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While achievement gaps have been well-established, much remains to be understood about the manner and extent to which school leadership either increases or decreases student access to opportunity to learn. The current study uses nationally representative samples of U.S. and Flemish students in Grade 4 from the 2011 Trends in International Mathematics and Science Study (TIMSS2011) to test a series of structural equation models. U.S. and Belgium have contrasting academic tracking (formal vs informal) systems and Gini Index scores (economic inequality). Flemish schools had no significant paths between student family resources, instructional leadership, and learning; however, for the U.S., we found a negative path across these measures. This current study extends the instructional leadership literature by demonstrating that school leaders can implement goals intended to close achievement gaps but instead might unintentionally exacerbate them.

Abstract Objective The objective of this systematic literature review (SLR) was to summarize the latest studies evaluating the burden of illness in endogenous Cushing's syndrome (CS), including the impact of CS on overall and domain‐specific health‐related quality of life (HRQoL) and the economic burden of CS to provide a holistic understanding of disease and treatment burden. Methods An SLR was conducted in PubMed, MEDLINE and Embase using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist to identify peer‐reviewed manuscripts and conference abstracts published in English from 2015 to December 4, 2020. Results Forty‐five publications were eligible for inclusion; data were extracted from 37 primary studies while 8 SLRs were included for reference only. Thirty‐one studies reported HRQoL using validated patient reported outcome (PRO) measures in pre‐ or post‐surgery, radiotherapy and pharmacotherapy patients. Overall, this SLR found that patients with CS have worse outcomes relative to healthy populations across specific dimensions, such as depression, despite an improvement in HRQoL post‐treatment. These findings reveal that CS symptoms are not fully resolved by the existing care paradigm. Few studies report on the economic burden of CS and currently available data indicate a high direct healthcare system cost burden. Conclusions Patients with CS experience a significant, complex and multifactorial HRQoL burden. Symptom‐specific burden studies are sparse in the literature and the understanding of long‐term CS symptomatic burden and economic burden is limited. This review intends to provide an updated reference for clinicians, payers and other stakeholders on the burden of CS as reported in published literature and to encourage further research in this area.

Context Treatment of hyperprolactinemia with ergoline dopamine agonists (DAs) can be complicated by intolerance and resistance. Objective This study examines the efficacy and tolerability of the nonergot DA ropinirole for the long-term treatment of hyperprolactinemia. Methods Twelve hyperprolactinemic women were treated with ropinirole in a 6-month, open-label, dose-escalation trial; 7 of the 12 continued treatment in an extension study for up to 17 months. Ropinirole doses were uptitrated to achieve normal prolactin (PRL) levels, restore menses, and eliminate galactorrhea. Results Two of the 12 participants were DA naive; 6 of 12 were ergot DA intolerant; and 1 of 12 had known ergot DA resistance. Baseline PRL levels were 126.2 ± 41.4 ng/mL (SEM). Ropinirole was uptitrated from 0.125 to 0.25 mg/h to a median total daily dose (TDD) of 2 mg/d (1-4 mg/d [interquartile range]). PRL normalization was achieved in 50% of the participants (5 with microadenomas and 1 with idiopathic hyperprolactinemia) at a median effective TDD of 1 mg/d. Of the patients achieving PRL normalization, 83% were ergot DA intolerant. A persistent partial biochemical response (PRL reduction >50% from baseline) was achieved in 17% of the participants. During treatment, menses resumed in 67% of amenorrheic patients; galactorrhea resolved in 67%. Mild adverse effects were reported in 92% of participants; however, ropinirole was not discontinued because of intolerance even among the 50% of individuals with a prior history of ergot DA intolerance and resultant medication discontinuation. Conclusion These data demonstrate the efficacy and tolerability of ropinirole for the treatment of hyperprolactinemia in patients with microprolactinomas and idiopathic hyperprolactinemia and suggest ropinirole may represent a novel therapeutic alternative for treating hyperprolactinemic disorders in patients with ergot DA intolerance. [ABSTRACT FROM AUTHOR]

Objective: The objective of this systematic literature review (SLR) was to summarize the latest studies evaluating the burden of illness in endogenous Cushing's syndrome (CS), including the impact of CS on overall and domain‐specific health‐related quality of life (HRQoL) and the economic burden of CS to provide a holistic understanding of disease and treatment burden. Methods: An SLR was conducted in PubMed, MEDLINE and Embase using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist to identify peer‐reviewed manuscripts and conference abstracts published in English from 2015 to December 4, 2020. Results: Forty‐five publications were eligible for inclusion; data were extracted from 37 primary studies while 8 SLRs were included for reference only. Thirty‐one studies reported HRQoL using validated patient reported outcome (PRO) measures in pre‐ or post‐surgery, radiotherapy and pharmacotherapy patients. Overall, this SLR found that patients with CS have worse outcomes relative to healthy populations across specific dimensions, such as depression, despite an improvement in HRQoL post‐treatment. These findings reveal that CS symptoms are not fully resolved by the existing care paradigm. Few studies report on the economic burden of CS and currently available data indicate a high direct healthcare system cost burden. Conclusions: Patients with CS experience a significant, complex and multifactorial HRQoL burden. Symptom‐specific burden studies are sparse in the literature and the understanding of long‐term CS symptomatic burden and economic burden is limited. This review intends to provide an updated reference for clinicians, payers and other stakeholders on the burden of CS as reported in published literature and to encourage further research in this area. [ABSTRACT FROM AUTHOR]

ACTH and alpha-subunit are co-expressed in rare human pituitary corticotroph cell adenomas proposed to originate from ACTH-committed early pituitary progenitor cells. Keywords: adrenocortical cells; choristoma; corticotroph tumour EN adrenocortical cells choristoma corticotroph tumour 1 6 6 02/03/22 20220215 NES 220215 We describe a rare TPIT-positive corticotroph PitNET that is admixed with SF1-positive adrenocortical cells. Only one mitotic figure in a small tumour cell was found across four haematoxylin and eosin (H&E) slides; the Ki-67 labelling index was low at 1.6% and predominantly immunostained the nuclei of small tumour cells. The smaller cells were sometimes arranged at the periphery of the cytoplasm of the larger cells, as though they might be within the larger cells (Figure 1C). [Extracted from the article]