Accounting for early job turnover in recent pediatric surgery fellowship graduates: An American Pediatric Surgical Association Membership and Credentials Committee study

PURPOSE: Employment opportunities for graduating pediatric surgeons vary from year to year. Significant turnover among new employees indicates fellowship graduates may be unsophisticated in choosing job opportunities which will ultimately be satisfactory for themselves and their families. The purpose of this study was to assess what career, life, and social factors contributed to the turnover rates among pediatric surgeons in their first employment position. METHODS: American Pediatric Surgical Association members who completed fellowship training between 2011 and 2016 were surveyed voluntarily. Only those who completed training in a pediatric surgery fellowship sanctioned by the American Board of Surgery and whose first employment involved the direct surgical care of patients were included. The survey was completed electronically and the results were evaluated using chi-squared analysis to determine which independent variables contributed to a dependent outcome of changing place of employment. RESULTS: 110 surveys were returned with respondents meeting inclusion criteria. 13 (11.8%) of the respondents changed jobs within the study period and 97 (88.2%) did not change jobs. Factors identified that likely contributed to changing jobs included a perceived lack of opportunity for career [p = <0.001] advancement and the desire to no longer work at an academic or teaching facility [p = 0.013]. Others factors included excessive case load [p = 0.006]; personal conflict with partners or staff [p = 0.007]; career goals unfulfilled by practice [p = 0.011]; lack of mentorship in partners [p = 0.026]; and desire to be closer to the surgeon's or their spouse's family [p = 0.002]. CONCLUSIONS: Several factors appear to play a role in motivating young pediatric surgeons to change jobs early in their careers. These factors should be taken into account by senior pediatric fellows and their advisors when considering job opportunities

Human Mesenchymal Stromal Cells Decrease Mortality Following Intestinal Ischemia and Reperfusion Injury

Background Cellular therapy is a novel treatment option for intestinal ischemia. Bone marrow–derived mesenchymal stromal cells (BMSCs) have previously been shown to abate the damage caused by intestinal ischemia/reperfusion (I/R) injury. We therefore hypothesized that (1) human BMSCs (hBMSCs) would produce more beneficial growth factors and lower levels of proinflammatory mediators compared to differentiated cells, (2) direct application of hBMSCs to ischemic intestine would decrease mortality after injury, and (3) decreased mortality would be associated with an altered intestinal and hepatic inflammatory response. Methods Adult hBMSCs and keratinocytes were cultured on polystyrene flasks. For in vitro experiments, cells were exposed to tumor necrosis factor, lipopolysaccharides, or 2% oxygen for 24 h. Supernatants were then analyzed for growth factors and chemokines by multiplex assay. For in vivo experiments, 8- to 12-wk-old male C57Bl6J mice were anesthetized and underwent a midline laparotomy. Experimental groups were exposed to temporary superior mesenteric artery occlusion for 60 min. Immediately after ischemia, 2 × 106 hBMSCs or keratinocytes in phosphate-buffered saline were placed into the peritoneal cavity. Animals were then closed and allowed to recover for 6 h (molecular/histologic analysis) or 7 d (survival analysis). After 6-h reperfusion, animals were euthanized. Intestines and livers were harvested and analyzed for inflammatory chemokines, growth factors, and histologic changes. Results hBMSCs expressed higher levels of human interleukin (IL) 6, IL-8, vascular endothelial growth factor (VEGF), and epidermal growth factor and lower levels of IL-1, IL-3, IL-7, and granulocyte-monocyte colony-stimulating factor after stimulation. In vivo, I/R resulted in significant mortality (70% mortality), whereas application of hBMSCs after ischemia decreased mortality to 10% in a dose-dependent fashion (P = 0.004). Keratinocyte therapy offered no improvements in mortality above I/R. Histologic profiles were equivalent between ischemic groups, regardless of the application of hBMSCs or keratinocytes. Cellular therapy yielded significantly decreased murine intestinal levels of soluble activin receptor-like kinase 1, betacellulin, and endothelin, whereas increasing levels of eotaxin, monokine induced by gamma interferon (MIG), monocyte chemoattractant protein 1, IL-6, granulocyte colony-stimulating factor (G-CSF), and interferon gamma-induced protein 10 (IP-10) from ischemia were appreciated. hBMSC therapy yielded significantly higher expression of murine intestinal VEGF and lower levels of intestinal MIG compared to keratinocyte therapy. Application of hBMSCs after ischemia yielded significantly lower murine levels of hepatic MIG, IP-10, and G-CSF compared to keratinocyte therapy. Conclusions Human BMSCs produce multiple beneficial growth factors. Direct application of hBMSCs to the peritoneal cavity after intestinal I/R decreased mortality by 60%. Improved outcomes with hBMSC therapy were not associated with improved histologic profiles in this model. hBMSC therapy was associated with higher VEGF in intestines and lower levels of proinflammtory MIG, IP-10, and G-CSF in liver tissue after ischemia, suggesting that reperfusion with hBMSC therapy may alter survival by modulating the systemic inflammatory response to ischemia

