Germline Pathogenic Variants Identified in Patients With Genitourinary Malignancies Undergoing Universal Testing: A Multisite Single-Institution Prospective Study.

PURPOSE: This study aimed to investigate the prevalence of pathogenic germline variants (PGVs) in hereditary cancer genes utilizing a universal testing approach and to determine the rate of PGVs that would have been missed based on National Comprehensive Cancer Network (NCCN) guidelines in genitourinary (GU) malignancies. MATERIALS AND METHODS: A multisite, single-institution prospective germline genetic test (GGT) was universally offered to patients with new or active diagnoses of GU malignancies (prostate, bladder, and renal) from April 2018 to March 2020 at Mayo Clinic sites. Participants were offered GGT using a next-generation sequencing panel of > 80 genes. Demographic, tumor characteristics, and genetic results were evaluated. NCCN GU cancer guidelines were used to identify whether patients had incremental findings, defined as PGV-positive patients who would not have received testing based on NCCN guidelines. RESULTS: Of 3095 individuals enrolled in the study, 601 patients had GU cancer (prostate = 358, bladder = 106, and renal = 137). The mean enrollment age was 67 years (SD 9.1), 89% were male, and 86% of patients were non-Hispanic White. PGVs were identified in 82 (14%) of all GU patients. PGV prevalence breakdown by cancer type was: 14% prostate, 14% bladder, and 13% renal cancer. Nearly one-third of identified PGVs were high penetrance, and the majority of these (67%) were clinically actionable. Incremental PGVs were identified in 28 (57%) prostate, 15 (100%) bladder, and 14 (78%) renal cancer patients. Of the 82 patients with PGV findings, 29 (35%) had at least 1 relative undergo cascade testing for the familial variant(s) identified. CONCLUSIONS: More than 1 in 8 patients with GU malignancies were found to carry a PGV, with 67% of patients with high-penetrance PGVs undergoing clinically actionable changes. The majority of these PGVs would not have been identified based on current testing criteria. These findings support universal GGT for GU malignancies and underscore its potential to enhance risk assessment and guide precision interventions in urologic oncology.

Excision of recurrent penile schwannoma with neurovascular bundle sparing: A novel surgical approach.

Penile schwannomas are rare, often painless lesions usually growing on the dorsum of the penis. A young and otherwise healthy male with recurrent painful penile schwannomas and decreased libido was successfully treated with surgical excision. Through fine dissection of the nerve fascicles leading to the primary schwannoma, the lesion was successfully removed without compromising erectile or ejaculatory function. This novel approach allowed for significant symptomatic relief and improved quality of life.

Evolutionary analysis of cellular reduction and anaerobicity in the hyper-prevalent gut microbe Blastocystis.

Blastocystis is the most prevalent microbial eukaryote in the human and animal gut, yet its role as commensal or parasite is still under debate. Blastocystis has clearly undergone evolutionary adaptation to the gut environment and possesses minimal cellular compartmentalization, reduced anaerobic mitochondria, no flagella, and no reported peroxisomes. To address this poorly understood evolutionary transition, we have taken a multi-disciplinary approach to characterize Proteromonas lacertae, the closest canonical stramenopile relative of Blastocystis. Genomic data reveal an abundance of unique genes in P. lacertae but also reductive evolution of the genomic complement in Blastocystis. Comparative genomic analysis sheds light on flagellar evolution, including 37 new candidate components implicated with mastigonemes, the stramenopile morphological hallmark. The P. lacertae membrane-trafficking system (MTS) complement is only slightly more canonical than that of Blastocystis, but notably, we identified that both organisms encode the complete enigmatic endocytic TSET complex, a first for the entire stramenopile lineage. Investigation also details the modulation of mitochondrial composition and metabolism in both P. lacertae and Blastocystis. Unexpectedly, we identify in P. lacertae the most reduced peroxisome-derived organelle reported to date, which leads us to speculate on a mechanism of constraint guiding the dynamics of peroxisome-mitochondrion reductive evolution on the path to anaerobiosis. Overall, these analyses provide a launching point to investigate organellar evolution and reveal in detail the evolutionary path that Blastocystis has taken from a canonical flagellated protist to the hyper-divergent and hyper-prevalent animal and human gut microbe.

Evaluation of a revised AERMOD treatment of plume dispersion in the daytime elevated stable layer.

