Triclosan administration to humanized UDP-glucuronosyltransferase 1 neonatal mice induces UGT1A1 through a dependence on PPARα and ATF4.

Triclosan (TCS) is an antimicrobial toxicant found in a myriad of consumer products and has been detected in human tissues, including breastmilk. We have evaluated the impact of lactational TCS on UDP-glucuronosyltransferase 1A1 (UGT1A1) expression and bilirubin metabolism in humanized UGT1 (hUGT1) neonatal mice. In hUGT1 mice, expression of the hepatic UGT1A1 gene is developmentally delayed resulting in elevated total serum bilirubin (TSB) levels. We found that newborn hUGT1 mice breastfed or orally treated with TCS presented lower TSB levels along with induction of hepatic UGT1A1. Lactational and oral treatment by gavage with TCS leads to the activation of hepatic nuclear receptors constitutive androstane receptor (CAR), peroxisome proliferator-activated receptor alpha (PPARα), and stress sensor, activating transcription factor 4 (ATF4). When CAR-deficient hUGT1 mice (hUGT1/Car-/-) were treated with TCS, TSB levels were reduced with a robust induction of hepatic UGT1A1, leaving us to conclude that CAR is not tied to UGT1A1 induction. Alternatively, when PPARα-deficient hUGT1 mice (hUGT1/Pparα-/-) were treated with TCS, hepatic UGT1A1 was not induced. Additionally, we had previously demonstrated that TCS is a potent inducer of ATF4, a transcriptional factor linked to the integrated stress response. When ATF4 was deleted in liver of hUGT1 mice (hUGT1/Atf4ΔHep) and these mice treated with TCS, we observed superinduction of hepatic UGT1A1. Oxidative stress genes in livers of hUGT1/Atf4ΔHep treated with TCS were increased, suggesting that ATF4 protects liver from excessive oxidative stress. The increase oxidative stress may be associated with superinduction of UGT1A1. The expression of ATF4 in neonatal hUGT1 hepatic tissue may play a role in the developmental repression of UGT1A1.

End of Affirmative Action-Who Is Impacted Most? Analysis of Race and Sex Among US Internal Medicine Faculty.

BACKGROUND: For over 50 years, the United States (US) used affirmative action as one strategy to increase diversity in higher education including medical programs, citing benefits including training future public and private sector leaders. However, the recent US Supreme Court ending affirmative action in college admissions threatens advancements in the diversity of medical college faculty. OBJECTIVE: Our study evaluated the demographic trends in Internal Medicine (IM) faculty in the US by assessing sex and race/ethnicity diversity to investigate who is likely to be impacted most with the end of affirmative action. DESIGN: Longitudinal retrospective analysis SUBJECTS: IM faculty from the Association of American Medical Colleges faculty roster from 1966 to 2021 who self-reported sex and ethnicity MAIN OUTCOMES: The primary study measurement was the annual proportion of women and racial/ethnic groups among IM faculty based on academic rank and department chairs. RESULTS: Although racial/ethnic diversity increased throughout the era of affirmative action, African American, Hispanic, and American Indian populations remain underrepresented. White physicians occupied > 50% of faculty positions across academic ranks and department chairs. Among the non-White professors, Asian faculty had the most significant increase in proportion from 1966 to 2021 (0.6 to 16.6%). The percentage of women increased in the ranks of professor, associate professor, assistant professor, and instructor by 19.5%, 27.8%, 25.6%, and 26.9%, respectively. However, the proportion of women and racial/ethnic minority faculty decreased as academic rank increased. CONCLUSION: Despite an increase in the representation of women and racial/ethnic minority IM faculty, there continues to be a predominance of White and men physicians in higher academic ranks. With the end of affirmative action, this trend has the danger of being perpetuated, resulting in decreasing diversity among IM faculty, potentially impacting patient access and health outcomes.

Leadership gender disparity in the fifty highest ranking North American universities: Thematic analysis under a theoretical lens.

