Decrease In Representation Research Articles

D69. Racial/Ethnic and Gender Representation Trends of Applicants and Matriculants to Plastic Surgery Residency Programs from 2010-2018

PURPOSE: To evaluate representation trends of races and genders applying to plastic surgery using novel methodology. METHODS: Reports on race and gender of medical school graduates, plastic surgery applicants, and matriculants between 2010-2018 were obtained. The proportion of each racial and gender identity among applicants and matriculants were divided by a denominator of their proportion among medical school graduates to produce representation quotients: RQapp, RQmat. Linear regression was performed to assess yearly representation changes. Non-parametric testing was used to assess differences in average representation within identities. P<0.05 was deemed significant. RESULTS: There were 4,251 applicants and 1,197 matriculants. Among matriculants, Asian men declined in representation (RQmat slope: -6.0x10-2); Asian women had increased representation (RQmat slope: +9.7x10-2). On average, all men applicants were overrepresented (RQmat=1.29). Hispanics were the most represented among women applicants (RQapp=0.87); all others had RQapp<1. For matriculants, Hispanic men (RQmat=1.41) were most represented; Black women (RQmat=0.38) were the least. Black men experienced the largest decrease in representation (RQapp=1.60 vs. RQmat=0.76; p=0.002). CONCLUSION: Black men were overrepresented among plastic surgery applicants but underrepresented as matriculants. Women remained underrepresented in both cohorts. Greater support for these groups may help reduce the apparent representation gaps.

Quantifying the Pipeline of Ethnically Underrepresented in Medicine Physicians in Academic Plastic Surgery Leadership.

The lack of underrepresented in medicine (UIM) physicians in academic plastic surgery is emerging as a critical issue. Lack of diversity has a negative effect on patient care and on the culture of our health care system. This study reports the current status of ethnically UIM physicians in the plastic surgery pipeline, starting from the medical student level and progressing to national leadership positions. The Electronic Residency Applications Service, National Resident Matching Program, Association of American Medical Colleges, and professional Web sites for journals and national societies were accessed for racial demographic information from 2008 to 2019. Over the past decade, there has been no change or a slight decrease in representation of Blacks among plastic surgery residency applicants, trainees, and academic faculty, at half or less than expected, compared with US Census data. The first point of drop-off occurs at the resident (3.8% of integrated and 5.6% of independent residents) to faculty level (<2.8%). Two percent of program directors and department heads/division chiefs are Black. The next point of drop-off occurs at the national level: there has never been a Black president of American Society of Plastic Surgeons or Plastic Surgery Foundation, and there are no Black editors-in-chiefs of major plastic surgery journals.Following LatinX American surgeons down the pipeline over the past decade, there has been no change or a decrease in representation among plastic surgery residency applicants, resident physicians, and academic faculty, at one-third or less than expected, compared with US Census data. The first point of drop-off occurs at the faculty (4.8%) to local leadership level (0% of program directors and department heads/division chiefs) where there is no representation of LatinX. Once this drop-off occurs, there is no recovery at the national leadership level. In order for our profession to reflect our nation's demographics, academic plastic surgery is in need of a paradigm shift now. Attrition of UIM physicians in plastic surgery begins at medical school graduation and persists through surgical training, faculty appointments, and attainment of leadership positions. Creative and innovative commitment to diversity and inclusion is necessary.

Is There Color or Sex Behind the Mask and Sterile Blue? Examining Sex and Racial Demographics Within Academic Surgery.

The lack of underrepresented minorities has been a persistent issue within the surgical workforce. Equal sex representation has also been a problem in surgery. Underrepresented minorities females face the unique challenge of being a minority in both race and sex. The objective of this retrospective cross-sectional study is to determine the racial and sex demographics of medical trainees and faculty and determine the degree to which minority women are underrepresented at higher ranks and leadership. Race and sex demographic data for all medical students, surgical residents and faculty was extracted from the AAMC data files. This data was compared to the US population using chi squared tests. Race and sex breakdowns of the different surgical subspecialties was also analyzed using chi squared tests. Demographics of surgical faculty at various ranks are also reported. White men made up 37% of all surgical residents. Black men made up only 1.9% of all surgical residents whereas Black women made up 2.6%. The subspecialty with the smallest percentage of Black women was Orthopedic Surgery with 0.6%. The specialty with the highest representation of Black women was Ob/Gyn with 6.2%. There was a decrease in representation of Black women with each increase in professional rank, with 2.8%, 1.6%, and 0.7% for assistant, associate, and full professor, respectively, as compared to Black men, who as a percentage, remained stable at the various ranks with 2.1%, 2.4%, and 2.1% for assistant, associate, and full professor, respectively. There is a striking lack of minority women in surgery. This trend is amplified as surgeons progress from student, to resident, to attending, and then to leadership positions.