Advanced dispersion models such as AERMOD specifically address the portion of a plume emitted in convective conditions that is sufficiently buoyant to rise into the stable layer above the elevated inversion. This portion of the plume mass is often referred to as the "penetrated plume" because that plume component breaks through the elevated inversion and penetrates into the stable layer aloft. A premature mixing of the penetrated plume to the ground has been identified in the current formulation of AERMOD, which is the U.S. EPA-preferred short-range dispersion model and used in several other countries. This behavior has been observed based on data from field studies where the model is found to overpredict ground-level concentration events due to the penetrated plume component, with the timing of these peak predictions too early in the day. A proposed update to AERMOD to address the penetrated plume issue (referred to as "HBP" for modifications particularly important for "highly buoyant plume") is documented and evaluated in this manuscript. The revised approach involves a check on the convective mixing height for the current hour as well as the next hour to determine how much of the penetrated plume has been captured by the convective boundary layer by the end of the current hour. The amount of the penetrated plume mass that is allowed to mix to the ground in the HBP modifications depends upon the result of this calculation. The HBP modification has been evaluated as an update to AERMOD for three databases along with a sensitivity analysis of the effects of the HBP changes on a variety of stack heights and buoyancy fluxes. The findings of the evaluation indicate that the HBP changes to AERMOD result in reduced overprediction tendencies.Implications: A proposed enhancement to AERMOD to address a premature mixing of penetrated plume material to the ground has been performed by implemented and evaluated by the authors. The enhancement, referred to as the highly buoyant plume (HBP) is based on work developed by Jeffrey Weil. HBP is designed to better characterize the penetrated plume behavior in the model such that it aligns more closely with observations based on data from field studies.

Virtual "Matchmaking": Stakeholder Perspectives on the Future of the Urology Residency Match.

OBJECTIVE: To examine stakeholder perspectives regarding the lack of in-person externships and transition to a virtual urology residency interview format. The unprecedented disruption from the COVID-19 pandemic forced an abrupt pivot to a "virtual" Urology Match for the 2021 cycle. We aim for our study to inform ongoing deliberations on the future of the Urology Match. MATERIALS AND METHODS: Following Urology Match day in February 2021, two surveys were distributed by the Society of Academic Urologists to all applicants and program directors (PDs) who participated in the 2021 Urology Match. RESULTS: Overall, 192 of 481 applicants (40%) and 63 of 160 PDs (39%) responded. Most applicants (67%) were satisfied with their match outcomes, although unmatched applicants were significantly more likely to be unsatisfied than matched applicants (98% vs 9%, P <.0001). Most PDs were equally (79%) or more satisfied (13%) with their match outcomes compared with prior years. Nearly all applicants (93%) and PDs (94%) recommended retaining an in-person externship option. Most applicants (61%) and PDs (71%) felt their outcomes would not have changed with in-person interviews. Applicants and PDs were evenly split as to whether interviews should be conducted in-person or virtually in the future. CONCLUSION: The vast majority of applicants and PDs recommended retaining in-person externships for future match cycles despite high costs. In contrast, there was ambivalence amongst both groups of stakeholders regarding the format of interviews for future match cycles. We recommend virtual interviews moving forward to help alleviate the financial burden placed on applicants and increase equity.

YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy.

INTRODUCTION: YouTube is an unregulated platform that patients are using to learn about treatment options. AIM: To assess the reliability of YouTube videos (YTVs) related to male hypogonadism and testosterone therapy. METHODS: Searching on YouTube by relevance and view count, we analyzed the top 10 videos (80 videos total) for the following search terms: low testosterone, testosterone replacement therapy, AndroGel, and hypogonadism. MAIN OUTCOME MEASURE: We recorded the number of views for each video, evaluated videos using the DISCERN score (DS) criterion, and compared the DS for videos including board-certified physicians and videos without. A second comparison was made between videos with board-certified physicians in urology, endocrinology, other MD, and those without any physician. RESULTS: The YTVs analyzed received a total of 38,549,090 views, a median of 25,201 and 17.30 views/day. Videos that featured physicians had significantly fewer views/day than videos that did not (39.48 CI 9,72 vs 1,731 CI 330, 3,132; P = .019). Most YTVs studied were unreliable. The median DS across all videos was 2. However, most videos created by physicians were found to be reliable with a median DS of 4. In addition, YTVs that did not feature a physician were found to be significantly less reliable than videos that featured a physician (3.22 CI 3.06, 4.09 vs 1.87 CI 1.56, 2.18; P < .001). There was no significant difference in the reliability or viewership of YTVs stratified by physician type. CONCLUSION: Most YTVs related to male hypogonadism/testosterone therapy were unreliable, but there are reliable YTVs available. Reliable videos usually feature a physician and receive fewer views than unreliable YTVs. Physicians and academic societies should work to provide verified videos to provide patients with reliable information about male hypogonadism and testosterone therapy. CJ Warren, J Wisener, B Ward, et al. YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy. Sex Med 2021;9:100324.

YouTube and Men's Health: A Review of the Current Literature.

