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BACKGROUND: Image-guided approaches improve the diagnostic yield of prostate biopsy and frequently modify estimates of clinical risk. To better understand the impact of magnetic resonance imaging-ultrasound fusion targeted biopsy (MRF-TB) on risk assessment, we compared the distribution of National Comprehensive Cancer Network (NCCN) risk groupings, as calculated from MRF-TB vs systematic biopsy alone. METHODS: We performed a retrospective analysis of 713 patients who underwent MRF-TB from January 2017 to July 2021. The primary study objective was to compare the distribution of National Comprehensive Cancer Network risk groupings obtained using MRF-TB (systematic + targeted) vs systematic biopsy. RESULTS: Systematic biopsy alone classified 10% of samples as very low risk and 18.7% of samples as low risk, while MRF-TB classified 10.5% of samples as very low risk and 16.1% of samples as low risk. Among patients with benign findings, low-risk disease, and favorable/intermediate-risk disease on systematic biopsy alone, 4.6% of biopsies were reclassified as high risk or very high risk on MRF-TB. Of 207 patients choosing active surveillance, 64 (31%), 91 (44%), 42 (20.2%), and 10 (4.8%) patients were classified as having very low-risk, low-risk, and favorable/intermediate-risk and unfavorable/intermediate-risk criteria, respectively. When using systematic biopsy alone, 204 patients (28.7%) were classified as having either very low-risk and low-risk disease per NCCN guidelines, while 190 men (26.6%) received this classification when using MRF-TB. CONCLUSION: The addition of MRF-TB to systematic biopsy may change eligibility for active surveillance in only a small proportion of patients with prostate cancer. Our findings support the need for routine use of quantitative risk assessment over risk groupings to promote more nuanced decision making for localized cancer.

The course-based research experience (CRE) with its documented educational benefits is increasingly being implemented in science, technology, engineering, and mathematics education. This article reports on a study that was done over a period of 3 years to explicate the instructional processes involved in teaching an undergraduate CRE. One hundred and two instructors from the established and large multi-institutional SEA-PHAGES program were surveyed for their understanding of the aims and practices of CRE teaching. This was followed by large-scale feedback sessions with the cohort of instructors at the annual SEA Faculty Meeting and subsequently with a small focus group of expert CRE instructors. Using a qualitative content analysis approach, the survey data were analyzed for the aims of inquiry instruction and pedagogical practices used to achieve these goals. The results characterize CRE inquiry teaching as involving three instructional models: 1) being a scientist and generating data; 2) teaching procedural knowledge; and 3) fostering project ownership. Each of these models is explicated and visualized in terms of the specific pedagogical practices and their relationships. The models present a complex picture of the ways in which CRE instruction is conducted on a daily basis and can inform instructors and institutions new to CRE teaching.

BackgroundAlthough the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment.ObjectiveTo evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance.Design setting and participantsThis was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care.Outcome measurements and statistical analysisWe evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score.Results and limitationsWe identified 133 patients for inclusion with a median age of 67.7 yr and median prostate-specific of 5.6 ng/ml. At enrollment, 75.9% had GG1 and 24.1% had GG2 disease. Forty-three patients experienced biopsy upgrading. On multivariable logistic regression, the Decipher score was significantly associated with biopsy upgrading (odds ratio 1.37 per 0.10 unit increase, 95% confidence interval [CI] 1.05-1.79; p = 0.02). The Decipher score was associated with upgrading among patients with biopsy GG 1 disease, but not GG2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved by integration of the Decipher score (AUC 0.69, 95% CI 0.58-0.80).ConclusionsThe Decipher genomic classifier score was associated with short-term biopsy Gleason upgrading among patients on active surveillance.Patient summaryThe results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

Utilizing both cationic and anionic oxygen redox reactions is regarded as an important approach to exploit high-capacity layered cathode materials with earth abundant elements. It has been popular strategies to effectively elevate the oxygen redox activities by Li-doping to introduce unhybridized O 2p orbitals in Nax MnO2 -based chemistries or enabling high covalency transition metals in P2-Na0.66 Mnx TM1- x O2 (TM = Fe, Cu, Ni) materials. Here, the effect of Li doping on regulating the oxygen redox activities P2-structured Na0.66 Ni0.25 Mn0.75 O2 materials is investigated. Systematic X-ray characterizations and ab initio simulations have shown that the doped Li has uncommon behavior in modulating the density of states of the neighboring Ni, Mn, and O, leading to the suppression of the existing oxygen and Mn redox reactivities and the promotion of the Ni redox. The findings provide a complementary scenario to current oxygen redox mechanisms and shed lights on developing new routes for high-performance cathodes.

