Gender Differences in Faculty Rank Among Academic Emergency Physicians in the United States

Academic Emergency Medicine (2019)

Bennett CL, Raja A, Kapoor N, Kass D, Blumenthal D, Gross N, Mills A

Background: The purpose of this study was to complete a comprehensive analysis of gender differences in faculty rank among United States (U.S.) emergency physicians that reflected all academic emergency physicians.

 

Methods: We assembled a comprehensive list of academic emergency medicine physicians with U.S. medical school faculty appointments from Doximity.com linked to detailed information on physician gender, age, years since residency completion, scientific authorship, National Institutes of Health (NIH) research funding, and participation in clinical trials. To estimate gender differences in faculty rank, multivariable logistic regression models were used that adjusted for these factors.

 

Results: Our study included 3600 academic physicians (28%, or 1016, female). Female emergency physicians were younger than their male colleagues [mean age, years (+SD), was 43.8 (+ 8.7) for females and 47.4 (+ 9.9) for males (p<0.001)], had fewer years since residency completion (12.4 vs. 15.6 years, p<0.001), had fewer total and first/last author publications [4.7 vs. 8.6 total publications, p<0.001; 4.3 vs. 7.1 first or last author publications, p<0.001], and were less likely to be principal investigators on NIH grants [1.2% vs. 2.9%, p=0.002] or clinical trials [1.8% vs. 4.4%, p<0.001]. In unadjusted analysis, male physicians were more likely than female physicians to hold the rank of Associate or Full Professor vs. Assistant Professor [13.7 percentage point difference, p<0.001], a relationship that persisted after multivariable adjustment [5.5 percentage point difference, p=0.001].

 

Conclusions: Female academic emergency medicine physicians are less likely to hold the rank of Associate or Full Professor compared to male physicians even after detailed adjustment for other factors that may influence faculty rank.

Changes in Sex, Race, and Ethnic Origin of Emergency Medicine Resident Physicians from 2007‐2017

Academic Emergency Medicine (2018)

Bennett CL, McDonald DA, Hurwitz S, Zheng H, Nadel E, Ranney M.

Diversity among residents in particular, and among the emergency medicine workforce in general, is a goal of both specialty societies and accrediting agencies.1,2 The proportion of medical students and residents who self‐identify as female has increased over the last few decades, but the proportion who are racial and ethnic minorities remains low.3‐6 The percentage of emergency physicians and emergency medicine residents who are women and minorities are known to be lower than that of the general population..

ROBO4 variants predispose individuals to bicuspid aortic valve and thoracic aortic aneurysm

Nature Genetics (2018)

Gould RA, Aziz H, Woods CE, Seman-Senderos MA, Sparks E, Preuss C, Wünnemann F, Bedja D, Moats CR, McClymont SARose RSobreira N, Ling H, MacCarrick G, Kumar AA, Luyckx I, Cannaerts E, Verstraeten A, Björk HM, Lehsau ACJaskula-Ranga VLauridsen HShah AA, Bennett CLEllinor PT, Lin HIsselbacher EM, Lino Cardenas CL, Butcher JTHughes GC, Lindsay ME, Baylor-Hopkins Center for Mendelian GenomicsMIBAVA Leducq ConsortiumMertens L, Franco-Cereceda A, M. A. Verhagen J, Wessels M, Mohamed SA, Eriksson P, Mital S, Van Laer L, Loeys BL, Andelfinger GMcCallion AS, Dietz HC.