INTRODUCTION: YouTube is the most used social media website, and there is a growing body of literature examining the reliability of healthcare information on this platform. Patients seeking men's health information may be more likely to use YouTube owing to the sensitivity of these issues. OBJECTIVES: The objective of this study is to review the literature for studies related to the reliability of YouTube videos about men's health topics. METHODS: A literature review was conducted using PubMed and Google Scholar for publications related to the reliability of YouTube videos about men's health as of July 1, 2020. RESULTS: There were 17 studies related to YouTube and Men's Health. Most videos were found to be unreliable, and videos uploaded by physicians or healthcare organizations were usually more reliable. However, there were no studies in which more reliable videos had higher metrics of user engagement (views, likes, comments) than unreliable videos and there were several studies where unreliable videos had higher metrics of user engagement. In addition, the methods used to evaluate YouTube videos are not uniform across studies including the way that terms are searched (filtering by relevance vs view count) and the way in which reliability is assessed. For example, some studies create custom evaluation forms based on clinical guidelines, whereas others use validated questionnaires. The only validated questionnaire used across multiple studies was the DISCERN score criterion. CONCLUSIONS: Most information on YouTube about men's health is unreliable. Videos created by physicians and healthcare organizations are more reliable, and videos that are advertisements are less reliable. Physicians and healthcare systems should continue to upload educational YouTube videos but work to increase their views and user engagement. It may benefit patients if physician organizations could work with YouTube to create verified videos disseminating healthcare information that are favored in the search algorithm. Warren CJ, Sawhney R, Shah T, et al. YouTube and Men's Health: A Review of the Current Literature. Sex Med Rev 2021;9:280-288.

Reporting of Research by Matched Otolaryngology Residency Applicants.

OBJECTIVES: Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program's "Charting Outcomes in the Match" (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs. METHODS: The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs' websites. Using PubMed, each resident's number of publications, authorship status, and journal type were recorded. RESULTS: A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91. CONCLUSIONS: The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.

PubMed-Indexed Research Productivity of Students Matching at Top Urology Programs: 2017-2020.

OBJECTIVE: To evaluate the number of PubMed-indexed research projects of medical students matching at top-ranked urology programs as compared to the average publications reported in the Electronic Residency Applicant Service (ERAS). METHODS: Doximity Residency Navigator was used to generate the top 50 residency programs when sorted by reputation. Residents were then found using program websites. PubMed was queried for peer-reviewed publications of incoming interns through post graduate year 3 residents as of February 2020. All PubMed-indexed research was recorded before September 15th of the residents' fourth year of medical school. We recorded the number of publications, first/last author publications, and urology-specific publications. RESULTS: The average number of publications across all 4 years was 2.38 ± 4.19. The average for urology-specific publications was 1.05 ± 3.19 and for first/last author publications was 0.80 ± 1.77. Most matched applicants had at least one PubMed-indexed publication (61.2%) and having over 3 placed them in the 75th percentile. It is uncommon for students to have urology specific or first/last author publications (34.0%, 36.5%). Top 10 programs matched applicants with significantly more research in each of the aforementioned categories and as program reputation declined, so did the publications of the applicants they matched. CONCLUSION: Most research that matched urology applicant's report in ERAS is not PubMed Indexed. Most had at least one PubMed-indexed publication by the time they submitted ERAS and those at top programs had more. It would be helpful to students and faculty advisors if ERAS published research metrics for matched and unmatched applicants separating PubMed-indexed work from posters and presentations.

Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis.

The epicenter of the COVID-19 crisis since March 17, 2020-the New York metropolitan area-is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It has been challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information has seldom been disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19-relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professions, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.

Fall and fracture rates following a change from carpet to vinyl floor coverings in a geriatric rehabilitation hospital. A longitudinal, observational study.

OBJECTIVE: To investigate whether changing from 5 mm thick carpet tiles to vinyl on a concrete subfloor would alter fall or fracture rates. DESIGN: Longitudinal, observational study. SETTING: Six wards (129 beds) of a geriatric rehabilitation hospital. SUBJECTS: All inpatients during this time. INTERVENTIONS: The floor covering was changed from 5 mm carpet tiles to vinyl on these wards when they were closed for other maintenance. This occurred in stages from November 2007 to December 2009. MEASURES: Falls are routinely reported using a quality improvement event reporting form. Fall and fracture rates were calculated in the 12 months prior to and following the change in floor covering on each ward. RESULTS: There were 854 falls on the carpet tiles in the 12 months prior to the flooring change and 878 falls on the vinyl in the 12 months after (19.5 and 19.6 falls/1000 bed days, respectively, [P = 0.95] NS. Fifteen fractures occurred on carpet and 11 fractures on vinyl, [P = 0.39] NS. Using run charts there were no detectable trends in either the fall or fracture rates following the change in flooring surface. CONCLUSION: There may be no difference in fall rates or fractures on carpet or vinyl floor covering of similar thickness and subfloor type.