Resident Research Research Articles

Comfort With Uncertainty in Medical Students and Their Residency Choice: A Residency Research Network of Texas Study.

Little is known about how comfort with uncertainty (CwU) influences career choice in medical students. The authors of this study examined the correlation between CwU and primary care career choice. In academic years 2017-2018 and 2018-2019, the authors distributed surveys to third-year medical students from eight US medical schools, seven in Texas. The survey tool included two CwU scales and one comfort with ambiguity scale. Other questions covered career plans, family and personal background, and student debt. In the subjects' fourth year of medical school, authors obtained match data from the medical schools and the authors further communicated with the students where indicated. The primary outcome was the composite score of the three scales correlated to career choice, with a focus on primary care and family medicine. Among 642 participants, there was no difference in CwU scores between students who matched into primary care versus specialty fields (3.39 vs 3.37 average of three scales, P=.65, each individual scale NS) or family medicine (FM) vs all other fields (3.39 vs 3.37 average of three scales, P=.81). Other bivariate predictors of FM choice were more similar than different to previous studies, such as osteopathic more likely than allopathic, lower family income, planning to care for underserved populations, and had a primary care role model. Logistic regression found the two biggest predictors of FM were osteopathic training and the importance of educating patients about health promotion and disease prevention. We found no correlation between CwU and medical student career choice for primary care or FM. We discuss confounding factors that may impact results, as well as recommendations for medication education and public policy.

Publication rates of pharmacy residents involved in a team-based research program.

The University of Oklahoma College of Pharmacy (OUCOP) implemented an individualized residency research committee and skill development program to facilitate completion and publication of research projects. The purpose of this study was to evaluate the outcomes the program had on project publication rates and subsequent publications after graduation for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents. This study included OUCOP PGY1 and PGY2 residents from classes graduating from 2011 through 2019. Literature searches for all resident projects and subsequent publications were performed. Data collection included residency type (PGY1 vs PGY2), initial position after residency, and project type. The primary objective was to identify the publication rate of research projects. Secondary objectives included a comparison of the number of publications after residency graduation between residents who did and did not publish their residency project and analysis of factors associated with subsequent publications. Zero-inflated Poisson regression was utilized to analyze subsequent publication status controlling for other factors. Statistical analyses were performed using SAS/STAT with an a priori P value of <0.05. Eighty-two projects were completed by 73 residents. Forty-three of 82 projects were published (52.4%) by 39 of 73 residents (52.1%). After residency graduation, 54 residents (74.0%) had a subsequent publication. Factors associated with subsequent publications were initial position in an academic role and completion of additional training after residency. After implementation of the program, the majority of residents published their projects and had subsequent publications. Future efforts should be taken to identify opportunities to foster independence in research and scholarship for residents.

Learning to SuRRF: Sustained Engagement and Increased Academic Productivity Over Two Years of a Resident-Led Virtual Laboratory

To determine if implementation of a resident-led virtual laboratory can sustain increased engagement and academic productivity in residents and faculty. We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. SuRRF utilizes monthly virtual lab meetings, weekly newsletters, a centralized database of projects, project tracking tools, and a shared calendar of deadlines to facilitate research among surgical residents. Data on number of participating residents, faculty, and projects across SuRRF meetings at 1-year (7/2020) and 2-years post-implementation (9/2021) were collected to evaluate engagement. Institutional ACGME Resident Scholarly Activity and Faculty Scholarly Activity reports were evaluated for the pre-SuRRF implementation (2018-2019) and post-implementation (2020-2021) academic years to assess productivity pre- and post-implementation. Three tertiary academic hospitals of a single health system in New York. All residents in our general surgery program during the study period, including research residents, were eligible to participate in our study. At 1-year, there were 2 attendings, 13 residents, and 23 projects, compared to 12 attendings, 25 residents, and 42 projects at 2-years post-implementation. Post-SuRRF implementation, residents had significantly more publications (0.56 ± 0.15 vs. 1.10 ± 0.15, p = 0.005), textbook chapters (0.00 vs. 0.010 ± 0.044, p = 0.014), research participation (p < 0.01), and scholarly activity (p = 0.02). Post-SuRRF, faculty had significantly more publications (0.74 ± 0.15 vs. 2.20 ± 0.33, p < 0.001) and scholarly activity (p = 0.006). SuRRF promotes exposure to projects and resources and increases collaboration and peer-to-peer mentorship. Our experience with SuRRF suggests that resident-led virtual laboratories may increase peer-reviewed publications and improve resident and faculty engagement in scholarly activity, thus supporting academic growth.