Three-Dimensional Printing and Its Applications in Otorhinolaryngology–Head and Neck Surgery

Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology–head and neck surgery, discusses future innovations, and explores the financial impact of these advances. Data Sources Articles were identified from PubMed and Ovid MEDLINE. Review Methods PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models. Conclusions Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices. Implications for Practice After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes

Accounting for early job turnover in recent pediatric surgery fellowship graduates: An American Pediatric Surgical Association Membership and Credentials Committee study

PURPOSE: Employment opportunities for graduating pediatric surgeons vary from year to year. Significant turnover among new employees indicates fellowship graduates may be unsophisticated in choosing job opportunities which will ultimately be satisfactory for themselves and their families. The purpose of this study was to assess what career, life, and social factors contributed to the turnover rates among pediatric surgeons in their first employment position. METHODS: American Pediatric Surgical Association members who completed fellowship training between 2011 and 2016 were surveyed voluntarily. Only those who completed training in a pediatric surgery fellowship sanctioned by the American Board of Surgery and whose first employment involved the direct surgical care of patients were included. The survey was completed electronically and the results were evaluated using chi-squared analysis to determine which independent variables contributed to a dependent outcome of changing place of employment. RESULTS: 110 surveys were returned with respondents meeting inclusion criteria. 13 (11.8%) of the respondents changed jobs within the study period and 97 (88.2%) did not change jobs. Factors identified that likely contributed to changing jobs included a perceived lack of opportunity for career [p = <0.001] advancement and the desire to no longer work at an academic or teaching facility [p = 0.013]. Others factors included excessive case load [p = 0.006]; personal conflict with partners or staff [p = 0.007]; career goals unfulfilled by practice [p = 0.011]; lack of mentorship in partners [p = 0.026]; and desire to be closer to the surgeon's or their spouse's family [p = 0.002]. CONCLUSIONS: Several factors appear to play a role in motivating young pediatric surgeons to change jobs early in their careers. These factors should be taken into account by senior pediatric fellows and their advisors when considering job opportunities

