Northwestern football players were the first college sports team to participate in a union certification election. The NLRB declined to assert jurisdiction and the ballots were not counted. This paper examines the nexus of factors influencing voting patterns at Northwestern based on both survey data and extensive interviews. The findings affirm and extend those from prior union voting behavior studies. Here, however, intersectionality of race and socio-economic status was a key factor. Voting also turned-on perceptions of employee status and what party or parties constituted management. Animosity toward the NCAA was close to unanimous while players were hesitant to shed negative light on Northwestern.

Internships are increasingly becoming an essential facet of a student's portfolio because of demonstrated linkages with employability and career opportunities. While undergraduate internships have expanded globally, most studies have examined the relationship between internship characteristics and student outcomes within a single country. In this cross-cultural study, we examine the generalizability of existing findings using survey data from 210 university students in France and the United States (U.S.). Results showed that in both countries the internship characteristics of supervisor support and mentoring, autonomy, and task goal clarity positively relate to student perceptions of the developmental value of their internship and job pursuit intention with the intern-host. However, the nature of these relationships varies, with U.S. students benefiting more from greater autonomy, while French students benefit more from increased supervisor mentoring. Contrary to expectations, increased task goal clarity led to poorer outcomes for French students. We discuss the implications of our findings for students and higher education institutions, intern-host organizations, and future cross-cultural research on internships.

Media bias is well documented in the industrial relations domain. This paper extends this research by exploring whether union participation among former professional baseball players affects the likelihood of moving through two stages of the selection process for the Major League Baseball Hall of Fame (HOF), a selection process controlled by sports media. At the HOF ballot inclusion stage, union activism increased position players’ and pitchers’ likelihoods of inclusion, regardless of time period. Conversely, at the HOF voting stage, position players who were union representatives during labor-management conflict (i.e., strikes and lockouts) received significantly less votes than non-activists, while position players who were representatives during labor-management cooperation received significantly more votes. Union activism did not affect pitchers at this stage. We conclude that union activists can be subject to negative media bias during labor-management conflict that, in turn, negatively affects post-employment outcomes.

Research increasingly links internships and specifically internship characteristics (e.g., compensation, supervision, and work design) to positive student outcomes. However, while the popularity of internships has expanded globally, most research in this area has examined the phenomenon within a single culture. This study explores the applicability of research findings using survey data from university students in two countries: the United States and France. Results showed that the internship characteristics of supervisor support and mentoring, autonomy, and task goal clarity are significantly positively related to student perceptions of the value of their internship and job pursuit intention with their intern-host. In addition, the country in which the internship was performed had a significant moderating influence on the relationship between the internship characteristics of autonomy, supervisor mentoring, and task goal clarity and student outcomes. Based on these results, we outline implications and future directions for cross-cultural research on internships, for students and higher education institutions, and for intern-host organizations.

Internships are a growing, yet controversial, labour market phenomenon. In particular, the issue of unpaid internships has been the source of legislative, judicial and ethical debate. Some have criticised colleges and universities for promoting an expansion of internships for undergraduate students - with little regard for internship characteristics such as compensation, quality of supervision and work activities. Meanwhile, there is a paucity of research examining the role internship characteristics, such as compensation, supervisor behaviours and work design have on internship efficacy. Based on a survey of undergraduate students in the US, the results showed that supervisor mentoring, the developmental value of the internship and the job pursuit intentions of the intern with the host employer were lower for those reporting on their unpaid internship vs. paid internship. Meanwhile, supervisor support and supervisor mentoring are significant predictors of internship efficacy regardless of internship compensation, while work design has much less of an impact on internship efficacy. The implications of the findings for educators, employers and prospective interns are highlighted.

In a multi-source, team-based field study of 71 in tact teams from an automobile parts manufacturer, we examine the relationship between team-level helping and team performance, in teams characterized by different levels of internal and external interdependence. Results reveal that in teams with complimentary levels of interdependence there is a positive relationship between team level helping and team performance. In contrast, in teams with congruent levels of interdependence there is a negative relationship between helping and team performance. Using social information processing theory as a conceptual framework, our results indicate that both internal and external factors may affect relations between helping and team performance. The implications for research for the management of teams are discussed.

