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Tumin D, Baumgarten N, Buckman C, Kuehn D, Higginson JD. Increasing Pediatricians' Scholarly Productivity on and off the Tenure Track. J Contin Educ Health Prof 2022; 42:148-150. [PMID: 35180740 DOI: 10.1097/ceh.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Physician faculty have increasingly been appointed to nontenure track positions, which provide limited support for scholarly activity. We evaluated how a centralized departmental research group affected the scholarly productivity of faculty on and off the tenure track. METHODS A research team providing both mentorship and logistical study support was implemented in 2018. We identified a pre-intervention cohort of physician faculty employed in July 2016, and a postintervention cohort, employed in July 2018. A publication search was conducted for these cohorts in the period 2017 to 2018 and 2019 to 2020, respectively. RESULTS Seventy-five faculty were included in the analysis, with approximately two-thirds appointed on the clinical (nontenure) track. In the pre-intervention cohort (n = 59), 15 faculty (25%) had at least one publication in the period 2017 to 2018. In the postintervention cohort (n = 59), 33 faculty (56%) published at least one article in the period 2019 to 2020 (P = .001). Multivariable random-effects regression analysis confirmed that postintervention, odds of publishing in a given year increased for both clinical-track and tenure-track faculty. CONCLUSION Both clinical and tenure-track faculty contribute to the academic mission at medical schools, yet scholarly activity is supported and rewarded for tenure-track faculty more often than for clinical-track faculty. Our centralized research team successfully fostered scholarly activity among both clinical-track and tenure-track faculty.
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Affiliation(s)
- Dmitry Tumin
- Dr. Tumin: Research Associate Professor, Department of Pediatrics, and Assistant Dean of Clinical and Educational Scholarship, Brody School of Medicine at East Carolina University, Greenville, NC. Mr. Baumgarten: Medical student, California Northstate University College of Medicine, Elk Grove, CA. Ms. Buckman: Director of Research Administration, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC. Dr. Kuehn: Vice Chair for Research, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC. Dr. Higginson: Executive Dean, Brody School of Medicine at East Carolina University, Greenville, NC
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Higginson JD, Tumin D, Kuehhas TC, DeLozier-Hooks SE, Powell CA, Ramirez DD, Dabelić A, Basso MR. COVID-19 Vaccine Hesitancy Among Deployed Personnel in a Joint Environment. Mil Med 2021; 188:e32-e36. [PMID: 34897473 PMCID: PMC9383089 DOI: 10.1093/milmed/usab518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In the United States, vaccine hesitancy has been identified as a major barrier to vaccination against COVID-19, but attitudes toward COVID-19 vaccination among military personnel are not well understood. We evaluated the prevalence and correlates of COVID-19 vaccine consent or refusal among deployed personnel in a joint environment. MATERIALS AND METHODS Deidentified data were retrospectively extracted from the electronic medical record of the Military Health System in May 2021. All personnel currently assigned to the deployment area of operations were included in the analysis if their choice to receive the vaccine was known. Personnel characteristics were compared by vaccine acceptance status using chi-square tests, Fisher's exact tests, or correlation coefficients. This analysis was exempted from Institutional Review Board review. RESULTS The sample included 1,809 individuals, primarily members of the Army (72%) and members of Reserve (53%) or National Guard (27%) units. In the overall sample, 61% accepted the vaccine, with vaccine acceptance rates being lowest among Black or African American personnel (54%; P = .03 for comparison across racial groups) and members of Reserve or National Guard units (59%; P < .001 for comparison by component). No differences in vaccine acceptance were found according to sex or health status (including prior COVID-19 infection). CONCLUSIONS Overall vaccine acceptance was greater among deployed military personnel than that reported in the U.S. population as a whole. However, lower vaccine acceptance among personnel from marginalized populations suggests a need to ensure that all service members have sufficient opportunities to have a frank and ongoing discussion with health care providers to address concerns related to vaccination. Additionally, lower vaccine acceptance among Reserve and National Guard personnel indicates a need for innovative educational approaches to counter vaccine hesitancy in the premobilization phase of deployment.
