bluuebunny/crossref_metadata_2025 huggingface dataset:
Workers—and Consumers—of the World Unite! Opportunities for Hybrid Co-operativism
Authors: Cohen Maurie J.
Published: November 2017

It has long been acknowledged that co-operatives can buffer economic insecurity, offset some of the vagaries of market capitalism, and enhance social solidarity. An interesting—and in many respects peculiar—facet of the history of co-operativism is how worker (or producer) cooperatives and consumer cooperatives have evolved along completely separate trajectories. Yet production and consumption are inextricably bound up in tight configurations. Moreover, no one is exclusively a producer or consumer and we repeatedly and iteratively change roles, often numerous times during the course of a single day. We seem, though, to be at an auspicious moment to rectify this anomalous situation. This chapter outlines the notion of multi-stakeholder co-operativism and highlights how worker-consumer cooperatives can bridge this enduring divide. These organizations can also inculcate democratic values and solidaristic social relations that will be essential for easing the process of innovating a new system of social organization over the next few decades.
The Worker Co-operative Form in the Home Care Industry in the USA
Authors: Berry Daphne
Published: November 2017

In the United States, the work that home health aides perform provides a valuable service to society. Changing views of care are necessitating care models in which people who are elderly or have disabilities receive care in their homes or communities. There is a growing gap between the sharply increasing need for those requiring care and the pool of women from whom caregivers are drawn, which is increasing much more gradually. The poor quality of home care jobs exacerbates this problem. This chapter examines worker attitudes across three home care facilities under different governance structures—a worker co-operative, a for-profit business with no participation or ownership by workers (‘conventional’), and a nonprofit. The study uses data from multiple sources and describes worker attitudes across the agencies. The research shows that aides at the worker co-operative were significantly less likely to leave and were more satisfied and committed to their jobs.
Statutory Employee Stock Ownership Plans in the USA
Authors: Rosen Corey
Published: November 2017

An Employee Stock Ownership Plan (ESOP) is the most common vehicle for broad-based worker ownership in the United States. An ESOP is a legal trust that holds the shares of all the workers in a firm and thus makes it possible to have long-lasting worker ownership. Under US law existing companies can contribute stock or cash to this trust in order to buy shares of company stock to gradually establish worker ownership. Probably, unique to the United States, this workers’ trust can borrow funds to buy shares on behalf of workers in order to establish significant, majority, or even 100 per cent worker ownership in one single transaction. All company contributions to the worker trust, whether in cash or stock or to repay loans used to buy stock for workers, gives the company a tax deduction under US federal law. Also interest on the loan is deductible.
Employee Ownership in Britain Today
Authors: Pendleton Andrew , Robinson Andrew
Published: November 2017

The chapter reviews the development of new forms of employee ownership in Britain since the 1980s. It compares trust-based and direct forms of ownership, as well as hybrids of the two, drawing attention to the perceived benefits of each. The chapter then considers the influences on the development of these forms of ownership. It highlights the role of political factors within a broader context of economic change. Finally, drawing on a research project currently under way, it discerns four main circumstances in which employee ownership is created, such as privatization and business succession. It is noted that those involved in ownership conversions varies by these circumstances. This in turn reflects on the forms of ownership and governance adopted.
From Traditional to Innovative Multi-Stakeholder Mutuals
Authors: Yeoman Ruth
Published: November 2017

The UK Coalition Government’s public-sector transformation initiatives produced a growing number of public-service mutuals. Despite this, there is little understanding of the transition experiences of such organizations, and associated processes of organizational change. This chapter describes the case of Rochdale Boroughwide Housing (RBH), an affordable housing provider, and now a dual constituency mutual, jointly owned by staff and tenants. A key characteristic of the change was the need for individuals to craft new self-identities by holding in tension the identity of being a co-owner with that of being a public-service worker or tenant. Smith and Graetz’s (2011) ‘paradox management’ was used to investigate new values arising from the proliferation of dualities. Although the stresses of change were not avoided, the co-owners of RBH created new capabilities with the potential to, not only sustain the organization, but also increase the resilience and innovative capacities of the communities it exists to serve.
The Emergence of Multi-Stakeholder Co-operatives in the Movement of Farm Machinery Co-operatives (CUMAs) in France
Authors: Thomas Franck
Published: November 2017

