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Appleton A, Black K, Sellke NC, Washington SL, Does S, Rhodes S, Downs TM, Saigal C, Vince RA, Ghanney Simons EC. The Future State of Race/Ethnicity in Urology: Urology Workforce Projection From 2021-2061. Urology 2024:S0090-4295(24)00025-6. [PMID: 38354914 DOI: 10.1016/j.urology.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To project the proportion of the urology workforce that is from under-represented in medicine (URiM) groups between 2021-2061. METHODS Demographic data were obtained from AUA Census and ACGME Data Resource Books. The number of graduating urology residents and proportion of URiM graduating residents were characterized with linear models. Stock and Flow models were used to project future population numbers and proportions of URiM practicing urologists, contingent on assumptions regarding trainee demographics, retirement trends, and growth in the field. RESULTS Currently, there is an increase in the percentage of URiM graduates by 0.145% per year. If historical trends continue, URiM urologists will likely comprise 16.2% of urology residency graduates and 13.3% of the practicing urological workforce in 2061. These percentages would constitute an underrepresentation of URiM urologists relative to the projected 44.2% of the U.S. population who would identify as American Indian/Alaskan Native, Black/African American, Latinx/Hispanic and Native Hawaiian/Pacific Islander by 2060.1 An increase in the percentage of URiM graduates by 0.845% per year would result in 44.2% URiM urology residency graduates and 26.1% URiM practicing urologists by 2061. An interactive app was designed to allow for a range of assumptions to be explored and for future data to be incorporated. CONCLUSION URiM physician representation within urology over the next 40years will remain disproportionately low compared to that of the projected share of people of color in the general U.S. POPULATION In order to achieve the AUA's Diversity, Equity and Inclusion goals, a concerted effort to implement interventions to recruit, train, and retain a generation of racially diverse urologists appears necessary.
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Affiliation(s)
- Ashley Appleton
- David Geffen School of Medicine (DGSOM) at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | | | | | | | - Serena Does
- Verwey-Jonker Institute, Utrecht, Netherlands; VU Amsterdam, Amsterdam, Netherlands
| | - Stephen Rhodes
- Department of Urology, University Hospitals, Cleveland, OH
| | | | - Christopher Saigal
- David Geffen School of Medicine (DGSOM) at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Randy A Vince
- Department of Urology, University Hospitals, Cleveland, OH; Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Efe C Ghanney Simons
- David Geffen School of Medicine (DGSOM) at the University of California, Los Angeles (UCLA), Los Angeles, CA.
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Kianian R, Andino JJ, Morrison JJ, Grundy D, Appleton A, Lavold AJ, Eleswarapu SV, Mills JN. Potential primary prevention of Peyronie's disease post prostatectomy?-retrospective analysis of peri-operative multi-modal penile rehabilitation. Transl Androl Urol 2023; 12:1708-1712. [PMID: 38106686 PMCID: PMC10719776 DOI: 10.21037/tau-23-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/01/2023] [Indexed: 12/19/2023] Open
Abstract
The surgical management of prostate cancer through radical prostatectomy has the potential to impact patients' sexual function, including erectile dysfunction and Peyronie's disease (PD). Historical data suggests the incidence of PD in post-prostatectomy patients is higher than in the general population at 15.9%. Our study objective was to measure the rate of the development of PD among patients that receive penile rehabilitation (PR) regimen prior to and immediately after radical prostatectomy. In this study, we retrospectively reviewed the charts of 581 patients who were diagnosed with prostate cancer, treated with radical prostatectomy, and engaged in a PR program. Patients with the diagnosis of PD prior to prostatectomy were excluded from this study. The PR program consists of daily tadalafil, L-citrulline, and weekly vacuum erectile device with the option of intracavernosal injections if patients fail to respond to the regular regimen. We found the incidence of PD to be 2.9%, suggesting that PR regimens programs may be associated with a reduced incidence of PD in post-prostatectomy patients. Ten (out of 17) patients were diagnosed with PD after 2 years of follow up. The return of erections was not statistically different among patients who developed PD and the rest of the patients. Prospective, multi-institutional trials will be required to elucidate whether PR can prevent the development of PD in this patient population.