The course-based research experience (CRE) with its documented educational benefits is increasingly being implemented in science, technology, engineering, and mathematics education. This article reports on a study that was done over a period of 3 years to explicate the instructional processes involved in teaching an undergraduate CRE. One hundred and two instructors from the established and large multi-institutional SEA-PHAGES program were surveyed for their understanding of the aims and practices of CRE teaching. This was followed by large-scale feedback sessions with the cohort of instructors at the annual SEA Faculty Meeting and subsequently with a small focus group of expert CRE instructors. Using a qualitative content analysis approach, the survey data were analyzed for the aims of inquiry instruction and pedagogical practices used to achieve these goals. The results characterize CRE inquiry teaching as involving three instructional models: (1) being a scientist and generating data; (2) teaching procedural knowledge; and (3) fostering project ownership. Each of these models is explicated and visualized in terms of the specific pedagogical practices and their relationships. The models present a complex picture of the ways in which CRE instruction is conducted on a daily basis and can inform instructors and institutions new to CRE teaching.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer Early Detection provide recommendations for prostate cancer screening in healthy men who have elected to participate in an early detection program. The NCCN Guidelines focus on minimizing unnecessary procedures and limiting the detection of indolent disease. These NCCN Guidelines Insights summarize the NCCN Prostate Cancer Early Detection Panel's most significant discussions for the 2016 guideline update, which included issues surrounding screening in high-risk populations (ie, African Americans, BRCA1/2 mutation carriers), approaches to refine patient selection for initial and repeat biopsies, and approaches to improve biopsy specificity.

A single early prostate-specific antigen (PSA) level has been correlated with a higher likelihood of prostate cancer diagnosis and death in younger men. PSA testing in older men has been considered of limited utility. We evaluated prostate cancer death in relation to age and PSA level immediately prior to prostate cancer diagnosis. Using the Veterans Affairs database, we identified 230,081 men aged 50-89 years diagnosed with prostate cancer and at least one prior PSA test between 1999 and 2009. Prostate cancer-specific death over time was calculated for patients stratified by age group (e.g., 50-59 years, through 80-89 years) and PSA range at diagnosis (10 ranges) using Kaplan-Meier methods. Risk of 10-year prostate cancer mortality across age and PSA was compared using log-rank tests with a Bonferroni adjustment for multiple testing. 10.5% of men diagnosed with prostate cancer died of cancer during the 10-year study period (mean follow-up = 3.7 years). Higher PSA values prior to diagnosis predict a higher risk of death in all age groups (p

PurposeGleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management.Materials and methodsMembers of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes.ResultsThe Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes.ConclusionsThe definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.

Glomus tumors are rare vascular hamartomas most commonly found in the subungual region of the fingers. They present with a classic triad of paroxysmal pain, point tenderness, and cold sensitivity. The diagnosis is often missed for several years due to under recognition of this condition. A 42-year-old female presented with a several year history of pain in the middle finger when it was struck or exposed to cold. She had point tenderness on the fingernail, and increased curvature of the nail. Magnetic Resonance Imaging (MRI) revealed a 7mm subungual glomus tumor. The tumor was surgically excised via a transungual approach, resulting in complete relief of her pain. Glomus tumors are diagnosed clinically based on the presence of classic symptoms and positive provocative tests. These tests include point tenderness on palpation and pain when ice is placed on the digit. MRI imaging can be used when the diagnosis is unclear or to localize the tumor prior to surgery. Increased awareness of this condition among physicians could reduce the time to diagnosis and treatment. [ABSTRACT FROM AUTHOR]

In this essay, we respond to Simon's article (2012). We discuss our view that therapy works best when therapists can match therapeutic interventions to the worldview of clients. We see this matching to client worldview as rooted in research evidence, and we suggest that therapists can practice authentically and effectively using more than one divergent therapy approach. We conclude the paper by pointing out points of disagreement we have with Simon's use of Davis and Piercy's ("Journal of Marital and Family Therapy," 2007a; 33, 298; "Journal of Marital and Family Therapy," 2007b, 32, 515) study, a study Simon uses to ground his arguments.

The gap between clinical research and practice is a major challenge facing marriage and family therapy (MFT) training programs. Until now, the answer to bridge this gap has primarily been the Boulder Scientist-Practitioner Model. Although realistic for doctoral students, it may not be a good fit for MFT master's students who have primarily clinical career ambitions--which we believe is a legitimate and positive career choice. The following article articulates a "research informed" perspective as opposed to the scientist-practitioner framework as a research-training model for clinically oriented MFT master's programs. After articulating the similarities and differences between these two approaches, the authors outline 10 practical ideas to integrate research into programs that desire to remain clinical in focus, but also research informed.

Doctoral education is greatly impacted by context, and the large majority of marital and family therapy (MFT) doctoral programs are PhD programs in research-focused universities. I believe their primary mission is to equip students to become scientist-practitioners and do original research that will advance the science of the discipline, whereas the mission of the typical master's program is to produce strong practitioners who are research informed. It is the emphasis on the scientific method, not the content specialty area, that should be the hallmark of PhD programs in research-focused contexts. I describe metrics for success that include not only research productivity but also the development of a supportive, open, flexible, and generous program culture. The research mission of these programs has been only modestly helped by the Commission on Accreditation for Marriage and Family Therapy Education process and the programs are largely not doing the programmatic intervention research that the field needs. As the universities that house these programs are also "raising the bar," the long-term viability of the programs themselves will likely hinge on success in this arena.

