An observational study of severe cutaneous adverse reactions at a tertiary care teaching hospital

Background

The term severe cutaneous adverse reactions to drugs (SCAR) comprises of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms complex (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN) and drug-induced erythroderma or exfoliative dermatitis (ED). The present study aims at describing the epidemiological and clinical profile, probable cause and the extent of morbidity and mortality in patients with severe cutaneous adverse drug reactions.

Methods

An observational study of all cases of SCAR presenting to our centre during the period from Jun 2018 to July 2019 was carried out.

Results

A total of 24 SCAR patients were studied. Most of the patients were in the age group of 11-20 years. The commonest reactions observed were SJS-TEN (54.2%) followed by DRESS (42%). Antibiotics are the most common cause of SJS-TEN, whereas almost all the drug groups were implicated equally in DRESS. No causative drug could be found in two of the SJS-TEN patients. These patients had raised atypical targetoid lesions as well as evidence of viral reactivation which could have been the probable trigger for the SCAR. A total of five patients (20.8%) died during treatment in hospital, and the percentage mortality was highest in SJS-TEN.

Conclusion

Nondrug aetiologies for SJS-TEN are on the rise, and this was observed in this study too. Viral reactivation may be the commonest aetiology in such cases, and the morphology of the rash can give a clue to such cases.

Multi-scale time-resolved electron diffraction: A case study in moiré materials

Ultrafast-optical-pump - structural-probe measurements, including ultrafast electron and x-ray scattering, provide direct experimental access to the fundamental timescales of atomic motion, and are thus foundational techniques for studying matter out of equilibrium. High-performance detectors are needed in scattering experiments to obtain maximum scientific value from every probe particle. We deploy a hybrid pixel array direct electron detector to perform ultrafast electron diffraction experiments on a WSe2/MoSe2 2D heterobilayer, resolving the weak features of diffuse scattering and moiré superlattice structure without saturating the zero order peak. Enabled by the detector's high frame rate, we show that a chopping technique provides diffraction difference images with signal-to-noise at the shot noise limit. Finally, we demonstrate that a fast detector frame rate coupled with a high repetition rate probe can provide continuous time resolution from femtoseconds to seconds, enabling us to perform a scanning ultrafast electron diffraction experiment that maps thermal transport in WSe2/MoSe2 and resolves distinct diffusion mechanisms in space and time.

Navigating Barriers and Challenges to Achieving Critical Career Milestones Among Faculty Mentees

For faculty members, job satisfaction, compensation, and career advancement hinge on achieving 'critical' career milestones (e.g., external funding, tenure). Faculty face unique barriers to achieving career milestones (Bagley et al., 2018), and therefore must employ tailored strategies to overcome challenges. The current project extends research on barriers to career milestones (Soller et al., 2022) to examine strategies faculty employ to overcome barriers in the pursuit of critical career milestones. Thirty-seven faculty members participated across eight US academic institutions, including 22 under-represented minorities in science (URM-S; women or racial/ ethnic minorities). Respondents identified critical career milestones they achieved or will pursue within the next 24 months and then discussed strategies used and suggestions for achieving milestones during semi-structured qualitative interviews. The research team conducted a thematic, qualitative, descriptive analysis of qualitative data using NVivo software in a systematic, interactive, team-based process. Four key strategies emerged for navigating barriers in the pursuit of critical career milestones: 1) Careful engagement of mentors and allies; 2) Collaborate and network; 3) Set boundaries and prioritize; and 4) Reflect on values and use personal strengths. Administrators should aim to remove structural barriers, particularly those that reduce equity (Davis et al., 2022). Identifying strategies that faculty employ to overcome challenges can enhance mentoring by helping mentors understand how mentees overcome unique challenges, particularly those that are not easily addressed through structural interventions.

Why Faculty Leaders Leave a School of Medicine?

Faculty attrition at academic health centers (AHCs) is significant at about 11% nationally, with one in five physicians intending to leave, and replacement costs averaging $500,000 per physician. Attrition among AHC faculty leaders is inadequately studied. This study compares reasons to leave between exiting faculty leaders and faculty non-leaders at the University of New Mexico School of Medicine (UNM SOM). The SOM deans interview all exiting faculty using a structured exit survey. 329 faculty non-leaders and 58 faculty leaders left UNM SOM between July 2017 and June 2022. Distributions of each variable were analyzed for statistically significant differences between the two groups using Fisher's 2-sided exact test. Text comments by leaders were analyzed qualitatively for content using a team-based, iterative process. As compared to non-leaders, exiting faculty leaders were more likely to be professors (51.7% vs 16.7%, p<0.001), and hold tenure (32.8% vs. 12.2%, p=0.001). Faculty leaders were more likely than non-leaders to cite high-level leadership as a reason to leave (41.4% vs. 24.3% p=0.01) and better leadership as a critical issue in development and retention (51.7% vs. 36.8% p=0.04). Qualitative analyses of textual leader comments showed a similar distribution of themes as the quantitative variables when examining open text related to the survey questions related to reasons to leave and the most critical issues. In addition, when asked what would need to change for them to return, qualitative data showed open-ended responses by exiting faculty leaders were twice as frequent to include leadership comments than those by non-leaders (34.2% vs. 16.2%). Exiting faculty leaders disproportionately cite high-level leadership as a reason to leave. The mediatory factors for this association are not known. Investigations to determine the causes for the study findings, and data-driven intervention strategies to retain faculty leaders at SOMs are needed.

