internal Medicine and Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Alexis D, Fahl C, Higginbotham E, Bateman JB. Gender Diversity on Corporate Boards Associated with Ophthalmology. Am J Ophthalmol 2022; 239:154-158. [PMID: 35314192 DOI: 10.1016/j.ajo.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Enhancing diversity on boards has been linked to greater profitability and innovation. Unfortunately, there remains an underrepresentation of women in executive management and leadership positions in the ophthalmic corporate world. The purpose of these analyses was to examine the gender composition of directors for boards associated with the discipline of ophthalmology. DESIGN Cross-sectional research design. METHODS Using contemporary data, we examined a specific cohort, the American Academy of Ophthalmology (AAO) Foundation Ophthalmic Business Council corporate members as reported in the annual 2019 meeting program (N = 23). The board composition was analyzed using an online search of publicly available information in January and February 2020. The specific outcome measures included the number and percentage of women board members and their roles. RESULTS There were a total of 23 Ophthalmic Business Council members with publicly available data; 37 of 195 total directorship seats (19%) were held by women, and 9 of 23 companies (39%) listed women as previous or current chairs of committees or outside corporations. Four of the 23 (17%) members of the Ophthalmic Business Council corporations had no women directors. CONCLUSIONS The boards of directors of the AAO Foundation Ophthalmic Business Council corporate members remain predominately male. Despite the increasing number of women entering the specialty, women remain underrepresented in the corporate world of ophthalmology. Gender parity on boards is essential for the economic well-being of ophthalmic corporations as well as the relationship of the Ophthalmic Business Council with AAO members, health care systems, insurance carriers, government officials, and the public.
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Kearney MD, Barg FK, Alexis D, Higginbotham E, Aysola J. Employee Health and Wellness Outcomes Associated With Perceived Discrimination in Academic Medicine: A Qualitative Analysis. JAMA Netw Open 2022; 5:e2145243. [PMID: 35089355 PMCID: PMC8800072 DOI: 10.1001/jamanetworkopen.2021.45243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Organizational culture and workplace interactions may enhance or adversely impact the wellness of all members of learning and work environments, yet a nuanced understanding of how such experiences within health care organizations impact the health and wellness of their membership is lacking. OBJECTIVE To identify and characterize the reported health and wellness outcomes associated with perceived discrimination among academic medicine faculty, staff, and students. DESIGN, SETTING, AND PARTICIPANTS This qualitative study analyzed anonymously submitted written narratives from 2016 that described experiences related to inclusion in the workplace or lack thereof. Narratives that described health outcomes associated with work- or school-based discrimination were purposively sampled. Participants were faculty, staff, and students at health-related schools or hospitals affiliated with the University of Pennsylvania. Data analysis was performed from March 2019 to January 2020. EXPOSURES Self-reported experiences, both witnessed and personal, of discrimination in the workplace. RESULTS A total of 315 narratives were collected, and 115 narratives from 115 participants were analyzed. Most respondents identified as female (70 respondents [60.9%]), non-Hispanic White (68 respondents [59.1%]), and heterosexual (89 respondents [77.4%]) and had worked at the institution for at least 1 year (99 respondents [86.0%]). The outcomes associated with adverse workplace experiences were broad and ranged in nature from emotional to mental and physical. Most reported outcomes were emotional (101 respondents [87.8%]), and more than 1 in 10 narratives (14 respondents [12.2%]) described a mental or physical health outcome. Many of the participants felt devaluated, overexerted, and hopeless, resulting in clinically relevant manifestations, such as increased stress and anxiety levels and even elevated blood pressure. CONCLUSIONS AND RELEVANCE This qualitative study identified a continuum of negative outcomes on employee health and well-being associated with perceived discrimination and chronic exclusion in the workplace. These findings suggest the need for organizations to promote inclusion as a component of workplace wellness interventions.
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Affiliation(s)
- Matthew D. Kearney
- Department of Family Medicine and Community Health and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Frances K. Barg
- Department of Family Medicine and Community Health and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dominique Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eve Higginbotham
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Obeng R, Parihar V, Alexis D, Behera M, Owonikoko T, Pillai R, Ramalingam S, Sica G, Ahmed R. Mature tertiary lymphoid structures in lung adenocarcinoma are associated with better progression free survival. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
The presence of inducible lymphoid structures known as tertiary lymphoid structures in the tumor microenvironment has been shown to correlate with positive clinical outcome. However, the maturation states of lymphoid aggregates in lung adenocarcinoma are not completely understood.
