Abstract Objective To describe the publication productivity of academic urologists in the United States by gender. Materials and Methods Gender inequality is prevalent in most surgical ...subspecialties, including urology. Despite small numbers of women in academic positions, differences in scholarly impact by gender are relatively unknown. We assembled a list of 1922 academic urologists (1686 male (87.7%), 236 female (12.3%)) at 124 academic institutions throughout the United States as of February 2016. Scopus and Google Scholar were queried for bibliometric data on each individual, including h-index and m-quotient. We analyzed these metrics for both genders by educational background, subspecialty, NIH funding, and academic rank. Results Men had higher median h-indices than women overall (p<0.05), and by successive academic ranks (p<0.05). Proportionally fewer women attained senior academic ranking (professor/chair), (p<0.05). There was no difference in research productivity by successive rank after controlling for career duration ( m-quotient ). Women were more likely to choose a practice that specialized in pediatric urology or female urology/pelvic reconstructive surgery than their male counterparts (p<0.05). Conclusions and Relevance Women represent a growing proportion of academic urology faculty, but despite the recent increase in number entering the field, relatively few women occupy senior leadership positions. Improving psychosocial barriers to advancement such as lack of mentorship or discriminatory policies may help pioneering female urologists as they progress in their careers.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objective To further understand the association between semen quality and cancer risk by means of well defined semen parameters. Design Retrospective cohort study. Setting Not applicable. Patient(s) ...A total of 20,433 men who underwent semen analysis (SA) and a sample of 20,433 fertile control subjects matched by age and birth year. Intervention(s) None. Main Outcome Measure(s) Risk of all cancers as well as site-specific results for prostate cancer, testicular cancer, and melanoma. Result(s) Compared with fertile men, men with SA had an increased risk of testicular cancer (hazard rate HR 3.3). When the characterization of infertility was refined using individual semen parameters, we found that oligozoospermic men had an increased risk of cancer compared with fertile control subjects. This association was particularly strong for testicular cancer, with increased risk in men with oligozoospermia based on concentration (HR 11.9) and on sperm count (HR 10.3). Men in the in the lowest quartile of motility (HR 4.1), viability (HR 6.6), morphology (HR 4.2), or total motile count (HR 6.9) had higher risk of testicular cancer compared with fertile men. Men with sperm concentration and count in the 90th percentiles of the distribution (≥178 and ≥579 × 106 /mL, respectively), as well as total motile count, had an increased risk of melanoma (HRs 2.1, 2.7, and 2.0, respectively). We found no differences in cancer risk between azoospermic and fertile men. Conclusion(s) Men with SA had an increased risk of testicular cancer which varied by semen quality. Unlike earlier work, we did not find an association between azoospermia and increased cancer risk.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To investigate the relationship between acute exposure to air pollutants and spontaneous pregnancy loss.
Case-crossover study from 2007 to 2015.
An academic emergency department in the Wasatch Front ...area of Utah.
A total of 1,398 women who experienced spontaneous pregnancy loss events.
None.
Odds of spontaneous pregnancy loss.
We found that a 10-ppb increase in 7-day average levels of nitrogen dioxide was associated with a 16% increase in the odds of spontaneous pregnancy loss (odds ratio OR = 1.16; 95% confidence interval CI 1.01–1.33; P=.04). A 10-μg/m3 increase in 3-day and 7-day averages of fine particulate matter were associated with increased risk of spontaneous pregnancy loss, but the associations did not reach statistical significance (OR3-day average = 1.09; 95% CI 0.99–1.20; P=.05) (OR7-day average = 1.11; 95% CI 0.99–1.24; P=.06). We found no evidence of increased risk for any other metrics of nitrogen dioxide or fine particulate matter or any metric for ozone.
We found that short-term exposure to elevated levels of air pollutants was associated with higher risk for spontaneous pregnancy loss.
Efectos agudos de los contaminantes atmosféricos en el aborto espontáneo: un estudio de casos cruzados
Investigar la relación entre la exposición aguda a contaminantes atmosféricos y el aborto espontáneo.
