Against the tide: Recruiting, managing, and developing leadership faculty in graduate and professional leadership programs.

This article examines several vexing problems faced by faculty within leadership programs including university finances, balancing teaching, service, and research responsibilities, burnout, poor communication, and structural barriers to creating diversity among faculty. Using insights from practitioners and my experiences, I also share strategies that may help the leaders of higher education leadership programs address these challenges.

Computer-aided scoring of erb-b2 receptor tyrosine kinase 2 (HER2) gene amplification status in breast cancer.

Background: Identification of HER2 protein overexpression and/or amplification of the HER2 gene are required to qualify breast cancer patients for HER2 targeted therapies. In situ hybridization (ISH) assays that identify HER2 gene amplification function as a stand-alone test for determination of HER2 status and rely on the manual quantification of the number of HER2 genes and copies of chromosome 17 to determine HER2 amplification. Methods: To assist pathologists, we have developed the uPath HER2 Dual ISH Image Analysis for Breast (uPath HER2 DISH IA) algorithm, as an adjunctive aid in the determination of HER2 gene status in breast cancer specimens. The objective of this study was to compare uPath HER2 DISH image analysis vs manual read scoring of VENTANA HER2 DISH-stained breast carcinoma specimens with ground truth (GT) gene status as the reference. Three reader pathologists reviewed 220, formalin-fixed, paraffin-embedded (FFPE) breast cancer cases by both manual and uPath HER2 DISH IA methods. Scoring results from manual read (MR) and computer-assisted scores (image analysis, IA) were compared against the GT gene status generated by consensus of a panel of pathologists. The differences in agreement rates of HER2 gene status between manual, computer-assisted, and GT gene status were determined. Results: The positive percent agreement (PPA) and negative percent agreement (NPA) rates for image analysis (IA) vs GT were 97.2% (95% confidence interval [CI]: 95.0, 99.3) and 94.3% (95% CI: 90.8, 97.3) respectively. Comparison of agreement rates showed that the lower bounds of the 95% CIs for the difference of PPA and NPA for IA vs MR were -0.9% and -6.2%, respectively. Further, inter- and intra-reader agreement rates in the IA method were observed with point estimates of at least 96.7%. Conclusions: Overall, our data show that the uPath HER2 DISH IA is non-inferior to manual scoring and supports its use as an aid for pathologists in routine diagnosis of breast cancer.

Advancing Commercial Tobacco Control and Health Equity Through Policy, Systems, and Environmental Change.

Commercial tobacco products have been protected from regulation, yet are designed to addict, are deadly, and are promoted to young people whose brains are not yet fully developed. Until everyone is protected from addiction and exposure, we must keep working toward fairness and value-based policy, systems, and environmental change.

Artificial Intelligence-Assisted Amphiregulin and Epiregulin IHC Predicts Panitumumab Benefit in RAS Wild-Type Metastatic Colorectal Cancer.

PURPOSE: High tumor mRNA levels of the EGFR ligands amphiregulin (AREG) and epiregulin (EREG) are associated with anti-EGFR agent response in metastatic colorectal cancer (mCRC). However, ligand RNA assays have not been adopted into routine practice due to issues with analytic precision and practicality. We investigated whether AREG/EREG IHC could predict benefit from the anti-EGFR agent panitumumab. EXPERIMENTAL DESIGN: Artificial intelligence algorithms were developed to assess AREG/EREG IHC in 274 patients from the PICCOLO trial of irinotecan with or without panitumumab (Ir vs. IrPan) in RAS wild-type mCRC. The primary endpoint was progression-free survival (PFS). Secondary endpoints were RECIST response rate (RR) and overall survival (OS). Models were repeated adjusting separately for BRAF mutation status and primary tumor location (PTL). RESULTS: High ligand expression was associated with significant PFS benefit from IrPan compared with Ir [8.0 vs. 3.2 months; HR, 0.54; 95% confidence interval (CI), 0.37-0.79; P = 0.001]; whereas low ligand expression was not (3.4 vs. 4.4 months; HR, 1.05; 95% CI, 0.74-1.49; P = 0.78). The ligand-treatment interaction was significant (P interaction = 0.02) and remained significant after adjustment for BRAF-mutation status and PTL. Likewise, RECIST RR was significantly improved in patients with high ligand expression (IrPan vs. Ir: 48% vs. 6%; P < 0.0001) but not those with low ligand expression (25% vs. 14%; P = 0.10; P interaction = 0.01). The effect on OS was similar but not statistically significant. CONCLUSIONS: AREG/EREG IHC identified patients who benefitted from the addition of panitumumab to irinotecan chemotherapy. IHC is a practicable assay that may be of use in routine practice.