Methods/Case Report
Seventy tumor samples from 69 patients diagnosed with lung adenocarcinoma (Stages I to III) between 2013 and 2015 were included in the study. The presence and maturation states of the lymphoid structures within the tumors were evaluated by conventional and 26 samples were further analyzed by multiplexed immunohistochemistry of formalin fixed paraffin embedded tissues and then quantified. Mature lymphoid follicles containing germinal centers were identified by the presence of CD21+ and BCL-6+ cells in an organized configuration within tight clusters of T and B cells.
Results (if a Case Study enter NA)
Samples with fully mature lymphoid structures (germinal centers) had larger tumors and higher disease stage. The number of mature lymphoid structures correlated with the total number of lymphoid aggregates present in the tumor microenvironment. Additionally, tumor samples with ≥10 mature lymphoid structures had more primary follicles. While there was no difference in overall survival, progression free survival was significantly longer in patients who had ≥10 mature lymphoid structures in comparison with patients who had <10 mature structures.
Conclusion
In conclusion, a spectrum of lymphoid aggregates in different stages of maturation are present in lung adenocarcinoma. An increase in the number of mature lymphoid structures may be associated with progression free survival in patients with lung adenocarcinoma.
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Affiliation(s)
- R Obeng
- Pathology, Northwestern University, Chicago, Illinois, UNITED STATES
| | - V Parihar
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - D Alexis
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - M Behera
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - T Owonikoko
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - R Pillai
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - S Ramalingam
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - G Sica
- Winship Cancer Institute, Emory University, Atlanta, Georgia, UNITED STATES
| | - R Ahmed
- Emory Vaccine Center, Emory University, Atlanta, Georgia, UNITED STATES
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Obeng R, Parihar V, Alexis D, Sica G. MA09.06 Mature Tertiary Lymphoid Structures in Lung Adenocarcinoma Are Associated With Better Progression Free Survival. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Agawu A, Fahl C, Alexis D, Diaz T, Harris D, Harris MC, Aysola J, Cronholm PF, Higginbotham EJ. The Influence of Gender and Underrepresented Minority Status on Medical Student Ranking of Residency Programs. J Natl Med Assoc 2019; 111:665-673. [PMID: 31668360 DOI: 10.1016/j.jnma.2019.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Physician diversity is linked to improved quality of care of diverse patient populations. The transition from medical school to residency is an opportunity to improve and increase workforce diversity in all specialties. However, there is limited published literature on the factors contributing to the ranking of residency programs on women and underrepresented minorities (URMs). OBJECTIVE To characterize factors medical students used to rank residency programs and describe any differences based on race/ethnicity or gender. METHODS A mixed-methods study consisting of a web-based survey and semi-structured interviews with National Resident Matching Program (NRMP) participating graduates over a two-year period. The survey assessed demographics and a 6-point Likert scale rating of various factors used to rank residency programs. Unpaired student t-tests were used to compare means. A subset of students was interviewed and a modified grounded theory approach identified decision-making themes as well as the role of gender and URM status. RESULTS Out of a total of 316 invitations sent, 148 completed the survey (46.8% response rate), of which 21% of respondents self-identified as URMs. The majority of respondents graduated in 2014 (53%), and were male (51%). Participants ranked program atmosphere, reputation, location, and proximity to family the highest. URM students ranked patient population (p < 0.01), revisit opportunities (p = 0.04), gender diversity (p < 0.01), and ethnic diversity (p < 0.01) significantly higher than non-URM students. Female students ranked patient population (p < 0.01) and gender diversity (p < 0.01) significantly higher than males. Qualitative findings revealed differences in perceptions by URMs and non-URMs of patient population, revisit opportunities, gender diversity, and ethnic diversity. CONCLUSIONS While all students prioritized pragmatic factors, women and URM students assess and weigh additional factors related to culture, inclusion, and diversity more than others. By tailoring recruitment strategies to meet the expectations of women and URMs, residency programs can better meet goals in becoming more diverse and inclusive.
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Affiliation(s)
- Atu Agawu
- General Pediatrics/Emergency Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Corrinne Fahl
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dominique Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tomas Diaz
- Resident in Emergency Medicine at the University of California - San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Diana Harris
- Department of Philosophy, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary C Harris
- Pediatrics and Advisory Dean, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaya Aysola
- Department of Medicine and Pediatrics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Inclusion and Diversity, Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Higginbotham EJ, Alexis D. Is Newer Necessarily Better? The Evolution of Incisional Glaucoma Surgery Over the Last 100 Years. Am J Ophthalmol 2018; 191:xxv-xxix. [PMID: 29655641 DOI: 10.1016/j.ajo.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine the progress made in glaucoma incisional surgery and determine if there has been sufficient progress to meet the needs of glaucoma patients. DESIGN Perspective (literature review). METHODS This is a retrospective assessment of key milestones in the evolution of glaucoma incisional surgery and an evaluation of the risks and the benefits of these procedures. Benefits are defined as effective reduction in intraocular pressure (IOP) and protecting visual function, while risks are defined as safety and complications for our patients. Quality of life is also considered. RESULTS Although advances have been made in the last 100 years, the trabeculectomy, a procedure that was described more than 50 years ago, remains the optimal choice for reducing IOP among those patients who require pressures in the teens, who do not respond to medications and prior laser therapy. CONCLUSIONS Appropriate patient selection, careful attention to surgical technique, and intensive follow-up of patients will optimize the results of a trabeculectomy. Newer procedures must be carefully studied in well-designed clinical trials to determine comparative levels of safety and efficacy to this gold standard. Advances in drug delivery and minimally invasive glaucoma surgery may ultimately produce the best outcome for glaucoma patients in the future.