Estudio de casos cruzados entre 2007 y el 2015.
Departamento de urgencias académico en el área de Wasatch Front en Utah.
Un total de 1398 mujeres que presentaron eventos de abortos espontáneos.
ninguna.
probabilidad de aborto espontáneo.
Encontramos que un aumento de 10 ppb en un período de 7 días en los niveles promedio de dióxido de nitrógeno se asoció con un aumento del 16% en la probabilidad de tener un aborto espontáneo (proporción de probabilidad OR= 1.16; intervalo de confianza del 95% IC 1.01–1.33; P=.04). Un aumento de 10-μg/m3 en el promedio de materia particulada fina en períodos de 3 y 7 días fue asociado a un aumento del riesgo de aborto espontáneo, pero estas asociaciones alcanzaron signficación estadística (ORpromedio de 3 días = 1.09; 95% IC 0.99–1.20; P = 0.05) (ORpromedio de 7 días = 1.11; 95% IC 0.99–1.24; P=0.06). No encontramos evidencia de aumento de riesgo para niguna otra medida del dióxido de nitrógeno ni para la materia particulada fina ni para ninguna medida de ozono.
Hemos encontrado que la exposición a corto plazo de niveles elevados de contaminantes atmosféricos se asocia a un mayor riesgo de aborto espontáneo.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
There is a differential in prostate cancer mortality between black and white men. Advances in precision medicine have shifted the research focus toward underlying genetic differences. However, ...nonbiological factors may have a large role in these observed disparities. Therefore, we sought to measure the relative importance of race compared to health care and social factors on prostate cancer specific mortality.
Using the SEER (Surveillance, Epidemiology, and End Results) database we identified 514,878 men diagnosed with prostate cancer at age 40 years or greater between 2004 and 2012. We also selected a subset of black and white men matched by age, stage and birth year. We stratified patients by age 40 to 54, 55 to 69 and 70 years or older and disease stage, resulting in 18 groups. By applying random forest methods with variable importance measures we analyzed 15 variables and interactions across 4 categories of factors (tumor characteristics, race, and health care and social factors) and the relative importance for prostate cancer specific mortality.
Tumor characteristics at diagnosis were the most important factors for prostate cancer mortality. Across all groups race was less than 5% as important as tumor characteristics and only more important than health care and social factors in 2 of the 18 groups. Although race had a significant impact, health care and social factors known to be associated with racial disparities had greater or similarly important effects across all ages and stages.
Eradicating disparities in prostate cancer survival will require a multipronged approach, including advances in precision medicine. Disparities will persist unless health care access and social equality are achieved among all populations.
To enhance physiological function of NMDA receptors (NMDARs), we identified positive allosteric modulators (PAMs) of NMDARs with selectivity for GluN2A subunit-containing receptors. X-ray ...crystallography revealed a binding site at the GluN1-GluN2A dimer interface of the extracellular ligand-binding domains (LBDs). Despite the similarity between the LBDs of NMDARs and AMPA receptors (AMPARs), GluN2A PAMs with good selectivity against AMPARs were identified. Potentiation was observed with recombinant triheteromeric GluN1/GluN2A/GluN2B NMDARs and with synaptically activated NMDARs in brain slices from wild-type (WT), but not GluN2A knockout (KO), mice. Individual GluN2A PAMs exhibited variable degrees of glutamate (Glu) dependence, impact on NMDAR Glu EC50, and slowing of channel deactivation. These distinct PAMs also exhibited differential impacts during synaptic plasticity induction. The identification of a new NMDAR modulatory site and characterization of GluN2A-selective PAMs provide powerful molecular tools to dissect NMDAR function and demonstrate the feasibility of a therapeutically desirable type of NMDAR enhancement.