Faculty Retention at a School of Medicine, 2010-2022

Faculty retention at academic health centers is a concern with about one-fifth of physicians reporting intentions to leave. We studied factors affecting faculty at risk for attrition, defined as women, racial/ethnic underrepresented minorities (URM), and clinical faculty. Identification of factors predicting retention of at-risk faculty may help mentors and minority-serving institutions devise novel targeted retention strategies. Our study site was a minority-serving institution in a majority-minority state in the US Southwest where at-risk faculty constitute the majority group. Faculty characteristics and departure dates were extracted from an institutional database maintained by the University of New Mexico (UNM) School of Medicine (SOM) for 2,427 participants employed from July 2009 through June 2022. Annual attrition rates and relative risk (RR) of attrition were estimated by discrete-time hazard rate models assuming a Poisson distribution. The overall annual attrition rate was 11.5%, which projects to 50% attrition in 6.0 years. Time to 50% attrition was 4.6 years for assistant professors, 8.9 years for associate professors 7.2 years for full professors. Faculty with a PhD degree had lower attrition (7.2%, RR=0.69, 95% CI 0.60, 0.79) compared to faculty with an MD degree (10.5%) in adjusted analyses. Clinician educators had a higher attrition rate (8.9%) compared to tenure track (6.4%, RRtenure track=0.72, 95% CI 0.61, 0.85). Black faculty had a higher risk of attrition compared to White faculty (RR=1.56, 95% CI 1.09, 2.25), and non-Hispanic White faculty had a lower risk of attrition (RR=0.83, 95% CI 0.71, 0.98). Annual attrition rates increased over the study period with most of the increase before about 2016. We did not detect significant differences in attrition due to sex or URM status.

Gender Differences in Self-reported Faculty Developmental Networks

Scholars have long recognized gender variation in social relationship dynamics. However, how gender shapes developmental networking relationships for career advancement, particularly among university faculty members, is understudied. This area of research is important since women comprise an increasing proportion of faculty and yet report receiving less mentoring and lower career satisfaction, productivity, and advancement than their male counterparts. This cross-sectional study assessed gender differences in self-reported dimensions of faculty participants' developmental networks by collecting information on relationships with developers, who are people who have taken concerted action and offered professional and personal guidance to help participants advance in their careers over the past year. The investigators used egocentric network data from an electronically administered Mentoring Network Questionnaire collected from 159 faculty involved in a mentoring intervention during the pandemic. Faculty were from multiple Southwest and Mountain West institutions. Statistical analyses were performed using the Chi-squared test, Wilcoxon rank-sum test, and unadjusted multilevel regression. Female faculty chose developers of lower gender diversity than male faculty (p=0.01). Compared to male faculty, female faculty reported receiving more psychosocial support from individual developers (p=0.03). Female faculty members' developers were more often characterized as friends and less often described as sponsors and allies than male faculty, based on relative levels of career and psychosocial support that individual developers provided (p<0.001). No gender differences were found in other network characteristics. Female faculty build developmental networks that have different factors compared to male faculty. Greater levels of psychosocial support and fewer allies and sponsors for female faculty may have long-term implications for differential career advancement for women vs. men in academic careers. Strategies to enhance networking should address gender differences and include a structured framework for assessing network gaps.

Inter-Rater Reliability of the Mentor Behavioral Interaction Rubric

An objective assessment of a mentor's behavioral skills is needed to assess the effectiveness of mentor training interventions in academic settings. The Mentor Behavioral Interaction (MBI) Rubric is a newly developed, content-valid, observational measure of a mentor's behavioral skill during single-episode interactions with a mentee. The purpose of this study was to assess the inter-rater reliability (IRR) of the MBI Rubric when used to assess video-recorded mentor-mentee interactions. Three of a pool of four faculty raters with expertise in mentor training synchronously rated 26 videos of mentor-mentee interactions using structured guidelines. The MBI Rubric includes six items (Part 1), each with ratings on a 3- or 4-point scale, and ten yes/no items (Part 2) that characterize the content of the interaction. After initial individual ratings were completed, the three raters met, reviewed disagreements, and reached decisions about final item scores by either consensus or majority vote. Mean total Part 1 scores ranged between 1.42-2.69. IRRs ranged from good (Part 1 IRR=0.67) to excellent (Part 2 IRR=0.83). No training effects were observed, with no decrease (i.e., showing less variability) in inter-rater standard deviations over time. Rater effects in initial individual scoring were observed, with a significant difference between one vs. the other three raters on Part 1 individual scores, with no effects for Part 2 scores. Raters tended to score lower on initial individual scores than the final score for both Part 1 and 2. The MBI Rubric is the first observational measure to assess single episodes of video-recorded mentor-mentee interactions and has demonstrated content validity, and now inter-rater reliability. It may be used in parallel with other instruments to measure the efficacy of mentor training. Limitations include possible ceiling effects, and resource-intensive administration in terms of rater expertise and time. Future work will assess the responsiveness of the Rubric to change in mentor skill and construct validity.