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Díez-Morrondo C, Pantoja L, Fernández R, Brañanova P, López A, Alexis D. Good response to rituximab in a patient with granulomatosis with polyangiitis and pulmonary, renal manifestations and ophthalmoplegia. Acta Reumatol Port 2016; 41:74-77. [PMID: 27115111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cyclophosphamide (CYC) is a classical drug for the treatment of severe granulomatosis with polyangiitis (GPA). However, a considerable number of patients are resistant to standard treatment and it can show substantial toxicity. Therefore, alternative agents should be considered in refractory cases. We report the successful use of rituximab (RTX) in a 70-year-old patient diagnosed of GPA who developed ophthalmoplegia, an uncommon complication of GPA. The patient also had upper and lower respiratory tract involvement and kidney manifestations with good prognosis. We review the causes of ophtalmoparesis and the treatment with RTX in GPA.
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Owonikoko T, Busari A, Chen Z, Kim S, Alexis D, Somers E, O’Shannessy D, Ramalingam S, Khuri F, Sica G. Clinical and Pathologic Characterization of Folate Receptor Alpha, Mesothelin, and Endosialin Expression in Mesotheliomas. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vincent HK, Percival S, Creasy R, Alexis D, Seay AN, Laura Ann Z, MacMillan M, Vincent KR. Acute Effects of Enhanced Eccentric and Concentric Resistance Exercise on Metabolism and Inflammation. ACTA ACUST UNITED AC 2014; 4. [PMID: 26807345 DOI: 10.4172/2165-7025.1000200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study compared the metabolic, cardiopulmonary and inflammatory responses of novel acute machine based concentrically-focused resistance exercise (CON RX) and eccentrically-focused resistance exercise (ECC RX). Twenty healthy adults (26.8 ± 5.9 yrs; 25.4 ± 4.0 kg/m2) performed two work-matched RX exercise sessions. Cardiopulmonary responses, rating of perceived exertion (RPE), soreness, oxygen consumption; (VO2) were collected during each session. Blood lactate and levels of inflammatory cytokines interleukin-1 alpha (IL1α), interleukin-6 (IL6) and tumor necrosis factor-alpha (TNFα) were analyzed pre, post ad 24 hours post-exercise. HR were higher (5-15bpm) during ECC RX (p<.05). Soreness ratings were consistently higher post-ECC RX compared to CON RX. VO2 area under the curve was higher during ECC than CON (31,905 ml/kg/min vs 25,864 ml/kg/min; p<.0001). Post-ECC RX, TNFα levels increased compared to CON RX 23.2 ± 23.9% versus 6.3 ± 16.2% ( p=.021). ECC RX induced greater metabolic, cardiopulmonary and soreness responses compared to matched CON RX. This may be due to recruitment of additional stabilizer muscles and metabolic stress during the ECC RX. These factors should be considered when designing ECC RX programs particularly for untrained persons, older adults or those with history of cardiovascular disease.
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Affiliation(s)
- H K Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
| | - S Percival
- Department of Food Science and Nutrition, University of Florida, USA
| | - R Creasy
- Department of Food Science and Nutrition, University of Florida, USA
| | - D Alexis
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
| | - A N Seay
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
| | - Zdziarski Laura Ann
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
| | - M MacMillan
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
| | - K R Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, USA
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Roopnarinesingh S, Alexis D, Lendore R, Morris D. Fetal steroid levels at delivery. Obstet Gynecol 1977; 50:442-4. [PMID: 904807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to investigate cortisol levels in the circulation of neonates following spontaneous onset of labor. There was no significant difference of values between primigravidas and multigravidas, male and female babies, or normal and preeclamptic pregnancies. There was no significant change in mean cord plasma cortisol values with advancing gestational age, after the 33rd week. It is conceivable that spontaneous labor in humans may be preceded by a release of cortisol into the fetal circulation, and when a critical "parturient" level is reached labor becomes established.
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