Studying the microbial landscape of peritoneal exudate in acute diffuse purulent peritonitis

Aim. To study current trends in changing microbial landscape of peritoneal exudate for improving treatment outcomes, as well as the generalization of the methods of predicting fatal outcomes of postoperative peritonitis, its etiological and pathogenetic treatment.Methods. A bacteriological study of peritoneal exudate in 60 patients with purulent peritonitis at toxic and terminal phases, who were treated in the department of purulent surgery, and their comparison with the results obtained 10 years ago were performed. Laboratory testing was performed, APACHE II (Acute Physiology And Chronic Health Evaluation - scale for the evaluation of various acute and chronic diseases), Mannheim peritoneal index, albumin-globulin ratio, leukocyte index of intoxication were calculated.Results.During the 10-year period change in the microbial landscape of peritoneal exudate in patients with postoperative peritonitis was registered, with a statistically significant decrease in representation of Enterobacter, Staphylococcus, Escherichia coli, Pseudomonas aeruginosa bacteria, and increase in representation of Streptococci, Enterococci and anaerobic gram-negative cocci, Citrobacter, Klebsiella. Study results of microflora sensitivity to antibiotics showed that the vast majority (over 90%) of peritoneal infection pathogens has full or partial resistance to all antibiotics; antimicrobial effect increased in case of combined treatment using two or three drugs with a synergistic effect. With a decrease in the albumin-globulin ratio by 0.1 from 1.5 the mortality rate increased by 5-10%, and in patients with multiple organ failure was doubled (pConclusion. Prediction of postoperative peritonitis, complications and outcomes allows their timely prevention and treatment; basic conditions of preventing peritonitis are primary qualitative debridement of the abdominal cavity, the right choice of surgical volume, starting adequate antibiotic therapy, qualified perioperative anesthetic management and a complex of adequate pathogenetic treatment.

Deficits in receptor-mediated endocytosis and recycling in cells from mice with Gpr107 locus disruption.

GPR107 is a type III integral membrane protein that was initially predicted to be a member of the family of G-protein-coupled receptors. This report shows that deletion of Gpr107 leads to an embryonic lethal phenotype that is characterized by a reduction in cubilin transcript abundance and a decrease in the representation of multiple genes implicated in the cubilin-megalin endocytic receptor complex (megalin is also known as LRP2). Gpr107-null fibroblast cells exhibit reduced transferrin internalization, decreased uptake of low-density lipoprotein (LDL) receptor-related protein-1 (LRP1) cargo and resistance to toxins. Colocalization studies and proteomic analyses suggest that GPR107 associates with clathrin and the retromer protein VPS35 and that GPR107 might be responsible for the return of receptors to the plasma membrane from endocytic compartments. The highly selective deficits observed in Gpr107-null cells indicate that GPR107 interacts directly or indirectly with a limited subset of surface receptors.

Effects of emergency department Care Coordination Team referrals in older people presenting with a fall

The study aims to describe the characteristics of patients presenting to an ED with a fall and evaluate multidisciplinary Care Coordination Team (CCT) referrals on patient outcomes. A single-centred retrospective analysis of electronic data at an adult tertiary hospital was performed using data from 2004 to 2009 of presentations for patients aged 65 years or over with a fall. The primary outcome measure was representation to hospital within 30 days, comparing patients referred to CCT and those not referred. Secondary outcomes were differences in demographic characteristics, mode of arrival, triage score and readmission. The proportion of ED patients presenting with a fall and their mean age is stable over time. From 2006 to 2009, 5162 fallers were referred to CCT in a decreasing trend, but with increased urgency. Statistically significant predictors for being referred to CCT were increasing age, being female, arriving by ambulance, being transferred from a nursing home and higher socioeconomic category. Arrival by ambulance and a history of previous falls were associated with representation and readmission. A decreasing trend from 2006 to 2009 was seen in rate ratios and odds ratios via regression modelling for both representation and readmission in patients referred to CCT. Maturing of the CCT is associated with a decrease in representation and readmission rate. Over time, the CCT attended higher urgency patients associated with stable admission rates. These associations were not significant and the clinical effectiveness of ED CCTs requires further examination.

