Electrochemiluminescent resonance energy transfer between amino-modified g-C3N4/Bi2MoO6 composite and carboxyl CoS2 nanoboxes for sensitive detection of alpha fetoprotein.

This work demonstrates an effective quenching electrochemiluminescent (ECL) immunosensor based on resonance energy transfer for the sensitive detection of alpha fetoprotein (AFP). In this strategy, graphitic carbon nitride (g-C3N4) was coupled with bismuth molybdenum oxide (Bi2MoO6) to form a g-C3N4/Bi2MoO6 nanocomposite as a novel type of ECL immunosensor. The as-synthesized amino-modified g-C3N4/Bi2MoO6 nanocomposite presents strong and stable cathodic ECL activity compared to pristine g-C3N4. One plausible reason is that the synergistic effect between the g-C3N4 and Bi2MoO6 could facilitate charge transfer process and thereby enhancing the separation efficiency of electron-hole pairs. The other functional part of the immunosensor, carboxyl CoS2 nanoboxes with a broad absorption range, was rationally designed and introduced. The evidence that the absorption spectra of carboxyl CoS2 NBs overlap with ECL spectra of g-C3N4/Bi2MoO6 nanocomposite holds accountable for exceptionally weakened ECL signal. This sandwich-type immunosensor was setup based on quenching mechanism concerning amino-modified g-C3N4/Bi2MoO6 as an ECL donor and carboxyl CoS2 NBs as an ECL accepter. The strategy was optimized to achieve a convincible and sensitive detection goal for AFP with a wide quantifiable range of 0.5 pg/mL-10 ng/mL whilst a sufficiently low detection limit of 0.04 pg/mL (S/N = 3). This immunosensor shows great potential for real sample analysis with reasonable recoveries ranging from 95.5 to 99.0 %, demonstrating its high precision for AFP determination.

Cryoablation Allows the Ultimate De-escalation of Surgical Therapy for Select Breast Cancer Patients.

BACKGROUND: Widespread use of screening mammography has allowed breast cancer to be detected at earlier stages. This allows for increased customization of treatment and less aggressive management. De-escalation of therapy plays an important role in decreasing treatment burden and improving patient quality of life. This report examines cryoablation as the next step in the surgical de-escalation of breast cancer. METHODS: Women with a diagnosis of clinically node-negative, estrogen receptor-positive (ER +), progesterone receptor-positive (PR +), human epidermal growth factor receptor 2-negative (HER2 -) infiltrating ductal carcinomas 1.5 cm or smaller underwent ultrasound-guided cryoablation. Either the Visica 2 treatment system (before 2020) or the ProSense treatment system (since 2020) was used to perform the cryoablation. Patients received mammograms and ultrasounds at a 6 months follow-up visit, and magnetic resonance images at baseline, then at 1 year follow-up intervals. Adjuvant therapy decisions and disease status were recorded. RESULTS: This study enrolled 32 patients who underwent 33 cryoablation procedures (1 patient had bilateral cancer). One patient had a sentinel node biopsy in addition to clinical staging of the axilla. For all the patients, adjuvant endocrine therapy was recommended, and six patients (18.75%) received adjuvant radiation. Of the 32 patients, 20 (60.6%) have been followed up for 2 years or longer, with no residual or recurrent disease at the site of ablation. CONCLUSION: Cryoablation of the primary tumor foregoing sentinel node biopsy offers an oncologically safe and feasible minimally invasive office-based procedure option in lieu of surgery for patients with early-stage, low-risk breast cancer.

Automated Detection and Scoring of Tumor-Infiltrating Lymphocytes in Breast Cancer Histopathology Slides.