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal

Objective: To determine outcomes in patients undergoing liver transplantation (LT) for metastatic neuroendocrine tumors (NETs).Design: Retrospective analysis.Setting: University of Kentucky Medical Center.Patients: Patients undergoing LT performed for NET metastases from October 1, 1988, through January 31, 2008, were analyzed using the United Network for Organ Sharing database.Main Outcome Measure: Patient survival.Results: During the study period, 87 280 LTs were performed. One hundred fifty LTs were performed for metastatic NETs. Among those 150 patients undergoing LT, 51 patients (34.0%) had carcinoid, 6 had insulinoma (4.0%), 3 had glucagonoma (2.0%), 11 had gastrinoma (7.3%), and 9 had vasoactive intestinal peptide-secreting tumors (6.0%); an additional 70 (46.7%) had an unspecified NET. The mean (SE) age of the patients was 45.1 (12.5) years. The mean (SE) cold ischemic time was 8.9 (4.1) hours. One hundred forty- four patients were adults and 6 were children. Thirteen patients received another organ at the time of LT. During the same period, 4693 patients underwent transplantation for hepatocellular carcinoma. Overall, 1-, 3-, and 5-year survival rates for patients with NETs undergoing isolated LT were 81%, 65%, and 49%, respectively. No difference in survival was observed in patients with carcinoid vs noncarcinoid tumors (P=.84). No significant difference was observed in patient survival between those with metastatic NETs and those with hepatocellular carcinoma. Patients waiting for LT longer than 2 months had improved survival (P=.005).Conclusions: Patients with liver metastases from NETs who were undergoing LT had long-term survival similar to that of patients with hepatocellular carcinoma. Longer wait times were associated with better outcomes in our series. Waiting for disease to stabilize before considering patients with liver metastases from NETs for transplantation may be appropriate. Excellent results can be obtained in highly selected patients.

BACKGROUND/AIMS In cirrhotic patients, ascites may increase weight and adversely impact liver transplant candidacy. METHODOLOGY In this study we used linear and volume measurements from abdominal CT imaging to estimate dry weight of transplant candidates using multivariable linear regressions. We reviewed 200 scans. For males there were 81, 26, and 41 scans with no/small, moderate, and large ascites, respectively, and 41, 6, and 5 scans of females with no/small/moderate, and large ascites respectively. RESULTS In males without ascites, subxiphoid subcutaneous fat volume had the strongest correlation with weight (r = 0.826); the best prediction utilized four variables including height, subcutaneous subxiphoid fat volume, and intraabdominal and subcutaneous umbilicus fat volumes (r = 0.923, r2 = 0.852, SEE = 15.15, p < 0.001). In females, subcutaneous fat volume above the umbilicus had the best correlation (r = 0.815); incorporating height and anterior subxiphoid fat thickness increased predictive accuracy (r = 0.892, r2 = 0.796, SEE = 15.37, p < 0.001). These regressions consistently under-predicted scale weight in patients with moderate and large ascites (5.92 +/- 25.50 pounds and 11.21 +/- 19.34 pounds in males, and 2.29 +/- 23.76 and 8.37 +/- 11.44 in females). CONCLUSIONS Equations to estimate patient weight regardless of ascites may offer a more accurate representation of size than scale weight in transplant candidates with ascites.