Research Productivity of Integrated Plastic Surgery Residents: Does Reputation Matter?

It is unknown whether the ranking of plastic surgery residency programs influences resident research output. This study aims to determine whether program reputation and other factors are associated with integrated plastic surgery resident academic productivity. Programs were divided into four tiers based on Doximity reputation rankings. Residents from 2019 to 2020 were found through program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year to August 10, 2020. Variables included resident demographics and medical school, residency reputation ranking, geographic region, and medical school affiliation. 'High research output' was defined as having ≥75th percentile of publications adjusted by training year. In total, 921 residents in 80 programs were identified. The median (IQR) number of total publications and original articles was 3 (1-6) and 2 (0-4), respectively. On multivariable analysis, residents in top-20 ranked programs (OR=2.31, 95% CI [1.55; 3.43], P<0.001) or from programs associated with top-20 medical schools (OR=1.61, 95% CI [1.08; 2.41], P=0.020) were more likely to have higher research output. On the other hand, coming from a top-50 in research medical school (OR=1.80, 95% CI [1.31; 2.47], P<0.001) or being in a program affiliated with a top-20 medical school (OR=2.52, 95% CI [1.69; 3.78], P<0.001) were associated with higher original article output. Gender and geographic location were not associated with higher research output. Program reputation and affiliated medical school research rankings are associated with research productivity during integrated plastic surgery residency. Applicants with a particular interest in research careers may consider this as they apply to residency.

Research and surgical residency: moving beyond one-and-done projects and motivating for scholarly excellence.

SummaryAmong surgical residents, research is often perceived as a check-mark exercise. Focus then turns to studying for exams and honing skills for independent practice. While some residents are passionate about research and enroll in other formalized training, pragmatists argue that not every surgeon should engage in research at this level. However, no resident should view research as a one-and-done activity. Rather, research should be viewed as an exercise to improve practice, share gaps in knowledge, collaborate, and empower others to formally study and implement change. The skills acquired during research experiences, at minimum, have value in improving the trainee’s literature literacy, which in turn serves as a foundational element of continuing medical education. A culture supportive of scientific discovery, facilitated by both faculty and peer-to-peer mentorship, will result in better collaborative efforts and lead to improved knowledge generation and resident research satisfaction.

Research on the Impact of Social Propaganda and Guidance Policies on Public Green Travel Intention: Evidence From China

Social propaganda and guidance policies have important practical significance for promoting public green travel. In recent years, the rapid development of digital technology, network, and mobile communication technology has promoted a revolutionary change in the dissemination of information and services. However, in the era of new media communication driven by emerging technologies, there is still a lack of research on the impact of social propaganda and guidance policies on public willingness to travel green. Based on the theory of planned behavior and the survey research of China's urban residents, this study investigates the impact of social propaganda and guidance policies on public willingness to travel green. Regression analysis is used to identify the influencing factors of public green travel willingness, and to reveal the internal impact mechanism of social propaganda and guidance policies on public green travel willingness. The mediating role of public green travel attitude, subjective norm, and perceived behavior control in social propaganda and guidance policy and travel willingness are also empirically analyzed. The results show that social propaganda and guidance policies have a significant positive impact on green travel attitudes, subjective norms, perceived behavior control, and green travel intentions. Green travel attitude, subjective norm, and perceived behavior control play a mediating role in the relationship between social propaganda and guiding policies and green travel willingness, but the mediating effect of the subjective norm is relatively weak.

A Bibliometric Analysis of Ophthalmology Resident Research Productivity in the United States.

Background The extent and impact of ophthalmology resident scholarly output is not well known. The authors aim to quantify scholarly activity of ophthalmology residents during residency and assess what factors may be associated with greater research productivity of these residents. Material and Methods Ophthalmology residents who graduated in 2021 were identified from their respective program Web sites. Bibliometric data published by these residents between the beginning of their postgraduate year 2 (July 1, 2018) until 3 months after graduation (September 30, 2021) were captured through searches via PubMed, Scopus, and Google Scholar. The association of the following factors with greater research productivity numbers was analyzed: residency tier, medical school rank, sex, doctorate degree, type of medical degree, and international medical graduate status. Results We found 418 ophthalmology residents from 98 residency programs. These residents published a mean (±standard deviation [SD]) number of 2.68 ± 3.81 peer-reviewed publications, 2.39 ± 3.40 ophthalmology-related publications, and 1.18 ± 1.96 first-author publications each. The mean (±SD) Hirsch index (h-index) for this cohort was 0.79 ± 1.17. Upon multivariate analysis, we discovered significant correlations between both residency tier and medical school rank and all bibliometric variables assessed. Pairwise comparisons revealed that residents from higher tier programs had greater research productivity numbers than those from lower tier programs. Conclusion We obtained bibliometric standards for ophthalmology residents on a national scale. Residents who graduated from higher-ranked residency programs and medical schools possessed higher h-indices and published more peer-reviewed publications, ophthalmology-related articles, and first-author publications.

