Geographic Trends in General Surgery Resident Compensation Across the United States.

OBJECTIVE: To examine the effect of cost of living on general surgery resident salaries and identify factors associated with greater incomes and availability of housing stipends. DESIGN: Retrospective cross-sectional analysis of Fellowship and Residency Electronic Interactive Database (FREIDA), institutional websites, and Doximity. Program characteristics were compared through Kruskal-Wallis tests, ANOVA, and χ2 tests. Multivariable linear mixed modeling and multivariable logistic regression were utilized to determine factors associated with higher salary and availability of housing stipend, respectively. SETTING: Three-hundred fifty-one general surgery residency programs in the United States. PARTICIPANTS: Three-hundred-seven general surgery residency programs with available salary data for the 2022 to 2023 academic year. RESULTS: The average postgraduate year 1 resident annual salary was $59,906.00 (standard deviation [SD] ± $5051.97). After adjustment for the cost of living, the average annual income surplus was $22,428.42 (SD ± $4848.64). Cost of living and resident remuneration varied substantially across regions (p < 0.001). Annual income surplus was the highest for programs in the Northeast when compared to other regions (p < 0.001). Resident annual income increased by $510 (95% confidence interval [CI] $430-$590) for each $1000 increase in the cost of living and $150 (95% CI $80-$210) for each 10-rank increase in Doximity general surgery program reputation ranking. An increased cost of living was associated with a higher likelihood of housing stipend availability (odds ratio 1.17, 95% CI 1.07-1.28). CONCLUSIONS: General surgery residents are inadequately compensated for the cost of living, indicating the potential for increased compensation to alleviate economic strain of surgical trainees. As financial stress can have implications for mental and physical well-being, further discussion of current resident salaries and benefits is warranted.

The Readability of Ophthalmological Patient Education Materials Provided by Major Academic Hospitals.

INTRODUCTION: The internet is an increasingly important resource for patients seeking health-related information. Because of this trend, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online patient education materials (PEMs) be written between a third and seventh grade level. The present study evaluates the readability levels of ophthalmological PEMs provided by five major academic hospitals, quantifies the availability of accompanying videos and graphics, and examines the extent to which readability may be increased. METHODS: In March 2021, 397 PEMs from five major academic hospitals were extracted for subsequent analysis by seven validated readability assessments. The presence of an accompanying video or graphic was noted. Statistical significance was assessed using the Kruskal-Wallis test with Dunn's multiple comparisons test and the chi-square test. RESULTS: Nearly all articles were written above the recommended reading level of 7th grade. After averaging the scales for each article, the median grade level was 11.7 (interquartile range [IQR], 10.7-12.7). The PEMs with the highest median reading level were provided by the Johns Hopkins University Wilmer Institute (12.6, IQR, 11.3 - 13.6). Only 13.6% and 13.1% of articles had an accompanying video and graphic, respectively. Reduction of sentence length beneath 15 words resulted in an improvement of readability by 2.7 grade levels. CONCLUSIONS: The readability of online patient resources provided by major academic hospitals were above the literacy guidelines recommended by the NIH and AMA. Furthermore, most articles did not include a video or graphic, both of which could potentially improve patient understandability of educational materials. By altering these PEMs, as demonstrated here, institutions could increase the value these articles provide for patients and therefore the quality of the patient-physician relationship.

Trends in Soccer-Related Ocular Injuries within the United States from 2010 through 2019.

PURPOSE: Soccer participation within the United States continues to increase, necessitating consideration of the various injuries that may occur. The present study analyzes trends in the incidence of ocular injuries secondary to soccer trauma, the associated mechanism, and related visual sequelae, and quantifies age- and sex-specific differences in the distributions of these variables. METHODS: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) was queried for soccer-related ocular injuries from 2010 through 2019. Data exclusively focused on the globe were selected, and information regarding age, sex, specific diagnosis, mechanism of injury, and visual sequelae were acquired. Significance was calculated using the chi-squared test. RESULTS: 628 NEISS entries were evaluated, extrapolating to a national average incidence of approximately 1580 soccer-related ocular injuries per year. There were a relatively static number of events during the ten-year time period of study. The most common diagnoses were contusions or abrasions (36.1%); among records with a reported mechanism of injury, the most common was contact with the soccer ball (80.9%). Visual sequelae were noted in a significant minority of patients (15.4%). Patients ≤18 and males comprised the majority of visits (68.2% and 70.2%, respectively). Significant sex- and age-specific differences were observed in the distributions of diagnoses. CONCLUSIONS: There are serious visual consequences associated with soccer-related ocular injury. Despite the existence of eye protection, there remain no regulations requiring its consistent use. Therefore, among all parties involved (e.g., players, families, and physicians), there remains a need to increase education regarding the potential ocular dangers associated with the sport.

National Institutes of Health Funding Trends to Ophthalmology Departments at U.S. Medical Schools.

