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Romaine Johnson, MD MPH

@pediairwaydoc.bsky.social
104 followers 221 following 151 posts

Pediatric ENT Specialist | Professor | UT Southwestern Medical Center | Editor in Chief | Laryngoscope Investigative Otolaryngology | ΑΦΑ

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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 28/09/2026
New in JAMA Oto: a tracheostomy-specific risk tier system for children, built from administrative data. 14,275 kids, 44 hospitals. Median LOS 34 → 105 → 173 days across tiers; mortality 4.7% → 7.6% → 16.1%. APR-DRG can't separate these patients. This can. jamanetwork.com/journals/jam...
jamanetwork.com
Application of a Pediatric Tracheostomy-Specific Risk Tier System Using Administrative Data
This cohort study evaluates the efficacy of a tracheostomy-specific risk-tier system for children undergoing tracheostomy.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 23/07/2026
Key Lesson from the OpenAI and Hugging Face breaches: anything the system can access may be treated as part of the task environment, even when humans regard it as outside the legitimate scope of the task. #openai #llm
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 20/07/2026
The imagination of the problem. open.substack.com/pub/pediairw...
open.substack.com
WATCH THE DRIFT
The Imagination of the Problem
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 18/07/2026
The imagination of the disease (the framing, the metaphor, the model) determines the means — and the means are not merely instrumental. They are the ideal being realized or corrupted in real time. There is no separable "outcome" waiting at the end, untouched by how it was reached.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 03/07/2026
New editorial: the risk of AI in scholarly publishing isn't tool use. It's a loss of provenance. 5.2M papers, only 0.1% disclosed AI use despite policies requiring it. Govern outcomes, not tool lists. The tools will change quickly; human responsibility will not. doi.org/10.1002/lio2...
doi.org
Provenance, Not Prohibition: A Framework for AI in Scholarly Publishing
Generative AI is now embedded in scholarly workflows, yet publishing policy has often jumped to permission or prohibition without first defining what is being governed. The central risk is not tool u....
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 15/05/2026
1/3 New paper: 88.2% of obese children with severe OSA had no severe perioperative event after tonsillectomy. The guideline treats this population as uniformly high-risk. Inside the category, the variation is enormous. #PediatricOtolaryngology #SleepMedicine 📄 doi.org/10.1002/lary...
doi.org
Identifying High‐Risk Children Safe for Same‐Day Discharge After Tonsillectomy
Objective Current guidelines recommend overnight admission for children with severe obstructive sleep apnea (OSA) and obesity undergoing tonsillectomy, although most have uneventful postoperative co...
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 07/05/2026
What the Hantavirus Cruise Outbreak Reveals About Public Health, Journalism, and Human-Centered Design. #hantavirus open.substack.com/pub/pediairw...
Image of Substack Essay Cover
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 27/04/2026
Decoding the OR Black Box and Similar Technologies and Considerations in Otolaryngologic Surgery - Li - 2026 - Laryngoscope Investigative Otolaryngology - Wiley Online Library #ORBLACKBOX #AI onlinelibrary.wiley.com/doi/full/10....
onlinelibrary.wiley.com
Decoding the OR Black Box and Similar Technologies and Considerations in Otolaryngologic Surgery
Multimodal data-capturing technologies are becoming increasingly prevalent in operating rooms as they use physiologic, audiovisual, and health record data to improve safety, quality, and efficiency. ...
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 28/03/2026
A systems reading of the House Judiciary Committee's report on medical residency open.substack.com/pub/pediairw...
open.substack.com
The Match Isn't Broken. The Reform Might Break It.
A systems reading of the House Judiciary Committee's report on medical residency
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 28/03/2026
Medicine does require sacrifice. The question is which sacrifices are necessary for patient care, and which ones persist because the system is inefficient, under-resourced, or nostalgic for a harsher era.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 19/03/2026
Using a Directed Acyclic Graph (DAG) to map the potential inputs of stagflation. #stagflation open.substack.com/pub/pediairw...
open.substack.com
The Emerging Geometry of Stagflation
Figure 1: Causal Map of Emerging Stagflation Dynamics
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 13/03/2026
Match Week, Grief, and the Things We Don’t Let Medical Students Feel open.substack.com/pub/pediairw...
open.substack.com
What Happens to a Dream Deferred?