Open Mental Health: A Mental Health Eco System Developed in Collaboration With Communities

AimsSomerset drew upon the Community Mental Health (MH) Service Framework, and local experience and recognised that too often service user experience of mental health was beset with artificial barriers, gateways and eligibility with people sometimes needing to deteriorate before they got the vital support they needed. In addition, we recognised that the gap between secondary care and primary care was experienced by service users as a “cliff edge”. The radical redesign of mental offers in Somerset aimed to deliver an experience of “no wrong door” and where, via a partnership between health, social care and Voluntary, Community and Social Enterprise (VCSE), people's needs could be met; both in terms of specific mental health offers as well as tackling the wider determinants of mental ill health.MethodsOMH was launched early 2019, just before the pandemic, and so traditional project methodology did not always apply. Instead all partners focused on standing up the offer at pace in order to support the population within Somerset with the emotional and psychological consequences of the pandemic, and any pre existing challenges. The model was co-produced with Experts by Experience significantly contributing to the shape of the offers.The model developed comprised of two key facets: •A mental health offer, where the needs of individuals, families and carers are met by a range of health, social care and VCSE partners (including the wider determinants of mental well being such as finance / housing)•A mental health eco system developed in collaboration with communities (including underserved communities), where support is available throughout geographical communities and communities of identity.ResultsThe project has delivered both quantitively and qualitatively. Over 4100 additional appointments are offered to people in Somerset per month and reported outcomes and evaluation has been very positive. Work is underway to collate further Patient Related Outcome Measures. Following a Realist Evaluation methodology, the researcher in residence has highlighted the culture changes that are key to delivering the aspirations of the Community MH Service framework. These include; the narrative of “no wrong door”, an increased and open range of offers and interventions, blended staffing models across traditional organisational boundaries, partnership working, the role of lived experience and the ambition of addressing inequalities.ConclusionOMH, the product of Community MH Transformation in Somerset, is a radical and co produced redesign of MH services in partnership with the VCSE and Local Authority that has improved access and support to all people in Somerset.

Academic career outcomes of Orthopedic Research and Education Foundation resident grant recipients.

The Orthopedic Research and Education Foundation (OREF) awards resident research grants to orthopedic surgery residents. Outcomes are lacking for OREF resident grant recipients including academic career choice and scholarly productivity. This was a retrospective cohort study of OREF resident grant recipients (2012-2020). The percentage of OREF resident grant recipients selecting an academic career was compared with the percentage of academic orthopedic surgeons in the United States via a χ2 test. Two hundred and seventy-six OREF resident grants were issued to 272 orthopedic surgery residents at 73 programs. OREF resident grant recipients were predominantly male (79.0%) and Caucasian (70.2%). OREF resident grant recipients had greater women representation than the national cohort of orthopedic surgery residents (21.0% vs. 16.0%, p = 0.030) with similar proportions of underrepresented racial minorities (29.8% vs. 27.2%, p = 0.351). OREF resident grants consisted of clinical (69.6%) and basic/translational science (30.4%) research and were awarded mostly for sports medicine (25.4%), trauma (18.8%), and adult reconstruction (15.9%) topics. The average h-index was 8.5 ± 9.2 resulting from 29.5 ± 51.2 manuscripts. The majority of OREF resident grant recipients selected an academic career, which was higher than the national benchmark of academic orthopedic surgeons (63.8% vs. 24.4%, p < 0.001). Two OREF resident grant recipients transitioned to National Institutes of Health research funding (0.7%). Multivariable logistical regression demonstrated two independent characteristics associated with pursuit of a future academic career: female sex (p = 0.042) and higher h-index values (p = 0.002). Procurement of OREF resident grants is associated with pursuit of an academic career.Clinical significance: There is great interest in fostering the next generation of orthopedic surgeon scientists. Results from this study demonstrate the association between receipt of an OREF resident research grant and pursuit of a future career in academic orthopedic surgery.