In rural areas, in order to respond to economic and social needs, the co-operative movement has always developed entrepreneurship models based on democracy, solidarity, responsibility of actors, proximity, transparency, and consideration of future generations. Amongst others, the 11,500 farm machinery co-operatives (coopératives d’utilisation de matériel agricole or ‘Cuma’) which are active in the French countryside can testify to this dynamism. Catching the opportunity of the introduction of
US Worker Co-operatives
Authors: Kaswan Mark J.
Published: November 2017

The United States has a long and proud tradition of co-operative labour arrangements. Today, worker co-operatives in the US encompass great diversity, not only in the type and size of enterprise, but also in their objectives and ideological commitments. This, in addition to the fact that the US lacks a consistent national policy as regards co-operatives, makes it challenging for researchers to provide more than a general picture of the sector in the United States. It is, however, clear that, although co-operatives are present in many different sectors, worker co-operatives today make up a very small portion of the US economy. This chapter discusses the historical development and current extent of US worker co-operatives, and the challenges and opportunities for growth and change they face. It also considers the character of the sector in terms of different development models, its role in community/economic development, and its orientation towards democratic social change.
Conversion from Stakeholder Value to Shareholder Value Banks
Authors: Llewellyn David T.
Published: November 2017

There is merit in having a diversity of ownership structures in a financial sector and mutuals and similar ownership models have a substantial contribution to make to diversity. The chapter considers the arguments in the UK in favour of conversion of mutuals to shareholder value institutions and reviews the outcomes. They are shown to have been largely bogus and have been found to be irrelevant. Members of converting institutions voted for conversion because the ‘windfalls’ implied an inter-generation transfer of wealth from previous and potentially future members to the current cohort. Comparison is made between the UK and other European countries with regard to conversions: in most other European countries such conversions are impossible because residual net worth is regarded as being held in perpetuity within the institution rather than a saleable asset owned by the current cohort of members.
Co-operative Principles and Co-operative Law Across the Globe
Authors: Henrÿ Hagen
Published: November 2017

This chapter first outlines the legitimacy of measuring co-operative law by the internationally recognized co-operative principles, and the evolution of co-operative law across the globe over the past decades. Based thereupon it then suggests re-establishing the rationale for a co-operative law which distinguishes co-operatives from other types of enterprises, this rationale being the sustainable development enhancing diversity of enterprise types. The locus of competition/competitiveness is shifting from financial performance to the normative capacity of enterprises to contribute to sustainable development. Co-operatives have a competitive advantage in this respect. This chapter will therefore suggest how to translate this capacity into the legal structure of co-operatives. It does so against the background of the economic, political, sociological, and socio-psychological changes and challenges, of which globalization is both cause and effect, and which impact the co-operative values and the notion of (co-operative) law and of law-making.
Creating Socially Sustainable Enterprise
Authors: Erdal David
Published: November 2017

This chapter discusses evidence that the design of business as a human institution can be improved far beyond the current template of corporations owned by financial institutions, a template which led to the near collapse of the global economy in 2008, with costly consequences for generations of taxpayers. Re-evaluating business theory from a perspective of human evolution leads to the recognition that human autonomy and voluntary co-operation in every business require the rights currently bundled as ‘ownership’—the rights to information, influence, and wealth—to be allocated, not to financiers, but to the individuals directly co-operating as participants in the wealth-creation process. Evidence is discussed showing that member-owned enterprises perform as well or better than conventionally structured business in terms of human and economic sustainability, and that the problems of financing such enterprises are soluble.
The Co-operative Business Model
Authors: Gould Charles
Published: November 2017

The author shows that the future success of the co-operative business model will depend on its ability to distinguish itself, not only from the corporate form, but also from the variety of social economy options. It must be democratically controlled and independent from government, and it needs a supportive legal framework and access to capital for start-up and growth. The long-standing and globally accepted Statement on Co-operative Identity sets forth the accepted Principles that define a co-operative. With the Blueprint for a Co-operative Decade, co-operatives are now prepared to position themselves as the most participatory business model and as leaders in sustainability— environmental, social, and economic—at a time when these are priorities for the emerging generation.
Co-operation as Co-ordination Mechanism
Authors: Borzaga Carlo , Tortia Ermanno C.
Published: November 2017

