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.

Growth hormone for in vitro fertilisation (IVF)

BACKGROUND

In an effort to improve outcomes of in vitro fertilisation (IVF) cycles, the use of growth hormone (GH) has been considered as adjuvant treatment in ovarian stimulation. Improving the outcomes of IVF is especially important for women with infertility who are considered 'poor responders'. We have compared the outcomes of IVF with adjuvant GH versus no adjuvant treatment in routine use, and specifically in poor responders.

OBJECTIVES

To assess the effectiveness and safety of growth hormone as an adjunct to IVF compared to standard IVF for women with infertility SEARCH METHODS: We searched the following databases (to November 2020): Cochrane Gynaecology and Fertility (CGF) Group specialised register, CENTRAL, MEDLINE, Embase, CINAHL, Epistemonikos database and trial registers together with reference checking and contact with study authors and experts in the field to identify additional trials.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) of adjuvant GH treatment in IVF compared with no adjuvant treatment for women with infertility. We excluded trials where additional adjuvant treatments were used with GH. We also excluded trials comparing different IVF protocols.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recommended by Cochrane. Two review authors independently performed assessment of trial risk of bias and extraction of relevant data. The primary review outcome was live birth rate. The secondary outcomes were clinical pregnancy rate, oocytes retrieved, embryo transfer, units of gonadotropin used and adverse events, i.e. ectopic pregnancy, multiple pregnancy, ovarian hyperstimulation syndrome (OHSS), congenital anomalies, oedema.

MAIN RESULTS

We included 16 RCTs (1352 women). Two RCTs (80 women) studied GH in routine use, and 14 RCTs (1272 women) studied GH in poor responders. The evidence was low to very low certainty, the main limitations being risk of bias, imprecision and heterogeneity. Adjuvant growth hormone compared to no adjuvant: routine use for in vitro fertilisation (IVF) The evidence is very uncertain about the effect of GH on live birth rate per woman randomised for routine use in IVF (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.40 to 4.43; I² = 0%; 2 trials, 80 participants; very low-certainty evidence). If the chance of live birth without adjuvant GH is assumed to be 15%, the chance of live birth with GH would be between 6% and 43%. There was insufficient evidence to reach a conclusion regarding clinical pregnancy rates per woman randomised, number of women with at least one oocyte retrieved per woman randomised and embryo transfer achieved per woman randomised; reported data were unsuitable for analysis. The evidence is very uncertain about the effect of GH on mean number of oocytes retrieved in normal responders (mean difference (MD) -0.02, 95% CI -0.79 to 0.74; I² = 0%; 2 trials, 80 participants; very low-certainty evidence). The evidence is very uncertain about the effect of GH on mean units of gonadotropin used in normal responders (MD 13.57, 95% CI -112.88 to 140.01; I² = 0%; 2 trials, 80 participants; very low-certainty evidence). We are uncertain of the effect of GH on adverse events in normal responders. Adjuvant growth hormone compared to no adjuvant: use in poor responders for in vitro fertilisation (IVF) The evidence is very uncertain about the effect of GH on live birth rate per woman randomised for poor responders (OR 1.77, 95% CI 1.17 to 2.70; I² = 0%; 8 trials, 737 participants; very low-certainty evidence). If the chance of live birth without adjuvant GH is assumed to be 11%, the chance of live birth with GH would be between 13% and 25%. Adjuvant GH results in a slight increase in pregnancy rates in poor responders (OR 1.85, 95% CI 1.35 to 2.53; I² = 15%; 11 trials, 1033 participants; low-certainty evidence). The results suggest, if the pregnancy rate without adjuvant GH is assumed to be 15%, with GH the pregnancy rate in poor responders would be between 19% and 31%. The evidence suggests that GH results in little to no difference in number of women with at least one oocyte retrieved (OR 5.67, 95% CI 1.54 to 20.83; I² = 0%; 2 trials, 148 participants; low-certainty evidence). If the chance of retrieving at least one oocyte in poor responders was 81%, with GH the chance is between 87% and 99%. There is a slight increase in mean number of oocytes retrieved with the use of GH for poor responders (MD 1.40, 95% CI 1.16 to 1.64; I² = 87%; 12 trials, 1153 participants; low-certainty evidence). The evidence is very uncertain about the effect of GH on embryo transfer achieved (OR 2.32, 95% CI 1.08 to 4.96; I² = 25%; 4 trials, 214 participants; very low-certainty evidence). If the chance of achieving embryo transfer is assumed to be 77%, the chance with GH will be 78% to 94%. Use of GH results in reduction of mean units of gonadotropins used for stimulation in poor responders (MD -1088.19, 95% CI -1203.20 to -973.18; I² = 91%; 8 trials, 685 participants; low-certainty evidence). High heterogeneity in the analyses for mean number of oocytes retrieved and units of GH used suggests quite different effects according to differences including in trial protocols (populations, GH dose and schedule), so these results should be interpreted with caution. We are uncertain of the effect of GH on adverse events in poor responders as six of the 14 included trials failed to report this outcome.

AUTHORS' CONCLUSIONS

The use of adjuvant GH in IVF treatment protocols has uncertain effect on live birth rates and mean number of oocytes retrieved in normal responders. However, it slightly increases the number of oocytes retrieved and pregnancy rates in poor responders, while there is an uncertain effect on live birth rates in this group. The results however, need to be interpreted with caution, as the included trials were small and few in number, with significant bias and imprecision. Also, the dose and regimen of GH used in trials was variable. Therefore, further research is necessary to fully define the role of GH as adjuvant therapy in IVF.

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.

Varicella Zoster in pregnancy

Chickenpox during pregnancy can cause serious complications for both mother and fetus. This includes varicella pneumonia in the mother, fetal varicella syndrome and varicella of newborn. Primary prevention includes vaccination against varicella infection and is part of standard childhood immunisation programme in many countries. Timely post-exposure prophylaxis of susceptible pregnant women with varicella zoster immunoglobulin is key to preventing chickenpox during pregnancy and its adverse fetomaternal sequelae. Antiviral therapy and appropriate supportive treatment improve maternal and neonatal 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.

Prediction of significant OHSS by ovarian reserve and ovarian response - implications for elective freeze-all strategy

Ovarian Hyperstimulation Syndrome (OHSS) remains a risk to women undergoing assisted conception despite available preventative measures, which are usually applied on the basis of ovarian response. We performed a retrospective cohort study with robust ascertainment of OHSS cases in women undergoing treatment using GnRH antagonist. FSH dose was based on Anti-Mullerian Hormone concentration. A total of 1492 cycles were carried out over 18 months. Moderate/severe OHSS occurred in 24 cycles (1.6%). AMH of 35 pmol/L and/or AFC of 20 or more identified 18/24 (76%) OHSS cases. The optimal thresholds for predicting OHSS were 22.5 pmol/L for AMH (sensitivity 87.5%, specificity 60.6%), 19.5 for AFC (sensitivity 70.8%, specificity 67%), and 9.5 for egg numbers (sensitivity 83.5%, specificity 62.7%). Peak oestradiol levels had no predictive value. The utility of egg number is limited as it is only known after the ovulatory trigger has been administered. Thus, ovarian reserve parameters are better than ovarian response at predicting the risk of significant OHSS in GnRH antagonist cycles in modern clinical practice. Patients with a high ovarian reserve are at risk of OHSS even if their ovarian response is not excessive. Decisions about preventative measures should be based on ovarian reserve rather than ovarian response.