Curriculum-based Faculty Training in Networking: Knowledge and Self-efficacy Outcomes

Although the advantages of developmental networks are well-known, most faculty do not know how to participate in such networks actively. Additionally, institutions face challenges in teaching faculty the best practices of networking. This deficiency constitutes a critical gap in the literature, which may slow career advancement for faculty, particularly from underrepresented groups. The study's purpose was to examine the effectiveness of a curriculum-based faculty training in developmental networks, utilizing the Extension for Community Health Outcomes (ECHO) platform. In this pre-post study, 33 faculty members participated in the intervention utilizing eight modules involving four competencies. Each module followed a standard format, including a short didactic, two facilitated case study discussions based on real-life scenarios, and self-reading of selected literature. Outcomes included (i) change in knowledge scores obtained from two questions per module and (ii) self-efficacy scores measured on a scale of 0-100. Paired student's t-test and mixed model regression analyses were used. A significant increase in knowledge score was documented using mixed model regression for 4 of the eight modules (mean change score 0.4-0.8, p≤0.03 for all analyses). The proportion of faculty participants reporting correct knowledge items for all modules increased from 49.8% (pre) to 64.3% (post), which was statistically significant (p<0.001). Significant increases in paired self-efficacy scores were reported for each of the eight modules (mean change score 17-37, p<0.05 for all analyses). This study highlights the importance of curriculum-based training in networking. Participants showed a significant increase in pre-post networking self-efficacy and knowledge scores. Our ECHO-based curriculum, facilitator training, and manual enable easy implementation in other institutions, ensuring scalability and adaptability. Our analysis provides the evidence basis for examining the impact of a developmental network intervention in enhancing individual career networks.

Inequity Analysis in Faculty Recognition Awards at a School of Medicine

As part of developmental networks, sponsors help provide recognition and visibility opportunities to their faculty protégés. Recognition awards given to the School of Medicine (SOM) faculty are an important mechanism for acknowledging what is valued in academic medicine. Beyond their impact on individual careers, awards help define the culture and climate of an organization. The literature suggests inequities in recognition awards for women and racial/ethnic underrepresented minority faculty. The study's purpose was to examine the characteristics of the awardees relative to the SOM faculty in a minority-serving institution in a minority-majority state. In this observational cross-sectional study, 47 SOM faculty were recognized between 2000-2023 as Regents' Lecturers (9), Regents' Professors (20), Community Engagement Awardees (5), and Gold-headed Cane Awardees (13). SOM sought nominations which a search committee competitively reviewed. Award recipients were characterized by their department, rank, academic track, degree, country of origin, sex, and race/ethnicity, and were compared to all SOM faculty. Male faculty were more likely than women faculty to receive an award (p=0.04). Faculty with tenure, Ph.D. degree, or Professor rank were more likely to receive an award than their counterparts (p<0.001, all analyses). Faculty in basic and diagnostic specialties were more likely to receive an award than medical or surgical specialties (p<0.001). Although rates of awards for racial/ethnic URM faculty were about half that of non-URM faculty, this difference did not reach statistical significance (p=0.14). In addition to demonstrating sex-related inequity in awards, recognized faculty are traditionally associated with the scholarship of discovery compared to other models of scholarship or clinical activity. Sponsors should promote women, physicians, and clinician educators for recognition awards to advance their academic careers. SOM leaders need to examine award criteria and processes to ensure recognition of the diversity of talents and achievements that are critical to the future of academic medicine.