BACKGROUND:To determine factors associated with outcomes and microvascular invasion (MVI) in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC).METHODS:Between July 1996 and August 2008 at the Universities of Kentucky or Tennessee, LT recipients were retrospectively analysed.RESULTS:One hundred and one patients had HCC in the explanted liver; one patient was excluded because of fibrolamellar histology. Seventy-nine (79%) were male and 81 (81%) were older than 50. HCC was incidental in 32 patients (32%). Median follow-up was 31 months. Ten patients (10%) developed recurrence, which was associated with poor survival (P= 0.006). Overall 1-, 3-, and 5-year survival rates were 87%, 69% and 62%, respectively. Excluding patients with lymph node metastasis (LNM) or MVI yielded 91%, 81% and 75% survival at the same time points. MVI was independently associated with recurrence (OR 28.40, 95% CI 1.77-456.48, P= 0.018) and decreased survival (OR 4.70, 95% CI 1.24-17.80, P= 0.023), and LNM with decreased survival (OR 6.05, 95% CI 1.23-29.71, P= 0.027). Tumour size (OR 4.1, 95% CI 1.2-13.5, P= 0.013) and alpha-fetoprotein (AFP) > 100 (OR 5.0, 95% CI 1.4-18.1, P= 0.006) were associated with MVI.CONCLUSIONS:MVI greatly increases the risk of recurrence and death after LT for HCC, and is strongly associated with tumour size and AFP > 100.

Compared to a surgical shunt, a transjugular intrahepatic portosystemic shunt (TIPS) is a less invasive means of lowering portal venous pressure in patients with cirrhosis experiencing complications of portal hypertension, with relatively low procedure-related morbidity. Presently, the most common indications for TIPS placement are acute variceal bleeding and refractory ascites. The number of other indications is growing, but many are still controversial. We present a patient with partial portal vein thrombosis (PVT) who received TIPS to maintain portal vein patency when it was suspected that complete PVT was imminent. The TIPS was able to preserve the remaining portal flow until successful liver transplantation (LT) 3 months later.

OBJECTIVE:To investigate independent contributions of obesity, diabetes, and smoking to resource utilization in patients following liver resection.SUMMARY BACKGROUND DATA:Despite being highly resource-intensive, liver resections are performed with increasing frequency. This study evaluates how potentially modifiable factors affect measures of resource utilization after hepatectomy.METHODS:The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) public-use database was queried for patients undergoing liver resection. Resource variables were operative time (OT), intraoperative transfusion, length of stay (LOS), ventilator support at 48 hours, and reoperation. Bivariable and multivariable linear and logistic regressions were performed.RESULTS:There were 1029 patients identified. Most resections involved less than a hemiliver (599 patients, 58.2%). Mean BMI was 28.0 +/- 6.0. Mean OT was 253 +/- 122 minutes (range, 27 to 794) but varied by procedure (P < 0.001). Mean LOS was 8.7 +/- 10.7 days (range, 0 to 202). Morbid obesity added 48 minutes to OT (P = 0.018), 1.1 units to transfusions (P = 0.049), 2.2 days to LOS (P < 0.001), and accounted for delayed ventilator weaning (odds ratio, 4.5; P = 0.022). Underweight patients had shorter OT, but stayed 3.3 days longer than normal weight patients (P < 0.001). Insulin-treated patients with diabetes had longer OT (P < 0.001), increased transfusions (P < 0.001), and delayed ventilator weaning (odds ratio, 6.7; P < 0.001), while orally-treated patients with diabetes showed opposite trends. Smokers stayed 1.9 days longer (P < 0.001), with increased risk of prolonged ventilation (odds ratio, 3.3; P = 0.002) and reoperation (odds ratio, 2.3; P = 0.015).CONCLUSION:Obesity, diabetes, and smoking are each associated with important components of healthcare expenditure. Education and prevention programs are needed to limit their impact on overall resource utilization.

We have reported that cyclosporine (CsA) has direct effect to promote Epstein-Barr virus (EBV) transformation of human peripheral blood B lymphocytes. In this article, we have reported that CsA promoted EBV-infected, human B-cell transformation as assayed by three methods of colony number counting, cell number counting, and 3 H-thymidine incorporation. At first, we sought to correlate the three methods in EBV-infected human B-cell transformation, observing that they are convenient correlate with each other, and only vary in the degree when transformed cells are compared to the controls. Based on these pilot experiments, the three assay methods were then applied to CsA-treated and nontreated, EBV-infected human B cells to investigate whether CsA treatment promoted EBV-infected human B-cell transformation. We observed that CsA treatment increased colony formation above the control value of 28 4.5/well to 49 +/- 4.3 (colonies/well; n = 5; P < .05). CsA treatment increased the cell number from the control of 33,025 1900 to 50,925 4194 (cells/well; n = 5; P < .05). CsA treatment increased 3 H-thymidine incorporation from the control result of 12,481 1341 to 26,514 5464 (CPM/well; n = 5; P < .05). In conclusion, CsA promoted EBV-B-cell transformation in three correlated assay methods in vitro using a model of posttransplant lymphoproliferative disorder.