Detection of tumor-infiltrating lymphocytes (TILs) in cancer images has gained significant importance as these lymphocytes can be used as a biomarker in cancer detection and treatment procedures. Our goal was to develop and apply a TILs detection tool that utilizes deep learning models, following two sequential steps. First, based on the guidelines from the International Immuno-Oncology Biomarker Working Group (IIOBWG) on Breast Cancer, we labeled 63 large pathology imaging slides and annotated the TILs in the stroma area to create the dataset required for model development. In the second step, various machine learning models were employed and trained to detect the stroma where U-Net deep learning structure was able to achieve 98% accuracy. After detecting the stroma area, a Mask R-CNN model was employed for the TILs detection task. The R-CNN model detected the TILs in various images and was used as the backbone analysis network for the GUI development of the TILs detection tool. This is the first study to combine two deep learning models for TILs detection at the cellular level in breast tumor histopathology slides. Our novel approach can be applied to scoring TILs in large cancer slides. Statistical analysis showed that the output of the implemented approach had 95% concordance with the scores assigned by the pathologists, with a p-value of 0.045 (n = 63). This demonstrated that the results from the developed software were statistically meaningful and highly accurate. The implemented approach in analyzing whole tumor histology slides and the newly developed TILs detection tool can be used for research purposes in biomedical and pathology applications and it can provide researchers and clinicians with the TIL score for various input images. Future research using additional breast cancer slides from various sources for further training and validation of the developed models is necessary for more inclusive, rigorous, and robust clinical applications.

Comparing Phantom and Animal Metrics Applied in the Determination of Focused Ultrasound Stable and Inertial Cavitation Levels.

OBJECTIVE: The opening of the blood-brain barrier (BBB) to allow therapeutic drug passage can be achieved by inducing microbubble cavitation using focused ultrasound (FUS). This approach can be monitored through analysis of the received signal to distinguish between stable cavitation associated with safe BBB opening and inertial cavitation associated with blood vessel damage. In this study, FUS phantom and animal studies were used to evaluate the experimental conditions that generate several cross-consistent metrics having the potential to be combined for the reliable, automatic control of cavitation levels. METHODS: Typical metrics for cavitation monitoring involve observing changes in the spectrum generated by applying the discrete Fourier transform (DFT) to the time domain signal detected using a hydrophone during FUS. A confocal hydrophone was used to capture emissions during a 10 ms FUS burst, sampled at 32 ns intervals, to produce 321,500 points and a high-resolution spectrum when transformed. The FUS spectra were analyzed to show the impact that equipment-transients and well-known DFT-related distortions had on the metrics used for cavitation control. A new approach, physical sparsification (PH-SP), was introduced to sharpen FUS spectral peaks and minimize the effect of these distortions. DISCUSSION: It was demonstrated that the general spectral signal-to-noise ratio (SNR) could be improved by removing the initial noisy phantom hydrophone signal transient. Minor changes in the transient length digitally removed from the sampled values significantly changed the spectral bandwidths of all the harmonically related FUS signals. We evaluated signal processing techniques to minimize the impact these DFT-related distortions on area-under-the-curve (AUC) metric calculations, and we identified the advantages of using PH-SP and proposed new metrics when characterizing FUS spectral properties. The results show many second, third and sub-harmonic metrics provide cross-consistent evidence of changes between stable and inertial cavitation levels. Removing the first harmonic signal component with a hardware low-pass filter allowed the hydrophone gain to be boosted without introducing distortion, leading to an improved analysis of the sub-harmonic signal orders of magnitude smaller in intensity. Metrics that optimized the energy in the real component of the complex-valued PH-SP spectra provided a 32% increase in the sub-harmonic sensitivity compared to standard metrics. CONCLUSION: A preliminary investigation of existing and proposed metrics showed that system noise could be large enough to mask the transition between stable and inertial cavitation. Strong narrowing of sub-harmonic peak shapes on applying physical sparsification (PH-SP) were seen in both phantom and animal studies. However, validating equivalent trends of the metrics with pressure were limited by the increased system noise level in the animal study combined with the natural variability between subjects studied. The combined use of hardware low-pass filters and physical sparsification to selectively removing distortions in the spectrum allowed the optimization of metrics for cavitation monitoring by improving the sub-harmonic sensitivity.

Dishevelled 2 regulates cancer cell proliferation and T cell mediated immunity in HER2-positive breast cancer.