The interpretations hitherto produced on co-operatives firms have been, in general terms, unsatisfactory. The reasons are to be found in the limitations of the dominant theoretical paradigms in interpreting the individual, collective, and social reality of co-operation. Recent theoretical developments allow a new start in dealing with the most relevant economic dimensions of co-operation, by: (i) recognizing co-operation as a peculiar and basic co-ordination mechanism of the economic activity, different from market exchange and authority; (ii) considering collective and mutually beneficial entrepreneurial action, and not only individual action, as legitimate and fruitful; (iii) understanding economic motivations not only as self-interested and opportunistic ones, but also as intrinsically driven, as reciprocal, and as social. Starting from the analysis of the main market imperfections we develop a theory of co-operatives as enterprises that do not, as a norm, maximize net economic returns as their main objective, but instead pursue mutually beneficial and social aims.
Worker Co-operatives
Authors: Pérotin Virginie
Published: November 2017

The chapter examines the implications of the key international research findings of the last two decades for our understanding of why worker co-operatives are created, the objectives pursued by founding and subsequent members and the spill-over effects of their performance for the communities in which the firms are found. The chapter argues that worker co-operatives, by providing institutions in which employees control most aspects of their job and firm strategy (including pay and employment trade-offs) internalise a number of externalities to the conventional operation of firms. They provide good, stable jobs in which employees’ potential and creativity can flourish. In addition to promoting economic democracy, worker co-operatives offer sustainable and local employment and are likely to have a number of positive effects on their communities’ economies, public finances and health.
Plants, People, and Diet in the Neolithic of Western Eurasia
Authors: Bogaard Amy , Styring Amy
Published: November 2017

The establishment of farming is a defining feature of the Neolithic period in western Asia and Europe. Decades of archaeobotanical research have clarified the spectrum of crops that emerged, geographical and diachronic variation in the cultivation of particular species, and, more recently, aspects of arable land management. Most of the available evidence, however, is indirect as regards the actual role of crops in the human (and animal) diet. Taking western Eurasia as a particularly well-researched frame of reference, this chapter uses case studies to illustrate complementary inferences from plant processing, storage, and food preparation evidence, on the one hand, and direct dietary inferences incorporating preserved human remains, on the other. This integrated approach supports the rarely tested assumption that crops were dietary staples in Neolithic communities, and that the ‘politics’ of their production and storage shaped social life.
Pilgrimage
Authors: Rutherford Ian C.
Published: November 2017

This chapter looks at pilgrimage and sacred travel in the Second Sophistic. The principal topics covered are: the survival of traditional Greek forms of pilgrimage (e.g., involving healing, oracles, and initiation); pilgrimage and the festival culture of the Roman Empire, the sacred tourism practiced by members of the intellectual elite to places of religious and cultural significance; visits made by Roman emperors to sacred destinations; pilgrimage and sacred tourism to and within Roman Egypt; and pilgrimage destinations in the East, including Jewish and early Christian pilgrimage to Jerusalem. It takes account of both literary accounts (Pausanias, Lucian, the Greek novel, Philostratus) and epigraphic sources.
Longus and Achilles Tatius
Authors: Zeitlin Froma
Published: November 2017

This chapter pairs two Greek novels: Longus’s Daphnis and Chloe and Achilles Tatius’s Leucippe and Cleitophon, both generally dated to the second century ce. At first glance, they may seem to be strange bedfellows: Longus’s work is a pastoral romance, a small-scale miniature set entirely in an idyllic landscape on the island of Lesbos, where the young lovers enjoy conditions of unimaginable innocence and what adventures they have are limited to their own surroundings, while Achilles Tatius’s is a sprawling tale of maximum complexity of twice the length, involving a wide-ranging geography, and generally encompasses a much broader range of experience. Yet a preliminary comparison of the two romances is an object lesson in the flexibility of the genre itself, that is, the creative possibilities of using novelistic tropes and thematic conventions to produce entirely different results, while reinforcing (if, at times, challenging) the ideological underpinnings of the ideal romance.
Mythography
Authors: Trzaskoma Stephen
Published: November 2017

This chapter provides an overview of many of the important mythographical texts approximately contemporaneous with the Second Sophistic. The authors of these works sought to systematize or interpret traditional mythological lore and individual myths. Although mythography itself tended to be expressed in subliterary texts, both systematic and interpretive mythographical texts formed an important part of the context of the intellectual world of the Second Sophistic. The chapter concludes with a consideration of the ways in which the influence of mythography as a mode of transmission of mythological data and hermeneutic approaches can be traced in the literary works of the period.
Plutarch
Authors: Brenk Fred
Published: November 2017