Deep Learning in Toxicologic Pathology: A New Approach to Evaluate Rodent Retinal Atrophy.

Quantification of retinal atrophy, caused by therapeutics and/or light, by manual measurement of retinal layers is labor intensive and time-consuming. In this study, we explored the role of deep learning (DL) in automating the assessment of retinal atrophy, particularly of the outer and inner nuclear layers, in rats. Herein, we report our experience creating and employing a hybrid approach, which combines conventional image processing and DL to quantify rodent retinal atrophy. Utilizing a DL approach based upon the VGG16 model architecture, models were trained, tested, and validated using 10,746 image patches scanned from whole slide images (WSIs) of hematoxylin-eosin stained rodent retina. The accuracy of this computational method was validated using pathologist annotated WSIs throughout and used to separately quantify the thickness of the outer and inner nuclear layers of the retina. Our results show that DL can facilitate the evaluation of therapeutic and/or light-induced atrophy, particularly of the outer retina, efficiently in rodents. In addition, this study provides a template which can be used to train, validate, and analyze the results of toxicologic pathology DL models across different animal species used in preclinical efficacy and safety studies.

Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA.

OBJECTIVE: Previous research suggests that some adolescents are using e-cigarette devices to vaporise ('vaping') cannabis in the form of hash oil, tetrahydrocannabinol (THC) wax or oil, or dried cannabis buds or leaves. However, it is unclear how adolescents who vape cannabis use other tobacco products. This study examined the extent to which adolescents reported ever vaping cannabis and investigated how demographic variables and tobacco behaviours were associated with use. DESIGN: We used cross-sectional data from adolescents (total response rate 64.5%) who participated in the 2017 North Carolina Youth Tobacco Survey. SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. SETTING: North Carolina, USA. PARTICIPANTS: Adolescents in high school (n=2835). PRIMARY OUTCOME AND MEASURE: Adolescents were asked to indicate whether they had ever used an e-cigarette device with marijuana, THC or hash oil, or THC wax. RESULTS: Approximately 1 in 10 high school students reported ever vaping cannabis in the overall sample (9.6%). In multivariable models, adolescents who reported using cigars (adjusted OR (aOR) 3.76, 95% CI 2.33 to 6.07), waterpipe (aOR 2.32, 95% CI 1.37 to 3.93) or e-cigarettes (aOR 3.18, 95% CI 2.38 to 4.25) in the past 30 days had higher odds of reporting ever vaping cannabis compared with their counterparts. There was no significant association between use of smokeless tobacco (aOR 0.89, 95% CI 0.42 to 1.91) or use of cigarettes (aOR 1.27, 95% CI 0.71 to 2.29) in the past 30 days and odds of reporting ever vaping cannabis. CONCLUSIONS: These findings provide evidence that large numbers of high school students who use tobacco products have vaped cannabis. As tobacco control policies-such as communication campaigns or smoke-free laws-increasingly focus on e-cigarettes, attention to understanding how adolescents use e-cigarettes to vape substances other than nicotine is essential.

Youth source of acquisition for E-Cigarettes.

As rates of traditional cigarette smoking have decreased among youth over the past several years, rates of e-cigarette use have increased. Little evidence exists on how youth obtain e-cigarettes. We used data from middle and high school students under the age of 18 who reported using an e-cigarette in the past 30 days from the 2017 North Carolina Youth Tobacco Survey (n = 640). We used chi-square tests and multivariable logistic regressions to examine correlates of access and place of acquisition. Over half (51.5%) of youth report acquiring e-cigarettes from a friend. Youth in 12th grade had higher odds of acquiring e-cigarettes from a vape shop (aOR: 2.54, 95% CI: 1.25, 5.15) or retail outlet (aOR: 2.40, 95% CI: 1.18, 4.90) than youth in middle school. Compared to non-Hispanic white youth, Hispanic youth had lower odds of acquiring e-cigarettes from a vape shop (aOR: 0.42, 95% CI: 0.20, 0.87). Youth living with someone who uses e-cigarettes, compared to those who did not, had higher odds of acquiring e-cigarettes from a family member (aOR: 3.95, 95% CI: 1.94, 8.05). Finally, current smokers had higher odds of acquiring e-cigarettes from a retail outlet (aOR: 3.28, 95% CI: 1.88, 5.70) and lower odds of acquiring e-cigarettes from a friend (aOR: 0.53, 95% CI: 0.36, 0.77). Youth primarily reported obtaining e-cigarettes from a friend. Living with someone who uses e-cigarettes may be a risk factor for acquiring e-cigarettes from family members. Identifying sources of e-cigarette acquisition will help inform interventions preventing youth e-cigarette access.

