Uncover your inner power: Breaking leadership biases in global healthcare.

Women currently represent approximately 70% of the global healthcare workforce, 60.9% of the global dental workforce, 77.6% of the US healthcare workforce, and 36.7% of the US dental workforce. The American Dental Association states that the number of practicing women dentists in the United States has increased by 2.25 times since 2001, with a projected trajectory to level off by 2040. Despite having a major impact on the healthcare sector globally, women earn 24% less than men and only serve in 25% of senior leadership positions. In the US dental schools, only 14% of faculty serve in administrative roles, and as of April 2022, 28.6% of the US dental school deans were women, indicating gender underrepresentation in the highest roles of academic leadership. This corresponds to the data on gender parity still not being the norm in many societies and workplaces and can be attributed to public policies, stereotypical perceptions, and individual factors. Five key factors have been identified to be crucial for women's entry or advancement in global health leadership: a) public policy, b) community, c) institutional, d) interpersonal, and e) individual. Individual self-improvement and institutional practices may be used to overcome these barriers to women's leadership in healthcare and shift the power dynamics toward reinforcing gender equality. These transformative changes are measured through women's collective capacities and skills, relationship dynamics, community perceptions, and environmental practices. This article recognizes the present obstacles to women in healthcare leadership and proposes strategies to achieve gender equality both through individual and institutional practices.

Faculty diversity, equity, and inclusion in academic dentistry: Has dental education missed the call of #MeToo?

Faculty, students, and staff experience sexual harassment in the workplace and educational environment. Frequently, the victim takes no action either due to a lack of understanding of their rights or concern about retaliation or adverse outcomes if an incident is reported. The #MeToo movement has enhanced awareness of sexual harassment and its impact on victims. However, dental institutions vary in their approach to creating an environment free from harassment and supportive of individuals subject to inappropriate or illegal behaviors. In this article, four vignettes provide examples of harassment, mistreatment, or bias. Common themes and critical issues within the vignettes are then identified, discussing the potentially illegal, unethical, inappropriate, and unprofessional behaviors and comments. Strategies to address the issues identified are described. Recommendations are also provided to assist dental institutions and educators in evaluating their current practices and policies and implementing change.

Faculty diversity, equity, and inclusion in academic dentistry: Revisiting the past and analyzing the present to create the future.

AIM: In 2021, NIDCR published the landmark report "Oral Health in America." It described that while oral health-related research and care has seen amazing progress, oral health inequities and lack of oral care for large segments of the US population have not improved. This situation plus the predicted increase of the diversification of the US population requires decisive actions to ensure that future dentists will be optimally prepared to provide the best possible care for all patients. A diverse dental educator workforce plays a crucial role in obtaining this goal. The objectives of this document were threefold. Aim 1 was to analyze past and current trends in the diversity and inclusion of historically underrepresented ethnic/racial (HURE) and marginalized (HURM) dental faculty members. Aim 2 focused on reviewing best practices and challenges related to achieving dental faculty and leadership diversity and inclusion. Aim 3 was to develop recommendations for increasing the diversity and inclusion of dental faculty in the present and future. METHODS: An analysis of ethnicity/race and gender faculty data collected by the American Dental Education Association (ADEA) in 2011-2012 and 2018-2019 showed that achieving faculty diversity and inclusion has been an ongoing challenge, with limited success for faculty from HURE backgrounds. In order to create this much-needed change, best practices to increase the applicant pool, change recruitment strategies, and develop solid retention and promotion efforts were described. Research discussing the challenges to creating such changes was analyzed, and strategies for interventions were discussed. CONCLUSION: In conclusion, evaluations of efforts designed to create a more diverse and inclusive work force is crucial. Institutions must evaluate their diversity data, practices utilized, and the policies implemented to determine whether the desired outcomes are achieved. Only then will the future dental workforce be optimally prepared to provide the best possible care for all patients in the United States.

SKAP2-BRAF fusion and response to an MEK inhibitor in a patient with metastatic melanoma resistant to immunotherapy.

A woman in her 40s presented to the emergency department with headache and unintentional weight loss in September 2018. Investigations revealed a widely metastatic pan-negative melanoma of unknown primary. She had multiple lines of treatment including combination immunotherapy and chemotherapy. Next-generation sequencing identified an SKAP2-BRAF fusion protein, and she was commenced on an MEK inhibitor in September 2019 with a partial response seen on restaging scans after 6 weeks and a dramatic fall in her lactate dehydrogenase from 2248 IU/L to 576 IU/L. Unfortunately, the response was not maintained and she died from progression of her cancer in January 2020. SKAP2-BRAF fusions have a dimerisation domain that paradoxically activates the mitogen-activated protein kinase pathway, resulting in hyperproliferation if first-generation or second-generation BRAF inhibitors are used. Our knowledge is limited regarding the complex effects of targeted therapy in rare BRAF fusion proteins.

Barriers and opportunities for dental school faculty research.

PURPOSE/OBJECTIVES: Identify barriers and opportunities regarding faculty participation in research. METHODS: Sixty-four faculty members of all ranks and days of employment completed a survey designed to reveal attitudes toward participation in research. RESULTS: Among those responding, three-quarters said they were actively engaged in research, and 45% of these identified no perceived barriers. Those reporting obstacles rank-ordered 10 barriers, but no consistent patterns emerged. A factor analysis revealed three clusters of concerns: (a) school barriers, (b) personal barriers, and (c) team opportunities. A large number of comments were offered, and these tended to group by the three quantitatively identified factors. CONCLUSION: These findings were consistent with the view that lack of time and formal training in standardized research skills were not major impediments to scholarship. Instead, assistance in navigating administrative hurdles and participation on multiskilled teams appeared to offer the best prospect for helping faculty interested in research.