Match Week, Grief, and the Things We Don’t Let Medical Students Feel
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 11/03/2026
Health systems don’t exist outside history. Appreciated the opportunity to reflect on how understanding the past helps us redesign the systems we work within. www.utsouthwestern.edu/ctplus/stori...
utsouthwestern.edu
Honoring legacy, inspiring change - Center Times Plus, UT Southwestern
UT Southwestern celebrates Black History Month, with guest speaker Romaine Johnson, M.D., M.P.H., FACS.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 10/03/2026
Repeated moral injury does not just produce protest. It produces a search for forms of public action that let people remain human inside an inhumanizing system.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 09/03/2026
AI does not remove the need for judgment. It raises the skill threshold for judgment, because the system’s most consequential failures occur not when it is obviously wrong, but when it is persuasive in ways that make correction feel unnecessary.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 09/03/2026
Be the human in the negative feedback loop.
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Reposted by Romaine Johnson, MD MPH
Barack Obama @barackobama.bsky.social · 07/03/2026
Reverend Jesse Jackson called on each of us to be heralds of change, to be messengers of hope; to step forward and say “Send me” wherever we have a chance to make an impact. How fortunate we were that Jesse Jackson answered that call. What a great debt we owe to him.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 07/03/2026
What a single conversation revealed about AI evaluation, framing, and why the prompt is the experiment. open.substack.com/pub/pediairw...
open.substack.com
The Essay, the Model, and the Mirror
What a single conversation revealed about AI evaluation, framing, and why the prompt is the experiment
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 05/03/2026
Medicaid Retrenchment and Population Health open.substack.com/pub/pediairw...
open.substack.com
Medicaid Retrenchment and Population Health
What the Evidence Actually Shows
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 03/03/2026
It was great talking to the editors of OTO-HNSF about our latest research. Take a listen. podcasts.apple.com/us/podcast/o...
podcasts.apple.com
Association Between Weight Gain Trajectories and Severe Obstructive Sleep Apnea Among Adolescents
Podcast Episode · OTO Journal · February 27 · 33m
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 28/02/2026
The Destroy-Without-Build Trap open.substack.com/pub/pediairw...
open.substack.com
The Destroy-Without-Build Trap
Why Complex Systems Fail the Same Way, Every Time
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 21/02/2026
Hope to see you there on Wednesday, February 25th for the UTSW BMH celebration.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 16/02/2026
Measure Zero: An ongoing series on near misses—events that should not exist in a well-designed system. #safety #quality substack.com/@pediairwayd...
substack.com
Measure Zero
An ongoing series on near misses—events that should not exist in a well-designed system.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 20/01/2026
open.substack.com/pub/pediairw...
open.substack.com
When the Game Isn't the Game You Think You're Playing
There’s a class of strategic failure that’s hard to see from inside it.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 30/12/2025
What AI Gets Right about Pre Med Advice - And What Fits in Your Pocket. open.substack.com/pub/pediairw...
open.substack.com
Seven Things on an Index Card
What AI Gets Right About Pre-Med Advice—and What Fits in Your Pocket
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 30/12/2025
open.substack.com/pub/pediairw...
open.substack.com
The Mathematics of Mattering
A conversation about measure zero, consciousness, and the ontology of the actual
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 16/12/2025
New paper out: Multidisciplinary tracheostomy teams cut ED visits in half for pediatric patients—and the benefit grew over time (50% → 65% → 91% reduction across study periods). open.substack.com/pub/pediairw...
open.substack.com
The System That Learned
What 364 Children Taught Us About Teams, Coordination, and the Limits of Our Interventions
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 10/12/2025
It's Not Where You Start—It's the Slope. How weight gain trajectory impact ssleep among adolescents. open.substack.com/pub/pediairw...
open.substack.com
It's Not Where You Start—It's the Slope
New research from our group challenges a common assumption about childhood obesity and sleep apnea.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 07/12/2025
The Belonging Paradox open.substack.com/pub/pediairw...
open.substack.com
How Our Greatest Strength Becomes Our Gravest Vulnerability
The Belonging Paradox
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 07/12/2025
Hepatitis B vaccine guidance set to be rolled back for US babies: what the science says www.nature.com/articles/d41...
nature.com
Hepatitis B vaccine guidance set to be rolled back for US babies: what the science says
A panel of US vaccine advisers voted to rescind a recommendation that all newborns should receive a hepatitis B vaccine at birth.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 04/12/2025
The NYT piece on Kennedy’s tenure at HHS highlights a dangerous trend: dismantling evidence-based processes, marginalizing career scientists, and reorienting vaccine policy through ideology rather than data. This is how complex systems become brittle. www.nytimes.com/2025/12/04/u...
nytimes.com
Inside Kennedy’s Methodical Quest to Shake Up America’s Vaccine System
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 29/11/2025
Why the Obese Child with "Mild" Sleep Apnea Deserves Your Attention open.substack.com/pub/pediairw...
open.substack.com
Why the Obese Child with "Mild" Sleep Apnea Deserves Your Attention
Two Phenotypes of Pediatric OSA
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 27/11/2025
The Graphite is Showing. open.substack.com/pub/pediairw...