Abstract A97: An analysis of diversity based on race and ethnicity in the radiation oncology workforce

Abstract Background/Purpose: The American Association for Cancer Research has created initiatives to increase the participation of minority scientists in cancer research, while the American Society of Clinical Oncology has similarly set the objective of diversifying the clinical oncology workforce as a “requisite to improving cancer care for the underserved.” Studies indicate that racial/ethnic minority providers are more likely to serve in minority and medically underserved communities and more likely to pursue research on health disparities. The Association of American Medical Colleges (AAMC) recently examined diversity in the oncology workforce in Forecasting the Supply of and Demand for Oncologists, however, data on Radiation Oncology (RadOnc), specifically, were not included. To our knowledge, no published studies have examined racial/ethnic diversity within RadOnc. Nearly two-thirds of all cancer patients will undergo radiation therapy during their treatment course. The purpose of this study was to assess the diversity of the RadOnc workforce, with particular attention to the resident trainee level, and compare the findings to that of medical school graduates, Hematology/Medical Oncology (MedOnc) fellows, and the general population. Methods: The most recent available public registries (2004–2010) from the American Medical Association, AAMC, and United States Census were used to assess racial/ethnic diversity. Significant differences in race/ethnicity were investigated between RadOnc residents and: 1) medical school graduates, 2) MedOnc fellows, and 3) RadOnc practicing physicians. All levels were compared to the general population. Statistical analyses were performed using chi-squared tests. Results: Based on 2007 data, there was a significant decrease in representation of Blacks from medical school graduates to RadOnc residents (6.7% vs. 3.4%, p=0.0038), an increase of Asians (20.4% v. 29.1%, p&amp;lt;0.0001) and no change for Hispanics (6.8% vs. 7.2%, p=0.91). Blacks submitted on average less RadOnc residency applications (28.5) than did Whites (35.4), Asians (35.7), or Hispanics (36.0); overall mean 34.3. When comparing RadOnc and MedOnc trainees, there was no difference in Blacks (3.4 vs. 3.7%, p=0.87) and Hispanics (7.2 vs. 7.4%, p=0.90), less Asians (29% vs. 36%, p=0.006), and more Whites (59.2% vs. 52.9%, p=0.019). When comparing the pool of RadOnc residents to practicing physicians, there were no significant differences for Blacks and Hispanic, while Asians were increased (35.5% vs. 14.9%, p&amp;lt;0.0001). Blacks and Hispanics were significantly underrepresented as RadOnc residents (3.4% and 7.2%, respectively) and practicing physicians (4.4% and 3.1%, respectively) and MedOnc fellows (3.7% and 7.4%, respectively) in comparison to the general population (12.6% and 16.3%, respectively), while Asians and Whites were proportionally increased (all Ps &amp;lt; 0.0001). Conclusions: Blacks and Hispanics are underrepresented in RadOnc at the residency and practicing physician levels compared to the overall population. Blacks remain underrepresented in the RadOnc resident trainee level when compared to their proportions as medical school graduates, suggesting that underrepresentation of these groups is not diminishing. Given existing cancer disparities and the potential to address them through diversification of the physician workforce, further research is needed to investigate whether these disparities simply represent different preferences in specialty choice, or other factors such as differences in exposure, selection, recruitment, mentorship, research, and/or real vs. perceived ability to successfully attain residency positions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A97.

Effects of elevated atmospheric CO 2 on rhizosphere soil microbial communities in a Mojave Desert ecosystem

The effects of elevated atmospheric carbon dioxide [CO 2] on microbial communities in arid rhizosphere soils beneath Larrea tridentata were examined. Roots of Larrea were harvested from plots fumigated with elevated or ambient levels of [CO 2] using Free-Air CO 2 Enrichment (FACE) technology. Twelve bacterial and fungal rRNA gene libraries were constructed, sequenced and categorized into operational taxonomical units (OTUs). There was a significant decrease in OTUs within the Firmicutes (bacteria) in elevated [CO 2], and increase in Basiomycota (fungi) in rhizosphere soils of plots exposed to ambient [CO 2]. Phylogenetic analyses indicated that OTUs belonged to a wide range of bacterial and fungal taxa. To further study changes in bacterial communities, Quantitative Polymerase Chain Reaction (QPCR) was used to quantify populations of bacteria in rhizosphere soil. The concentration of total bacteria 16S rDNA was similar in conditions of enriched and ambient [CO 2]. However, QPCR of Gram-positive microorganisms showed a 43% decrease in the population in elevated [CO 2]. The decrease in representation of Gram positives and the similar values for total bacterial DNA suggest that the representation of other bacterial taxa was promoted by elevated [CO 2]. These results indicate that elevated [CO 2] changes structure and representation of microorganisms associated with roots of desert plants.