Mentoring Network Questionnaire Support Scales Reliable and Valid with University Faculty

The Developmental Network Questionnaire (DNQ) is used in business to self-assess relationships with developers, or people who support one's career. The Mentoring Network Questionnaire (MNQ) is an online modification of the DNQ and includes two scales that rate developer's contributions to career or psychosocial help. The psychometrics of these scales for different populations are unreported. This study analyzed the construct validity and reliability of the two scales measuring support provided by developers of university faculty. Mentors and mentees (G=156) from multiple Southwestern and Mountain West universities rated 741 developers on the MNQ's five-item career- and psychosocial-support scales. Participants responded on a seven-point scale ranging from "never, not at all" to "to the maximum extent possible." Multilevel confirmatory factor analysis (MCFA) using Mplus and the multi-level reliability coefficient omega assessed construct validity and internal consistency reliability, respectively. Results supported the validity of two latent constructs of career- and psychosocial support, each measured by the established five-item scale: Comparative fit index (CFI)=.93, Tucker-Lewis Index (TLI)=.91, root mean square error of approximation (RMSEA)=.06, standardized root mean square residual (SRMR): W=.09, B=.10. The measurement model was improved when the "removes barriers" item was removed from the career-support scale (CFI=.96, TLI=.95, RMSEA=.05, SRMR: W=.06 B=.09. Factor loadings at both the within- and between-levels were strong and statistically significant. Reliability omegas ranged from .85 to .92. Career and psychosocial support provided to university faculty by developers in their networks may be validly and reliably measured at both the within- and between-levels by a modified four-item career support scale and the original five-item psychosocial support scale from the DNQ and the modified MNQ. Limitations include reduced statistical power due to small sample size and lack of testing at the university level. Future work will assess the responsiveness of these scales to measuring change over time in the amount of support provided.

DRESS, the maverick among SCARS: A case series-based review of literature

DRESS is a potentially life-threatening severe cutaneous adverse reaction (SCAR). Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome; however, it was later found to be caused by various other medications, with the commonest been aromatic anticonvulsants, allopurinol and sulfonamides. The severity of this entity is related to systemic involvement, which can result in multiorgan failure and death. The diagnosis of DRESS, especially in the early stages, remains challenging and elusive due to its heterogeneous clinical presentation and the complex course of the disease with different patterns depending on the causal drug. The most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug along with oral steroids or immunosuppressants to control the disease. We describe the varying presentation and management of six adults with DRESS from a tertiary care hospital, observed over a two-year period with a brief review of the literature.

Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study

Background

Hair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined.

Methods

Twenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0.

Results

Follicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from 'shock effluvium' in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the 'lead' increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05).

Conclusion

Intraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.

Organizations' Mentoring Culture is Associated With Mentoring Climate and Involvement

Organizational culture is the shared, often unspoken, basic values, beliefs, and assumptions. Underlying culture influences organizational climate, the observable policies, practices, and procedures that faculty experience. Yet little is known about mentoring culture and climate in higher education. The purpose of this study was to a) conduct a psychometric evaluation of the 4-item Organizational Culture Mentoring Values (OCuM-V) scale and b) determine if organizational culture, operationalized as values related to mentoring, is associated with organizational mentoring climate (OMC) and involvement with mentoring. 298 [55 under-represented minority (URM)] faculty from University of New Mexico and Arizona State University completed a cross-sectional survey, including the OCuM-V scale and the 15-item OMC Availability (OMCA) scale. Items for both scales were rated No (1), Don't know (0), or Yes (1). Faculty reported if they were being mentored or providing mentoring. Exploratory factor analysis (EFA) and Cronbach's alpha were used for scale evaluation. Spearman correlation and logistic regression were used to assess OCuM-V association with climate and mentoring involvement, respectively. Overall, 24% of faculty were being mentored (27% for URM), and 43% were mentoring (38% for URM). OCuM-V items loaded on a single factor in EFA (Cronbach's alpha=0.84 for all; 0.88 for URM). OCuM-V was positively correlated with OMCA (including institutional expectations, mentor-mentee relationships, and resources subscales) for both all and URM faculty (r>0.4 p<.001 for all). Greater OCuM-V was associated with an increased odds of being mentored (OR=1.75±1.19-2.61) and providing mentoring (OR=1.83±1.30-2.58). Mentoring culture is associated with mentoring climate. Faculty who perceive stronger OCuM-V report a stronger OMC (available structure, programs/activities, policies/guidelines) and are being mentored or providing mentoring more often. Limitations include a small sample size for the URM group and cross-sectional data collection. Organizational leaders should explicitly promote values related to mentoring to strengthen both mentoring culture and climate at their institutions.