PURPOSE: To analyze trends in National Institutes of Health (NIH) funding in ophthalmology and characterize its distribution to departments and principal investigators (PIs) affiliated with U.S. medical schools. DESIGN: Longitudinal descriptive analysis. METHODS: We queried publically accessible data from the Blue Ridge Institute for Medical Research and NIH RePORTER to determine annual funding trends in ophthalmology from 2009 to 2020. To characterize the distribution of funding, we further ranked the top departments and principal investigators (PIs). Department websites (among other online resources) were utilized to extract characteristics of the latter cohort. RESULTS: After adjusting for inflation, we observed a modest 9% increase in median NIH funding to academic ophthalmology departments between 2009 and 2020. In the same time period, among individual PIs, this translated to a 9% decline in median funding. Our results among both departments and PIs indicated a persistent inequality in NIH funding. In 2020, 10 ophthalmology departments received 44% of total funding, which is consistent with findings from prior years. Our ranking of PIs by average annual NIH funding indicated a disproportionate representation of males (76%) and PhDs (58%) in the top 50. CONCLUSIONS: Overall, the results of this investigation suggest NIH funding remains limited for individual investigators, reflecting the increasingly competitive nature of the grant application process. Systemic alterations will be required to reverse these trends. If not accomplished, nascent and established researchers alike will continue to endure challenges in obtaining and maintaining funding.

Characteristics of the least-cited and most-cited articles in ophthalmology journals: A pilot study.

BACKGROUND: Limited research has examined differences between uncited papers and their most-cited counterparts. By comparing characteristics of each cohort, it is possible to better determine factors associated with increased citation count in the ophthalmology literature. METHODS: We initially identified all research articles published in six popular general ophthalmology journals (Ophthalmology, JAMA Ophthalmology, Investigative Ophthalmology and Visual Sciences, American Journal of Ophthalmology, British Journal of Ophthalmology, and Graefe's Archive for Clinical and Experimental Ophthalmology) between 2001 and 2011. Forty-nine articles were identified as having accrued zero citations as of March 2021 and were compared with an equivalent number of articles with the highest number of citations published in the same journals and time period. Significance (p < 0.05) for comparisons was determined using the Mann-Whitney U test and Fisher's exact test. RESULTS: Compared to the least-cited articles, the most-cited articles were significantly more likely to be clinical, multi-institutional, and multi-national in scope, report a statistically significant result, have a conflict of interest, state a funding source, and have higher sample sizes. These publications had significantly more words in the abstract and manuscript and more references. Overall, the first authors of the most-cited articles were significantly more likely to be female and report greater prior research productivity, as assessed by the relative citation ratio (RCR). CONCLUSION: Considering a small number of articles were uncited at least a decade after publication, it appears most research is useful for future investigations. However, there remain distinct differences between uncited articles and their most-cited equivalents in ophthalmology.

The Relative Citation Ratio: Examining a Novel Measure of Research Productivity among Southern Academic Ophthalmologists.

PurposeTo analyze research productivity, as assessed by the National Institutes of Health-supported relative citation ratio (RCR), for a cohort of Southern academic ophthalmologists.DesignA descriptive and cross-sectional design was used. Data on gender, academic rank (assigned as an assistant professor, associate professor, professor, or degrees, and career duration were collected using online resources. Research yield was quantified using mean and weighted RCR data queried from the iCite database. Significant between-group differences were calculated using the Mann-Whitney U-test and the Kruskal-Wallis test.SettingsPracticing academic ophthalmologists at Accreditation Council for Graduate Medical Education-accredited ophthalmology programs in the Southern United States (n = 1018).ResultsFor all Southern academic ophthalmologists, median mean RCR was 0.90 (IQR 0.18-1.71) and median weighted RCR was 5.12 (IQR 0.34-33.18). Advanced academic rank and PhD acquisition were significantly associated with increased mean and weighted RCR. After exclusion of faculty within the "other" category, median mean RCR was 1.12 (IQR 0.54-1.80) and median weighted RCR was 11.65 (IQR 2.03-45.58). Furthermore, effects of career duration and gender emerged. Ophthalmologists with longer careers had significantly higher mean and weighted RCR than their younger counterparts. Males had significantly higher mean and weighted RCR than females.ConclusionsAcademic rank and attainment of a PhD degree were correlated with increased research productivity. When analyses focused exclusively on faculty not in the "other" subgroup, male gender, and lengthier career were associated with increased mean and weighted RCR, the former of which potentially highlights differences in professional advancement between genders.

The relative citation ratio and the h-index among academic ophthalmologists: A retrospective cross-sectional analysis.

