Existing (binary) understandings of gender affirm some types of gendered accounts as “authentic,” while others are discredited or obscured. As a consequence, many transgender people express anxiety about whether their experience of gender can be distilled into a narrative that is intelligible to others and appears consistent over time. In this article, I assess the identity narratives produced by two cohorts of trans respondents—binary-identified respondents, and non-binary respondents—as a means of understanding the narrative strategies that respondents employ to establish themselves as “authentically” trans. To affirm themselves as trans, I find that non-binary participants tended to elide or to minimize potential inconsistencies in their stories, producing narratives that reflect dominant cultural accounts of trans experience—accounts that center an early-childhood affiliation with the “opposite” sex, endorsing and affirming binary gender distinctions. In turn, binary-identified participants often produced accounts that complicated or questioned these tropes. While non-binary individuals have been hailed as the primary arbiters of gender’s undoing, the social and institutional constraints that inform how we account for gender—which shape both our production of those accounts and others’ interpretations of them—suggest that binary-identified respondents may be better positioned to work towards this “undoing” than their non-binary counterparts.
Background-Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results-Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions-Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. (Circ Cardiovasc Qual Outcomes. 2016;9:641-648.
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