Accelerating Climate Action Through Academic Health Systems: Leadership's Call to Duty.

This Viewpoint makes the case for academic health systems to lead the way on climate change action in the US, including planning to reduce greenhouse gas emissions, educating current and future clinicians, and communicating with their patients and communities.

Promotion and Tenure Policies and Practices at U.S. Medical Schools: Is Tenure Irrelevant or More Relevant Than Ever?

ABSTRACT: Promotion and tenure (P&T) have been common mechanisms to support and nurture faculty at higher education institutions and, therefore, have been of continual interest to medical school faculty and administrators. In the last decade, significant changes in the academic medicine sector have occurred, including new medical schools, mergers and acquisitions of academic hospitals and health systems, and institutional and societal efforts to address systemic racism and inequality. In addition, societal controversies have revived long-dormant concerns about academic freedom for medical school faculty, a bedrock principle of U.S. higher education for more than a century. These developments raise the question of whether tenure at medical schools is increasingly irrelevant for large numbers of full-time faculty or more relevant than ever.Using a 2022 survey of 118 medical schools, a review of P&T policies at 37 other medical schools, and an analysis of Association of American Medical Colleges Faculty Roster data, the authors review the prevalence of tenure systems at U.S. MD-granting medical schools; trends in the use of such systems for full-time basic science and clinical faculty; models of including diversity, equity, and inclusion (DEI) criteria in P&T standards; and alterations to introduce greater flexibility into the P&T process.The authors' analysis shows that, although tenure systems remain well established at U.S. MD-granting medical schools, the percentage of full-time faculty on tenured or tenure-eligible tracks declined over the last 4 decades. Troubling gaps in tenure-eligible appointments persist between men and women faculty and among faculty by race and ethnicity. Medical schools have begun to deploy a variety of tactics in P&T processes focused on DEI to address these systemic inequities. To adapt the traditional tenure system to meet the needs of academic medicine, medical schools have altered their policies, including tenure financial guarantees, probationary period extensions, and post-tenure review.

Reasons for Optimism About Academic Medicine's Actions Against Climate Change.

Since the first mention of climate change in Academic Medicine in 2009, the pace of the climate crisis has accelerated, its impacts on every facet of planetary health have grown more severe, and the urgency for humans to act has become more dire. Medical schools, teaching hospitals and health systems, universities, affiliated organizations, and the millions of people who traverse the halls of these institutions as leaders, physicians, scientists, educators, learners, patients and families, and community members have an obligation to respond. In this commentary, the authors describe 3 reasons they are optimistic that academic medicine will continue to act against climate change. First, the mission of academic medicine, inherently aligned with climate action, propels teaching hospitals and health systems to address climate change to improve the health of patients, families, and communities. Second, younger generations of learners, faculty, and staff who populate the workforce increasingly desire, and often demand, to work at institutions that are aligned with their personal values for climate action. Third, broader forces are pushing academic medicine forward in action against climate change. Economic factors will continue to reduce the cost and increase the return on investment of climate-smart facilities, purchased goods and services, fuel, transportation, food systems, and waste management. The authors are optimistic but not complacent. Current levels of climate action in academic medicine are not nearly enough. Faculty, staff, learners, leaders, patients and families, and community partners can and must apply a "climate lens" to everything they do: weave climate solutions into education, patient care, research, community collaborations, operations, and supply chain and facility management; integrate climate actions into strategic thinking, planning, and doing; address health inequities and climate injustice; and leverage their trusted voices to press for climate action and climate justice in the health sector and in society.

Relative Age Effect: Beyond the Youth Phenomenon.

Introduction. The relative age effect (RAE) refers to performance advantage of youth born in the first quarter of the birth year when auditioning for select, age-restricted sports. This advantage conferred to the older athlete is a result of being more physically and emotionally mature, therefore, assumed to be a more advanced player. We hypothesize an RAE exists in Olympic athletes, and this extends across selected categories of athletes (by gender), such as team versus individual sports, winter versus summer athletes, and sports using a ball versus those not using a ball. Methods. We extended the exploration of an RAE beyond specific sports by examining the birth quarter of more than 44 000 Olympic athlete's birthdates, born between 1964-1996. The data were summarized by birth quarter (January 1 to March 31, etc) and presented as percentages and 95% confidence intervals. Results. The fractions of births in the first versus the fourth quarter were significantly different ( P < .001) from each other for the summer and winter Olympians, ball and nonball sports, and team as well as individual sports. Conclusions. The general presence of an RAE in Olympic athletes exists regardless of global classification.

Relative age effect: beyond the youth phenomenon.