The Pandemic Effect on Faculty Attrition at a School of Medicine

Mentors at Academic Health Centers (AHC) are challenged by mentee attrition, with one in five physicians reporting an intent to leave in 2020. AHCs struggle with physician replacement costs, which are exorbitant. Data-driven efforts to mitigate attrition during the pandemic require an understanding of reasons to leave. This study compares characteristics of exiting faculty at the University of New Mexico School of Medicine (UNM SOM) two years before to two years after April 1, 2020. Demographic and reason to leave variables from exit interviews of 168 faculty that left UNM SOM between April 2018-to-March 2020 and 151 faculty that left between April 2020-to-March 2022 were compared. Exiting faculty were stratified into those resigning vs. retiring. Distributions of each variable were analyzed for statistically significant differences using a chi-square or Fisher's 2-sided exact test. The pandemic was associated with an approximately three-fold higher proportion of retirement contributing to total attrition than before (25.8% vs. 8.9%; p<0.001). Among those who resigned, the pandemic was associated with a higher proportion of physicians than before (84.3% vs. 72.8%; p=0.03). Hispanic faculty may be more likely to resign during the pandemic than before (p=0.06). Those who resigned during the pandemic may be significantly less likely to cite "inadequate adherence to FTE" or a "challenging work environment" (p= 0.048 and 0.053 respectively) but more likely to cite personal family matters (p=0.06) as reasons to leave than before the pandemic. The increased proportion of retirees during the pandemic presents challenges for AHCs by exacerbating the current shortage of mentors while providing leadership opportunities for those retained. Mentors need to be aware of the top reasons for faculty leaving (which have not materially changed during the pandemic): challenging work environment, personal/family matters, inadequate work-life balance, greater career opportunities, and inadequate salary.

A Qualitative Review of Comments by Faculty Who Cite Work-Life Balance as a Reason to Leave

Despite growing evidence for the need for work-life balance (WLB) for faculty at academic health centers, mentors frequently do not know how to advise their mentees on this topic. WLB impacts job satisfaction and intent to stay, and physicians are particularly at risk. In this study, we explored exit survey comments of faculty of the University of New Mexico School of Medicine citing work-life balance as a reason to leave (WLB-ARTL). Between July 2017 and December 2020, 59 faculty provided open-ended survey responses related to reasons for leaving, what they liked and disliked about being faculty, mentorship, and more. Using a qualitative descriptive design, we analyzed open-ended responses using a systematic, iterative, thematic approach via NVIVO software. We classified themes using Shanafelt's drivers of engagement and burnout: workload/job demands; efficiency/ resources; meaning in work; culture/values; control/flexibility; social support/community at work; and work-life integration. While there were numerous quotes across all themes, we chose to summarize emergent codes with the most faculty representation and those that can most easily be addressed through mentorship: career development, culture and people, and hours and schedule (related to themes of meaning in work, culture and values, community at work, work-life integration, and control and flexibility). To improve faculty retention, institutional leaders should focus on developing mentors' career coaching and mentoring skills. Additional focus should be placed on training mentors to discuss and address WLB among their faculty mentees.

Barriers and Challenges for Career Milestones Among Faculty Mentees

'Critical' career milestones for faculty (e.g., tenure, securing grant funding) relate to career advancement, job satisfaction, service/leadership, scholarship/research, clinical or teaching activities, professionalism, compensation, and work-life balance. However, barriers and challenges to these milestones encountered by junior faculty have been inadequately studied, particularly those affecting underrepresented minorities in science (URM-S). Additionally, little is known about how barriers and challenges to career milestones have changed during the COVID-19 pandemic for URM-S and non-URM faculty mentees in science. In this study, we conducted semi-structured interviews with 31 faculty mentees from four academic institutions (located in New Mexico, Arizona, Idaho, and Hawaii), including 22 URM-S (women or racial/ethnic). Respondents were given examples of 'critical' career milestones and were asked to identify and discuss barriers and challenges that they have encountered or expect to encounter while working toward achieving these milestones. We performed thematic descriptive analysis using NVivo software in an iterative, team-based process. Our preliminary analysis identified five key themes that illustrate barriers and challenges encountered: Job and career development, Discrimination and a lack of workplace diversity; Lack of interpersonal relationships and inadequate social support at the workplace; Personal and family matters; and Unique COVID-19-related issues. COVID-19 barriers and challenges were related to online curriculum creation and administration, interpersonal relationship development, inadequate training/service/conference opportunities, and disruptions in childcare and schooling. Although COVID-19 helped create new barriers and challenges for junior faculty mentees, traditional barriers and challenges for 'critical' career milestones continue to be reported among our respondents. URM-S respondents also identified discrimination and diversity-related barriers and challenges. Subsequent interviews will focus on 12-month and 24-month follow-ups and provide additional insight into the unique challenges and barriers to 'critical' career milestones that URM and non-URM faculty in science have encountered during the unique historical context of the COVID-19 pandemic.

Development and Content Validity Testing of the Mentor Behavioral Interaction Rubric