Establishing a Departmental Symposium for Resident Scholarly Activity: How We Did It

Many radiology departments have successfully increased trainee research involvement by providing protected academic time for research, offering travel funding for conferences, and developing research-focused curriculum via resident research tracks and other mechanisms. A departmental platform for trainees to share their scholarly projects can foster intradepartmental awareness and collaborations, supplement the existing resident research curriculum, encourage peer learning amongst trainees, and allow departmental celebration of their trainees' accomplishments. The authors describe the development of a departmental symposium for resident scholarly activity at their institution and detail a practical framework for implementation and lessons learned, which may serve as a guide for other radiology departments interested in establishing a similar event.

0794 Understanding Barriers and Communication Behaviors Impacting Referral to Sleep Surgery: Qualitative Patient Perspectives

Abstract Introduction Shared decision-making is a process when patients, families, and clinicians work together to make optimal, personalized medical choices in the face of more than one reasonable treatment option. These interactions can influence the joint decision and may have lasting impressions for future healthcare encounters. Considering the American Academy of Sleep Medicine’s recent clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation, we aimed to understand patient experiences, in terms of barriers and communication behaviors in the referral process to sleep surgery consultation. Methods We performed a qualitative study consisting of in-depth semi-structured virtual interviews with adult patients (aged ≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep, scored by AASM-accredited standards) and who were recommended for sleep surgery at a tertiary Sleep Surgery Clinic. Open ended questions focused on patient experiences during healthcare encounters from diagnosis, trials with noninvasive management options and ultimate referral to sleep surgery. The interviews were audio-recorded, transcribed, and analyzed using content analysis to identify themes. Results Ten adult patients with OSA who were evaluated in sleep surgery clinic were approached and enrolled from March through April 2021. Barriers to sleep surgery clinic included delays in OSA diagnosis due to limited OSA awareness and perceived inconvenience of sleep study, providers faulting patient for persistent sleep symptoms, patient-reported lack of urgency by providers in troubleshooting noninvasive management options, scheduling delays and waitlists, and cost. Patients were open to trialing noninvasive treatment options, though opportunities for reevaluation and shared decision-making may address unmet needs, as inadequate improvements led to frustration after multiple encounters. Patients appreciated providers who were empathetic and provided information sharing, in terms of transparent and understandable explanations. Conclusion This study focused on experiences of patients with OSA and barriers faced to reach sleep surgery consultation. Improved communication structure to discuss unresolved concerns and remaining management options, as well as vetted resources, would set the foundation for effective shared decision-making and timely referral for sleep surgery consultation. Support (If Any) Academy of Otolaryngology Head and Neck Surgery Resident Research Centralized Otolaryngology Research Efforts (CORE). NIH T32 DC000018.

Are resident research projects correlated to future subspecialty choice in orthopaedic surgery? A ten-year retrospective review of a single centre's experience.

To determine (1) frequency of resident research projects being in the same orthopaedic subspecialty that they ultimately choose for fellowship and practice; (2) percentage of research projects that were published. Resident Thesis Day programs were independently assessed by two reviewers from 2010 to 2020. Reviewers classified projects based on orthopaedic subspecialty: Spine, Joints, Trauma, Hand, Foot and Ankle, Sports, Pediatrics, Oncology, and Shoulder Elbow. Presenting residents' fellowship subspecialty, current practice specialty, and geographic state of current practice were collected using internet searches. Correlation of residents who completed a thesis day project in the same subspecialty as their fellowship and current practice was calculated. A total of 81 resident physicians, 11 (13.6%) female, were included. In the entire cohort, 50.6% did a thesis day project in a different field than their current or projected subspecialty. Of those who completed, or are currently completing fellowship, 33 (52.4%) did their thesis day project in the same subspecialty as their fellowship. Of the current residents who have matched into fellowship, 46.7% did a thesis day project in the same subspecialty. A total of 51 (63.0%) projects were published. The majority of resident research projects were published, and about 50% of orthopaedic residents went on to complete a fellowship and practice in the same subspecialty as their research project. As residents often spend a considerable amount of time and effort on their projects, these findings may help tailor resident education and research curriculums to focus more on research principles than specific orthopedic content.