VH replacement is unlikely to contribute significantly to receptor editing due to an ineffectual embedded recombination signal sequence

Receptor editing is a process consisting of replacement of pre-existing H or L chain rearrangements by secondary rearrangements. This process could serve to remove autoreactive specificities, or to rescue loci with non-functional rearrangements. At the H chain locus, functional replacement of a V HDJ H rearrangement by an upstream V H requires the presence of an embedded RSS located in reverse orientation near the 3′ end of the V H segment. Although most V H genes contain a fairly consensus embedded heptamer, the nonamer sequence bears little resemblance to the consensus RSS nonamer. Therefore, the physiologic rate of H chain editing by V H replacement is yet unknown. In this study, we used both conventional and sensitive competition recombination substrate assays to determine the recombination frequency of the V H81X embedded RSS relative to consensus and non-consensus RSS’s. Results show no detectable recombination of the 81X embedded RSS in a recombination substrate, and the competition substrate allows us to estimate that the 81X embedded RSS recombines at least 1300 fold less often than a consensus RSS. This suggests that V H gene replacement is not responsible for the decrease in representation of the 81X gene during differentiation. Furthermore, since the sequence of the embedded RSS is very similar for many V H genes, our results suggest that receptor editing of the H chain will be an infrequent event, leaving L chain editing as the main mode of avoiding autoreactive specificities in vivo.

Pollen dispersal and representation on an offshore island.

The effects of spatial isolation on pollen representation were examined in a study of seven small kettle ponds on Block Island, a small, unforested island 19 km off the New England Coast (USA). Modern pollen assemblages from the ponds were compared with modern assemblages from similar ponds on the adjacent, partly forested mainland and in extensively forested northern New York. Representation of pollen from local and extralocal sources was amplified on the island owing to spatial isolation. However, variation among pollen assemblages on the island was not clearly related to spatial variation in vegetation composition. Significant transport of pollen from the mainland to the island was observed. There appeared to be little or no decrease in representation of large, poorly dispersed mainland pollen types between the mainland and island. This latter result may indicate differences between the mainland and island in the predominant modes of pollen transport, or alternatively, effects of local pollen source strength on representation of pollen from distant sources. Based on our results, we propose a theory of pollen representation on islands that can be tested and applied on offshore islands and patchy landscapes.

Anthophilous Fly Distribution Across an Elevation Gradient

-Flower-visiting Diptera are abundant in montane and Arctic areas. This research, conducted on the western slope of the Colorado Rocky Mountains: (1) characterizes the predominant anthophilous fly taxa in comparison with other high-elevation and highlatitude sites; (2) examines changes in fly abundance with elevation, and (3) examines the potential of flies as pollinators by examining quality and quantity of pollen loads. Flies collected from 66 flowering species were identified to species to produce a data base containing taxonomic information, elevation and floral records. Malaise trap censuses were conducted in three elevational zones. Pollen carried by flies and pollen in their guts were quantified and examined to determine the number of plant species represented. Proportional representation of dipteran families changed in a similar manner in different mountain systems and the Arctic. The predominance of flies on flowers at high elevations appears to be due to a decrease in representation of other orders of insects. Most fly taxa fed at multiple plant species, but gut contents indicated that individual flies fed largely on a single pollen type. Total pollen loads of flies and solitary bees were similar although flies collected on Linum lewisii carried less pollen than bees.

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For investigation of the hypothesis that elevated birth weight characterizes children dying from cancer, birth weights of over 3,000 children who died of cancer were compared with those of matched controls alive at the time of the case's death. Analysis revealed no consistent pattern of association between birth weight and subsequent cancer death. Girls who died of solid tumors between ages 1 and 10 had a significantly higher mean birth weight and an excess of high birth weights separate from the influence of maternal age, birth order, and socioeconomic status. Boys who died of solid tumors between birth and 2 years had a significantly lower mean birth weight and exhibited a significant, progressive linear decrease in representation across the birth-weight distribution in the controlled analysis. However, this study, the largest to date, did not support previous claims that birth weight may be an important predictor of childhood cancer risk.