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Affiliation(s)
- Jason D Higginson
- Office of the Dean Brody School of Medicine, East Carolina University, Greenville, NC 27858, USA
| | - Dmitry Tumin
- Office of the Dean Brody School of Medicine, East Carolina University, Greenville, NC 27858, USA
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- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55902, USA
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Tumin D, Buckman C, Kuehn D, Higginson JD. Blending research support and mentorship to foster scholarly activity at a resource-limited institution. Paediatr Child Health 2020; 25:554-555. [PMID: 33365112 DOI: 10.1093/pch/pxaa095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Devon Kuehn
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Jason D Higginson
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Kohler JA, Fowler JO, Moore RT, Higginson JD. Improved Use of Human Milk, Growth, and Central Line Utilization With Standard Feeding Roadmap in an Academic NICU. Nutr Clin Pract 2019; 35:703-707. [PMID: 31840305 DOI: 10.1002/ncp.10441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/06/2022] Open
Abstract
BACKGROUND Before the initiation of a standardized feeding roadmap in our regional, level IV academic neonatal intensive care unit, utilization of central lines was high, and initiation of enteral feeds delayed in the very low-birth-weight population (<1500 g). Given our review of the literature, it appeared that the standardization of feeding advancement would likely result in improved performance in both issues. METHODS This was a retrospective cohort comparison of very low-birth-weight patients before initiation of any feeding roadmap with a second cohort following completion of the final roadmap. Infants were examined retrospectively in 2 historical cohorts: Phase 1, infants fed before roadmap development and rollout, October 1, 2012-March 31, 2013; and Phase 2, following promulgation of the final feeding roadmap, January 1, 2017-June 30, 2017. RESULTS During Phase 2, we observed a significant reduction in median (interquartile range) days to first feed (3 [1] vs 1 [1] [P < 0.0001]) and utilization of a second central line (35% vs 12% [P < 0.01]). Weight gain was significantly improved from before roadmap implementation to final, mean (SD) (g/d, 21 [5] vs 24 [4]; [P < .0001]). Percentage of first enteral feedings that were human milk also increased significantly from 71% to 91% (P = 0.0007). CONCLUSION Implementation of a standardized feeding roadmap was associated with a reduction in days to first enteral feeds, an increase in the primary use of human milk for initiation of enteral feeds, and a decrease in the utilization of central lines while improving weight gain in very low-birth-weight infants.
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Affiliation(s)
- John A Kohler
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
| | - Jennifer O Fowler
- Department of Clinical Nutrition, Vidant Medical Center, Greenville, North Carolina, USA
| | - Ryan T Moore
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
| | - Jason D Higginson
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
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Ley D, Hallberg B, Hansen-Pupp I, Dani C, Ramenghi LA, Marlow N, Beardsall K, Bhatti F, Dunger D, Higginson JD, Mahaveer A, Mezu-Ndubuisi OJ, Reynolds P, Giannantonio C, van Weissenbruch M, Barton N, Tocoian A, Hamdani M, Jochim E, Mangili A, Chung JK, Turner MA, Smith LEH, Hellström A. rhIGF-1/rhIGFBP-3 in Preterm Infants: A Phase 2 Randomized Controlled Trial. J Pediatr 2019; 206:56-65.e8. [PMID: 30471715 PMCID: PMC6389415 DOI: 10.1016/j.jpeds.2018.10.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate recombinant human insulin-like growth factor 1 complexed with its binding protein (rhIGF-1/rhIGFBP-3) for the prevention of retinopathy of prematurity (ROP) and other complications of prematurity among extremely preterm infants. STUDY DESIGN This phase 2 trial was conducted from September 2014 to March 2016. Infants born at a gestational age of 230/7 weeks to 276/7 weeks were randomly allocated to rhIGF-1/rhIGFBP-3 (250 µg/kg/ 24 hours, continuous intravenous infusion from <24 hours of birth to postmenstrual age 296/7 weeks) or standard neonatal care, with follow-up to a postmenstrual age of 404/7 weeks. Target exposure was ≥70% IGF-1 measurements within 28-109 µg/L and ≥70% intended therapy duration. The primary endpoint was maximum severity of ROP. Secondary endpoints included time to discharge from neonatal care, bronchopulmonary dysplasia, intraventricular hemorrhage, and growth measures. RESULTS Overall, 61 infants were allocated to rhIGF-1/rhIGFBP-3, 60 to standard care (full analysis set); 24 of 61 treated infants achieved target exposure (evaluable set). rhIGF-1/rhIGFBP-3 did not decrease ROP severity or ROP occurrence. There was, however, a 53% decrease in severe bronchopulmonary dysplasia in the full analysis set (21.3% treated vs 44.9% standard care), and an 89% decrease in the evaluable set (4.8% vs 44.9%; P = .04 and P = .02, respectively) for severity distribution between groups. There was also a nonsignificant trend toward decrease in grades 3-4 intraventricular hemorrhage in the full analysis set (13.1% vs 23.3%) and in the evaluable set (8.3% vs 23.3%). Fatal serious adverse events were reported in 19.7% of treated infants (12/61) and 11.7% of control infants (7/60). No effect was observed on time to discharge from neonatal care/growth measures. CONCLUSIONS rhIGF-1/rhIGFBP-3 did not affect development of ROP, but decreased the occurrence of severe bronchopulmonary dysplasia, with a nonsignificant decrease in grades 3-4 intraventricular hemorrhage. TRIAL REGISTRATION ClinicalTrials.gov: NCT01096784.