Resident Research Mentoring Teams: A Support Program to Increase Resident Research Productivity [A64

INTRODUCTION: Inspiring, supporting, and disseminating resident scholarly activity can be difficult for residency programs. In an effort to stimulate more resident and faculty engagement in the research process, we developed resident research mentoring teams (RRMT) alongside financial and resource support for resident scholarly activity (research) requirements. The RRMT involved 24 months of longitudinal curriculum of didactics and semi-annual formal meetings with a group of faculty and other team members with research expertise. The RRMT included biostatisticians, coordinators, regulatory experts, and database managers. The objective of this study was to determine if productivity from resident research increased after RRMT implementation. METHODS: We performed an analysis of rates of resident research projects presented at meetings and/or published before (8 total years) and after (4 years) implementation of the RRMT, with a 4-year washout during the RRMT implementation and revision. For presentations, we only included regional or national presentations outside of the local school environment. RESULTS: Overall, 43 (37.7%) of the 114 resident projects were published and 27 (23.7%) were presented at meetings. After implementation of the RRMT, resident projects were more likely to be published (55.0% vs. 28.4%, P=.005) and presented (40.0% vs. 14.9%, P=0.003). After implementation, resident projects were more likely to be either presented or published (67.5% vs. 36.5%, P=.002). CONCLUSION: Implementation of departmental support and mentoring programs such as the RRMT can increase the rate of resident research projects that are presented and published.

CGAS-STING Mediated Inflammation In Diabetic Wound Macrophages Is Regulated By Histone Demethylase JMJD3

Abstract Recent work has shown that the cGAS-STING inflammatory pathway is elevated in conditions that are marked by chronic inflammation, such as obesity and diabetes. Using single cell RNA (scRNA) sequencing from human wounds, we show that the Sting gene is increased in diabetic wound macrophages. Histone demethylase JMJD3 specifically demethylates lysine 27 on histone 3 (H3K27me3) - a repressive mark for gene transcription. Using diabetic mice, we note on ChIP analysis, a decrease in the H3K27me3 repressive mark at the STING promoter in diabetic wound macrophages relative to littermate controls, with subsequently enhanced STING protein levels by western blot. Additionally, scRNA from wound macrophages obtained from a novel murine strain deficient in Jmjd3 in myeloid-cell lineages (Jmjd3f/fLyz2Cre+), revealed significantly decreased Sting gene levels. Further, ChIP analysis of H3K27me3 levels at the STING promoter from Jmjd3f/fLyz2Cre+ wound macrophages reveal increased H3K27me3 levels compared to littermate controls, with a concomitant decrease in STING protein as determined by western blot. Mechanistically, we use mRNA, protein and ChIP studies to reveal that in diabetic wound macrophages, IL6 is responsible for increased JMJD3 leading to increased JAK1,3/STAT3 activity and increased STING production. Wound healing curves from diabetic mice locally treated with macrophage-specific nanoparticles against JMJD3 showed significantly improved healing, and decreased STING protein production in these wounds. Taken together, this data highlights a unique epigenetic regulator of STING production in diabetic wound macrophages and provides a viable cell-specific, nanotherapeutic approach to non-healing diabetic wounds. Supported by NIH (F32DK126471), Vascular and Endovascular Surgical Society Resident Research Award

PD27-02 IS CAPSULAR ABUTMENT ON MRI A PREDICTOR OF EXTRAPROSTATIC EXTENSION (EPE) ON RADICAL PROSTATECTOMY?

You have accessJournal of UrologyCME1 May 2022PD27-02 IS CAPSULAR ABUTMENT ON MRI A PREDICTOR OF EXTRAPROSTATIC EXTENSION (EPE) ON RADICAL PROSTATECTOMY? Mohammad Siddiqui, Jonathan Aguiar, Eric Li, Brandon Ansbro, Moataz Soliman, Mary-Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Eric LiEric Li More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Mary-Kate KeeterMary-Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extraprostatic extension (EPE) on radical prostatectomy (RP) pathology is an established prognostic indicator of recurrence and metastasis. Furthermore, suspicion of EPE guides neurovascular preservation during surgery. Here we investigate whether capsular ‘abutment’ on pre-operative mpMRI of the prostate predicts pathological findings. METHODS: We queried our prospectively collected institutional database from 2018 for all men undergoing radical prostatectomy (RP) who had undergone preoperative prostate MRI. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p <0.05. RESULTS: 539 men underwent RP since March 2018. 307 (56%) men had pre-operative MRI. 163 (53.1%) had abutment of the capsule on MRI. For men with capsular abutment, 75 (46.25%) had EPE at prostatectomy (matched laterality in 42 (56%), on the contralateral side from their MRI lesion in 33 (44%)). 65/144 (45.1%) of men without capsular abutment on MRI had EPE on RP pathology. Men with ipsilateral EPE to their MRI lesions with capsular abutment were more likely to have a higher total prostate health index (PHI) (mean 64.20 vs. 50.95, p-value 0.024), and higher Gleason Grade Group (GG) lesion on diagnostic biopsy (p-value 0.001). Independent predictors of having ipsilateral EPE on multivariable logistic regression analysis include GG3 (OR 3.65, 95% CI 1.2-11.1) and GG4 (OR 4.7, 95%CI 1.2-18.8) on primary biopsy. On multivariable logistic regression analysis, MRI PIRADS scores were not predictive of either presence of ‘any’ EPE or ipsilateral EPE on final RP pathology. CONCLUSIONS: In our series, the presence or absence of “capsular abutment” alone read on MRI was a poor indicator of extra-prostatic extension on final pathology. Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e493 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Siddiqui More articles by this author Jonathan Aguiar More articles by this author Eric Li More articles by this author Brandon Ansbro More articles by this author Moataz Soliman More articles by this author Mary-Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP37-01 PILOT TRIAL FOR PIVoT: PREVENTION OF RECURRENT URINARY TRACT INFECTION USING VAGINAL TESTOSTERONE