BACKGROUND: Despite changes in the discourse around gender distributions within academic leadership, women continue to be under-represented in academia. Our study aims to identify the extent of gender disparity in the academic leadership in the top 50 North American universities and to critically analyse the contributing factors through a comprehensive theoretical framework. METHODS: We adopted the theoretical framework of leadership continuum model. A retrospective analysis of the gender of the leadership ranks was conducted between December 2018 and March 2019 for the top 50 universities in North America (2019 Quacquarelli Symonds World University Ranking system). The leadership hierarchy was classified into six tiers. RESULTS: A total of 5806 faculty members from 45 US and five Canadian universities were included. Women were overall less likely to be in a senior leadership role than men (48.7% vs 51.3%; p value=0.05). Women accounted for fewer positions than men for resident/chancellor (23.8% vs 76.2%; p value<0.001), vice-president/vice-chancellor (36.3% vs 63.7%; p value<0.001), vice provost (42.7% vs 57.3%; p value=0.06), dean (38.5% vs 61.5%; p value<0.001) and associate dean (48.2% vs 51.8%; p-value=0.05). Women however were in a greater proportion in the assistant dean positions (63.8% vs 36.2%; p value<0.001). CONCLUSION: Leadership gender imbalance is trans-organisational and transnational within the top 50 universities of North America and progressively widens towards the top leadership pyramid. This correlates with the lack of women leadership progress and sustainability in later cycles of the leadership continuum model (beyond assistant dean).

American Society of Emergency Radiology (ASER) social media committee workgroup: best practices for the use of social media in emergency radiology.

Social media has become integrated within the profession of medicine, and emergency radiology has inevitably felt the impact of its presence. Emergency radiologists are encouraged to consider the advantages of embracing the digital era and the benefits it may bring to our careers. We aim to present the best practice guidelines for emergency radiologists and radiology departments. This paper is a product of the American Society of Emergency Radiology Social Media (ASER) Committee workgroup and represents the best practices of the society.

Influences of the Social Media Continuum Model in Radiology: Theory and Reality.

Social media utilization has been growing exponentially worldwide and has created a thriving venue for radiologists and the profession of radiology to engage in on both the academic and social levels. The aim of this article is to conduct updated literature review and address a gap in the literature by introducing a simple classification for social media utilization and a new theoretical model to outline the role and potential value of social media in the realm of radiology. We propose classifying social media through usage-driven and access-driven indices. Furthermore, we discuss the interdependency of radiologists, other physicians and non-physician stakeholders, scientific journals, conferences/meetings and the general public in an integrated social media continuum model. With the ongoing sub-specialization of radiology, social media helps mitigate the physical barriers of making connections with peers and audiences which would have otherwise been unfeasible. The constant evolution and diversification of social media platforms necessitates a novel approach to better understand its role through a radiological lens. With the looming fear of 'ancillary service' labelling, social media could be the golden plate to halt the path towards commoditization of radiology.

Investigating Gender Differences in Canadian Plastic Surgery Online Patient Education.

BACKGROUND: The public interest and demand for cosmetic surgery is growing in North America. As practices continue to advertise cosmetic procedures, male consumers must also be given fair consideration in a market targeted mostly towards women. OBJECTIVES: This study investigated the advertising trends of plastic surgery clinics to assess for prevailing gender differences among online Canadian plastic surgery practice advertising. METHODS: The 2021 College of Physicians and Surgeons directory for each province and territory was utilized to identify all practicing plastic surgeons. A systematic search with Google (Mountain View, CA) was conducted to analyze the websites of Canadian plastic surgery centers in the following manner: "[physician name] [province of practice]." RESULTS: A total of 209 websites and 13,838 images were identified and analyzed. Of these images, 12,386 (90%) were female and 1452 (10%) were male patients or models. Although only 20% had a male services page, 62% of all centers offered gynecomastia procedures. The most common procedures targeting men were blepharoplasty (95%), liposuction (93%), and abdominoplasty (93%). The Prairies region had significantly fewer websites with male-only pages compared with all other Canadian regions. CONCLUSIONS: Despite the increase in cosmetic surgery procedures for males, the market for cosmetic surgery procedures targeted towards males remains insignificant. An increase in the advertising of in-demand male cosmetic procedures can allow for a broader consumer market and a subsequent increase in benefits for plastic surgeons.