BACKGROUND: Dishevelled paralogs (DVL1, 2, 3) are key mediators of Wnt pathway playing a role in constitutive oncogenic signaling influencing the tumor microenvironment. While previous studies showed correlation of ß-catenin with T cell gene expression, little is known about the role of DVL2 in modulating tumor immunity. This study aimed to uncover the novel interaction between DVL2 and HER2-positive (HER2+) breast cancer (BC) in regulating tumor immunity and disease progression. METHODS: DVL2 loss of function studies were performed with or without a clinically approved HER2 inhibitor, Neratinib in two different HER2+ BC cell lines. We analyzed RNA (RT-qPCR) and protein (western blot) expression of classic Wnt markers and performed cell proliferation and cell cycle analyses by live cell imaging and flow cytometry, respectively. A pilot study in 24 HER2+ BC patients was performed to dissect the role of DVL2 in tumor immunity. Retrospective chart review on patient records and banked tissue histology were performed. Data were analyzed in SPSS (version 25) and GraphPad Prism (version 7) at a significance p < 0.05. RESULTS: DVL2 regulates the transcription of immune modulatory genes involved in antigen presentation and T cell maintenance. DVL2 loss of function down regulated mRNA expression of Wnt target genes involved in cell proliferation, migration, invasion in HER2+ BC cell lines (±Neratinib). Similarly, live cell proliferation and cell cycle analyses reveal that DVL2 knockdown (±Neratinib) resulted in reduced proliferation, higher growth arrest (G1), limited mitosis (G2/M) compared to non-targeted control in one of the two cell lines used. Analyses on patient tissues who received neoadjuvant chemotherapy (n = 14) further demonstrate that higher DVL2 expression at baseline biopsy pose a significant negative correlation with % CD8α levels (r = - 0.67, p < 0.05) while have a positive correlation with NLR (r = 0.58, p < 0.05), where high NLR denotes worse cancer prognosis. These results from our pilot study reveal interesting roles of DVL2 proteins in regulating tumor immune microenvironment and clinical predictors of survival in HER2+ BC. CONCLUSION: Our study demonstrates potential immune regulatory role of DVL2 proteins in HER2+ BC. More in-depth mechanistic studies of DVL paralogs and their influence on anti-tumor immunity may provide insight into DVLs as potential therapeutic targets benefiting BC patients.

The Role of Cryoablation in Breast Cancer Beyond the Oncologic Control: COST and Breast-Q Patient-Reported Outcomes.

BACKGROUND: Cryoablation has been established as a minimally invasive alternative to resection of early-stage breast cancer; however, there are no data on the cost and impact on patients' financial, psychosocial, sexual, physical, and cosmetic outcomes utilizing this approach. This study compares cost-effectiveness and patient-reported quality-of-life factors in cryoablation versus resection. METHODS: Women with early-stage, low-risk infiltrating ductal carcinomas ≤ 1.5 cm underwent cryoablation or resection. Adjuvant therapy was provided according to tumor board recommendations. Direct and indirect costs were tracked for both groups. Financial toxicity and well-being outcome were measured by administering the Comprehensive Score of Financial Toxicity (COST) and BREAST-Q surveys, respectively, at 6-month follow-up. RESULTS: Of the 34 eligible patients, 14 (41.1%) consented for cryoablation and 20 (58.8%) underwent resection. The median (centile) (range) follow-up was 35.0 (21.3) (15-50) months for cryoablation vs. 25 (20.8) (17-50) months for resection [p = 0.6479]. Mean (standard deviation) cost of care for cryoablation versus resection was $2221.70 (615.70) versus $16,896.50 (1332.40) [p < 0.0001], and median financial well-being scores for the cryoablation versus resection groups were 38.0 (34.5, 40.0) versus 10 (5.3, 14.0) [p < 0.0001]. Poor financial well-being was directly correlated with the cost of care [p < 0.0001]. Median psychosocial well-being scores were similar across both groups, however the cryoablation group had higher scores for physical [100 (100, 100) vs. 89 (79, 100); p = 0.0141], sexual [100 (91, 100) vs. 91 (87.5, 91); p = 0.0079], and cosmetic [100 (100, 100) vs. 88 (88, 100); p = 0.0171] outcomes. CONCLUSION: Cryoablation offers a cost-effective and quality-of-life advantage compared with resection for early-stage, low-risk breast cancer.