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Affiliation(s)
| | - Juan J. Andino
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeff J. Morrison
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dayna Grundy
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley Appleton
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abigail J. Lavold
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sriram V. Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Yao Q, Doyle ME, Liu QR, Appleton A, O'Connell JF, Weng NP, Egan JM. Long-Term Dysfunction of Taste Papillae in SARS-CoV-2. NEJM Evid 2023; 2:10.1056/evidoa2300046. [PMID: 38145006 PMCID: PMC10745124 DOI: 10.1056/evidoa2300046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND We sought to determine whether ongoing taste disturbance in the postacute sequelae of coronavirus disease 2019 period is associated with persistent virus in primary taste tissue. METHODS We performed fungiform papillae biopsies on 16 patients who reported taste disturbance lasting more than 6 weeks after molecularly determined severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Then, on multiple occasions, we rebiopsied 10 of those patients who still had taste complaints for at least 6 months postinfection. Fungiform papillae obtained from other patients before March 2020 served as negative controls. We performed hematoxylin and eosin staining to examine fungiform papillae morphology and immunofluorescence and fluorescence in situ hybridization to look for evidence of persistent viral infection and immune response. RESULTS In all patients, we found evidence of SARS-CoV-2, accompanying immune response and misshapen or absent taste buds with loss of intergemmal neurite fibers. Six patients reported normal taste perception by 6 months postinfection and were not further biopsied. In the remaining 10, the virus was eliminated in a seemingly random fashion from their fungiform papillae, but four patients still, by history, reported incomplete return to preinfection taste perception by the time we wrote this report. CONCLUSIONS Our data show a temporal association in patients between functional taste, taste papillae morphology, and the presence of SARS-CoV-2 and its associated immunological changes. (Funded by Intramural Research Program/National Institute on Aging/National Institute of Allergy and Infectious Diseases/National Institutes of Health; ClinicalTrials.gov numbers NCT03366168 and NCT04565067.).
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Affiliation(s)
- Qin Yao
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
| | - Máire E Doyle
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
| | - Qing-Rong Liu
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
| | - Ashley Appleton
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
| | - Jennifer F O'Connell
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
| | - Nan-Ping Weng
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore
| | - Josephine M Egan
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore
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Doyle ME, Appleton A, Liu QR, Yao Q, Mazucanti CH, Egan JM. Human Type II Taste Cells Express Angiotensin-Converting Enzyme 2 and Are Infected by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Am J Pathol 2021; 191:1511-1519. [PMID: 34102107 PMCID: PMC8179718 DOI: 10.1016/j.ajpath.2021.05.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
Chemosensory changes are well-reported symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The virus targets cells for entry by binding of its spike protein to cell-surface angiotensin-converting enzyme 2 (ACE2). It is not known whether ACE2 is expressed on taste receptor cells (TRCs), or whether TRCs are infected directly. in situ hybridization probe and an antibody specific to ACE2 indicated presence of ACE2 on a subpopulation of TRCs (namely, type II cells in taste buds in taste papillae). Fungiform papillae of a SARS-CoV-2+ patient exhibiting symptoms of coronavirus disease 2019 (COVID-19), including taste changes, were biopsied. Presence of replicating SARS-CoV-2 in type II cells was verified by in situ hybridization. Therefore, taste type II cells provide a potential portal for viral entry that predicts vulnerabilities to SARS-CoV-2 in the oral cavity. The continuity and cell turnover of a patient's fungiform papillae taste stem cell layer were disrupted during infection and had not completely recovered 6 weeks after symptom onset. Another patient experiencing post-COVID-19 taste disturbances also had disrupted stem cells. These results demonstrate the possibility that novel and sudden taste changes, frequently reported in COVID-19, may be the result of direct infection of taste papillae by SARS-CoV-2. This may result in impaired taste receptor stem cell activity and suggest that further work is needed to understand the acute and postacute dynamics of viral kinetics in the human taste bud.