Subscription-based and open access dermatology journals: the publication model dilemma.

Medical journalism and the dissemination of peer-reviewed research serve to promote and protect the integrity of scholarship. We evaluated the publication models of dermatology journals to provide a snapshot of the current state of publishing. A total of 106 actively-publishing dermatology journals were identified using the SCImago Journal Rankings (SJR) citation database. Journals were classified by publication model (subscription-based and open-access), publishing company, publisher type (commercial, professional society, and university), MEDLINE-indexing status, and SJR indicator. Of these, 65 (61.32%) dermatology journals were subscription-based and 41 (38.68%) were open-access. In addition, 59 (55.66%) journals were indexed in MEDLINE and most were subscription-based (N=51) and published by commercial entities (N=54). MEDLINE-indexing status was significantly different across publisher types (P<0.001), access-types (P<0.001), and the top four publishers (P=0.016). Distribution of SJR indicator was significantly different across publisher types (P<0.001) and access-types (all journals, P=0.001; indexed journals only, P=0.046). More than 91% of MEDLINE-indexed titles were published by commercial entities, and among them, four companies controlled the vast majority. Discontinuation of access to any one of the top publishers in dermatology can significantly and disproportionately impact education and scholarship.

Biallelic variants in HPDL, encoding 4-hydroxyphenylpyruvate dioxygenase-like protein, lead to an infantile neurodegenerative condition.

PURPOSE: Dioxygenases are oxidoreductase enzymes with roles in metabolic pathways necessary for aerobic life. 4-hydroxyphenylpyruvate dioxygenase-like protein (HPDL), encoded by HPDL, is an orphan paralogue of 4-hydroxyphenylpyruvate dioxygenase (HPD), an iron-dependent dioxygenase involved in tyrosine catabolism. The function and association of HPDL with human diseases remain unknown. METHODS: We applied exome sequencing in a cohort of over 10,000 individuals with neurodevelopmental diseases. Effects of HPDL loss were investigated in vitro and in vivo, and through mass spectrometry analysis. Evolutionary analysis was performed to investigate the potential functional separation of HPDL from HPD. RESULTS: We identified biallelic variants in HPDL in eight families displaying recessive inheritance. Knockout mice closely phenocopied humans and showed evidence of apoptosis in multiple cellular lineages within the cerebral cortex. HPDL is a single-exonic gene that likely arose from a retrotransposition event at the base of the tetrapod lineage, and unlike HPD, HPDL is mitochondria-localized. Metabolic profiling of HPDL mutant cells and mice showed no evidence of altered tyrosine metabolites, but rather notable accumulations in other metabolic pathways. CONCLUSION: The mitochondrial localization, along with its disrupted metabolic profile, suggests HPDL loss in humans links to a unique neurometabolic mitochondrial infantile neurodegenerative condition.

Evaluation of Radiology Reports by the Emergency Department Clinical Providers: A Message to Radiologists [Formula: see text].

OBJECTIVES: This study is an evaluation of the emergency department (ED) satisfaction with the current radiologic reporting system used at a major Northeastern academic medical center. The radiology reports are the main form of communication and usually the final product of any radiological investigation delivered to clinicians. The aim of this study was to improve current radiology reporting practices and to better tailor reports to match the needs and expectations of ED clinicians. METHODS: A 9-question online survey was sent to ED residents, fellows, faculty, and nurse practitioners/advanced practice providers at a major Northeastern academic medical center in the United States. For the open-ended section, coding and emergent theme categorization was conducted for quantification of responses. The survey was designed to evaluate the attitudes toward the structure, style, form, and wording used in reports. RESULTS: The response rate was 48.6% (68/140). The ED respondents were generally satisfied with radiology reports, their language, vocabulary, and clarity. They preferred the impression section to be before the findings in simple examinations and to stratify the reports according to emergency status for complex examinations. They did not like extended differential, hedge terms, and delayed reporting. Additionally, ED respondents recommended focused, fast reporting with considerable changes toward a more standardized report. CONCLUSIONS: This evaluation delivered a list of actionable recommendations. The top recommendation is to standardize reporting structure, style, and lexicon, in addition to being focused, timely, and brief.