Reviews of Books

WANG ZHENPING. Ambassadors from the Islands of Immortals: China-Japan Relations in the Han-Tang Period. Honolulu: Association for Asian Studies and University of Hawaii Press, 2005. Pp. xiii, 387. $53.00 (US). Reviewed by Kent G. Deng PETER WHITFIELD. Cities of the World: A History in Maps. Berkeley and Los Angeles: University of California Press, 2005. Pp. 208.$39.95 (US). Reviewed by Jeremy Black GIROLAMO ARNALDI. Italy and Its Invaders, trans. Antony Shugaar. Cambridge, MA and London: Harvard University Press, 2005. Pp. ix, 229. $19.95 (US). Reviewed by Antonio Santosuosso WILLARD SUNDERLAND. Taming the Wild Field: Colonization and Empire on the Russian Steppe. Ithaca and London: Cornell University Press, 2004. Pp. xv, 239.$35.00 (US). Reviewed by Virginia Martin DAVID CROUGH. The Birth of Nobility: Constructing Aristocracy in England and France, 900-1300. London and New York: Pearson Longman, 2005. Pp. xiii, 361. £36.99, paper. Reviewed by Pauline Stafford ANGELO FORTE, RICHARD ORAM, and FREDERIK PEDERSEN. Viking Empires. New York: Cambridge University Press, 2005. Pp. xiv, 447. $53.95 (US). Reviewed by Simon Maclean OLAV RISTE. Norway's Foreign Relations: A History, 2nd ed. Oslo: Universitetsforlaget, 2005. Pp. 306. €50.00. Reviewed by Patrick Salmon DANIEL POWER. The Norman Frontier in the Twelfth and Early Thirteenth Centuries. New York: Cambridge University Press, 2004. Pp. xxi, 634.$140.00 (US). Reviewed by Hugh M. Thomas FRANCES STONOR SAUNDERS. The Devil's Broker: Seeking Gold, God, and Glory in 14th Century Italy. Toronto: McClelland & Stewart, 2005. Pp. xviii, 366. $36.99 (CDN). Reviewed by Montgomery Bohna ISABEL DE MADARIAGA. Ivan the Terrible: First Tsar of Russia. New Haven and London: Yale University Press, 2005. Pp. xxi, 484.$35.00 (US). Reviewed by Charles J. Halperin JAMES MCDERMOTT. England and the Spanish Armada: The Necessary Quarrel. New Haven and London: Yale University Press, 2005. Pp. xvi, 411. $40.00 (US). Reviewed by David Potter ALEXANDER MURDOCH. British Emigration, 1603-1914. Basingstoke and New York: Palgrave Macmillan, 2004. Pp. xi, 176.$65.00 (US). Reviewed by Stephen Constantine JENNY HALE PULSIPHER. Subjects Unto the Same King: Indians, English, and the Contest for Authority in Colonial New England. Philadelphia: University of Pennsylvania Press, 2005; dist. Toronto: Scholarly Book Services. Pp. 361. $57.75 (CDN). Reviewed by Trevor Burnard GWENDOLYN MIDLO HALL. Slavery and African Ethnicities in the Americas: Restoring the Links. Chapel Hill and London: University of North Carolina Press, 2005. Pp. xxi, 225.$34.95 (US). Reviewed by Kenneth Morgan STEPHEN CONWAY. War, State, and Society in Mid-Eighteenth-Century Britain and Ireland. New York: Oxford University Press, 2006. Pp. vi, 346. $165.00 (CDN). Reviewed by J.C.D. Clark MAYA JASANOFF. Edge of Empire: Lives, Culture, and Conquest in the East, 1750- 1850. New York: Alfred A. Knopf, 2005. Pp. ix, 404.$27.95 (US). Reviewed by Dane Kennedy JONATHAN R. DULL. The French Navy and the Seven Years' War. Lincoln and London: University of Nebraska Press, 2005. Pp. xiii, 445. $35.00 (US). Reviewed by Ian K. Steele CRAIG L. SYMONDS. Decision at Sea: Five Naval Battles that Shaped American History. New York: Oxford University Press, 2005. Pp. xvii, 378.