You have accessJournal of UrologyCME1 May 2022MP37-01 PILOT TRIAL FOR PIVoT: PREVENTION OF RECURRENT URINARY TRACT INFECTION USING VAGINAL TESTOSTERONE Mariela Martinez, Arshia Sandozi, Jeffrey Lee, Liliya Vafina, Cassandra Pond, Robert Adelson, Elie Kaplan-Marans, Katiana Vazquez-Rivera, Annette Lee, and Allison Polland Mariela MartinezMariela Martinez More articles by this author , Arshia SandoziArshia Sandozi More articles by this author , Jeffrey LeeJeffrey Lee More articles by this author , Liliya VafinaLiliya Vafina More articles by this author , Cassandra PondCassandra Pond More articles by this author , Robert AdelsonRobert Adelson More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Katiana Vazquez-RiveraKatiana Vazquez-Rivera More articles by this author , Annette LeeAnnette Lee More articles by this author , and Allison PollandAllison Polland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002591.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent urinary tract infections (rUTI) in postmenopausal women have been associated with changes in vaginal flora. Vaginal estrogen treats atrophy thereby restoring flora, which prevents UTIs. While estrogen is effective, some patients have contraindications or are unwilling to use it. Vaginal testosterone cream (VT) has been shown to improve atrophy, however, its effects on flora and rUTIs are unknown. The purpose of this study was to determine the effect of VT versus placebo on vaginal flora in postmenopausal women with rUTI. METHODS: This randomized, double- blind pilot study enrolled postmenopausal women with rUTIs. Patients were randomized to VT or placebo. Vaginal health index (VHI) and vaginal swab to assess flora via DNA sequencing were collected at baseline and at one month follow up. RESULTS: A total of 21 patients were enrolled. Average VHI at enrollment was 16.68±4. There was no difference between groups at baseline with regard to VHI. There was diversity of vaginal flora in both treatment arms at baseline (Figure 1). Among patients who completed follow up, almost half of those in the VT arm had an increase in relative abundance of lactobacilli, which was not seen in the placebo patients. As compared to the placebo arm, a greater number of patients in the VT arm had a decrease in relative abundance of uropathogens such as Bacteroides and Pseudomonas. The majority of patients in the VT arm had improvement in VHI, which was not seen with placebo at one month. Four patients developed UTIs during the study, two in each arm. CONCLUSIONS: Initial data demonstrates increased abundance of lactobacilli and improvement in VHI at one-month post treatment with VT. Although there was no difference in the number of patients who developed UTIs between groups, longer treatment follow up and increased patient enrollment will be valuable in determining if VT is effective for UTI prevention. Source of Funding: AUA Urology Care Foundation Residency Research Award © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e607 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mariela Martinez More articles by this author Arshia Sandozi More articles by this author Jeffrey Lee More articles by this author Liliya Vafina More articles by this author Cassandra Pond More articles by this author Robert Adelson More articles by this author Elie Kaplan-Marans More articles by this author Katiana Vazquez-Rivera More articles by this author Annette Lee More articles by this author Allison Polland More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD57-07 FACTORS PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN PIRADS 4 LESIONS