Enhancing fatty acid oxidation negatively regulates PPARs signaling in the heart.

High fatty acid oxidation (FAO) is associated with lipotoxicity, but whether it causes lipotoxic cardiomyopathy remains controversial. Molecular mechanisms that may be responsible for FAO-induced lipotoxic cardiomyopathy are also elusive. In this study, increasing FAO by genetic deletion of acetyl-CoA carboxylase 2 (ACC2) did not induce cardiac dysfunction after 16 weeks of high fat diet (HFD) feeding. This suggests that increasing FAO, per se, does not cause metabolic cardiomyopathy in obese mice. We compared transcriptomes of control and ACC2 deficient mouse hearts under chow- or HFD-fed conditions. ACC2 deletion had a significant impact on the global transcriptome including downregulation of the peroxisome proliferator-activated receptors (PPARs) signaling and fatty acid degradation pathways. Increasing fatty acids by HFD feeding normalized expression of fatty acid degradation genes in ACC2 deficient mouse hearts to the same level as the control mice. In contrast, cardiac transcriptome analysis of the lipotoxic mouse model (db/db) showed an upregulation of PPARs signaling and fatty acid degradation pathways. Our results suggest that enhancing FAO by genetic deletion of ACC2 negatively regulates PPARs signaling through depleting endogenous PPAR ligands, which can serve as a negative feedback mechanism to prevent excess activation of PPAR signaling under non-obese condition. In obesity, excessive lipid availability negates the feedback mechanism resulting in over activation of PPAR cascade, thus contributes to the development of cardiac lipotoxicity.

Novel Geographic Thematic Study of the Largest Radiology Societies Globally: How Is Gender Structure Biased Within Editorial Boards?

OBJECTIVE. Radiology has traditionally been a male-dominated medical specialty, and this is also reflected in the authorship of radiology publications and the composition of radiology journal editorial boards. The purpose of this study was to quantify the extent of the gender disparities reflected within the journal editorial boards of the largest international radiologic societies. MATERIALS AND METHODS. Methods were crafted to generate a geographically based gender analysis of the editorial boards of the largest general radiologic societies globally. All editorial board members of journals that were published by societies included in the study and that had an impact factor of 1 or greater were assessed to determine the gender composition of the board and the research productivity and career advancement of its members. Analyzed metrics included gender, academic rank, departmental leadership positions, subspecialty, total number of peer-reviewed publications, total number of citations, the h-index, and total number of years of active research. RESULTS. Significant gender disparity was noted across the six journal editorial boards included. Overall, 80.87% of editorial board members were men and 19.13% were women. Men were more prevalent than women across all academic ranks. Male editorial board members had longer publishing careers (22.5 vs 18 years; p = 0.015), a higher total number of publications (110 vs 65 publications; p < 0.001), and a higher h-index (25 vs 19; p < 0.001) than their female counterparts. Female editorial board members at higher academic ranks were less represented on editorial boards and were also less likely to have formal departmental leadership titles. CONCLUSION. Editorial boards have significant gender disparities, with no specific geographic regional variation noted. Male editorial board members published more, had higher h-indexes, and held more departmental leadership positions than their female counterparts.

Gender and race in radiology: An intersectional analysis of the American Association of Medical Colleges (AAMC) database from 1966 to 2021.