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Affiliation(s)
- Máire E Doyle
- National Institute on Aging/Intramural Program, Baltimore Maryland.
| | - Ashley Appleton
- National Institute on Aging/Intramural Program, Baltimore Maryland
| | - Qing-Rong Liu
- National Institute on Aging/Intramural Program, Baltimore Maryland
| | - Qin Yao
- National Institute on Aging/Intramural Program, Baltimore Maryland
| | - Caio H Mazucanti
- National Institute on Aging/Intramural Program, Baltimore Maryland
| | - Josephine M Egan
- National Institute on Aging/Intramural Program, Baltimore Maryland.
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Abstract
Loss and changes in taste and smell are well-reported symptoms of SARS-CoV-2 infection. The virus targets cells for entry by high affinity binding of its spike protein to cell-surface angiotensin-converting enzyme- 2 (ACE2). It was not known whether ACE2 is expressed on taste receptor cells (TRCs) nor if TRCs are infected directly. Using an in-situ hybridization (ISH) probe and an antibody specific to ACE2, it seems evident that ACE2 is present on a subpopulation of specialized TRCs, namely, PLCβ2 positive, Type II cells in taste buds in taste papillae. Fungiform papillae (FP) of a SARS-CoV-2+ patient exhibiting symptoms of COVID-19, including taste changes, were biopsied. Based on ISH, replicating SARS-CoV-2 was present in Type II cells of this patient. Therefore, taste Type II cells provide a portal for viral entry that predicts vulnerabilities to SARS-CoV-2 in the oral cavity. The continuity and cell turnover of the FP taste stem cell layer of the patient were disrupted during infection and had not fully recovered 6 weeks post symptom onset. Another patient suffering post-COVID-19 taste disturbances also had disrupted stem cells. These results indicate that a COVID-19 patient who experienced taste changes had replicating virus in their taste buds and that SARS-CoV-2 infection results in deficient stem cell turnover needed for differentiation into TRCs.
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Affiliation(s)
- Máire E Doyle
- National Institute on Aging/Intramural Program, 251 Bayview Blvd, Baltimore MD 21224
| | - Ashley Appleton
- National Institute on Aging/Intramural Program, 251 Bayview Blvd, Baltimore MD 21224
| | - Qing-Rong Liu
- National Institute on Aging/Intramural Program, 251 Bayview Blvd, Baltimore MD 21224
| | - Qin Yao
- National Institute on Aging/Intramural Program, 251 Bayview Blvd, Baltimore MD 21224
| | | | - Josephine M Egan
- National Institute on Aging/Intramural Program, 251 Bayview Blvd, Baltimore MD 21224
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Appleton A, Singh S, Eady N, Buszewicz M. Why did you choose psychiatry? a qualitative study of psychiatry trainees investigating the impact of psychiatry teaching at medical school on career choice. BMC Psychiatry 2017; 17:276. [PMID: 28754157 PMCID: PMC5534074 DOI: 10.1186/s12888-017-1445-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is no consensus regarding the optimal content of the undergraduate psychiatry curriculum as well as factors contributing to young doctors choosing a career in psychiatry. Our aim was to explore factors which had influenced psychiatry trainees' attitudes towards mental health and career choice. METHOD Qualitative in-depth interviews with 21 purposively sampled London psychiatry trainees analysed using the Framework method. RESULTS Early exposure and sufficient time in undergraduate psychiatry placements were important in influencing psychiatry as a career choice and positive role models were often very influential. Integration of psychiatry with teaching about physical health was viewed positively, although concerns were raised about the potential dilution of psychiatry teaching. Foundation posts in psychiatry were very valuable in positively impacting career choice. Other suggestions included raising awareness at secondary school level, challenging negative attitudes amongst all medical educators, and promoting integration within medical specialties. CONCLUSIONS Improvements in teaching psychiatry could improve medical attitudes and promote recruitment into psychiatry.