The impact of smoke-free legislation on population health in North Carolina.

Since the first Surgeon General's report documented the health impact of smoking 50 years ago, North Carolina has made much progress in reducing tobacco use. This article focuses on tobacco-related policies and legislation that have contributed to this progress and discusses measures that could be taken to further reduce tobacco use.

Hematologic malignancies: an opportunity to fill a gap in cancer surveillance.

BACKGROUND: Reporting of hematologic malignancies is an increasingly important focus for cancer surveillance. As trends in cancer care are shifting to the outpatient setting, hospital-based data collection methods used for cancer surveillance will result in under-reporting of these cancers. This study describes the testing and validation of an automated system for capturing and reporting cancers from community oncology providers. METHODS: The system was evaluated in 5 oncology practices in two states processing claims data for a 4- or 8-month interval. Resulting cancers were matched with the state registries. A random sample of nonmatched cases was reabstracted to measure the accuracy of the claims data for reporting of hematologic malignancies. RESULTS: The overall match rate for the 1,935 hematologic malignancies reported during the study period was 58.2 % (range, 37.4 % for CLL to 71.2 % for Hodgkin's Lymphoma). The overall accuracy rate for billing-reported hematologic malignancies was 95 %. Accuracy among cases that did not match with the cancer registry was 88 %. The estimated number of missed cases for the five participating practices ranged from 0.8 leukemia cases/oncologist/year to 3.4 CLL cases/oncologist/year. The estimated total number of missed cases in the five participating practices was 292 with an interquartile range of 263-323. CONCLUSION: As cancer diagnosis and treatment continue migration into ambulatory physician practice settings unreported hematopoietic cases will become increasingly problematic. Leveraging the standardized electronic billing data for automated reporting of cancer cases from physician practices may be an efficient method to reduce this gap in cancer surveillance reporting.

Effectiveness of a liaison program in meeting information needs of college of pharmacy faculty.

This article describes the creation and implementation of focus groups to evaluate the effectiveness of a health sciences library's liaison program of the College of Pharmacy faculty and to better understand the faculty's information needs in order to design new and improved library services. The liaison services support the teaching and research needs of faculty and students through literature research, classroom teaching, and an extensive library collection of pharmacy literature. Focus group results demonstrated a high level of satisfaction with library liaison services and collections. Opportunities exist for expanded interaction with graduate students and greater marketing of library services to increase faculty awareness of specific library programs.

Impact of community-based interventions on condom use in the Tlicho region of Northwest Territories, Canada.

BACKGROUND: Since 2005, the Tlicho Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tlicho regional rates were nearly four times that of the NT--91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention. METHODS: A baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tlicho region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI). RESULTS: One in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90). CONCLUSIONS: The measurable impact on condom use indicates a strong beginning for the Tlicho community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tlicho can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.

Visualizing fetal mouse great blood vessels by plastic casting.

In this protocol, the great vessels of the mouse are visualized by injecting colored plastic solutions directly into the heart, thereby filling the vessels. The plastic solidifies to create a stable cast that is then revealed by removing the mouse tissues with a caustic. This protocol can be modified for casting the vasculature of other organs by altering the delivery of the liquid plastic. For example, plastic casts of the maternal and fetal vasculature of the placenta can be generated.

Community-coordinated Research as HIV/AIDS Prevention Strategy in Northern Canadian Communities.

The Tlichǫ Community Services Agency's (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tlichǫ region of the Northwest Territories of Canada. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained community-based researchers who conducted a research survey on sexual health attitudes and behaviours in the four Tlichǫ communities, covering 65% of the population above 9 years of age. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings.

Low stocks of coarse woody debris in a southwest Amazonian forest.