Bicuspid aortic valve (BAV) is a common congenital heart defect (population incidence, 1–2%)1,2,3 that frequently presents with ascending aortic aneurysm (AscAA)4. BAV/AscAA shows autosomal dominant inheritance with incomplete penetrance and male predominance. Causative gene mutations (for example, NOTCH1, SMAD6) are known for ≤1% of nonsyndromic BAV cases with and without AscAA58, impeding mechanistic insight and development of therapeutic strategies. Here, we report the identification of variants in ROBO4 (which encodes a factor known to contribute to endothelial performance) that segregate with disease in two families. Targeted sequencing of ROBO4 showed enrichment for rare variants in BAV/AscAA probands compared with controls. Targeted silencing of ROBO4 or mutant ROBO4 expression in endothelial cell lines results in impaired barrier function and a synthetic repertoire suggestive of endothelial-to-mesenchymal transition. This is consistent with BAV/AscAA-associated findings in patients and in animal models deficient for ROBO4. These data identify a novel endothelial etiology for this common human disease phenotype.

North Carolina Medical Student Views on Abortion

North Carolina Medical Journal (2018)

 

Bennett CL, McDonald DA, Finch A, Rennie S, and Morse JE

Background: Abortion is a controversial yet common procedure within the United States and North Carolina. Although much effort has been directed at understanding the views of physicians and the general public, the views of medical students on abortion are understudied. This study examines the views of medical students at different stages in training on abortion at a public institution, the University of North Carolina at Chapel Hill School of Medicine.

 

Methods We surveyed incoming, second year, fourth year, and leave-of-absence medical students at the University of North Carolina at Chapel Hill about their views on abortion. We utilized an IRB-approved, anonymous online Qualtrics-based, cross-sectional survey during the spring of 2014.

 

Results We received 315 responses (58% response rate) from 98 incoming (54.5%), 126 second year (70.0%), and 91 fourth year and leave-of-absence (49.2%) students. The majority of students, regardless of stage of training, felt abortion was morally acceptable (incoming 64.3%, second year 74.0%, and fourth year and leave-of-absence 70.0%). Of the students who found abortion to be acceptable, second year (80.9%) and fourth year and leave-of-absence (85.5%) students found second-trimester abortion more acceptable than incoming students (57.15%, P = .002); second year students (42.2%) had greater acceptability of third-trimester abortions compared to incoming (26.2%) and fourth year and leave-of-absence students (22.2%; P = .03). Religiosity and Republican political affiliation were associated with more conservative views on abortion (P = .002); however, gender or intention to enter into an obstetrics/gynecology residency were not.

 

Limitations Our study reflects views from a single institution, the University of North Carolina at Chapel Hill School of Medicine. This limits the generalizability of our findings to the greater population of medical students across the country.

 

Conclusion Despite the controversy surrounding abortion, our work suggests that medical students at the University of North Carolina at Chapel Hill School of Medicine have accepting views of abortion

Association of the 2003 and 2011 ACGME Resident Duty Hour Reforms With Internal Medicine Initial Certification Examination Performance.

Journal of Graduate Medical Education (2017)

Bennett CL, McDonald DADorner SCNadel ESMcDonald FSMcPherson JA.

Adult male with diffuse neck masses

Visual Journal of Emergency Medicine (2017)

Bennett CL and Hayden E

A National Cross-Sectional Study of Surgery Residents Who Underreport Duty Hours.

Journal of Surgical Education (2017)

Bennett CLMcDonald DAChang YFinch AVuong KRennie SNadel ES

OBJECTIVE: Previous work demonstrates that many surgery residents underreport duty hours. The purpose of this study was to identify characteristics of these residents and better understand why they exceed duty hours.

 

DESIGN: During the winter of 2015 we conducted an anonymous cross-sectional survey of Accreditation Council for Graduate Medical Education accredited general surgery programs.

 

SETTING: A total of 101 general surgery residency programs across the United States.

 

PARTICIPANTS: A total of 1003 general surgery residents across the United States. Respondents' mean age was 29.9 ± 3.0 years; 53% were male.

 

RESULTS: Study response rate was 31.9%. Residents age <30 were more likely to exceed duty hours to complete charting/documentation (68% vs. 54%, p < 0.001). Females more often cited guilt about leaving the hospital (32% vs. 24%, p = 0.014) as to why they exceed duty hours. Programs with >40 residents had the highest rates of underreporting (82% vs. 67% in other groups p < 0.001) and residents who worked >90 hours on an average week more frequently cited external pressure (p = 0.0001), guilt (p = 0.006), and feeling it was expected of them (p < 0.0001) as reasons why they underreport compared to those who worked fewer hours.