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Affiliation(s)
- A. Appleton
- 0000000121901201grid.83440.3bResearch Department of Primary Care and Population Health, University College London, London, NW3 2PF UK
| | - S. Singh
- 0000000121901201grid.83440.3bResearch Department of Primary Care and Population Health, University College London, London, NW3 2PF UK
| | - N. Eady
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, 9 Alie Street, London, E1 8DE UK
| | - M. Buszewicz
- 0000000121901201grid.83440.3bResearch Department of Primary Care and Population Health, University College London, London, NW3 2PF UK
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Bartz B, Collins M, Stoddard G, Appleton A, Livingood R, Sobcynski H, Vogel KD. Assessment of nonpenetrating captive bolt stunning followed by electrical induction of cardiac arrest in veal calves. J Anim Sci 2016; 93:4557-63. [PMID: 26440354 DOI: 10.2527/jas.2015-9332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to evaluate the impact of nonpenetrating captive bolt stunning followed by electrical induction of cardiac arrest on veal calf welfare, veal quality, and blood yield. Ninety calves from the same farm were randomly assigned to 1 of 2 treatment groups in a balanced unpaired comparison design. The first treatment group (the "head-only" method-application of the pneumatic nonpenetrating stun to the frontal plate of the skull at the intersection of 2 imaginary lines extending from the lateral canthus to the opposite poll [CONTROL]) was stunned with a nonpenetrating captive bolt gun ( = 45). The second group ( = 45) was stunned with a nonpenetrating captive bolt gun followed by secondary electrical induction of cardiac arrest (the "head/heart" method-initial application of the pneumatic nonpenetrating captive bolt stun followed by 1 s application of an electrical stun to the ventral region of the ribcage directly caudal to the junction of the humerus and scapula while the stunned calf was in lateral recumbence [HEAD/HEART]). Stunning efficacy was the indicator of animal welfare used in this study. All calves were instantly rendered insensible by the initial stun and did not display common indicators of return to consciousness. For meat quality evaluation, all samples were collected from the 12th rib region of the longissimus thoracis. Meat samples were evaluated for color, drip loss, ultimate pH, cook loss, and Warner-Bratzler shear force. The L* values (measure of meat color lightness) were darker ( < 0.05) in the HEAD/HEART group (45.08 ± 0.72) than the CONTROL group (47.10 ± 0.72). There were no differences ( > 0.05) observed in a* (redness) and b* (yellowness) values between treatments. No differences ( > 0.05) were observed in drip loss, ultimate pH, cook loss, and Warner-Bratzler shear force. The blood yield from the CONTROL group (7,217.9 ± 143.5 g) was greater ( < 0.05) than that from the HEAD/HEART group (6,656.4 ± 143.5 g). Overall, the data indicated no difference between the CONTROL and HEAD/HEART groups with regard to animal welfare because the initial stun was effective in all calves. However, longissimus thoracis L* and blood yield were negatively impacted by the HEAD/HEART method. The data in this study suggest that secondary induction of cardiac arrest is not necessary with effective nonpenetrating captive bolt stunning in veal calves.
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Abstract
Re-expansion pulmonary oedema is a recognised but rare complication following the rapid drainage of a large pleural effusion or pneumothorax [1,2], usually occurring on the side of re-inflation. The pathogenesis of the pulmonary oedema is poorly understood but is thought to be due to micro-vascular shearing resulting in neutrophil activation and adhesion to the vascular endothelium resulting in increased micro-vascular permeability [3-7]. Few reports appear in the literature of invasive haemodynamic monitoring following this catastrophe. We describe a patient who sustained fatal pulmonary oedema arising in the contralateral lung, with pulmonary flow catheter data documenting the initial circulatory collapse following the aspiration of a massive pulmonary effusion.
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Affiliation(s)
- A Gascoigne
- Intensive Therapy Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Appleton A. Medicaid fraud & abuse control. Caring 1985; 4:53-4. [PMID: 10300234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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