This chapter describes Plutarch’s role as a Middle Platonist in the Second Sophistic. In philosophy he holds a literal interpretation of the Timaeus and often opposes the Stoics and Epicureans. He stresses the importance of philosophical inquiry and a certain caution, especially when speaking of difficult questions. His popular Table Talks (or Sympotic Questions) offer a kind of training in philosophical inquiry. In religion his monotheistic, Middle Platonic God has created the world and guides it with his providence through gods and daimones. He indulges in eschatological myths and is interested in foreign religions, especially Roman religion and the Egyptian Isis cult. One of his greatest contributions is in Platonizing and humanizing ethics. Greek paideia is the foundation for a good ethical life, which is based on reason over passion. In many ways he represents the ideal of an educated pepaideumenos in the Greco-Roman world of his time.
Was There a Latin Second Sophistic?
Authors: Habinek Tom
Published: November 2017

This chapter considers how Latin authors roughly contemporaneous with the Greek Second Sophistic sought to differentiate themselves from the practices of Greek intellectuals even as they adopted many of them. Pliny the Younger’s accounts of declamation, Aulus Gellius’s performance of erudition, and Fronto’s self-presentation opposed (explicitly or implicitly) the conduct of “Greek” intellectuals such as Isaeus and Favorinus. With their emphasis on the utility of their knowledge, the importance of writing at the expense of live performance, and the ethical nature of their self-presentation, Latin authors constructed a model of Roman intellectual behavior that was subtly opposed to that of Greeks. Only among Latin writers distant from the imperial center spatially (Apuleius) or temporally (Ausonius and his fellow fourth-century Gallic professors) do we encounter the sense of displacement or belatedness that characterizes the Greek Second Sophistic, as well as the overt deployment of sophistic literary, linguistic, and performative practices.
Greek and Latin Rhetorical Culture
Authors: Pernot Laurent
Published: November 2017

This chapter discusses the role of rhetorical culture in the Second Sophistic. In the Greco-Roman world of the imperial period, rhetoric was an educational system, a social practice, and a mental tool. Public speaking was omnipresent. The figure of the sophist combined literary activity and political influence: rhetoric was their secret link. Encomium—the principal rhetorical innovation of the Second Sophistic—was a refined, coded instrument, which not only served to express approval, but also aimed at communicating veiled messages. The phenomenon of the Second Sophistic did not disappear in the third century ce and some sophistic figures continued to flourish in the successive periods, a fact which motivates a current scholarly debate about “Third Sophistic.”
The Stoics
Authors: Reydams-Schils Gretchen
Published: November 2017

This chapter develops the contrast between Musonius Rufus and Dio of Prusa in their mode of self-representation. The later Stoics Seneca, Musonius Rufus, and Epictetus embrace a low-authority profile and recommend discretion for the philosopher (recommendations which Marcus Aurelius adopts in his own manner). In doing so they consciously resist the traditional status markers without giving up altogether on the notion of socio-political responsibility. Dio, on the other hand, in his role as public speaker makes full use of these status markers in the hope of increasing his effectiveness (as does Plutarch to some extent in his works on practical philosophy). Hence the contrast represents a cultural dilemma.
Atticism and Asianism
Authors: Kim Lawrence
Published: November 2017

This chapter treats two imperial Greek phenomena that have often been paired, usually in opposition: Atticism and Asianism. It first describes the theory, practice, and development of Atticism, the attempt by imperial Greeks to write in the language of the fifth and fourth century bce, treating its stylistic and grammatical variants and outlining its relation to imperial classicism. The second part treats the so-called “Asian” prose style associated primarily with the Hellenistic writer Hegesias of Magnesia and reminiscent of Gorgias and the first sophistic. The term itself is not current in the Second Sophistic, but the chapter argues that the style and aesthetic to which it refers are not only present in the work of many writers, but are also portrayed in a positive light by Philostratus. The tension between the classicizing tendencies of Atticism and the unclassical flavor of Asianism is an essential component of imperial Greek culture.
Skepticism
Authors: Bett Richard
Published: November 2017

This chapter assesses the relations between Greco-Roman philosophical skepticism, centered on the attitude of suspension of judgment, and the Second Sophistic. It begins with Favorinus, who identified as an Academic skeptic, and whose rhetorical activity is recognizably related to the practice of Academic skepticism, but who also engaged with the Pyrrhonist skeptical tradition. The rest of the chapter addresses Pyrrhonism, particularly Sextus Empiricus. The central point is Sextus’s complete lack of reference to the Second Sophistic, despite its being almost certainly contemporary with him. This may be due in part to his self-effacement and disengagement from the public arena, which is encouraged by the Pyrrhonist goal of ataraxia. But it also seems to be connected with the peculiar anachronism of his intellectual engagements, both concerning philosophy and (in his Against the Rhetoricians) concerning rhetoric itself.
The Aristotelian Tradition
Authors: Baltussen Han
Published: November 2017