 

CONCLUSIONS: Underreporting and duty-hour violations are a complex issue influenced by many variables including age, sex, and internal and external pressures

Surgical Resident Duty Hours

New England Journal of Medicine (2016)

Bennett CL, Finch AVuong KMcDonald D, Rennie S

January 01, 2020

A 15-Year-Old Male with Enlarging “Breast Lump”

Visual Journal of Emergency Medicine (2016)

 

Bennett CL, Singh Sabina, Lobo V

Massive hemoptysis in Loeys-Dietz syndrome.

American Journal of Medical Genetics, Part A (2016)

Bennett CLAziz HSparks EShah T, Yoder M, MacCarrick GDietz HC.

We describe four unrelated individuals with Loeys-Dietz syndrome (LDS) who presented with massive hemoptysis of unknown etiology. LDS is an autosomal dominant connective-tissue disorder characterized by altered cardiovascular, craniofacial, and skeletal development that is attributed to mutations in the TGFBR1, TGFBR2, SMAD3, or TGFB2 genes. Massive hemoptysis (MH) is a rare and often fatal pulmonary medical emergency. This is the first report of MH in individuals with LDS and establishes it as part of the LDS spectrum. It compels providers to educate their LDS patients on MH, although much investigation needs to be done to determine etiology and appropriate treatment for this newly described LDS feature.dience's attention...

Kaposi's Sarcoma-Associated Herpesvirus Viral Interferon Regulatory Factor 1 Interacts with a Member of the Interferon-Stimulated Gene 15 Pathway.

Journal of Virology (2015)

Jacobs SRStopford CMWest JABennett CL Giffin LDamania B.

 

Kaposi's sarcoma-associated herpesvirus (KSHV) is a gammaherpesvirus known to establish lifelong latency in the human host. We and others have previously shown that three KSHV homologs of cellular interferon regulatory factors (IRFs), known as viral IRFs (vIRFs), participate in evasion of the host interferon (IFN) response. We report that vIRF1 interacts with the cellular interferon-stimulated gene 15 (ISG15) E3 ligase, HERC5, in the context of Toll-like receptor 3 (TLR3) activation and IFN induction. The ISG15 protein is covalently conjugated to target proteins upon activation of the interferon response. Interaction between vIRF1 and HERC5 was confirmed by immunoprecipitation, and the region between amino acids 224 and 349 of vIRF1 was required for interaction with HERC5. We further report that expression of vIRF1 in the context of TLR3 activation results in decreased ISG15 conjugation of proteins. Specifically, TLR3-induced ISG15 conjugation and protein levels of cellular IRF3, a known ISG15 target, were decreased in the presence of vIRF1 compared to the control. vIRF1 itself was also identified as a target of ISG15 conjugation. KSHV-infected cells exhibited increased ISG15 conjugation upon reactivation from latency in coordination with increased IFN. Furthermore, knockdown of ISG15 in latently infected cells resulted in a higher level of KSHV reactivation and an increase in infectious virus. These data suggest that the KSHV vIRF1 protein affects ISG15 conjugation and interferon responses and may contribute to effective KSHV replication.

The viral interferon regulatory factors of kaposi's sarcoma-associated herpesvirus differ in their inhibition of interferon activation mediated by toll-like receptor 3.

Journal of Virology (2013)

Jacobs SR1, Gregory SMWest JAWollish ACBennett CLBlackbourn DJHeise MTDamania B.