Many mentor training interventions in higher education focus on improving interactions between mentors and mentees. Existing measures of interactions are based on reported perceptions of the mentor or mentee. However, there are currently no objective assessments of the mentor's behavioral skill. The purpose of this study was to develop a Mentor Behavioral Interaction (MBI) Rubric as a measure of a mentor's behavioral skill during single-episode interactions with a mentee. Subsequently, the content validity was assessed. The six items (Part 1), evaluated by five mentoring experts as quantifiable behaviors in any mentor-mentee interaction, were based on the Mentoring Competency Assessment (Fleming et al., 2013). The experts developed scoring criteria (highest, middle, and lowest performance) for each item, and created another eleven items (Part 2) to characterize the content (yes/no) of the interaction. Seven content experts rated the items and scoring criteria using a scale ranging from very (4) to not relevant (1) (Lynn, 1986). Five of the six Part 1 items and scoring criteria, and nine of the eleven Part 2 items had item content validity indices (I-CVI) ≥ 0.86. The Part 1 "motivates" item and scoring, and the Part 2 "personal/professional preferences" item were revised based on expert recommendations. One Part 2 item was deleted. Average scale content validity indices (S-CVI/Ave) were ≥ 0.90. The MBI Rubric is the first measure developed to assess single episodes of videoed mentor-mentee interactions. The Rubric may be used with other measures to assess the effectiveness of mentor training. Limitations include: evaluation of the mentor's behavior without accounting for the mentee's behavior; inability to infer cognitive processes; and focus on the quality of one interaction, rather than the effectiveness of the relationship over time. Future work will assess inter-rater reliability, sensitivity to change, and construct validity for the Rubric.

Cutaneous manifestations leading to a diagnosis of a case of severe disseminated histoplasmosis in a human immunodeficiency virus-positive child

This 9-year-old boy who was human immunodeficiency virus positive since birth presented with raised skin lesions, breathlessness, and cough and was treated as a case of disseminated tuberculosis. When no improvement was seen, he was referred to the dermatologist whose examination revealed papulonodular lesions with crusting over the face and extremities. Based on clinical suspicion of histoplasmosis, investigations done revealed a CD4 count of 3 cells/μL and histopathological features of histoplasmosis along with the disseminated disease. Cutaneous manifestations thus led to an early diagnosis of the case and a good prognostic outcome.

Developmental Networks Among Mentors and Mentees Involved in a Mentoring Intervention

The growing application of social network-based theories and methods (Burt et al., 2013) in scholarship on mentoring illustrates that mentoring goes beyond dyadic relationships comprising a senior mentor and a junior protégé (Higgins & Kram, 2001). However, limited data exist on the state of developmental networks of university faculty. This study examines developmental network characteristics among mentors and mentees participating in an ongoing intervention that aims to enhance career success through improved mentoring. Cross-sectional data come from 81 faculty mentors and mentees at three universities in the Southwestern United States. Using the online Modified Mentoring Network Questionnaire (MNQ), participants provided information on relationships with developers, who are people that have taken concerted action, and provided professional and/or personal guidance to help participants advance in their careers. An individual's developmental network comprises relationships with developers. We conducted exploratory analyses examining key characteristics of mentors' and mentees' developmental networks. Participants received psychosocial and career support from an average of 4.9 developers (4.8 and 5.1 for mentors and mentees respectively) from 2.3 arenas (2.2 and 2.4 arenas for mentors and mentees, respectively). While the most common arena was the respondents' current job/position (62%, 64% and 59% for all participants, mentors, and mentees respectively), developers were from graduate school (11%, 6% and 17%); prior jobs/positions (13%, 16% and 9%) and family (8%, 5% and 11%). Our preliminary findings suggest that developers are important for university faculty and that methods and insights from social network analysis can be applied to examine their support networks. As our study is part of an ongoing longitudinal intervention, these findings will inform future analyses that will examine changes in developmental network characteristics and its impact on participants' careers.

Faculty Rating of the Importance and Availability of Organizational Mentoring Climate

Organizational climate is the shared perception of and the meaning attached to the policies, practices, and procedures employees experience. University faculty can assess their organizational mentoring climate (OMC) using recently published, reliable, and valid OMC importance (OMCI) and availability (OMCA) scales. Factors affecting the OMC's importance and availability are, however, not known. By studying these factors, organizational leaders can determine whether and how to change the OMC to improve faculty mentoring outcomes. In this cross-sectional study, 300 faculty from the University of New Mexico (Main, Health Sciences Center [HSC] and branch campuses) and Arizona State University (a non-HSC campus) completed the online OMCI and OMCA scales, each with three subscales: Organizational Expectations, Mentor-Mentee Relationships, and Resources. OMCI scale items were rated from very unimportant (1) to very important (5); and, for OMCA, -1 (no), 0 (don't know), 1 (yes). The study used linear regression analysis after normalizing the scales to M=0 and SD=1. Although not explicitly targeted for recruitment, the respondents were predominantly women, non-Hispanic White, senior, tenure-track faculty members who were neither providing mentoring nor receiving mentoring. In the multivariable models, women faculty attached greater importance to mentoring climate components than men. HSC faculty and those receiving mentoring reported greater availability of mentoring climate components than their respective counterparts. Underrepresented minority (URM) faculty did not rate OMCI or OMCA differently than non-URM faculty. Faculty subgroups in this study attached varying levels of importance to the OMC and rated the availability of climate components differently. Factors impacting the importance of the OMC differed from those affecting the perceived availability of the climate components. Based on their relative importance and lack of availability, organizational leaders should create, modify and implement structures, programs, and policies to improve organizational mentoring expectations, mentor-mentee relationships, and mentoring resources, thereby strengthening their OMC.