Facebook and Suicidal Behaviour: User Experiences of Suicide Notes, Live-Streaming, Grieving and Preventive Strategies-A Scoping Review.

BACKGROUND: Facebook represents a new dimension for global information sharing. Suicidal behaviours and attempts are increasingly reported on Facebook. This scoping review explores the various aspects of suicidal behaviours associated with Facebook, discussing the challenges and preventive measures. METHODS: PubMed, Google Scholar, and Scopus were searched for related articles published in English up to October 2021, using different combinations of "Facebook" and "suicide". A group of experts comprising consultant psychiatrists screened the records and read the full-text articles to extract relevant data. Twenty-eight articles were chosen as relevant and included in the review under four selected themes. RESULTS: Facebook impacts on suicidal behaviours in different aspects. Announcing suicides through sharing notes or personal information may lead to the prediction of suicide but be harmful to the online audience. Live-streaming videos of suicide is another aspect that questions Facebook's ability to monitor shared contents that can negatively affect the audience. A positive impact is helping bereaved families to share feelings and seek support online, commemorating the lost person by sharing their photos. Moreover, it can provide real-world details of everyday user behaviours, which help predict suicide risk, primarily through novel machine-learning techniques, and provide early warning and valuable help to prevent it. It can also provide a timeline of the user's activities and state of mind before suicide. CONCLUSIONS: Social media can detect suicidal tendencies, support those seeking help, comfort family and friends with their grief, and provide insights via timelining the users' activities leading to their suicide. One of the limitations was the lack of quantitative studies evaluating preventative efforts on Facebook. The creators' commitment and the users' social responsibility will be required to create a mentally healthy Facebook environment.

Psychosis during the COVID-19 pandemic: A systematic review of case reports and case series.

BACKGROUND: Preliminary data suggest that patients with COVID-19 may experience psychiatric symptoms, including psychosis. We systematically reviewed the literature to evaluate the concurrence of new-onset psychosis or exacerbation of clinically stable psychosis through case reports and case series. METHODS: Six databases were searched, followed by an electronic and manual search of the relevant articles. Studies were identified using predetermined eligibility criteria. We evaluated the demographic characteristics, clinical history, course of illness, management, and prognosis of the patients in these studies. RESULTS: Case reports and case series, altogether consisting of 57 unique cases were included. The mean patient age for onset of psychotic symptoms was 43.4 years for men and 40.3 years for women. About 69% of patients had no prior history of psychiatric disorders. Most patients had mild COVID-19-related symptoms, with only 15 (26.3%) presenting with moderate to severe COVID-19-related disease and complications. The most commonly reported psychotic symptoms were delusions and hallucinations. Patients with psychotic symptoms were treated with antipsychotics, benzodiazepines, valproic acid, and electroconvulsive treatment. In 36 cases, psychotic symptoms resolved completely or improved significantly. Ten cases had partial improvement with residual psychotic symptoms, and one patient died due to cardiac arrest. CONCLUSION: Most patients responded to a low-to-moderate dose of antipsychotics with a quick recovery. However, the residual psychiatric symptoms highlight the need for careful monitoring and longer follow-up. Clinicians should be mindful of the occurrence of psychosis due to COVID-19 infection in a subset of COVID-19 patients that can be misdiagnosed as a psychotic disorder alone.

Over-the-counter drug use in suicidal/self-harm behavior: Scoping review.

Background and aims: Minor physical ailments are treated with over-the-counter (OTC) medications. The availability of OTC drugs helps reduce waiting times and ease the suffering of many. Suicidal behavior includes suicidal ideation, attempts, and completed suicides and affects people of all ages, religions, and cultures. This study aims to review use of OTC drugs for self-harm and suicidal attempts. Methods: We reviewed English language publications from the beginning of time to October 2021 on OTC drug use for suicidal behavior. Results: Twenty-seven studies met the eligibility criteria, and 1,816,228 participants were reported in these publications. OTC analgesics and sedatives/hypnotics were frequently used for suicidal behavior. Females and young people mainly were reported to self-harm using OTC medications. An increase in OTC analgesic use for self-harm in adolescents during the school months was reported. Elderly persons use hypnotics more frequently for suicidal attempts. Persons with major psychiatric disorders were reported to use OTC for suicidal behavior. Conclusion: The available information shows that the prevention strategies should focus on OTC analgesics and hypnotic use among women, the young, the elderly, and persons with mental health disorders.