$39.95 (CDN). Reviewed by George Baer OLIVER MARSHALL. English, Irish, and Irish-American Pioneer Settlers in Nineteenth- Century Brazil. Oxford: Centre for Brazilian Studies, University of Oxford, 2005. Pp. xii, 323. £20.00, paper. Reviewed by Marshall C. Eakin RANDOLF G. S. COOPER. The Anglo-Maratha Campaigns and the Contest for India: The Struggle for Control of the South Asian Military Economy. New York: Cambridge University Press, 2004. Pp. xvii, 437. $85.00 (US). Reviewed by Edward Ingram ROBERT MILL WARD. Private and Public Enterprise in Europe: Energy, Telecommunications, and Transport, 1830-1990. New York: Cambridge University Press, 2005. Pp. xix, 351.$90.00 (US). Reviewed by Nicholas Crafts TAN TAI YONG. The Garrison State: The Military, Government, and Society in Colonial Punjab, 1849-1947. New Delhi and Thousand Oaks: Sage, 2005. Pp. 333. $64.95 (US). Reviewed by Ian Talbot WINFRIED BAUMGART, ed. Englische Akten zur Geschichte des Krimkriegs. Ser. III: Band l: 20. November 1852 bis 10. Dezember 1853. Munich: R. Oldenbourg Verlag, 2005. Pp. 750. €148.00. Reviewed by Ann Pottinger Saab ALISON FLEIG FRANK. Oil Empire: Visions of Prosperity in Austrian Galicia. Cambridge, MA and London: Harvard University Press, 2005. Pp. xx, 343.$49.95 (US). Reviewed by Lothar Höbelt JOHN M. CARROLL. Edge of Empires: Chinese Elites and British Colonials in Hong Kong. Cambridge, MA and London: Harvard University Press, 2005. Pp. xii, 260. $39.95 (US). Reviewed by Catherine R. Schenk PAIGE RAIBMON. Authentic Indians: Episodes of Encounter from the Late-Nineteenth- Century Northwest Coast. Durham, NC and London: Duke University Press, 2005. Pp. xv, 307.$22.95 (US), paper. Reviewed by Olivia Patricia Dickason ELIZABETH BUETTNER. Empire Families: Britons and Late Imperial India.. New York: Oxford University Press, 2004. Pp. xii, 310. $75.00 (CDN). Reviewed by Nupur Chaudhuri JILL H. CASID. Sowing Empire: Landscape and Colonization. Minneapolis: University of Minnesota Press, 2005. Pp. xxiii, 281.$24.95 (US), paper. Reviewed by John M. MacKenzie MIKE HUGGINS. The Victorians and Sport. London and New York: Hambledon and London, 2004; dist. Basingstoke and New York: Palgrave Macmillan. Pp. xi, 318. $29.95 (US). Reviewed by Tony Collins DAVID DILKS, with the assistance of Richard Dilks. 'The Great Dominion': Winston Churchill in Canada, 1900-1954. Toronto: Thomas Allen, 2005. Pp. xx, 472.$45.00 (CDN). Reviewed by John L. Gordon, Jr. STEFAN AUGUST LUTGENAU, ed. Paul Esterhdzy, 1901-1989: Ein Leben im Zeitalter der Extreme. Innsbruck: Studien Verlag, 2005. Pp. 196. €19.00. Reviewed by Günter Bischof MICHAEL DOORLEY. Irish-American Diaspora Nationalism: The Friends of Irish Freedom, 1916-1935. Dublin and Portland: Four Courts Press, 2005. Pp. 223. $55.00 (US). Reviewed by Andrew J. Wilson JOHN D. MEEHAN, SJ. The Dominion and the Rising Sun: Canada Encounters Japan, 1929-41. Vancouver: University of British Columbia Press, 2004. Pp. xii, 250.$29.95 (CDN), paper. Reviewed by John Price ELIZABETH BORGWARDT. A New Deal for the World: America's Vision for Human Rights. Cambridge, MA and London: The Belknap Press of Harvard University Press, 2005. Pp. 437. 35.00 (US). Reviewed by Warren I. Cohen JUSTUS D. DOKNKCKE and MARK A. STOLER. Debating Franklin D. Roosevelt's Foreign Policies, 1933-1945. Lanham: Rowman & Littlefield, 2005. Pp. vi, 238. 