Factors Related to Faculty Work Life Balance as a Reason to Leave a School of Medicine

Mentoring can help promote faculty retention at academic health centers (AHCs). Faculty retention is important to optimize patient care and reduce replacement costs. Nationally "work life balance" (WLB) is identified by faculty as a reason to leave (ARTL) AHCs (Alexander & Lang, 2008). To help mitigate faculty attrition at AHCs, we examined work life balance as a reason to leave (WLB-ARTL) and other associated factors at the University of New Mexico School of Medicine (UNM SOM). Faculty responses from 255 faculty that left UNM SOM between July 2017 and December 2020 were analyzed using logistic regression with the outcome WLB-ARTL. Distributions of each variable were tabulated. Odds ratio associations from logistic regression between WLB-ARTL and each variable were obtained. Multivariate logistic regression modeling was performed with backward selection at p<0.05. Of the 255 faculty who exited the University of New Mexico School of Medicine (UNM SOM), 25% had WLB-ARTL, 48% were women, 72% were physicians, 58% were clinician-educators, and 13% were from racial/ethnic underrepresented minorities (URMs). Multivariate modeling found four factors associated with increased WLB-ARTL: compensation, time for academic pursuits, spousal and family support, and dislike of patient care conditions and environment. Two factors associated with lower WLB-ARTL were better leadership and periodic reviews addressing job satisfaction. Gender, URM, and physician status were not found to be significant. Similar to previous studies (Whittaker et al., n.d.), we found that WLB-ARTL at UNM SOM was associated with specific "work" and "life" factors. Faculty retention efforts should focus on "work" factors such as providing protected time for academic pursuits and improving patient care conditions, and "life" factors such as addressing compensation and supporting families.

Is "Transcolumnar" a better Terminology than "Transverse" in Judet-Letournel Classification of Acetabular Fractures?

Acetabular fractures are among the most complex and challenging injuries for orthopaedic surgeons. The choice of surgical treatment in acetabular fracture is important for optimal outcomes. It requires an understanding of the precise outline of the fracture by appropriate classification because it is important for decision making. For this purpose, the classification proposed by Judet and Letournel in 1963 remains the gold standard despite its shortcoming, which are attributed to the inclusion of multiple criteria including anatomical, directional and geometrical. This complex classification remains challenging especially to lesser experienced surgeons. In this article, a new method for classification of acetabulum fractures is proposed. It places posterior column with posterior wall fractures to simple fractures instead of complex fractures in Judet and Letournel classification. More importantly the proposed new classification renames “transverse fracture” as “transcolumnar fracture” to better represent anatomical structure rather than morphology. It is expected that by coining the new term “transcolumnar ”it will be easy to understand different types of acetabular fractures. Especially the confusion between “transverse” and “both column fractures” would not be a concern in future.

Cytomorphological Patterns of Nerve Aspirates in Pure Neuritic Leprosy-A Single Centre Cross-Sectional Observational Study

Background

Pure neuritic leprosy (PNL) poses a diagnostic challenge because of absence of skin patches, inconclusive skin biopsies and nerve conduction studies. Nerve biopsy though the diagnostic gold standard, is invasive, requires expertise, and may not be feasible in all cases. Fine needle aspiration cytology (FNAC) of accessible thickened nerves can be utilized as a minimally invasive diagnostic modality in PNL. This study was carried out to describe cytomorphological patterns of nerve aspirates in patients of PNL for diagnosis and classification of leprosy and study its advantage, if any, over skin biopsy.

Methods

Twenty-seven treatment naive clinically diagnosed patients of PNL were included in this cross-sectional study carried out from January 2017 to December 2018 at a tertiary care centre in Western India. FNAC was done from a clinically involved nerve and aspirates were evaluated for cytomorphological characteristics and the presence of Acid-Fast Lepra bacilli.

Results

Nerve aspirates were diagnostic in 10 (37%) patients while 17 (63%) aspirates showed non-specific or no inflammation. Of the diagnostic aspirates, six (22.2%) were classified as tuberculoid leprosy, three (11.1%) as lepromatous and one (3.7%) as borderline leprosy. Mycobacterium leprae were demonstrated among three (11.1%) of these aspirates. In comparison, only three (11.1%) skin biopsies were diagnostic of leprosy with features of indeterminate spectrum. Remaining 24 skin biopsies showed normal histology in 20 (74.1%) cases to perivascular lymphocytic infiltrate in four (14.8%) cases.

Conclusion

Our study demonstrates that FNAC of clinically thickened nerves has a better diagnostic yield than skin biopsy in PNL and shows all spectrums of leprosy. It also offers the advantage of sampling major nerve trunks without the fear of residual neurological deficit. However, most of the smears were paucicellular and a negative aspirate does not rule out leprosy.