INTRODUCTION: Initially described in a sports context in ice hockey in 1985, the relative age effect (RAE) refers to the performance advantages of youth born in the first quarter of the birth year when trying-out for select, age-restricted sports. The competitive advantage bestowed to the relatively older athlete in their age band is the result of the older athlete being more physically and emotionally mature. These more mature players will likely go on to be exposed to better coaching, competition, teammates and facilities in their respective sport. OBJECTIVES: Our study sought to characterise the ubiquity of this effect by examining the birth distribution of some of the world's most elite athletes, Olympians. METHODS: We extended the exploration of the RAE beyond specific sports by examining the birth quarter of over 44 000 Olympic athlete's birthdates, born between 1964 and 1996. Our hypothesis was that the RAE would be prominent in both Olympic athletes as a whole and in selected subcategories of athletes. RESULTS AND CONCLUSION: The fractions of births in the first versus the fourth quarter were significantly different (p<0.001) from each other for the summer and winter Olympians, ball and non-ball sports, and team as well as individual sports. This significant difference was not gender specific. We found the general existence of the RAE in Olympic athletes regardless of global classification. Our findings suggest that coaching staff should be cognisant of the RAE when working with young athletes and should take relative age into consideration when evaluating a burgeoning athlete's abilities.

Outcomes in Hispanics With COVID-19 Are Similar to Those of Caucasian Patients in Suburban New York.

BACKGROUND: Despite reported higher rates and worse outcomes due to COVID-19 in certain racial and ethnic groups, much remains unknown. We explored the association between Hispanic ethnicity and outcomes in COVID-19 patients in Long Island, New York. METHODS: We conducted a retrospective cohort study of 2,039 Hispanic and non-Hispanic Caucasian patients testing positive for SARS-CoV-2 between March 7 and May 23, 2020, at a large suburban academic tertiary care hospital near New York City. We explored the association of ethnicity with need for intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. RESULTS: Of all patients, 1,079 (53%) were non-Hispanic Caucasians and 960 (47%) were Hispanic. Hispanic patients presented in higher numbers than expected for our catchment area. Compared with Caucasians, Hispanics were younger (45 years vs. 59 years), had fewer comorbidities (66% with no comorbidities vs. 40%), were less likely to have commercial insurance (35% vs. 59%), or were less likely to come from a nursing home (2% vs. 10%). In univariate comparisons, Hispanics were less likely to be admitted (37% vs. 59%) or to die (3% vs. 10%). Age, shortness of breath, congestive heart failure (CHF), coronary artery disease (CAD), hypoxemia, and presentation from nursing homes were associated with admission. Male sex and hypoxemia were associated with ICU admission. Male sex, chronic obstructive pulmonary disease, and hypoxemia were associated with IMV. Male sex, CHF, CAD, and hypoxemia were associated with mortality. After other factors were adjusted for, Hispanics were less likely to be admitted (odds ratio = 0.62, 95% confidence interval = 0.52 to 0.92) but Hispanic ethnicity was not associated with ICU admission, IMV, or mortality. CONCLUSIONS: Hispanics presented at higher rates than average for our population but outcomes among Hispanic patients with COVID-19 were similar to those of Caucasian patients.

Detecting Common Eye Diseases Using the First Teleophthalmology GlobeChek Kiosk in the United States: A Pilot Study.

PURPOSE: The aim of this study was to assess the benefit and feasibility of the teleophthalmology GlobeChek kiosk in a community-based program. DESIGN: Single-site, nonrandomized, cross-sectional, teleophthalmologic study. METHODS: Participants underwent comprehensive evaluation that consists of a questionnaire form, brief systemic evaluation, screening visual field (VF), and GlobeChek kiosk screening, which included but not limited to intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated by a store-and-forward mechanism and follow-up questionnaires were obtained through phone calls. RESULTS: A total of 326 participatents were screened over 4 months. One hundred thirty-three (40.79%) participants had 1 condition in either eye, and 47 (14.41%) had >1 disease. Seventy (21.47%) had glaucoma, 37 (11.34%) narrow-angles, 6 (1.84%) diabetic retinopathy, 4 (1.22%) macular degeneration, and 43 (13.10%) had other eye disease findings. Age >65, history of high blood pressure, diabetes mellitus, not having a dental examination >5 years, hemoglobn A1c measurement of ≥5.6, predibates risk score of ≥9, stage 2 hypertension, and low blood pressure were found to be significant risk factors. As for the ocular parameters, all but central corneal thickness, including an intraocular pressure >21 mm Hg, vertical cup to disc ratio >0.7, visual field abnormalities, and retinal nerve fiber layer thinning were found to be significant. CONCLUSIONS: GlobeChek kiosk is both workable and effective in increasing access to care and identifying the most common causes of blindness and their risk factors.