We present a case of massive bleeding secondary to vaginal varices complicating portal hypertension in a patient awaiting orthotopic liver transplantation (OLT). The vagina is among the rarest of locations reported for portal hypertensive varices causing hemorrhage; in fact, our patient represents only the seventh such case since the first report by Kreek in 19671-5 and the only case in which the initial and definitive management was OLT. A 58-year-old white female, gravida 3, para 3, was referred to our transplant center for liver transplant evaluation for nonalcoholic steatohepatitis. Her past medical history included diabetes mellitus type 2 and nephrolithiasis, and her surgical history was notable for a total abdominal hysterectomy performed 17 years earlier for endometriosis as well as open cholecystectomy, bilateral tubal ligation, and renal lithotripsy. On physical examination, she had mild ascites but was otherwise unremarkable. Upon completion of the transplant evaluation, she was activated on the transplant waiting list. Approximately 1 year after she was listed, the patient underwent routine computed tomography imaging, which showed a small, cirrhotic liver without ascites, and patent vasculature. Three months later, she presented with a sudden onset of significant vaginal bleeding. Vaginal varices were identified by direct visualization, and after a 3-unit transfusion of packed red blood cells, she underwent emergent suture ligation of the varices with cessation of bleeding. However, bleeding recurred after an asymptomatic interval of 2 weeks. Shortly after her return to the hospital, the patient became hypotensive and was discovered to have a hematocrit of 22%. She was aggressively resuscitated and taken emergently to the operating room for examination under anesthesia. Actively bleeding varices were again seen at the upper aspect of the vaginal cuff; these were suture-ligated and packed, with cessation of bleeding. In all, she received 4 units of packed red blood cells, 1 unit of fresh frozen plasma, and a six-pack of platelets during this admission, with return of hemodynamic stability and no additional hemorrhage. During this time, placement of a transjugular intrahepatic portosystemic shunt (TIPS) was considered, but in light of the patient's recent stability, this was not performed, and she was discharged to the care of her primary physician. Ten days later, the patient again developed hemodynamically significant vaginal hemorrhage. At this time, she was evaluated with reconsideration of TIPS placement. Computed tomography imaging showed a patent splenic vein but also the new finding of portal vein thrombosis, which was then confirmed by carbon dioxide angiogram; TIPS placement was therefore precluded. Pelvic varices were appreciated adjacent to the bladder and vagina (Fig. 1). Of note, no thrombosis of the iliac venous system on either side was observed. Abdominal and pelvic angiography was performed the next day to rule out an arteriovenous malformation. Although none was seen, thrombosis of the portal vein was again visualized, along with retrograde flow in the superior mesenteric vein and enlarged mesenteric venous collaterals draining into numerous pelvic varices. Hypertrophy of the inferior mesenteric vein was also noted, with probable retrograde flow (Figs. 2 and 3). Venous phase computed tomography scan demonstrating prominent varices (V) adjacent to the bladder (Bl) and vagina (Va). Packing can be seen within the vaginal vault. R indicates rectum. Angiogram showing the dilated inferior mesenteric vein (IMV) and vaginal varices (V). Angiogram showing the inferior mesenteric vein (IMV) and superior mesenteric vein (SMV) in continuity with vaginal varices (V). Fortunately, a liver allograft became available 2 days later, and the patient underwent successful OLT. During transplantation, a 5-cm organized thrombus was removed from the portal vein, with return of brisk portal flow. Portal vein continuity was able to be restored by end-to-end anastomosis between the donor and recipient portal veins. During the operation, the patient again developed significant vaginal hemorrhage, which necessitated gynecology consultation at the conclusion of the transplantation. The gynecologists performed additional suture ligation of the varices while the patient was still in the operating room. She had no additional episodes of vaginal hemorrhage during her uneventful postoperative recovery. Bl, bladder; IMV, inferior mesenteric vein; OLT, orthotopic liver transplantation; R, rectum; SMV, superior mesenteric vein; TIPS, transjugular intrahepatic