Despite the proliferation of supervision models, there is no evidence to suggest that any one model of supervision is in any way superior to any other. Many in the field have called for models that can bridge the various theoretical approaches to clinical supervision, and identify the essential elements of supervision. This article briefly explores the range of existing supervision models, and suggests a rationale for seeking factors common across the various models. The authors highlight the development of a new supervision model that synthesizes current thinking about supervision into three dimensions. The three dimensions are defined, and resulting supervisory roles explored. Implications for supervision practice, research, and training are discussed.

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.

We discuss the status of the scientist-practitioner model in marriage and family therapy (MFT) doctoral programs. Issues discussed include a lack of faculty research role models in doctoral programs, "farming out" the majority of research courses to other disciplines, problems with curriculum, and how the culture of MFT does not support research. We also present suggestions for improving doctoral research training. The goal is to improve the quality of research training in doctoral programs. We hope that this will help change the culture of MFT to include research as one of its primary goals and greatest assets.

Explored common factors across theories of marriage and family therapy (MFT). Clinicians and researchers were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across various MFT theories, as well as what they personally considered to be core the ingredients of change. Implications for training and practice of MFTs are discussed. (BF)

Resurgence of interest in marriage and family enrichment has propelled educators to examine the training of new therapists in preventive approaches to therapy. This article presents a graduate course to educate students about the enrichment movement and skill and competency based approaches to family interventions. (BF)

Summarizes gaps between assumptions appearing in literature, research, and accepted standards for marital and family therapy (MFT) supervision, and the common practice of supervisors. Issues stemming from gaps are highlighted and recommendations made for closing them. In an effort to refine standard practice for MFT supervision, best practice recommendations are offered. (BF)

Uses six theoretical developments in marriage and family therapy (systems theory refinement, constructivism, feminism, emphasis on family resources, increased use of narrative metaphor, increased interest in qualitative research) as lenses through which to view U.S. family. Comments on strengths and weaknesses of family, current threats to family life, and what family therapists can do to strengthen families. (Author/NB)

Summarizes trends in theory and research on marriage and family therapy over the past decade. Finds particularly noteworthy the debates over the "new epistemology" and the feminist critique of family therapy. On basis of identified trends, makes recommendations for research in the 1990s. (Author/NB)

Examines developments in empirical research in family therapy training since Kniskern and Gurman's (1979) review. Assesses present knowledge concerning training outcomes in marital and family therapy from six studies of the development of instruments for measuring the outcome of training and nine studies which actually evaluate training outcome. Evaluates research methodologies, and makes recommendations for future research. (Author/PVV)

Elevated temperature molten Na batteries are seeing a resurgence of interest for low-cost electrochemical energy storage for the grid. Of the many recent innovations in this battery concept, new methods focused on intermediate temperature operation (e.g. 110–190 °C) have gained prominence as a way to enable comparable performance with less thermal energy loss and lower-cost materials of construction. However, the poor wettability of molten Na on suitable solid-electrolyte separators such as sodium Beta Alumina Solid-Electrolyte (Na-β"-Al 2 O 3 , 'BASE') requires continued innovation in interface engineering to promote full utilization of the solid-electrolyte surface area and minimize cell resistance. There have been many successful approaches to improve Na-wettability to-date including heat treatment in an inert atmosphere to remove adsorbed surface species, deposition of alloying metals such as Pb, Sn, or Bi, and use of carbon-based interfacial layers. However, these approaches either lack the ability to provide good wetting at very low temperatures (near the melting point of Na) or rely on non-scalable processes and/or toxic/expensive metals. To solve these issues, a new carbon-based sodiophilic treatment is demonstrated, which utilizes inexpensive components to form a meso/macroporous sodiophilic layer, is easily applied via drop-casting or spray-coating, provides excellent wetting as low as 110 °C, and is completely metal-free. It is found that the good sodium wetting can be attributed to the wider range of pore sizes in the carbon layers demonstrated in this study. Na wetting may occur as surface tension is initially broken by larger pores, followed by the intrusion of molten Na into smaller pores due to the apparent intrinsic affinity of Na-metal for carbon surfaces, in conjunction with the capillarity effect. Low cell-level area specific resistances of 20–30 and 13–15 Ω·cm2 are demonstrated at 110 and 140 °C respectively. Finally, the utility of this metal-free wetting layer for solid-Na anodes is explored, showing that the metal-free wetting layer can reach a critical current density of 1.88 mA·cm−2 at 30 °C. [Display omitted] • The MFWL using carbon-based ink easy application through drop-casting or spray-coating, exhibiting excellent Na wetting as low as 110 °C. • Low cell-level area specific resistances of 20–30 and 13–15 Ω cm2 are demonstrated at 110 and 140 °C respectively. • The MFWL present a uniform gradation in porosity ranging from a few nm to hundreds of nm, and high specific surface area of 206.2 m2 g-1.. • Symmetric molten Na-Na cells with this MFWL treatment show excellent cycling stability at intermediate temperatures. • Solid-state Na-Na symmetric cells show a critical current density at 30 °C of ∼ 0.47 mA cm-2 without applying pressure. [ABSTRACT FROM AUTHOR]