BACKGROUND: Limited research has evaluated the relative citation ratio (RCR), a novel measure of research productivity. Accordingly, there remains a minimal understanding of its practical value relative to established metrics such as the h-index. Here, we examined correlations between the mean and weighted RCR scores and the h-index and explore the influence of academic rank, career duration, PhD acquisition, and fellowship training on these metrics. METHODS: Data regarding the academic rank (e.g. assistant professor, associate professor, professor, or "other"), career duration, degrees, fellowship training, and research yield were collected for 1018 academic ophthalmologists practicing in the southern United States of America. The iCite and Scopus databases were utilized to quantify research yield via calculations of mean and weighted RCR, and h-index, respectively. RESULTS: Significant correlations were observed between the h-index and the mean (ρ = 0.62, P < 0.001) and weighted RCR (ρ = 0.84, P < 0.001). Advanced academic rank was associated with increased indices values. In a subset of ophthalmologists excluding members of the "other" category, career duration was moderately correlated with h-index (ρ = 0.45, P < 0.001), and weakly correlated with mean (ρ = 0.14, P < 0.001) and weighted (ρ = 0.26, P < 0.001) RCR. PhD and fellowship acquisition were associated with increased research yield. CONCLUSION: The findings suggest that the RCR is an effective measure of research yield, while resolving deficiencies present in the h-index. Further research remains to characterize the RCR's value relative to other established markers of research productivity.

Humor and emotion: Quantitative meta analyses of functional neuroimaging studies.

Humor is a ubiquitous aspect of human behavior that is infrequently the focus of neuroscience research. To localize human brain structures associated with the experience of humor, we conducted quantitative activation likelihood estimate (ALE) meta analyses of 57 fMRI studies (n = 1248) reporting enhanced regional brain activity evoked by humorous cues versus matched control cues. We performed separate ALE analyses of studies that employed picture-driven, text-based, and auditory laughter cues to evoke humor. A primary finding was that complex humor activates supramodal areas of the brain strongly associated with emotional processes, including bilateral amygdala and inferior frontal gyrus. Moreover, activation in brain regions associated with language, semantic knowledge, and theory of mind were differentially modulated by text and picture-driven humor cues, while hearing laughter enhances activation in auditory association cortex. The identification of humor-driven brain networks has the potential to expand brain-derived models of human emotion and could provide useful targets in translational research and therapy.

Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis.

BACKGROUND: Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes. METHODS: In this systematic review and individual participant data meta-analysis, we searched PubMed, Web of Science, Embase, MEDLINE, CINAHL, Global Health, MIDIRS, and Cochrane without language restrictions for relevant articles published between database inception, and Jan 1, 2020, using search terms referencing intrahepatic cholestasis of pregnancy, ursodeoxycholic acid, and perinatal outcomes. Eligible studies had 30 or more study participants and reported on at least one individual with intrahepatic cholestasis of pregnancy and bile acid concentrations of 40 µmol/L or more. We also included two unpublished cohort studies. Individual participant data were collected from the authors of selected studies. The primary outcome was the prevalence of stillbirth, for which we anticipated there would be insufficient data to achieve statistical power. Therefore, we included a composite of stillbirth and preterm birth as a main secondary outcome. A mixed-effects meta-analysis was done using multi-level modelling and adjusting for bile acid concentration, parity, and multifetal pregnancy. Individual participant data analyses were done for all studies and in different subgroups, which were produced by limiting analyses to randomised controlled trials only, singleton pregnancies only, or two-arm studies only. This study is registered with PROSPERO, CRD42019131495. FINDINGS: The authors of the 85 studies fulfilling our inclusion criteria were contacted. Individual participant data from 6974 women in 34 studies were included in the meta-analysis, of whom 4726 (67·8%) took ursodeoxycholic acid. Stillbirth occurred in 35 (0·7%) of 5097 fetuses among women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and in 12 (0·6%) of 2038 fetuses among women with intrahepatic cholestasis of pregnancy not treated with ursodeoxycholic acid (adjusted odds ratio [aOR] 1·04, 95% CI 0·35-3·07; p=0·95). Ursodeoxycholic acid treatment also had no effect on the prevalence of stillbirth when considering only randomised controlled trials (aOR 0·29, 95% CI 0·04-2·42; p=0·25). Ursodeoxycholic acid treatment had no effect on the prevalence of the composite outcome in all studies (aOR 1·28, 95% CI 0·86-1·91; p=0·22), but was associated with a reduced composite outcome when considering only randomised controlled trials (0·60, 0·39-0·91; p=0·016). INTERPRETATION: Ursodeoxycholic acid treatment had no significant effect on the prevalence of stillbirth in women with intrahepatic cholestasis of pregnancy, but our analysis was probably limited by the low overall event rate. However, when considering only randomised controlled trials, ursodeoxycholic acid was associated with a reduction in stillbirth in combination with preterm birth, providing evidence for the clinical benefit of antenatal ursodeoxycholic acid treatment. FUNDING: Tommy's, the Wellcome Trust, ICP Support, and the National Institute for Health Research.