This chapter examines the relationship between the Aristotelian philosophers (30 bce to 200 ce) and the so-called Second Sophistic. It discusses how the study of Aristotle’s works experienced a revival, leading to a new text-based approach to his corpus. The evidence for the main protagonists of those interested in Aristotle is fragmentary. Some were leading thinkers of the school (Andronicus of Rhodes), others eclectic readers of Aristotle (Xenarchus of Seleucia, Galen of Pergamum). The views of both styles of scholar on Aristotle arose mostly in a didactic context, clarifying the texts to students. Thus philosophers began to engage in scholarly commentary as a standard way to practice philosophy. This trend quickly culminated in the running commentary, the prime example of which is the work of Alexander of Aphrodisias (ca. 200 ce), who also had connections to the imperial court.
Early Christianity and the Classical Tradition
Authors: Johnson Aaron P.
Published: November 2017

Although frequently treated as a separate phenomenon in the Roman Mediterranean, the literary work produced by Christian intellectuals (especially Justin Martyr, Athenagoras, Tatian, and Theophilus) in the first centuries of our era is best appreciated within the literary, philosophical, and performative contexts of the Second Sophistic. Their adoption of a stance of free speech toward those in power was formulated as an extension of philosophical modes of self-presentation. Furthermore, the Christian explorations of middle Platonist notions of the Demiurge’s possession or use of logos coalesced with their impulse to quote and further proliferate logoi as part of Christian intellectual and textual culture. Of great importance was likewise the concern of many Christian apologists to combat the Hellenocentric assumptions of their day and to begin producing world chronological investigations that sought to remove the Greek identity from its position of cultural superiority.
Cosmopolitanism
Authors: Richter Daniel S.
Published: November 2017

This chapter describes the how various intellectuals active in the Second Sophistic conceived of the unity of the human community, a problem with philosophical, social, political, and, perhaps most importantly, ethnic implications. Intellectuals of the period inherited a rich conceptual vocabulary with which to think about human unity; ironically, fifth- and fourth-century Athenian rejections of aristocratic privilege provided a means for later intellectuals to debunk the importance of ethnic birth. As well, the Hellenistic Stoic idea of oikeiôsis is developed by intellectuals of the Second Sophistic as the basis of a philosophically oriented cosmopolitanism. The chapter discusses late Stoic cosmopolitan thought and rhetorical constructions of the Roman oikoumenê (inhabited world) as a single polis, and then turns to the figure of the exile as peculiarly suited to inhabit the world as if it were a single city.
Ethnicity, Culture, and Identity
Authors: Dench Emma
Published: November 2017

This chapter argues that certain traits associated with the Second Sophistic have attracted a disproportionate amount of scholarly attention in recent years: preoccupation with the past, Greekness, and the quirky performance of multiple identities. It emphasizes that these traits coexist with articulations of being and belonging that appeal less to early twenty-first-century sentiment, such as common descent, heredity, and “purity.” Finally, it focuses on the Second Sophistic not as a broad cultural or literary phenomenon reaching far beyond the individuals named by Philostratus, but as a group constructed by Philostratus, a variation on the proliferating contemporary groups in the Roman Empire that appealed to traditional modes of articulating being and belonging despite not being based primarily on fatherland, family descent, or place of residence.
Retrosexuality
Authors: Richlin Amy
Published: November 2017

This chapter argues that Second Sophistic texts express the erotic in terms of the past: retrosexuality. Starting from the all-male bilingual dinner party at Gellius 19.9, the discussion traces the eroticization of women, boys, eunuchs, cinaedi, and sophists, conditioned by slavery. Chastity armors women writers of the period, historians revel in past unchastity among Imperial women, and letter-writers pose with female icons; fiction invents women’s depravity and serves a policing function alongside medical and philosophical texts. Pederastic poetry valorizes itself through a Platonic or Stoic pedigree, abetted by the slave trade; allusive language veils the letters between Marcus Aurelius and his teacher Cornelius Fronto; explicit language enlivens the epigrams of Martial and Strato. If Domitian’s law illegalized castration of child sex slaves, still Statius and Martial praised Domitian’s boy eunuch Earinus. Cinaedi flourished as popular entertainers in the 100s ce, attested even by Justin Martyr. Philostratus’s sophists embrace a butch aesthetic.
Schools and Paideia
Authors: Webb Ruth
Published: November 2017