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Affiliation(s)
- David Ley
- Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden.
| | - Boubou Hallberg
- Department of Neonatology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Hansen-Pupp
- Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - Carlo Dani
- Careggi University Hospital of Florence, University of Florence, Florence, Italy
| | - Luca A Ramenghi
- Genova Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Neil Marlow
- Department of Academic Neonatology, UCL EGA Institute for Women's Health, UCL, London, United Kingdom
| | - Kathryn Beardsall
- Department of Pediatrics and the Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Faizah Bhatti
- Neonatal Perinatal Medicine, Department of Pediatrics, The Children's Hospital at the University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - David Dunger
- Department of Pediatrics and the Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Jason D Higginson
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Ajit Mahaveer
- St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre and Division of Developmental Biology and Medicine, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Peter Reynolds
- Neonatal Intensive Care Unit, St Peter's Hospital, Chertsey, Surrey, United Kingdom
| | - Carmen Giannantonio
- Department of Woman and Child Health, University Hospital A. Gemelli, IRCCS, Rome, Italy
| | - Mirjam van Weissenbruch
- Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Norman Barton
- Global Clinical Development, Rare Metabolic Diseases, Shire, Lexington, MA
| | - Adina Tocoian
- Global Clinical Development, Rare Metabolic Diseases, Shire, Zug, Switzerland
| | - Mohamed Hamdani
- Global Clinical Development, Rare Metabolic Diseases, Shire, Lexington, MA
| | - Emily Jochim
- Global Clinical Development, Rare Metabolic Diseases, Shire, Lexington, MA
| | - Alexandra Mangili
- Global Clinical Development, Rare Metabolic Diseases, Shire, Zug, Switzerland
| | - Jou-Ku Chung
- Global Clinical Development, Rare Metabolic Diseases, Shire, Lexington, MA
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Lois E H Smith
- Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Ann Hellström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
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Rohena L, Kuehn D, Marchegiani S, Higginson JD. Evidence for autosomal dominant inheritance of ablepharon-macrostomia syndrome. Am J Med Genet A 2011; 155A:850-4. [DOI: 10.1002/ajmg.a.33900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/03/2011] [Indexed: 11/08/2022]
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Eyster CA, Higginson JD, Huebner R, Porat-Shliom N, Weigert R, Wu WW, Shen RF, Donaldson JG. Discovery of new cargo proteins that enter cells through clathrin-independent endocytosis. Traffic 2010; 10:590-9. [PMID: 19302270 DOI: 10.1111/j.1600-0854.2009.00894.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Clathrin-independent endocytosis (CIE) allows internalization of plasma membrane proteins lacking clathrin-targeting sequences, such as the major histocompatibility complex class I protein (MHCI), into cells. After internalization, vesicles containing MHCI fuse with transferrin-containing endosomes generated from clathrin-dependent endocytosis. In HeLa cells, MHCI is subsequently routed to late endosomes or recycled back out to the plasma membrane (PM) in distinctive tubular carriers. Arf6 is associated with endosomal membranes carrying CIE cargo and expression of an active form of Arf6 leads to the generation of vacuolar structures that trap CIE cargo immediately after endocytosis, blocking the convergence with transferrin-containing endosomes. We isolated these trapped vacuolar structures and analyzed their protein composition by mass spectrometry. Here we identify and validate six new endogenous cargo proteins (CD44, CD55, CD98, CD147, Glut1, and ICAM1) that use CIE to enter cells. CD55 and Glut1 appear to closely parallel the trafficking of MHCI, merging with transferrin endosomes before entering the recycling tubules. In contrast, CD44, CD98, and CD147 appear to directly enter the recycling tubules and by-pass the merge with EEA1-positive, transferrin-containing endosomes. This divergent itinerary suggests that sorting may occur along this CIE pathway. Furthermore, the identification of new cargo proteins will assist others studying CIE in different cell types and tissues.