Adverse Childhood Experiences, Maternal/Fetal Attachment, and Maternal Mental Health

Background: This pilot study investigated the potential impact of exposure to childhood adversity on variables known to be related to posttraumatic stress (including attachment, mental health, and perceived stress) in a clinic sample of pregnant women.

Materials and Methods: Participants consisted of 101 pregnant women recruited from the Virginia Commonwealth University Health System in Richmond, VA. All participants completed the Adverse Childhood Experience (ACE) questionnaire, Parental Bonding Instrument, Maternal Fetal Attachment Scale, Posttraumatic Stress Disorder (PTSD) Checklist, Symptom Checklist, and the Perceived Stress Scale.

Results: Increased exposure to ACEs was negatively associated with retrospective report of viewing one's mother and father as caring and involved. ACE exposure was a statistically significant predictor of viewing one's mother and father as intrusive and controlling. ACEs were positively associated with self-reported PTSD symptoms, depressive and anxious symptomatology, and perceived stress. No direct effect of adverse childhood events on maternal/fetal attachment was found.

Conclusions: ACE associations are discussed in terms of study methodology and needs for future research. Providers may consider incorporating the ACE questionnaire to identify exposure to childhood adversity and events that may increase an individual's risk for toxic stress and negative health outcomes.

Exiting Medicine Faculty Want the Organizational Culture and Climate to Change

National data indicate about 50% of junior faculty leave a School of Medicine (SOM) within eight years of hire. The long-term goal of the study was to determine innovative strategies for promoting SOM faculty retention. The study objective was to determine factors influencing SOM faculty to exit, and what would encourage them to stay or return. All faculty exiting the University of New Mexico (UNM) SOM were surveyed and their responses analyzed to the following items: (a) If something could have been done differently that might have resulted in staying at UNM, what would it have been? (b) What would need to change at UNM SOM for you to return? and (c) general comments offered. Qualitative analysis of open-ended responses used an iterative process and systematic thematic approach and NVivo software. 173 faculty respondents surveyed between July 2017 and June 2019 included 86 women, 33 non-Caucasians, and 14 Hispanics. A total of 110 faculty reported an MD degree and 117 were assistant professors. Seventy-eight faculty were on clinician educator track. The 367 responses to the three questions were categorized into 10 themes. The most common themes included (a) people (leadership and others) and workplace culture (25.1% of responses); (b) extent of career support and resources (15.3%); (c) organizational systems and administration (13.6%); and (d) faculty feelings of autonomy and value (10.9%). Exiting faculty frequently discussed the need for a change of leadership and changes in organizational climate and culture, which may have influenced their willingness to stay or to return to UNM SOM. To retain faculty, SOM leaders need to strengthen and/or modify organizational climate and culture components. Innovative strategies for this purpose may include organizational interventions followed by evidence-based leadership training programs, and the use of exit surveys for monitoring interventions.

Factors Related to Faculty Retention in a School of Medicine: A Time to Event Analysis

National data indicate that 50% of assistant professors leave a School of Medicine (SOM) within eight years of hire. At-risk for attrition in some studies are women, racial/ethnic underrepresented minorities (URM), and clinical faculty. Retention of faculty is not adequately studied in the Southwestern US, where at-risk faculty constitute the majority group. The study hypothesized that at-risk faculty have lower retention rates than those not at-risk. Identification of factors predicting retention of at-risk faculty may help institutions devise novel and targeted retention strategies. Prospective time to event analyses studied assistant professors hired at the University of New Mexico's (UNM) SOM from 2008-2019. Eight factors, measured at the time of hire, included: rank, race/ethnicity, gender, MD degree, academic track, department type, salary, and fiscal year of hire. Univariate analyses included graphical analysis of Kaplan-Meier analysis and Cox proportional hazard ratios with years to departure measuring the main event to resignation. 844 full-time junior faculty included 50% women, 81% physicians, 42% clinician educators, and 18% racial/ethnic URM. Compared to non-Hispanic Whites, Black faculty (HR = 2.24, 1.25-4.03) and faculty with non-US degree (1.53, 1.19-1.94) had a higher risk of leaving. Faculty in clinician educator (2.01, 1.06-3.82) or visiting research tracks (2.41, 1.20-4.84) both had higher risk of leaving than tenure track faculty. Although URM faculty did not have an overall higher risk of departure, male faculty had higher risk of leaving than women when they are URM or unknown-URM status. In our analysis of junior faculty, we showed that faculty who were Black, had an international education, and in clinician educator or visiting research tracks were at greater risk of leaving, but women and Hispanic faculty had similar retention rates as their respective counterparts at UNM SOM. The differential retention rates among several at-risk subgroups of junior faculty may indicate the need to refocus the existing diversity and faculty development programs at UNM SOM.