Education (paideia) was central to the development of what is now called the Second Sophistic, but surprisingly little attention was paid to the subject in the contemporary texts. This omission may have been deliberate, a way of implying that the status of pepaideumenos or educated man was acquired through sociability rather than by tuition. This chapter outlines what we know about the teaching of grammar and rhetoric in the schools of the imperial period from witnesses, like Philostratus, Lucian, and Aelius Aristides, and from the surviving manuals. Emphasis is placed on the relationship between this teaching and its methods and the performances and writings of the sophists. Its role in the creation of a common culture shared by its recipients is also discussed.
Progress on a New Kind of Progress Test: Assessing Medical Students’ Clinical Skills
Authors: DeMuth Robin H. , Gold Jonathan G. , Mavis Brian E. , Wagner Dianne P.
Published: November 2017

Problem

Progress testing of medical knowledge has advantages over traditional medical school examination strategies. However, little is known about its use in assessing medical students’ clinical skills or their integration of clinical skills with necessary science knowledge. The authors previously reported on the feasibility of the Progress Clinical Skills Examination (PCSE), piloted with a group of early learners. This subsequent pilot test studied the exam’s validity to determine whether the PCSE is sensitive to the growth in students’ clinical skills across the four years of medical school.

Approach

In 2014, 38 medical student volunteers (years 1–4) in the traditional 2 + 2 curriculum at Michigan State University College of Human Medicine participated in the eight-station PCSE. Faculty and standardized patients assessed students’ clinical skills, and faculty assessed students’ responses to postencounter necessary science questions. Students performed pretest self-assessment across multiple measures and completed a posttest evaluation of their PCSE experience.

Outcomes

Student performance generally increased by year in medical school for communication, history-taking, and physical examination skills. Necessary science knowledge increased substantially from first-year to second-year students, with less change thereafter. Students felt the PCSE was a fair test of their clinical skills and provided an opportunity to demonstrate their understanding of the related necessary science.

Next Steps

The authors have been piloting a wider pool of cases. In 2016, they adopted the PCSE as part of the summative assessment strategy for the medical school’s new integrated four-year curriculum. Continued assessment of student performance trajectories is planned.
Rethinking the Educator Portfolio: An Innovative Criteria-Based Model
Authors: Shinkai Kanade , Chen Chen (Amy) , Schwartz Brian S. , Loeser Helen , Ashe Cynthia , Irby David M.
Published: November 2017

Problem

Academic medical centers struggle to achieve parity in advancement and promotions between educators and discovery-oriented researchers in part because of narrow definitions of scholarship, lack of clear criteria for measuring excellence, and barriers to making educational contributions available for peer review. Despite recent progress in expanding scholarship definitions and identifying excellence criteria, these advances are not integrated into educator portfolio (EP) templates or curriculum vitae platforms.

Approach

From 2013 to 2015, a working group from the Academy of Medical Educators (AME) at the University of California, San Francisco (UCSF) designed a streamlined, criteria-based EP (EP 2.0) template highlighting faculty members’ recent activities in education and setting rigorous evaluation methods to enable educational scholarship to be objectively evaluated for academic advancement, AME membership, and professional development.

Outcomes

The EP 2.0 template was integrated into the AME application, resulting in high overall satisfaction among candidates and the selection committee and positive feedback on the template’s transparency, ease of use, and streamlined format. In 2016, the EP 2.0 template was integrated into the campus-wide curriculum vitae platform and academic advancement system.

Next Steps

The authors plan to increase awareness of the EP 2.0 template by educating promotions committees and faculty at UCSF and partnering with other institutions to disseminate it for use. They also plan to study the impact of the template on supporting educators by making their important scholarly contributions available for peer review, providing guidance for professional development, and decreasing disparities in promotions.
A Rose by Other Names: Some General Musings on Lawrence and Colleagues’ Hidden Curriculum Scoping Review
Authors: Hafferty Frederic W. , Martimianakis Maria Athina
Published: November 2017