Investigation of hardware and software techniques to enhance the characteristics of focused ultrasound (FUS) spectra.

Objective. Microbubble cavitation generated by focused ultrasound (FUS) can induce safe blood-brain-barrier (BBB) opening allowing therapeutic drug passage. Spectral changes in the hydrophone sensor signal are currently used to distinguish stable cavitation from inertial cavitation that can damage theBBB.Gibbs' ringing, peak intensity loss and peak width increase are well-known distortions evident when using the discrete Fourier transform (DFT) to transform data containing a few hundred points. We investigate overcoming the fact thatFUStime signals (10 ms providing 312 500 points sampled at 32 ns intervals) can generate such sharp spectral peaks that variations in theirDFT-related distortions can significantly impact the values of the key metrics used for cavitation characterization.Approach. We introduce low-pass filter hardware to improve how the analogue to digital convertor handles high-frequency noise components and the orders of magnitude differences betweenFUSharmonic intensities. We investigate the enhancedFUSspectral stability and resolution obtained from a new technique, physical sparsification(PH-SP),customized to thea-prioriinformation that all keyFUScomponents are harmonically related. Results are compared with standardDFToptimizations involving time data windowing and Fourier interpolation.Main results. A new simulation model showed peak intensity, widths and metrics modified by small changes in the transformed signal's length when removing the noisy starting transient of theFUShydrophone signal or following minor excitation frequency or sampling rate adjustments. 25%-60% area-under-the-curve changes occurred in phantom studies at different pressure levels. Spectral peak sharpness was best optimized and stabilized withPH-SP.Significance. SpecialFUScharacteristics mean starting transients and minor variations in experimental procedures lead to significant changes in the spectral metrics used to monitor cavitation levels. CustomizingPH-SPto these characteristics led to sharper, more stable spectra with the potential to track the impact of microbubble environment changes.

Gender and Racial Disparity Among US Forensic Psychiatry Fellows: Broken System by Default.

Diversity enhances the performance of the healthcare system by providing better patient outcomes and reducing physician burnout. In this study, we explored the gender and racial trends in the recruitment of women and racial minorities into forensic psychiatry fellowship programs in the US. Retrospective data analysis was performed by utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from the year 2007 to 2021. Demographic data, including gender and race, were extracted for forensic psychiatry fellows. The number of female trainees increased significantly to become a majority, i.e., 58.8% of all forensic psychiatry trainees in 2020-2021 were female compared to 27.78% of women forensic psychiatry fellows in 2007-08. Between 2011-12 and 2020-2021, there was a relative increase in White (Non-Hispanic), Asian/Pacific Islander and Black (Non-Hispanic) forensic psychiatry fellows, by 54.75%, 114.4%, and 0.36% respectively. Despite the overall increase in the numbers of ethnic minorities in US psychiatry residency and fellowship programs, racial minorities remain significantly under-represented in forensic psychiatry fellowship programs. We need to revise policies to promote underrepresented minorities in medicine (URMM) in forensic psychiatry.

Working Towards Gender and Racial Diversity in Pediatric Residency Programs in the United States.

Introduction The gender and racial profile of the pediatric population in the United States (US) is more diverse than that of the pediatricians that cater to their healthcare needs. Gender and racial diversity remains limited among pediatric residents and fellows, faculty, and leadership. Our study objectives were to explore the gender and racial disparity among pediatric residents in the US. Methods This was a retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) database. The database encompassed all residents in US pediatrics residency programs from 2007 to 2021, categorizing them into White (non-Hispanic), Asian/Pacific Islander, Hispanic, African American/Black (non-Hispanic), Native American/Alaskan, others (races not included in the mentioned categories), and unknown. Gender was grouped into male, female, and not reported. Results From 2011 to 2021, the greatest increase in relative change (%) was seen for Asian or Pacific Islander (+58.42%), followed by Black (non-Hispanic) (+45.24%), White (non-Hispanic) (+43.37%), and Hispanic (+42.18%) races. The Native American/Alaskan relatively decreased 50%. The representation of female residents relatively increased by 13.27% as compared to the relative increase of male residents (+14.77%) from 2007 to 2021. Conclusion It is imperative to have a healthcare workforce that is representative of the existing communities in the US in terms of race, ethnicity, and gender to provide culturally sensitive care to the diverse patient population of the US.