Blood pressure in pregnancy-A stress test for hypertension? Five-year, prospective, follow-up of the ROLO study.

OBJECTIVE: To investigate whether maternal blood pressure (BP) below the diagnostic criteria of hypertensive disorders of pregnancy (HDP) is associated with maternal BP 5 years later. DESIGN: Prospective, observational study. SETTING: Dublin, Ireland (2007-2011). SAMPLE: Three hundred twenty-nine women from the ROLO study (Randomized cOntrol trial of LOw glycaemic index diet to prevent the recurrence of macrosomia). METHODS: Maternal BP measurements were taken during pregnancy (13, 28 and 34 weeks' gestation and day 1 postpartum) and at the 5-year follow-up. Systolic BP (SBP) and diastolic BP (DBP) were categorized as normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP 120-129 and DBP < 80 mm Hg), HTN stage 1 (SBP 130-139 or DBP 80-89 mm Hg) or HTN stage 2 (SBP ≥ 140 or DBP ≥ 90 mm Hg) at each timepoint. MAIN OUTCOME MEASURES: Maternal blood pressure at the 5-year follow-up. RESULTS: Women with elevated BP at 28 and 34 weeks' gestation had 2.68 (95% CI: 1.36-5.26) and 2.45-fold (95% CI: 1.22-4.95) increased odds of HTN stage 1 respectively, at the 5-year follow-up, compared to those with normal BP in pregnancy. CONCLUSION: Elevated BP at 28 and 34 weeks' gestation was associated with an increased risk of HTN stage 1 at 5 years later. Thus, raised BP, below the diagnostic criteria of HDP, could be flagged for follow-up postpartum.

MicroCT-based virtual histology evaluation of preclinical medulloblastoma.

PURPOSE: The purpose of this paper is to validate a rapid and cost-effective ex vivo technique, microCT-based virtual histology, as an alternative to MRI imaging for assessing the therapeutic response in genetically engineered mouse models of cancer. PROCEDURES: All animal procedures were conducted in accordance with the Guidelines for the Care and Use of Laboratory Animals and were approved by the Institutional Animal Care and Use Committee (IACUC) at the University of Texas Health Science Center at San Antonio. MRI imaging was performed on 6-week-old, bortezomib-treated genetically engineered Patched1, p53 mice that recapitulate the characteristics of human medulloblastoma. After MRI scans, the same mice were euthanized to collect brain or spine samples for virtual histology staining followed by microCT scanning. RESULTS: Nine-micrometer resolution ex vivo micro X-ray computed tomography (microCT)-based virtual histology images were qualitatively reflective of high-field live animal images obtained with magnetic resonance imaging (MRI) and histopathology. Cerebellar volumes on microCT-based virtual histology correlated closely with MRI cerebellar volumes (R = 0.998). MRI and microCT-based virtual histology both indicated a significant difference between cerebellar volumes of untreated and treated mice (p = 0.02 and p = 0.04, respectively). The ex vivo microCT method also allowed a 7,430-fold improvement in voxel resolution (voxel volume of 729 µm³ for 9-µm isometric resolution microCT vs. 5,416,800 µm³ for 400 × 111 × 122 µm resolution MRI) at a 28% cost savings ($400 vs. $555 per animal). CONCLUSION: The ex vivo, en bloc technique of microCT-based virtual histology matched MRI in reflecting histopathology. MicroCT-based virtual histology proved to be a more cost-effective technique and less labor-intensive. On the other hand, MRI provides ability to perform in vivo imaging, faster scanning and lower radiation dose by sacrificing the spatial resolution. Thus, both in vivo MRI and ex vivo microCT-based virtual histology are effective means of quantitatively evaluating therapeutic response in preclinical models of cerebellar tumors including the childhood cancer, medulloblastoma.

Immune competency of a hairless mouse strain for improved preclinical studies in genetically engineered mice.

Genetically engineered mouse models (GEMM) of cancer are of increasing value to preclinical therapeutics. Optical imaging is a cost-effective method of assessing deep-seated tumor growth in GEMMs whose tumors can be encoded to express luminescent or fluorescent reporters, although reporter signal attenuation would be improved if animals were fur-free. In this study, we sought to determine whether hereditable furlessness resulting from a hypomorphic mutation in the Hairless gene would or would not also affect immune competence. By assessing humoral and cellular immunity of the SKH1 mouse line bearing the hypomorphic Hairless mutation, we determined that blood counts, immunoglobulin levels, and CD4+ and CD8+ T cells were comparable between SKH1 and the C57Bl/6 strain. On examination of T-cell subsets, statistically significant differences in naïve T cells (1.7 versus 3.4 x 10(5) cells/spleen in SKH1 versus C57Bl/6, P = 0.008) and memory T cells (1.4 versus 0.13 x 10(6) cells/spleen in SKH1 versus C57Bl/6, P = 0.008) were detected. However, the numerical differences did not result in altered T-cell functional response to antigen rechallenge (keyhole limpet hemocyanin) in a lymph node cell in vitro proliferative assay. Furthermore, interbreeding the SKH1 mouse line to a rhabdomyosarcoma GEMM showed preserved antitumor responses of CD56+ natural killer cells and CD163+ macrophages, without any differences in tumor pathology. The fur-free GEMM was also especially amenable to multiplex optical imaging. Thus, SKH1 represents an immune competent, fur-free mouse strain that may be of use for interbreeding to other genetically engineered mouse models of cancer for improved preclinical studies.