Kaposi's sarcoma-associated herpesvirus (KSHV) infection is correlated with three human malignancies and can establish lifelong latent infection in multiple cell types within its human host. In order to establish and maintain infection, KSHV utilizes multiple mechanisms to evade the host immune response. One such mechanism is the expression of a family of genes with homology to cellular interferon (IFN) regulatory factors (IRFs), known as viral IRFs (vIRFs). We demonstrate here that KSHV vIRF1, -2, and -3 have a differential ability to block type I interferon signaling mediated by Toll-like receptor 3 (TLR3), a receptor we have previously shown to be activated upon KSHV infection. vIRF1, -2, and -3 inhibited TLR3-driven activation of IFN transcription reporters. However, only vIRF1 and vIRF2 inhibited increases in both IFN-β message and protein levels following TLR3 activation. The expression of vIRF1 and vIRF2 also allowed for increased replication of a virus known to activate TLR3 signaling. Furthermore, vIRF1 and vIRF2 may block TLR3-mediated signaling via different mechanisms. Altogether, this report indicates that vIRFs are able to block IFN mediated by TLRs but that each vIRF has a unique function and mechanism for blocking antiviral IFN responses

A transition zone complex regulates mammalian ciliogenesis and ciliary membrane composition.

Nature Genetics (2011)

Garcia-Gonzalo FR1, Corbit KCSirerol-Piquer MSRamaswami GOtto EANoriega TRSeol ADRobinson JFBennett CLJosifova DJGarcía-Verdugo JMKatsanis NHildebrandt FReiter JF.

Mutations affecting ciliary components cause ciliopathies. As described here, we investigated Tectonic1 (Tctn1), a regulator of mouse Hedgehog signaling, and found that it is essential for ciliogenesis in some, but not all, tissues. Cell types that do not require Tctn1 for ciliogenesis require it to localize select membrane-associated proteins to the cilium, including Arl13b, AC3, Smoothened and Pkd2. Tctn1 forms a complex with multiple ciliopathy proteins associated with Meckel and Joubert syndromes, including Mks1, Tmem216, Tmem67, Cep290, B9d1, Tctn2 and Cc2d2a. Components of this complex co-localize at the transition zone, a region between the basal body and ciliary axoneme. Like Tctn1, loss of Tctn2, Tmem67 or Cc2d2a causes tissue-specific defects in ciliogenesis and ciliary membrane composition. Consistent with a shared function for complex components, we identified a mutation in TCTN1 that causes Joubert syndrome. Thus, a transition zone complex of Meckel and Joubert syndrome proteins regulates ciliary assembly and trafficking, suggesting that transition zone dysfunction is the cause of these ciliopathies

KIF7 mutations cause fetal hydrolethalus and acrocallosal syndromes.

Nature Genetics (2011)

Putoux A1, Thomas SCoene KLDavis EEAlanay YOgur GUz EBuzas DGomes CPatrier SBennett CLElkhartoufi NFrison MHRigonnot LJoyé NPruvost SUtine GEBoduroglu KNitschke PFertitta LThauvin-Robinet CMunnich ACormier-Daire VHennekam RColin EAkarsu NABole-Feysot CCagnard NSchmitt AGoudin NLyonnet SEncha-Razavi FSiffroi JPWiney MKatsanis NGonzales MVekemans MBeales PLAttié-Bitach T.

KIF7, the human ortholog of Drosophila Costal2, is a key component of the Hedgehog signaling pathway. Here we report mutations in KIF7 in individuals with hydrolethalus and acrocallosal syndromes, two multiple malformation disorders with overlapping features that include polydactyly, brain abnormalities and cleft palate. Consistent with a role of KIF7 in Hedgehog signaling, we show deregulation of most GLI transcription factor targets and impaired GLI3 processing in tissues from individuals with KIF7 mutations. KIF7 is also a likely contributor of alleles across the ciliopathy spectrum, as sequencing of a diverse cohort identified several missense mutations detrimental to protein function. In addition, in vivo genetic interaction studies indicated that knockdown of KIF7 could exacerbate the phenotype induced by knockdown of other ciliopathy transcripts. Our data show the role of KIF7 in human primary cilia, especially in the Hedgehog pathway through the regulation of GLI targets, and expand the clinical spectrum of ciliopathies.

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