Using a Summer REU to Help Develop the Next Generation of Mathematical Ecologists.

Understanding the complexities of environmental issues requires individuals to bring together ideas and data from different disciplines, including ecology and mathematics. With funding from the national science foundation (NSF), scientists from the University of Wisconsin-La Crosse and the US geological survey held a research experience for undergraduates (REU) program in the summer of 2016. The goals of the program were to expose students to open problems in the area of mathematical ecology, motivate students to pursue STEM-related positions, and to prepare students for research within interdisciplinary, collaborative settings. Based on backgrounds and interests, eight students were selected to participate in one of two research projects: wind energy and wildlife conservation or the establishment and spread of waterfowl diseases. Each research program was overseen by a mathematician and a biologist. Regardless of the research focus, the program first began with formal lectures to provide students with foundational knowledge followed by student-driven research projects. Throughout this period, student teams worked in close association with their mentors to create, parameterize and evaluate ecological models to better understand their systems of interest. Students then disseminated their results at local, regional, and international meetings and through publications (one in press and one in progress). Direct and indirect measures of student development revealed that our REU program fostered a deep appreciation for and understanding of mathematical ecology. Finally, the program allowed students to gain experiences working with individuals with different backgrounds and perspectives. Taken together, this REU program allowed us to successfully excite, motivate and prepare students for future positions in the area of mathematical biology, and because of this it can be used as a model for interdisciplinary programs at other institutions.

Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database.

BACKGROUND: Reoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations. METHODS: The association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1-3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed. RESULTS: The unadjusted ROR for 71,627 stages 1-3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy (p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49-0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56-0.75), 0.50 (95% CI 0.45-0.56), and 0.27 (95% CI 0.19-0.38) The p values for all were lower than 0.001. CONCLUSION: For a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.

Opportunities to reduce reoperations and to improve inter-facility profiling after initial breast-conserving surgery for cancer. A report from the NCDB.

BACKGROUND: Repeat operations after breast-conserving surgery (BCS) for cancer have been termed "epidemic." To aid improvement activities, we sought to identify those National Cancer Data Base (NCDB) characteristics that were associated with reoperations. METHODS: A retrospective cohort of patients with invasive breast cancer undergoing initial BCS in the NCDB from 2004 to 2015 were identified. Univariate, multivariate, ranking (effect size and R2), and time-trend methods were used to assess associations between patient, facility, tumor, treatment, and calendar-year characteristics with reoperation. RESULTS: In 1226 facilities, 84,462 (16.1%) of 524,594 patients underwent reoperations after BCS [range 0-75%; 10th/90th performance percentiles = 6.6%/25%]. Of 18 factors associated with reoperations, facility ID was the highest-ranked. Its estimated impact on the odds of reoperation was more than 10 times greater than any other factor considered, followed by tumor size, neo-adjuvant chemotherapy receipt, patient age, cancer histology, and nodal status. Reoperations after the year of the SSO-ASTRO margin guideline declined significantly compared with prior years. Significant inter-facility reoperation variability persisted after risk adjustment for more than a dozen distinct patient, facility, tumor, and treatment characteristics. CONCLUSION: In the NCDB, significant inter-facility variability exists regardless of case volume, case mix, and risk adjustment. There were fewer reoperations after the SSO-ASTRO guideline. An endorsed target rate of 10% was achieved by only 1 in 4 facilities. The most impactful determinant of reoperation was the facility itself. Thus, all stakeholders should consider participation in improvement activities. Such activities will benefit from risk-adjusted profiling; the relevant adjustors were identified.

Modifications to the AOAC use-dilution test for quaternary ammonium compound-based disinfectants that significantly improve method reliability.

The AOAC use-dilution test (UDT) for bactericidal disinfectant efficacy (Method 964.02) has often been criticized for its extreme variability in test results, particularly for quaternary ammonium compound (QAC)-based disinfectants against Pseudomonas aeruginosa. While efforts are under way to develop a new and better test method for hospital disinfectant products that is globally acceptable, U.S. manufacturers and formulators of QAC products must continue in the interim to measure their product performance against the current UDT method. Therefore, continued variability in the UDT places an unnecessary and unfair burden on U.S. QAC product manufacturers to ensure that their products perform against an, at best, unreliable test method. This article reports on evaluations that were conducted to attempt to identify key sources of UDT method variability and to find ways to mitigate their impact on test outcomes for the method. The results of testing across 4 laboratories, involving over 6015 carriers, determined that operator error was a key factor in test variability. This variability was found to be significantly minimized by the inclusion of a simple culture dilution step. The findings from this study suggest possible refinements to the current AOAC UDT method that would serve to improve the overall ruggedness and reliability of the method and to optimize recovery of cells from the carrier surface, thereby further improving the accuracy and reproducibility of counts and test outcomes until such time as a replacement method is implemented.

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

BACKGROUND: The influence of neoadjuvant chemotherapy (NAC) prior to breast cancer surgery on postoperative complications is unclear. Our objective was to determine whether NAC was associated with postoperative outcomes in patients undergoing lumpectomy or mastectomy without reconstruction. METHODS: Patients meeting inclusion criteria were identified from the National Surgical Quality Improvement Program (NSQIP) database participant user files from 2005 through 2012, after which NSQIP discontinued the NAC variable. Primary outcome measures included a composite measure of morbidity and mortality (M&M) and reoperations and readmissions within 30 days of the index procedure. Rates of postoperative complications stratified by receipt of NAC were compared by χ2. A logistic regression model was then built that included confounding factors for M&M. RESULTS: There were 30,309 patients meeting inclusion criteria. NAC was not associated with any postoperative outcomes from 2005 through 2012, but it was associated with higher M&M in lumpectomy patients during 2011 to 2012 [P=0.011, odds ratio (OR) 2.579; 95% confidence interval (CI), 1.239-5.368]. CONCLUSIONS: The finding that NAC was associated with higher M&M in lumpectomy patients during 2011 to 2012 warrants further investigation. Therefore, we recommend that the NSQIP database reinstitute the NAC variable to allow monitoring during anticipated changes in chemotherapy agents and protocols.