The stocks and dynamics of coarse woody debris (CWD) are significant components of the carbon cycle within tropical forests. However, to date, there have been no reports of CWD stocks and fluxes from the approximately 1.3 million km(2) of lowland western Amazonian forests. Here, we present estimates of CWD stocks and annual CWD inputs from forests in southern Peru. Total stocks were low compared to other tropical forest sites, whether estimated by line-intercept sampling (24.4 +/- 5.3 Mg ha(-1)) or by complete inventories within 11 permanent plots (17.7 +/- 2.4 Mg ha(-1)). However, annual inputs, estimated from long-term data on tree mortality rates in the same plots, were similar to other studies (3.8 +/- 0.2 or 2.9 +/- 0.2 Mg ha(-1) year(-1), depending on the equation used to estimate biomass). Assuming the CWD pool is at steady state, the turnover time of coarse woody debris is low (4.7 +/- 2.6 or 6.1 +/- 2.6 years). These results indicate that these sites have not experienced a recent, large-scale disturbance event and emphasise the distinctive, rapid nature of carbon cycling in these western Amazonian forests.

Colorectal cancer in U.S. adults younger than 50 years of age, 1998-2001.

BACKGROUND: Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. This population-based study focuses primarily on describing the CRC burden for persons in this age group. METHODS: The data used for this study were derived from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) surveillance systems. Age-adjusted incidence rates, rate ratios, and their corresponding 95% confidence intervals were calculated. RESULTS: CRC is ranked among the top 10 cancers occurring in males and females aged 20-49 years regardless of race. Persons younger than 50 years were more likely to present with less localized and more distant disease than do older adults. Among younger adults, age-adjusted incidence rates for poorly differentiated cancers were twice as high as rates for well-differentiated cancers. Incidence rates for poorly differentiated cancers were 60% higher than that for well-differentiated cancers diagnosed in older adults. Rates were significantly higher for blacks and significantly lower for Asians/Pacific Islanders when compared with that for whites for the most demographic and tumor characteristics examined. CONCLUSIONS: This study confirms the findings of previous population-based studies suggesting that younger patients present with more advanced disease than do older patients. This study also identifies racial and ethnic disparities in CRC incidence in this population. These findings suggest the need for additional studies to understand the behavior and etiology of CRC in blacks.

Associations of subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis with county-level poverty, by race and sex.

BACKGROUND: This study examined associations of subsite-specific colorectal cancer incidence rates and stage of the disease with county-level poverty. METHODS: The 1998-2001 colorectal cancer incidence data, covering 75% of the United States population, were from 38 states and metropolitan areas. The county-level poverty data were categorized into 3 groups according to the percentage of the population below the poverty level in 1999: <10% (low-poverty), 10%-19% (middle-poverty), and >or=20% (high-poverty). Age-adjusted subsite-specific incidence rates (for all ages) and stage-specific incidence rates (for ages >or=50) were examined by race (whites and blacks), sex, and the county's poverty level. The differences in the incidence rates were examined using the 2-tailed z-statistic. RESULTS: The incidence rates of proximal colon cancer were higher among white males (11% higher) and white females (15% higher) in the low-poverty than in the high-poverty counties. No differences across county poverty levels were observed among whites for distal colon and rectal cancers or among blacks for all the subsites. The late-to-early stage incidence rate ratios were higher in the high-poverty than in the low-poverty counties among white and black males for distal colon and rectal cancers, among white females for distal colon cancer, and among black females for rectal cancer. For proximal colon cancer, however, the late-to-early stage rate ratios were similar across all county poverty levels. CONCLUSIONS: Higher incidence rates of proximal cancer were observed among white males and females in the low-poverty counties relative to the high-poverty counties. The higher late-to-early stage rate ratios in high-poverty than in low-poverty counties is observed for distal colon and rectal cancers, but not for proximal colon cancer.

Master's degree-accredited professional education and development courses for general practitioners in the North Western Deanery 1997-2002: impact on effectiveness, retention and recruitment to additional roles.

WHAT IS ALREADY KNOWN IN THIS AREA • A high rate of GP retirement is likely in the next few years. • GPs with The necessary skills are needed to provide care. • Provision of MSc courses designed for GPs is limited. WHAT THIS WORK ADDS • After attending MSc accredited development courses, GPs clearly expressed their intention to retire later. • Many participants have extended their role to become educators, appraisers, GPwSI and also become involved in PCO work. • Participants demonstrated a high rate of progression to further academic modules. SUGGESTIONS FOR FUTURE RESEARCH • Follow-up of participants' intention of working longer, to measure if that translates into reduced early retirement. • Measurement of the impact of such courses directly against provision of patient care.