PURPOSE: To describe trends in gender and racial representation within academic radiology in the United States over a 55-year period from 1966 to 2021. METHODS: A retrospective analysis of the American Association of Medical Colleges database of radiology faculty members from 1966 to 2021 was conducted. Trends in academic rank and tenure status for five different ethnoracial groups (White, Asian, Black, Hispanic, and Native American) each subdivided into two gender identities (men and women) were analyzed. The proportional change over time of each demographic group per outcome was analyzed with linear regression models. RESULTS: Between 1966 and 2021, White men comprised the largest demographic in academic radiology each year. A significant decrease in both White individuals (-0.51 % per year) and men (-0.30 % per year) were observed over the study period. Additionally, the only demographic groups with meaningful changes in representation were White women (+0.20 % per year) and Asian men (+0.23 % per year), followed by Asian women in later years. Underrepresented minority groups (Black, Hispanic and Native American) collectively comprised less than 5 % of all academic radiologists. Finally, within each demographic group, the representation of women consistently lagged behind men. Despite these relative increases, in 2021, the majority of US academic radiologists were White (59.1 %) and male (70.1 %). CONCLUSION: Historically underrepresented minorities, especially women within these groups, continue to face discrimination and are consistently the least represented in radiology. Initiatives that incorporate the intersectionality framework are imperative to break this cycle.

Analysis of Additional Degrees in Academic Plastic Surgery Faculty.

Background: As plastic surgery continues to evolve, an increasing number of surgeons are attaining additional degrees (ADs). Prior studies illustrate this trend of increased AD attainment among plastic surgery faculty within the United States. Yet, no such study has documented AD attainment variability and influence within Canadian plastic surgery faculty. Objectives: Our objective was to investigate the relationship between AD attainment and gender, alongside research productivity, and academic rank of Canadian plastic surgery faculty members. Methods: All Canadian academic plastic surgery faculty members were identified and information regarding gender, academic rank, research productivity, timing of AD attainment was recorded. AD was defined as any degree beyond a medical degree or equivalent. Results: A total of 299 faculty members were identified. Of these, 33% (N = 99) attained an AD. A higher percentage of females (40%) obtained ADs compared to males (30%) (P = .0402). When controlling for number of years in practice, there was a significantly larger proportion of females than males with ADs as assistant and associate professor (P = .033). Faculty with ADs were associated with higher research productivity and higher academic rank than those with MDs (P < .05). ADs were commonly obtained post-residency (38%) and most common ADs were MSc (51%) and PhDs (21%). It was found that the Canadian plastic surgeons were less likely to pursue MBAs than US plastic surgeons (P = .002). Conclusion: One-third of Canadian academic plastic surgeons had ADs. Those with ADs present with higher research productivity and academic rank. When segmented by gender, there were significant differences among AD holders. The results of this study will lend support to ongoing endeavors voicing the need for gender equity in academic plastic surgery.

Historique : Tandis que la chirurgie plastique continue d'évoluer, de plus en plus de chirurgiens obtiennent des diplômes supplémentaires (DS). Des études antérieures démontrent cette tendance des professeurs en chirurgie plastique des États-Unis à obtenir des DS. Pourtant aucune étude n'a évalué la variabilité et l'influence des DS chez les professeurs de chirurgie plastique au Canada. Objectifs : Les chercheurs avaient comme objectif d'explorer la relation entre l'obtention de DS et le genre, conjointement avec la productivité de la recherche et le rang universitaire des professeurs de chirurgie plastique canadiens. Méthodologie : Les chercheurs ont répertorié tous les professeurs de chirurgie plastique canadiens et ont consigné l'information relative à leur genre, à leur rang universitaire, à la productivité de leur recherche, au moment de l'obtention des DS. Le DS était défini comme tout diplôme obtenu après un diplôme en médecin ou un diplôme équivalent. Résultats : Au total, 299 professeurs ont été répertoriés. De ce nombre, 33 % (N = 99) ont obtenu un DS. Un plus fort pourcentage de femmes (40 %) que d'hommes (30 %) (P = ,0402) a obtenu des DS. Après avoir tenu compte du nombre d'années d'exercice, une proportion beaucoup plus importante de femmes que d'hommes ayant des DS étaient professeurs adjoints et agrégés (P = 0,033). Les professeurs qui possèdent des DS étaient associés à une plus grande productivité de la recherche et à un rang universitaire plus élevé que ceux qui possédaient un diplôme en médecine (P < 0,05). Les DS étaient souvent obtenus après la résidence (38 %), et les plus courants étaient des maîtrises (51 %) et des doctorats (21 %). Il a été établi que les chirurgiens plasticiens canadiens étaient moins susceptibles de faire un MBA que les chirurgiens des États-Unis (P =0 ,002). Conclusion : Le tiers des chirurgiens plasticiens universitaires canadiens possédaient des DS. Ceux qui en détenaient présentaient une plus grande productivité en recherche et un meilleur rang universitaire. Lorsqu'ils étaient divisés par genre, les détenteurs de DS présentaient des différences importantes. Les résultats de la présente étude appuient les initiatives en cours soulignant la nécessité de respecter l'égalité des genres en chirurgie plastique universitaire.