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Affiliation(s)
- Craig A Eyster
- Laboratory of Cell Biology, NHLBI, National Institutes of Health, Bethesda, Maryland 20892, USA
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Abstract
The author outlines the cross-cultural and widespread expectation that the moral character of physicians is built on dual possession of skill and compassion. The details of the moral makeup of physicians are often hotly debated in the biomedical literature. Despite a lack of consensus regarding the required aspects of character, the author demonstrates that little debate exists that at a minimum physicians should possess not only knowledge but also a willingness to care for and comfort patients. The primacy of the patient in the physician's life is reflected in the panoply of oaths taken by new physicians despite great variability in other aspects of these oaths. The author details recent worrisome reports demonstrating the erosion of medical trainees' empathy and compassion by long work hours. Further, the continued linkage of these attitude changes and fatigue to poor medical outcomes is a call to action. Changes enacted by the Accreditation Council for Graduate Medical Education to reduce resident work hours are insufficient to achieve the goal of improved patient care while promoting moral development among resident physicians. The debate regarding resident work hours is often framed as an idealistic discussion of placing patients first. However, residents are used as an inexpensive labor force, and efforts to curtail this usage would have a significant economic impact. Economic concerns play a larger part in decision making than is generally discussed. The author calls for further alterations of resident work schedules to improve patient care and ensure the preservation of the moral ethos of medicine.
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Affiliation(s)
- Jason D Higginson
- Neonatal-Perinatal Medicine Fellowship, National Naval Medical Center, Bethesda, Maryland 20889, USA.
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Higginson JD. Emotion, Suffering, and Hope: Commentary on “How Much Emotion Is Enough?”. The Journal of Clinical Ethics 2007. [DOI: 10.1086/jce200718411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Higginson JD. Emotion, suffering, and hope: commentary on "How much emotion is enough"? J Clin Ethics 2007; 18:377-379. [PMID: 18320998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Jason D Higginson
- United States Navy, National Naval Medical Center, Bethesda, Maryland, USA.
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Abstract
In this study, we assess the adjustment achieved by patients following discharge from coronary care and the role of socioeconomic status (SES), social environment (SE), and depression in achieving that adjustment. Two hundred eighty-seven patients were enrolled. The SE into which the patients were to be discharged was rated significantly poorer for patients of lower SES, who also scored higher on depression. At 1, 6, and 12 months postdischarge, lower SES patients recorded significantly poorer levels of adjustment across a range of functioning. Predischarge depression, together with measures of SE and SES, determined 10% to 28% of the variance in 12-month postdischarge adjustment. These data suggest the importance of identifying patients at greater risk for less than optimal outcome (those lower in SES and higher in depression), and the need to address the nature of the SE in which the patient has to effect his/her recovery.
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Affiliation(s)
- D H Sykes
- School of Psychology, Queen's University, Belfast, Northern Ireland.
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McCallion WA, Templeton PA, McKinney LA, Higginson JD. Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit? Arch Emerg Med 1991; 8:102-7. [PMID: 1888402 PMCID: PMC1285749 DOI: 10.1136/emj.8.2.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. Ninety per cent of normal electrocardiographs and 57% of abnormal ECGs were correctly interpreted. Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.
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Affiliation(s)
- W A McCallion
- Accident and Emergency Department, Ulster Hospital, Dundonald, Belfast, Northern Ireland
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