You have accessJournal of UrologyCME1 May 2022PD57-07 FACTORS PREDICTING CLINICALLY SIGNIFICANT PROSTATE CANCER IN PIRADS 4 LESIONS Mohammad Siddiqui, Jasmine Lin, Jonathan Aguiar, Brandon Ansbro, Moataz Soliman, Jordan Rich, Johan Alfaro, Mary-Kate Keeter, Quan Mai, Edward Schaeffer, and Ashley Ross Mohammad SiddiquiMohammad Siddiqui More articles by this author , Jasmine LinJasmine Lin More articles by this author , Jonathan AguiarJonathan Aguiar More articles by this author , Brandon AnsbroBrandon Ansbro More articles by this author , Moataz SolimanMoataz Soliman More articles by this author , Jordan RichJordan Rich More articles by this author , Johan AlfaroJohan Alfaro More articles by this author , Mary-Kate KeeterMary-Kate Keeter More articles by this author , Quan MaiQuan Mai More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The PIRADS 4 lesions are commonly biopsied, however many are benign. Here, we sought to investigate factors that may help better risk stratify the PIRADS-4 lesions and predict the presence of clinically significant cancer (defined as Gleason Grade Group (GG) ≥ 2). METHODS: We queried the electronic medical record for patients diagnosed with PIRADS 4 lesions beginning in March 2018 with the focus on patients with total PSA 2-20ng/mL. We compared the clinical characteristics such as Age, African American race, PSA, prostate health index (PHI), and PSA Density (PSAD) of patients with and without clinically significant prostate cancer on biopsy. Statistics were performed using t-test, chi-squared analysis, and logistical regressions with significance defined as p<0.05. RESULTS: From March 2018 to present, 3553 men presented to urology with suspicion of prostate cancer and 1640 (46%) underwent prostate MRI. 571 (35%) of men were identified to have the PIRADS 4 lesion as their highest PIRADS lesion (Table 1). 556 (97%) men with PIRADS 4 lesions underwent prostate needle biopsy. Clinically significant cancer was detected in 288 (52%) of this population (206 (37%) men had negative biopsies, while GG1 was found in 61 (11%)). Predictors of identifying clinically significant prostate cancer on biopsy on multivariable analysis included African American race (OR 3.76, 95% CI 1.86-7.59), PSAD >0.15 (OR 3.01, 95% CI 1.5-5.74) and higher PHI (PHI>36 (OR 3.42, CI 1.58-7.4), PHI≥ 55(OR 10.5, 95% CI 4.07-25.1)). CONCLUSIONS: Consistent with literature, 37% of PIRADS 4 lesions are benign in our series. Our results suggest that men of AA race, or those with PSAD> 0.15, or PHI >36 and PIRADS 4 lesions should undergo prostate biopsy. Men with PSAD < 0.1 and PHI scores in the lowest quartile were least likely to have clinically significant prostate cancer on biopsy of PIRADS 4 lesions. Source of Funding: UROLOGY CARE FOUNDATION RESIDENCY RESEARCH AWARD © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e962 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Siddiqui More articles by this author Jasmine Lin More articles by this author Jonathan Aguiar More articles by this author Brandon Ansbro More articles by this author Moataz Soliman More articles by this author Jordan Rich More articles by this author Johan Alfaro More articles by this author Mary-Kate Keeter More articles by this author Quan Mai More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP06-10 KDM6A DEFICIENCY IN UROTHELIUM PRODUCES A DISTINCT IMMUNE PHENOTYPE IN A MOUSE MODEL OF BLADDER CANCER