65.00 (US), cloth; $19.95 (US), paper. Reviewed by Wiiliam R. Keylor HENRY ASHBY TURNER, JR. General Motors and the Nazis: The Struggle for Control of Opel, Europe's Biggest Carmaker. New Haven and London: Yale University Press, 2005. Pp. viii, 200.$38.00 (US). Reviewed by Andrew J. Crozier RICHARD BREITMAN, NORMAN J. W. GODA, TIMOTHY NAFTALI, and ROBERT WOLFE. US Intelligence and the Nazis. New York: Cambridge University Press, 2005. Pp. 495. $24.99 (US), paper. Reviewed by Thomas G. Mahnken WENDY LOWER. Nazi Empire-Building and the Holocaust in Ukraine. Chapel Hill: University of North Carolina Press, 2005. Pp. xviii, 307.$49.95 (US). Reviewed by John-Paul Himka DOUGLAS E. DELANEY. The Soldiers' General: Bert Hoffmeister at War. Vancouver: University of British Columbia Press, 2005. Pp. xvi, 299. $29.95 (CDN), paper. Reviewed by Tim Cook OTIS HAYS, JR. Alaska's Hidden Wars: Secret Campaigns on the North Pacific Rim. Fairbanks: University of Alaska Press, 2004. Pp. xvii, 182.$19.95 (US), paper. Reviewed by Terrence Cole ARIEH J. KOCHAVI. Confronting Captivity: Britain and the United States and Their POWs in Nazi Germany. Chapel Hill and London: University of North Carolina Press, 2005; dist. Toronto: Scholarly Book Services. Pp. x, 382. $69.75 (US). Reviewed by S. P. MacKenzie TSUYOSHI HASEGAWA. Racing the Enemy: Stalin, Truman, and the Surrender of Japan. Cambridge, MA and London: The Belknap Press of Harvard University Press, 2005. Pp. ix, 382.$29.95 (US). Reviewed by Akira Iriye DAVID MONOD. Settling Scores: German Music, Denazification, and the Americans, 1945-1953. Chapel Hill and London: University of North Carolina Press, 2005; dist. Toronto: Scholarly Book Services. Pp. xiv, 325. $69.75 (CDN). Reviewed by Carol S. Gruber ALLAN R. MILLETT. The War for Korea, 1945-1950: A House Burning. Lawrence: University Press of Kansas, 2005. Pp. xviii, 348.$39.95 (US). Reviewed by Steve I. Levine AMY KNIGHT. How the Cold War Began: The Gouzenko Affair and the Hunt for Soviet Spies. Toronto: McClelland & Stewart, 2005. Pp. ix, 358. $36.99 (CDN). Reviewed by Nector Mackenzie MICHAEL L. KRKNN. Fall-Out Shelters for the Human Spirit: American Art and the Cold War. Chapel Hill and London: University of North Carolina Press, 2005; dist. Toronto: Scholarly Book Services. Pp. xii, 300.$58.00 (CDN). Reviewed by Anders Stephanson KENNETH P. WERRELL. Sabres over MiG Alley: The F-86 and the Battle for Air Superiority in Korea. Annapolis: Naval Institute Press, 2005. Pp. x, 318. $29.95 (US). Reviewed by James I. Matray BALÁZS SZALONTAI. Kim Il Sung in the Khrushchev Era: Soviet-DPRK Relations and the Roots of North Korean Despotism, 1953-1964. Stanford: Stanford University- Press, 2006. Pp. xxiii, 343.$60.00 (US). Reviewed by Andrei Lankov CHRISTOPHER A. PREBLE. John F. Kennedy and the Missile Gap. DeKalb: Northern Illinois University Press, 2004. Pp. xi, 244. $32.00 (US). Reviewed by Campbell Craig MOREEN DEE, ed. Documents on Australian Foreign Policy: Australia and the Formation of Malaysia, 1961-1966. Canberra: Department of Foreign Affairs and Trade, 2005; dist. Melbourne: Melbourne Publishing Group. Pp. xlvi, 651.$49.95 (AUS), paper. Reviewed by Nicholas Tarling GARETH PORTER. Perils of Dominance: Imbalance of Power and the Road to War in Vietnam. Berkeley