open.substack.com
The Graphite Is Showing
Peter Marks has written a thoughtful essay in NEJM diagnosing the collapse of public health confidence in America.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 01/11/2025
Why are 30% of pediatric tracheostomy patients Black when they're only 15% of kids?" That question only emerged because we compared local data to national data. Here's the framework for how one observation generates increasingly sophisticated research: open.substack.com/pub/pediairw...
open.substack.com
The Clinical Research Flywheel: From Volume to Discovery
How surgeon expertise and patient volume create a self-reinforcing ecosystem for generating increasingly sophisticated research questions
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 27/10/2025
Virtual Versus In‐Person Interviews: The Impact of Perceived Success on the Applicant Experience - Moufarrej - 2025 - Laryngoscope Investigative Otolaryngology - Wiley Online Library onlinelibrary.wiley.com/doi/full/10....
onlinelibrary.wiley.com
Virtual Versus In‐Person Interviews: The Impact of Perceived Success on the Applicant Experience
In light of continuing changes to graduate medical education interview approaches, this cross-sectional survey-based study comparatively assesses otolaryngology residency applicant perspectives on vi...
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 23/10/2025
After 20+ years, we have finally updated the @atscommunity.bsky.social guidelines for pediatric tracheostomy. Strong recs on ethics, caregiver training, airway endoscopy, and decannulation pathways—built for the real world. Proud to be a co-author. doi.org/10.1164/rccm...
doi.org
Care of Infants and Children with Tracheostomies. An Official American Thoracic Society Clinical Practice Guideline | American Journal of Respiratory and Critical Care Medicine | Articles in Press
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 22/10/2025
Happy Birthday to my pops who apparently is having a street named aftet him. What an honor! oaklandside.org/2025/10/20/b...
oaklandside.org
Bobby Seale, a Black Panther founder, will have an Oakland intersection named after him
The city will host a dedication event Wednesday, Oct. 22 which will be designated "Bobby Seale Day" in Oakland.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 16/10/2025
What I would write today if I was applying for ENT again. open.substack.com/pub/pediairw...
open.substack.com
Personal Statement — Romaine F. Johnson, M.D., M.P.H.
Imaging what I would write if I had to apply to ENT again
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 16/10/2025
The Research Arms Race. open.substack.com/pub/pediairw...
open.substack.com
The Research Arms Race in Residency Applications
A Costly Distraction
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 24/09/2025
open.substack.com/pub/pediairw...
open.substack.com
The Dream That Taught Me What I’m Actually Looking For
I had a dream last night where I went back to fellowship—already accomplished, already credentialed, but choosing to start over.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 23/09/2025
America’s cancer research system, which has helped save millions of lives, is under threat in one of its most productive moments. www.nytimes.com/2025/09/14/m...
nytimes.com
Trump Is Shutting Down the War on Cancer
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 20/09/2025
Do We Celebrate Our Wins Enough? open.substack.com/pub/pediairw...
open.substack.com
Do We Celebrate Our Wins Enough?
Something has been weighing on my mind lately, and I suspect I'm not alone in this reflection.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 19/09/2025
The Adaption Gap. open.substack.com/pub/pediairw...
open.substack.com
The Adaptation Gap
The Mismatch at the Heart of Modern Life
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 15/09/2025
open.substack.com/pub/pediairw...
open.substack.com
The Journey Over the Destination
What I Told Premeds at UT Dallas
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 31/08/2025
There's Box Office and There's Oscars open.substack.com/pub/pediairw...
open.substack.com
There's Box Office and There's Oscars
A Soliloquy in the Voice of Denzel Washington
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 28/08/2025
Big Brother doesn't need to rewrite history when our algorithmic feeds do it for us, one swipe at a time.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 21/08/2025
This piece exemplifies how journalism can serve democracy by recognizing when standard practices (treating each policy as an isolated event) fail to capture systematic threats to democratic norms. www.nytimes.com/2025/08/21/u...
nytimes.com
In Trump’s Ideal Picture of America, Diversity Is Taboo
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 12/08/2025
My inner dialogue has become a nonstop Tik Tok fyp. Current loop: Golden Darlin hold my hand Slow mo political satire.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 07/08/2025
It starts with a perfect circle of universal rights. Then, "We must act outside of the law to save it." The erosion is not a single, dramatic event, but a creeping, iterative process until universal protection under the law becomes a fractured reality where the boundary of justice is arbitrary.
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Romaine Johnson, MD MPH @pediairwaydoc.bsky.social · 06/08/2025
Excellent writing by Mr. Bouie. www.nytimes.com/2025/08/06/o...
nytimes.com
Opinion | Donald Trump and John Roberts Have a Lot in Common
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