Ivory tower in MD/PhD programmes: sticky floor, broken ladder and glass ceiling.

OBJECTIVE: Achieving gender equity in academic medicine is not only a matter of social justice but also necessary in promoting an innovative and productive academic community. The purpose of this study was to assess gender distribution in dual MD/PhD academic programme faculty members across North America. METHODS: Academic metrics were analysed to quantify the relative career success of academic faculty members in MD/PhD programmes. Measured parameters included academic and leadership ranks along with nominal research factors such as peer-reviewed research publications, H-index, citation number and years of active research. RESULTS: Χ² analysis revealed a statistically significant (p<0.0001, χ²=114.5) difference in the gender distribution of faculty and leadership across North American MD/PhD programmes. Men held 74.2% of full professor positions, 64% of associate professor positions, 59.4% of assistant professor positions and 62.8% of lecturer positions. Moreover, men occupied a larger share of faculty leadership roles with a statistically significant disparity across all ranks (p<0.001, χ²=20.4). A higher proportion of men held positions as department chairs (79.6%), vice chairs (69.1%) and programme leads (69.4%). CONCLUSION: Gender disparity was prevalent in the MD/PhD programmes throughout North America with women achieving a lower degree of professional stature than men. Ultimately, steps must be taken to support women faculty to afford them better opportunities for academic and professional advancement.

Assessing sex and gender equity in submission guidelines of radiology journals: A cross-sectional study.

PURPOSE: Our study aimed to determine the current percentage of gender and sex equity promoting (GSEP) radiology journals, defined as satisfying at least one criterion of the Sex and Gender Equity in Research (SAGER) checklist, published by the European Association of Science Editors (EASE). A secondary objective was to compare characteristics of GSEP and non-GSEP journals. METHODS: A cross-sectional analysis between June 24 and July 3, 2023, was conducted. The author submission guidelines of radiology journals with a 2021 Journal Impact Factor (JIF) were assessed according to the SAGER checklist. GSEP journals were defined as satisfying one or more SAGER checklist criteria in their research instructions. Bibliometric data and journal information were collected from the Journal Citation Reports and National Library of Medicine catalogue. RESULTS: Only 39.7 % (52) of 132 journals satisfied at least one SAGER checklist criterion. Median 2021 JIFs were higher in GSEP journals (4.62, IQR: 3.73 - 5.21) than non-GSEP journals (2.70, IQR: 2.32) (p = 0.00). Median 2021 Journal Citation Index (JCI) scores were higher in GSEP (0.64, 0.56 - 0.73) than non-GSEP journals (0.97, 0.83 - 1.10) (p = 0.00). Cited half-life was shorter for GSEP (5.40, 4.80 - 6.50) than non-GSEP journals (6.70, 5.70 - 7.40) (p = 0.05). Elsevier published 33 of 52 of GSEP journals. CONCLUSION: 60.3% of radiology journals with a 2021 JIF do not meet a single SAGER checklist criterion in their author submission guidelines. GSEP journals had higher impact and source metrics and a shorter cited half-life. Publishers may play a significant role in promoting endorsement of the SAGER checklist in the author submission guidelines of radiology journals.