•Describe discovery of novel GluN2A-selective NMDAR positive allosteric modulators (PAMs)•Crystal structures identify a new modulatory site in the GluN2A GluN1 LBD interface•Distinct PAMs have unique effects on NMDAR biophysical properties•Distinct PAMs have unique impacts on LTP
Hackos et al. describe the discovery of positive allosteric modulators of GluN2A NMDA receptors that bind a novel site in the GluN1/GluN2A ligand-binding domain. Modulators with distinct pharmacological properties are then used to probe NMDAR function in brain slices.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case ...distribution, associated gross hospital revenue and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence.
A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using Institute for Health Metrics and Evaluation models. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age estimated the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries.
Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 160 to 130%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross revenue per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue.
Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross revenue when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue. In these estimates, adopting universal masking would help to avoid overcapacity in all states.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Attention mechanisms are now a mainstay architecture in neural networks and improve the performance of biomedical text classification tasks. In particular, models that perform automated medical ...encoding of clinical documents make extensive use of the label-wise attention mechanism. A label-wise attention mechanism increases a model's discriminatory ability by using label-specific reference information. This information can either be implicitly learned during training or explicitly provided through embedded textual code descriptions or information on the code hierarchy; however, contemporary studies arbitrarily select the type of label-specific reference information. To address this shortcoming, we evaluated label-wise attention initialized with either implicit or explicit label-specific reference information against two common baseline methods-target-attention and text-encoder architecture-specific methods-to generate document embeddings across four text-encoder architectures-a convolutional neural network, two recurrent neural networks, and a transformer. We also present an extension of label-wise attention that can embed the information on the code hierarchy. We performed our experiments on the MIMIC III dataset, which is a standard dataset in the clinical text classification domain. Our experiments showed that using pretrained reference information and the hierarchical design helped improve classification performance. These performance improvements had less impact on larger datasets and label spaces across all text-encoder architectures. In our analysis, we used an attention mechanism's energy scores to explain the perceived differences in performance and interpretability between the text-encoder architectures and types of label-attention.
Macular degeneration (MD) embodies a collection of disorders causing a progressive loss of central vision. Cross-sectional MRI studies have revealed structural changes in the grey and white matter in ...the posterior visual pathway in MD but there remains a need to understand how such changes progress over time. To that end we assessed the posterior pathway, characterising the visual cortex and optic radiations over a ~ 2-year period in MD patients and controls. We performed cross-sectional and longitudinal analysis of the former. Reduced cortical thickness and white matter integrity were observed in patients compared to controls, replicating previous findings. While faster, neither the rate of thinning in visual cortex nor the reduction in white matter integrity during the ~ 2-year period reached significance. We also measured cortical myelin density; cross-sectional data showed this was higher in patients than controls, likely as a result of greater thinning of non-myelinated tissue in patients. However, we also found evidence of a greater rate of loss of myelin density in the occipital pole in the patient group indicating that the posterior visual pathway is at risk in established MD. Taken together, our results revealed a broad decline in grey and white matter in the posterior visual pathway in bilateral MD; cortical thickness and fractional anisotropy show hints of an accelerated rate of loss also, with larger effects emerging in the occipital pole.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The paper advances literature on earlier-life socioeconomic status (SES) and later-life health in a number of ways, including conceptualizing later-life health as a developmental process and relying ...on objective rather than retrospective reports of childhood and adult SES and health. Data are from the Utah Population Database (N=75,019), which contains variables from Medicare claims, birth and death certificates, and genealogical records. The morbidity measure uses the Charlson Comorbidity Index. SES is based on converting occupation to Nam-Powers scores and then dividing these scores into quartiles plus farmers. Analyses are conducted in two steps. Group-based trajectory modeling estimates patterns of morbidity and survival and divides the sample into sex-specific groups ordered from least to most healthy. Multilevel ordered logistic regression incorporating Heckman selection predicts group trajectory membership by SES in adulthood conditioned upon childhood SES. Higher SES in childhood is associated with membership in groups that have more favorable morbidity trajectories and survival probabilities. SES in adulthood has additive impact, especially for females.
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