Understanding Distribution of Gender and Race across Consultation Liaison Psychiatry in USA.

The United States of America (USA) has a culturally and ethnically diverse population. Various gender and racial minorities in the healthcare system are not represented adequately when compared to their ratios in the general population. This study reviewed the gender and racial distribution and its temporal trends among fellows in Consultation-Liaison Psychiatry (CLP) within the USA. A retrospective analysis was performed to evaluate the gender and race of fellows in CLP fellowship programs in the USA from 2007 to 2019. Data was retrieved from publicly available Accreditation Council for Graduate Medical Education (ACGME) Resource Books. According to ACGME data, races were categorized as White (non-Hispanic), Asian/Pacific Islander, Hispanic, Black (non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was self-reported as male, female, and not reported. Among fellows in CLP, the White (Non-Hispanic) race remained the most represented and increased by 7.3% from 2011 to 2019, with an 18.6% increase in relative change. In contrast, the Asian/Pacific Islander, African American/Black (Non-Hispanic), and others decreased by 6.2%, 4.0%, and 4.6%, respectively. Gender distribution trends showed an increase in male representation with a relative increase of 14.7% and an absolute increase of 5.5%. Similar trends were seen in female representation with a relative and absolute increase of 5.2% and 2.8%, respectively. However, women remained the most represented throughout the period. Considering the ongoing globalization & rapidly evolving US demographics, it is crucial to analyze the gender and racial disparities within psychiatry. Racial concordance and a diversified culturally competent physician workforce is imperative for the effective delivery of mental health services.

Tumor-Infiltrating Lymphocytes (TILs) as a Biomarker of Abscopal Effect of Cryoablation in Breast Cancer: A Pilot Study.

BACKGROUND: Morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer is gaining momentum as an immunological biomarker. This experiment evaluates the role of TILs in distant tumors as a measure of abscopal effect from cryoablation of breast cancer. METHODS: BALB/c mice underwent bilateral orthotopic transplant with 4T1-12B (triple-negative) cells. At 2 weeks, left tumors were treated by either resection (standard of care group) or cryoablation (intervention group) followed by resection of the distant right tumors 1 week posttreatment. TIL scores were calculated from hematoxylin and eosin-stained sections and phenotyped for cytotoxic T-lymphocyte (CTL) markers by immunofluorescence. Primarily resected tumors served as baseline (Tbaseline), whereas resected distant right-sided served as the readout for abscopal effect (AbsRes or AbsCryo). Mice were monitored for tumor recurrence and metastasis. RESULTS: The AbsCryo had a significant mean (SD) increase in stromal (2.8 [1.1]%; p = 0.015) and invasive margin TILs (50 [12]%; p = 0.02) compared with TBaseline (1.0 [0]% and 31 [4.9]%, respectively). CTL phenotyping revealed a significant increase in mean (SD) CD8+ T cells (15.7 [12.1]; p = 0.02) and granzyme B (4.8 [3.6]; p = 0.048) for the AbsCryo compared with TBaseline (5.2 [4.7] and 2.4 [0.9], respectively). Posttreatment, the cryoablation group had no recurrence or metastasis, whereas the resected group showed local recurrence and lung metastasis in 40% of the mice. Postprocedure increase in TIL score of distant tumors was associated with decrease in tumor relapse (p = 0.02). CONCLUSIONS: Cryoablation induced a robust tumor-specific TIL response compared with resection, suggesting an abscopal effect leading to the prevention of cancer recurrence and metastasis.

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action.

OBJECTIVE: The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce. In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations. METHOD: This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported. RESULTS: Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trends and the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030. CONCLUSION: There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.