In this Commentary, the authors explore the scoping review by Lawrence and colleagues by challenging their conclusion that with over 25 years’ worth of “ambiguous and seemingly ubiquitous use” of the hidden curriculum construct in health professions education scholarship, it is time to either move to a more uniform definitional foundation or abandon the term altogether. The Commentary authors counter these remedial propositions by foregrounding the importance of theoretical diversity and the conceptual richness afforded when the hidden curriculum construct is used as an entry point for studying the interstitial space between the formal and a range of other-than-formal domains of learning. They document how tightly delimited scoping strategies fail to capture the wealth of educational scholarship that operates within a hidden curriculum framework, including “hidden” hidden curriculum articles, studies that employ alternative constructs, and investigations that target important tacit sociocultural influences on learners and faculty without formally deploying the term. They offer examples of how the hidden curriculum construct, while undergoing significant transformation in its application within the field of health professions education, has created the conceptual foundation for the application of a number of critical perspectives that make visible the field’s political investments in particular forms of knowing and associated practices. Finally, the Commentary authors invite readers to consider the methodological promise afforded by conceptual heterogeneity, particularly strands of scholarship that resituate the hidden curriculum concept within the magically expansive dance of social relationships, social learning, and social life that form the learning environments of health professions education.
Speaking Up: An Ethical Action Exercise
Authors: Dwyer James , Faber-Langendoen Kathy
Published: November 2017

Problem

Health care professionals encounter situations in which they need to speak up to prevent harm, ensure better care, and/or address unprofessional behavior. Speaking up is often difficult, especially for medical students; nonetheless, it is a skill students must practice, so they can better advocate for patients.

Approach

The authors have designed an ethical action exercise and incorporated it into a required bioethics course that meets concurrently with third-year clerkships. The exercise requires students to speak up to try to correct, resolve, or improve one situation during a clerkship. The exercise involves overt action, but students determine how, where, and when to act.

Outcomes

In 2013–2014, 111 students at State University of New York Upstate Medical University completed the exercise. Most spoke up about situations in which they thought that some aspect of patient care could be improved (n = 78; 70%); others spoke up when they perceived unprofessional conduct (n = 32; 29%). Although most students found speaking up to be difficult (n = 96; 86%), speaking up often led to improved care (n = 46; 41%). As a result of completing the ethical action exercise, 2 students reported becoming less likely to speak up in the future, whereas 64 students reported becoming more likely.

Next Steps

Going forward, the authors want to address three issues: the development of lasting habits, the role of culture, and connections with other initiatives to improve care.
Scheduled Intravenous Acetaminophen Improves Patient Satisfaction With Postcraniotomy Pain Management: A Prospective, Randomized, Placebo-controlled, Double-blind Study
Authors: Artime Carlos A. , Aijazi Hassan , Zhang Haijun , Syed Tariq , Cai Chunyan , Gumbert Sam D. , Ferrario Lara , Normand Katherine C. , Williams George W. , Hagberg Carin A.
Published: November 2017

Background:

Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy.

Materials and Methods:

In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared.

Results:

There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1±0.4 vs. 6.9±0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects.

Conclusions:

IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.
ABO Blood Group and Cochlear Status: Otoacoustic Emission Markers
Authors: Chen Welen Weilu , Chow Kin Tsun , McPherson Bradley
Published: November 2017

Objectives:

There are an increasing number of research studies examining the effects of ABO blood group on susceptibility to disease. However, little is known regarding the potential relationship between blood group and hearing. Higher risk of noise-induced hearing loss was linked to blood group O in several occupational health studies. Based on this finding, a recent study of cochlear status was conducted with normal-hearing female participants representing equal numbers of the four blood groups in the ABO blood group system. ABO blood group was associated with cochlear characteristics, including the prevalence of spontaneous otoacoustic emissions (SOAEs) and the amplitudes of transient-evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs). Females with blood group O showed significantly lower amplitudes of DPOAEs at some frequencies and lower prevalence of SOAEs compared with participants with blood group B. There was a general trend of reduced TEOAE and DPOAE amplitudes in blood group O individuals compared with participants with non-O blood groups. Following from this finding, and based on known sex differences in otoacoustic emission characteristics, the present study examined the possible effects of blood group on otoacoustic emission status in males.

Design:

Sixty clinically normal-hearing males aged between 18 and 26 years, with equal numbers of participants in each of the ABO blood groups, were recruited by purposive sampling. SOAE, DPOAE, and linear and nonlinear TEOAE recordings were collected from all participants, as well as tympanometric data related to external and middle ear characteristics.