You have accessJournal of UrologyCME1 May 2022MP06-10 KDM6A DEFICIENCY IN UROTHELIUM PRODUCES A DISTINCT IMMUNE PHENOTYPE IN A MOUSE MODEL OF BLADDER CANCER Ao Zhang, Hong Qiu, Timothy Chan, and Byron Lee Ao ZhangAo Zhang More articles by this author , Hong QiuHong Qiu More articles by this author , Timothy ChanTimothy Chan More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002523.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lysine-specific demethylase 6A (KDM6A) is a chromatin modifier that is frequently mutated in bladder cancer and causes epigenetic dysregulation. Recently immune check point inhibition has shown great clinical promise in bladder cancer. Because epigenetic signature has been shown to predict response to immunotherapy, here we assessed if loss of KDM6A leads to alterations of tumor immune microenvironment in a mouse bladder cancer model. METHODS: Kdm6a urothelium conditional knockout (cKO) mice were generated by crossing Kdm6aflox/flox mice with Upk3aCre mice that express Cre recombinase in the urothelium. Littermate control mice were of the same genetic background but intact Kdm6a gene. Mice at 8 weeks of age (three in each group) were fed with drinking water containing 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN). Bladders were harvested after 4 weeks and analyzed with H&E staining. Single cell RNA sequencing was performed on urothelium from control and Kdm6A cKO mice without BBN treatment. RESULTS: After treatment with BBN for 4 weeks, there was marked edema and inflammatory changes with increased infiltration of immune cells in H&E stained bladder sections in Kdm6a cKO mice compared to Kdm6a intact controls (Figure A). While urothelium from control mice maintained grossly unchanged tissue architecture, urothelium from cKO mice exhibited cytologic atypia with loss of organized cell layer. Comparison of single cell RNA sequencing profile revealed enrichment of immune cell population in cKO mice (Figure B, cluster 12), which was consistent with histological findings. CONCLUSIONS: Loss of KDM6A in the urothelium creates a distinct immune microenvironment in the BBN mouse bladder cancer model. Whether this immune cell-rich microenvironment affects response to immune check point inhibition warrants further investigation. Source of Funding: This work was supported in part by the 2021 Urology Care Foundation Residency Research Award Program and the Kahlert Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e80 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ao Zhang More articles by this author Hong Qiu More articles by this author Timothy Chan More articles by this author Byron Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...

Who is More Willing to Pay for Green Electricity? a Case Study of Anyang City, China

Green electricity (GE) is of great importance for effectively combating climate change and global Sustainable Development Goals (SDGs). The willingness-to-pay (WTP) for GE by end users has great influence on its widespread application, especially at the household level. Researchers have analyzed the mechanisms of residents' WTP and predicted how much they could afford for GE. However, most of these studies have focused on developed (affluent) countries and regions, and residents' WTP as well as the corresponding monetary amount of their WTP were not considered together in previous studies. In this study, we try to fill the gap of the inadequate research of residents' WTP in underdeveloped areas through an analysis of the WTP of urban residents in a small Chinese city (Anyang). A total of 274 household-scale samples were collected by face-to-face interviews in December 2019. We found that approximately 60% of respondents gave a positive response to WTP, with an average value of 8.39 yuan per month. Educational attainment, per capita disposable income in the household, the length of residents' time living in urban areas and the rate of neighbors' approval of WTP are all positively correlated with the tendency of the residents' positive response toward WTP. The three factors of per capita disposable income, the rate of neighbors' approval of WTP and the degree of residents' environmental concerns are positively correlated with the amount of residents' WTP. More importantly, we demonstrated the existence of a weak “Herd Effect” in residents' views of WTP. Finally, some suggestions for policymakers are given, such as raising household income through retraining and raising residents' environmental awareness through education and community advertisements. This study also highlights that the widespread application of GE at the household level will be of great assistance to the GE industry overall. Therefore, the rising economic cost of GE should not be shared by the households in the long term.

Creating a resident-centric rehabilitation research team

BackgroundThe 36-month Physical Medicine and Rehabilitation (PM&R) or Physiatry residency provides a number of multidisciplinary clinical experiences. These experiences often translate to novel research questions, which may not be pursued by residents due to several factors, including limited research exposure and uncertainty of how to begin a project.Limited resident participation in clinical researchnegatively affects the growth of Physiatry as a field and medicine as a whole. Thetwo largest Physiatry organizations – the Association of Academic Physiatristsand the American Academy of Physical Medicine and Rehabilitation – participate inthe Disability and Rehabilitation Research Coalition (DRRC), seeking to improvethe state of rehabilitation and disability research through fundingopportunities by way of the National Institutes of Health (NIH), the NationalInstitute on Disability, Independent Living and Rehabilitation Research(NIDILRR) and the Patient-Centered Outcomes Research Institute (PCORI). Apaucity of new Physiatry researchers neutralizes these efforts.ResultsThis paper detailsthe creation of a novel, multidisciplinary Rehabilitation Resident Researchprogram that promotes resident research culture and production. Mirroring ourcollaborative clinical care paradigm, this program integrates facultymentorship, institutional research collaborates (Neuroscience Nursing ResearchCenter, Neuroscience Research Development Office) and departmental resources(Shark Tank competition) to provide resident-centric research support.ConclusionsThe resident-centricrehabilitation research team has formed a successful research program that waspiloted from the resident perspective, facilitating academic productivity whilerespecting the clinical responsibilities of the 36-month PM&R residency. Residentresearch trainees are uniquely positioned to become future leaders ofmultidisciplinary and multispecialty collaborative teams, with a focus onpatient function and health outcomes.