portosystemic shunt; V, varices; Va, vagina. The pathophysiologic effects of cirrhosis can lead to serious complications in patients awaiting OLT. Portal hypertension, which frequently accompanies end-stage liver disease, can be caused by anything that compromises portal-systemic drainage. In a patient with cirrhosis, this is typically due to increased vascular resistance within the liver,6 although outflow and inflow impairments (such as portal vein thrombosis in our patient) can also be contributory. The formation of venous collaterals to decompress the portal system occurs as a direct consequence of increased portal pressure, typically in one or more areas in which there is native communication between portal and systemic circulation (distal esophagus/proximal stomach, rectum, umbilicus, and retroperitoneum). Varices are essentially venous collaterals in these transition zones that have become prominently dilated. Varices are most commonly found in the esophagogastric region, and the presence of these varices poses a high risk of developing hemorrhage, up to 30% within 2 years.6 Numerous ectopic locations have been reported as well, including the small bowel, colon, and biliary tree.7 The anatomy of the vagina and uterus makes them unlikely locations to develop varices for two reasons. First, the uterus has an extensive venous plexus, which primarily drains into the uterine veins and later the hypogastric veins (part of systemic circulation). The vagina also has a venous plexus, which similarly drains into the hypogastric veins via bilateral vaginal veins. The plexuses are in communication with each other and with the vesical and hemorrhoidal plexuses. Second, the nearest and only native communication between these networks and portal drainage is the superior portion of the hemorrhoidal plexus. Although anorectal varices may occur in up to 44% of patients with cirrhosis,8 the combined span of the vaginal and uterine plexuses provides numerous venues for decompressing venous hypertension, without the consequence of varix formation. We present a case of hemorrhagic vaginal varices complicating portal hypertension in a patient awaiting OLT, a problem that is rarely described in the literature. With one exception, all reported cases of vaginal variceal hemorrhage occurred in patients who had previously undergone hysterectomy; at 19 years, our patient had the longest interval between hysterectomy and onset of hemorrhage among these cases. In 2005, Orlando et al.5 described the 2 most recent cases and conducted a thorough review of the literature. They hypothesized that the loss of the uterine venous plexus creates the possibility of prominent venous congestion in the vaginal network, ultimately leading to variceal development. Only one reported patient with bleeding vaginal varices had not undergone hysterectomy, although she had a history of cervical cancer treated with radiotherapy 17 years earlier.4 Because a well-known effect of radiation is decreased vascularity,9 focused radiation to the cervix may have had the same result as hysterectomy in terms of disrupting communication between the vaginal and uterine venous plexuses. It appears that in certain patients, the vaginal plexus alone may not be sufficient to decompress severe portal hypertension, and this can result in venous engorgement and development of vaginal varices with hemorrhagic potential. The therapeutic approach to bleeding vaginal varices in a patient with cirrhosis does not differ greatly from the approach to varices in any other location. Initial management is usually directed toward the local control of bleeding using suture ligation, banding, or sclerotherapy, together with compression dressing and simultaneous correction of any underlying coagulopathy. Temporizing measures such as TIPS are also beneficial in reducing variceal pressure and possibly improving other complications of portal hypertension. Liver transplantation remains the definitive treatment for end-stage liver disease and severe portal hypertension resulting in bleeding varices and provides excellent outcome. As we identify potential risk factors for developing this complication, it may be advisable to consider including a thorough gynecologic examination as part of the transplant evaluation process for patients with cirrhosis with a previous hysterectomy. Early recognition of vaginal varices may allow for surveillance and preemptive therapy before life-threatening hemorrhage occurs. However, if this type of patient indeed presents with otherwise unexplained vaginal bleeding, varices must be a diagnostic consideration.