Results:

The male blood group O participants exhibited significantly lower SOAE prevalence and reduced amplitudes of DPOAEs on average, and in the midfrequency range, than participants with blood group B, and lower nonlinear and linear TEOAE amplitudes at a number of frequencies when compared with participants with blood groups A and B. A consistent trend of lower TEOAE and DPOAE response amplitudes was observed in participants with blood group O. No significant difference was noted among blood groups for outer or middle ear characteristics.

Conclusions:

These results were consistent with previous findings of reduced otoacoustic emission responses in female blood group O individuals. Results support the hypothesis that blood group O individuals may be at increased risk of cochlear damage from noise exposure. Further investigation on the potential link between ABO blood group and auditory status, including potentially differential effects of noise exposure on cochlear function, is needed. The possible effects of ABO blood group on other aspects of audition, such as hearing sensitivity, speech understanding, and auditory processing, should be evaluated.
Treatment of ankle fractures in diabetic patients
Authors: Ebraheim Nabil , Dammeyer Kyle , Paull Daniel
Published: November 2017

With an increasing population of diabetic patients and known complications of this disease, the treatment of ankle fractures in these patients has been of increasing interest over the past few decades. The purpose of this article was to review the literature and discuss the complications of ankle fractures in diabetic patients such as delayed wound healing, risk of infection, and amputation and to discuss the proper treatment methods to achieve a successful outcome. Diabetic patients with ankle fractures require twice the time as nondiabetic patients to achieve a successful union. Therefore, diabetic patients should be nonweight bearing for twice the recommended time for nondiabetic patients. However, there has been some success with protected weight bearing 2 wk after injury. Diabetic patients have an increased risk for infection at the surgical site and amputation so the skin should be carefully monitored for signs of infection. Patients should attempt to control their hemoglobin A1C to a level of <6.5% to increase the chance of a successful union, and displaced or unstable ankle fractures in the diabetic population should be treated surgically to avoid unnecessary complications. The use of bone marrow mesenchymal stem cells can aid in the treatment of ankle fracture nonunion in diabetic patients. Finally, diabetic patients with ankle fractures achieve better outcomes with additional fixation and a minimally invasive approach.
What’s New in Pediatric Upper Extremity Sports Injuries?
Authors: Beck Jennifer J. , Richmond Connor G. , Tompkins Marc A. , Heyer Ann , Shea Kevin G. , Cruz Aristides I.
Published: November 2017

Background:

Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to provide a comprehensive appraisal of the most recent literature, highlighting updates on sports-related upper extremity injuries in pediatric patients.

Methods:

An electronic search of the PubMed, EMBASE, and Google Scholar databases was performed for keywords related to pediatric overhead athletes, osteochondritis dissecans (OCD) of the capitellum, medial epicondyle fractures, shoulder instability, and clavicle fractures. Search results were filtered by publication date to yield articles published electronically or in print on or after January 1, 2013 to May 30, 2017. Papers were selected based on expert opinion and consensus by the authors and included if deemed to have contributed important findings to the above topics.

Results:

A total of 51 articles were deemed to have contributed significant findings to the literature: 11 overhead athlete, 9 OCD of the capitellum, 6 medial epicondyle fractures, 17 shoulder instability, and 8 clavicle fractures. The level of evidence for most studies was either Level III or IV.

Conclusions:

Overuse and traumatic conditions of the pediatric elbow including UCL tear, capitellar OCD, and medial epicondyle fractures represent a significant portion of injuries in the overhead athlete. Research in the prevention and treatment of primary and recurrent shoulder instability in young athletes continues to evolve. The operative treatment of clavicle fractures in adolescents has been increasing without a commensurate increase in the level of evidence supporting such treatment. Advances have been made in the treatment of sports-related upper extremity injuries in pediatric patients, however, high-level, comparative outcomes research in many areas is lacking and this review may help inform topics for future study.

Level of Evidence:

Level IV—Literature review.
Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions
Authors: Delmas Benjamin , Jabot Julien , Chanareille Paul , Ferdynus Cyril , Allyn Jérôme , Allou Nicolas , Raffray Loïc , Gaüzere Bernard-Alex , Martinet Olivier , Vandroux David
Published: November 2017

Objectives:

Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis.

Design:

Retrospective, descriptive, and single-center cohort study.

Settings:

The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital.

Patients:

Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015.

Interventions:

None.

Measurements and Main Results:

We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30–52 yr), with a Simplified Acute Physiology Score II of 38 (27–50) and a Sequential Organ Failure Assessment score of 10 (8–12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0–1) day after admission with a median urea of 25 mmol/L (17–32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6–11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 – 0.79).

Conclusions:

The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.