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.

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.

Efficacy and safety of methylprednisolone aceponate ointment 0.1% compared to tacrolimus 0.03% in children and adolescents with an acute flare of severe atopic dermatitis

BACKGROUND

Topical glucocorticosteroids are the gold standard in treatment of atopic dermatitis (AD). Recently, topical calcineurin inhibitors have been developed for treatment of this condition. This study compared efficacy and safety of 0.1% methylprednisolone aceponate (MPA) ointment with 0.03% tacrolimus ointment for 3 weeks, in children and adolescents with severe to very severe flare of AD.

METHODS

The primary end point was treatment success, defined as a score of 'clear' or 'almost clear' in the static Investigator's Global Assessment (IGA) score. Secondary end points were the percentage change in the Eczema Area and Severity Index (EASI) and patients' assessment of itch and sleep, Children's Dermatology Life Quality Index, patient's assessment of global response, affected Body Surface Area and medication costs.

RESULTS

265 patients were randomized to either MPA (n = 129) or tacrolimus (n = 136) treatment, 257 patients completed the study. Methylprednisolone aceponate 0.1% ointment once daily provided rapid and relevant clinical benefit. Tacrolimus 0.03% ointment twice daily was equally effective with regard to success rate. Methylprednisolone aceponate was superior to tacrolimus for EASI, itch and sleep. Both treatments were well tolerated. Drug-related adverse events were only observed in the tacrolimus group. Medication costs were significantly lower for MPA.

CONCLUSIONS

While both treatment groups showed similar efficacy results regarding treatment success (IGA), significant advantages were observed for EASI, itch and sleep with MPA 0.1%. These advantages and the significantly lower treatment costs highlight the benefits of MPA treatment, underlining its first-line role in treatment of children and adolescents with severe AD.

Circadian rhythms of dopamine and cholecystokinin in nucleus accumbens and striatum of rats--influence on dopaminergic stimulation

The concentrations of cholecystokinin (CCK) and dopamine (DA) were determined in the nucleus accumbens (anterior, posterior) and striatum of rats every 2 h during a period of 24 h. For both substances, a circadian rhythm was found, which was best fitted by a dominant 24-h period superimposed by the second (12 h) and fourth (6 h) harmonics. The rhythms in CCK and DA were negatively correlated because of a difference in phase position by approximately 3 h. A dominant DA peak was found in the light phase coinciding with a trough in CCK and vice versa in the dark phase. Based on these data, CCK and DA were determined in rats treated with gamma-butyrolactone (GBL; inhibitor of DA release) or thyrotropin-releasing hormone (TRH; stimulator of DA release) at 0900 h or 1300 h to study a putative time-dependency in drug effects. After GBL treatment, CCK as well as DA increased by up to 200% whereas TRH administration led to a rather complex alteration, inasmuch as CCK was increased or decreased, depending on circadian time, whereas the rhythmic pattern in DA remained relatively unaffected. Comparing the drug effects obtained at 0900 h with the response seen at 1300 h revealed significant quantitative as well as qualitative differences. The results demonstrate that the neurotransmission system investigated changed its level of activity depending on time of day. No changes were obtained that convincingly may be ascribed to colocalization of DA and CCK. It is concluded that the chronobiological data indicate a close interaction of CCK and DA in various areas of the rat brain, independent of colocalization.

Correlative circadian rhythms of cholecystokinin and dopamine content in nucleus accumbens and striatum of rat brain

Due to contrary results concerning the interaction of cholecystokinin and dopamine (CCK/DA) circadian variations in CCK/DA concentration were investigated in forebrain nuclei of rats (Nc. accumbens, striatum) in order to assess the influence of time of day on neurotransmission. CCK was determined by a radioimmunoassay, DA was measured by electrochemical detection after HPLC separation. A distinct circadian rhythm, superimposed by harmonics (12 h, 6 h) was found in the content of both DA and CCK. A trough was shown for CCK during the light phase and a crest during the late afternoon and the dark phase, respectively. For DA the opposite was found. Caused by a phase-shift of about 3-4 h, the CCK/DA rhythms are negatively correlated. The differences are significant at 11.00 h, 13.00 h, 21.00 h, and 03.00 h. The results indicate that circadian processes are involved in neuronal transmission of CCK and DA.

An enkephalin-like molecule in earthworm coelomic fluid modifies leukocyte behavior

Substances that were immunoreactive in an RIA specific for met-enkephalin were detected following HPLC fractionation of earthworm coelomic fluid. Earthworm coelomocytes and human granulocytes were analyzed for changes in conformation based on measurements of cellular area and perimeter and expressed mathematically by using the Form Factor (FF). For coelomocytes the FF decreased following exposure to DAMA, a synthetic enkephalin analogue (D-Ala2, Met5-enkephalinamide). DAMA stimulated migration whereas untreated cells and those exposed to the specific opiate blocker naloxone did not move. The enkephalin-like molecule when exposed to human granulocytes stimulated an increased number of activated cells. Our results suggest a relationship between the immune and nervous systems of earthworms.

Effects of exogenous factors on the cerebral glutathione in rodents

Since glutathione is thought to be involved in cerebral functions, changes in the glutathione level imply modulations of the neurotransmission in addition to all the known effects of GSH. It was investigated whether alterations of the cerebral glutathione can be induced by consumption of GSH, by inhibition or stimulation of the synthesis of GSH, or by an inhibition of the re-reduction of the oxidized glutathione. Aminophenazone, propyphenazone, acetaminophen, phenytoin, morphine and nitrofurantoin, known to deplete hepatic GSH, had no effects on cerebral GSH. Diethyl maleate (0.6 ml/kg) decreased the cerebral content of GSH and GSSG in adult rats as well as in fetuses. The depletion of the cerebral GSH caused by diethyl maleate treatment for 4 days was followed by an increase up to 125% and a subsequent return to the normal level after 1 week. In rats starved up to 71 h deficiency of exogenous amino acids caused only a minimal or no decrease in cerebral GSH. The specific inhibitor of the gamma-glutamylcysteine synthetase BSO only depleted GSH in the brain of young mice following the repeated s.c. administration of a high dose (890 mg/kg). After cobaltous chloride (20 mg/kg; twice a day for 2 or 4 days) the GSH level in the brain was unchanged. In vivo inhibition of the cerebral glutathione reductase was caused by ammonium metavanadate (12.5 mg/kg; three times a week for 6 weeks). Nitrofurantoin (150 mg/kg) had no effect. After lomustine (10 mg/kg) a minimal increase in glutathione reductase was found, but simultaneously also an increase in GSSG and of the ratio GSSG/total glutathione.

The MERMLS leadership institute for hospital librarians: a new concept in extension service

This paper describes a pilot Leadership Institute conducted by the Mid-Eastern Regional Medical Library Service (MERMLS) and a consultant group from Temple University. The purpose of the institute was to instill some basic group leadership techniques in a selected group of geographically dispersed hospital librarians. The institute was conducted in two sessions totalling three days, with two months separating the two sessions. Extensive evaluations by participants at the end of both sessions resulted in general endorsement that the institute's objectives had been attained and that more institutes of this type should be provided.