Strategic Adaptive Management for Transparency, Accountability and Learning: Insights from More Than a Quarter Century of Practice.

Adaptive management has long been advocated as a framework of choice for addressing the complexities and uncertainties of natural resource management. Despite its theoretical appeal, successful implementation remains elusive, with many documented barriers and limited operational examples. This paper examines Strategic Adaptive Management (SAM), a long-running adaptive management program originating from the Kruger National Park in South Africa.

Developing a framework for medical student feedback literacy using a triangulated thematic analysis.

Introduction: Feedback literacy is critical for medical students to develop their competencies. However, a conceptualisation or framework of feedback literacy specific to the medical education context has yet to be developed. A comprehensive framework that addresses diverse feedback sources, dynamic environments, and the prioritisation of patient safety can guide the development of feedback literacy in medical students.

Prostate-Related Germline Variant Frequencies Detected in a Cohort of Men With Metastatic Prostate Cancer in Northern India.

Purpose: Although prostate cancer is generally associated with favorable outcomes, metastatic disease remains incurable. Additionally, a subset of individuals with high-risk or metastatic disease are likely to harbor at least one germline variant in known prostate cancer association genes. Because of differences in cohort selection and sequencing strategies, the prevalence of germline variants in global populations is unclear.

Engaging for equity: Lessons from a cross-sector partnership addressing prostate cancer risk in the black community.

Black men are faced with a higher risk of developing prostate cancer worldwide, including earlier and more aggressive disease. While there are several known social and biological risk factors attributed to these trends, existing prostate cancer guidelines do not explicitly provide guidance for this group of men. A cross-sector partnership in Toronto, Canada has emerged to address the resulting health disparities through research, outreach, and education.

PSMA PET-detected mesorectal nodal metastasis: treatment outcomes and clinical implications.

Purpose: To evaluate the clinical significance of PSMA-PET/CT-detected mesorectal lymph node metastases in biochemically recurrent prostate cancer patients.

Methods: This is a retrospective analysis of biochemically recurrent prostate cancer patients (post-radical prostatectomy and/or radiotherapy) with a positive F-DCFPyL-PSMA-PET/CT, performed at a tertiary center (December 2018- February 2021). We evaluated the association between site of most advanced disease (mesorectal-only versus other sites) and development of castration resistance using a multivariable Cox model.

Can the free/total psa ratio predict undetected intraductal carcinoma and cribriform pattern at biopsy?

Background: Intraductal carcinoma (IDC) and cribriform pattern (Crib) of prostate cancer are recognised as independent prognosticators of poor outcome, both in prostate biopsies and radical prostatectomy (RP) specimens.

Objective: This study aimed to determine the predictive value of Free-to-total PSA ratio (FPSAR) in identifying missed IDC/Crib at the time of biopsy as compared to the final surgical specimen.

Materials And Methods: Patients who underwent RP between January 2015 and December 2022 were included in the study.

Establishing the measurement and psychometrics of medical student feedback literacy (IMPROVE-FL): A research protocol.

Current feedback models advocate learner autonomy in seeking, processing, and responding to feedback so that medical students can become feedback-literate. Feedback literacy improves learners' motivation, engagement, and satisfaction, which in turn enhance their competencies. However, there is a lack of an objective method of measuring medical student feedback literacy in the empirical literature.

Undetected Cribriform and Intraductal Prostate Cancer at biopsy is associated with adverse outcomes.

Background: Intraductal carcinoma (IDC) and cribriform pattern (Crib) of prostate cancer are increasingly recognized as independent prognosticators of poor outcome, both in prostate biopsies and radical prostatectomy (RP) specimens.

Objective: The aim of our project is to assess the impact of false negative biopsies for these two characteristics on oncological outcomes.

Material And Methods: Patients who underwent RP between January 2015 and December 2022 were included in the study.

Association of Free-to-Total PSA Ratio and F-DCFPyL Prostate-Specific Membrane Antigen PET/CT Findings in Patients with Biochemical Recurrence After Radical Prostatectomy: A Prospective Single-Center Study.

In Canada and across the globe, access to PSMA PET/CT is limited and expensive. For patients with biochemical recurrence (BCR) after treatment for prostate cancer, novel strategies are needed to better stratify patients who may or may not benefit from a PSMA PET scan. The role of the free-to-total prostate-specific antigen (PSA) ratio (FPSAR) in posttreatment prostate cancer, specifically in the PSMA PET/CT era, remains unknown.

Adjuvant immune checkpoint inhibitors for urothelial carcinoma: systematic review and Meta-analysis.

Purpose: To compare disease-free survival (DFS), overall survival (OS), and adverse events (AEs) among muscle-invasive urothelial carcinoma (MIUC) patients receiving adjuvant immune checkpoint inhibitors (ICIs) versus placebo/observation following radical surgery.

Methods: This was a systematic review/meta-analysis of all published phase 3 randomized controlled trials. MEDLINE, EMBASE, and Cochrane were searched from inception until April 4, 2024.

The Significance of Thyroid Hormone Receptors in Breast Cancer: A Hypothesis-Generating Narrative Review.

Background: Breast cancer (BC) is frequently diagnosed among Canadian women. While targeted therapies are available for most BC patients; treatment resistance is common and novel therapeutic targets are of interest. Thyroid hormones (TH) bound to thyroid hormone receptors (THR) influence cell proliferation and differentiation; they are also involved in the growth and development of normal breast tissue.

Association of extended core sampling with delayed intervention and pathologic outcomes for active surveillance patients A population-based analysis.

Introduction: Combined systematic plus targeted biopsy sampling improves detection of clinically significant prostate cancer (PCa). Our objective was to evaluate whether extended core sampling at initial biopsy in active surveillance (AS) patients is associated with subsequent AS discontinuation and pathologic outcomes.

Methods: National Comprehensive Cancer Network (NCCN) low- and favorable-intermediate-risk (FIR) AS patients diagnosed between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database.

Intraductal Prostate Cancer Affinity for Lymphatic-Predominant Metastases Through F-DCFPyL‒Prostate-Specific Membrane Antigen‒Positron Emission Tomography/CT Scans in Pretreatment Prostate Cancer Patients.

Purpose: Intraductal prostate cancer (IDC) is linked to unfavorable oncologic outcomes, marked by distinctive cellular intrinsic pathway changes and intricate immunosuppressive microenvironments that could impact the way cancer spreads. The aim of this study was to determine whether the presence of IDC in prostate biopsy specimens obtained from patients before primary prostate cancer (PCa) treatment is associated with a lymph node metastatic propensity in prostate-specific membrane antigen (PSMA)‒positron emission tomography (PET)/CT.

Materials And Methods: This was a cross-sectional analysis of all PCa patients undergoing a pretreatment F-DCFPyL-PSMA-PET/CT between January 1, 2016, and August 2021 at The Princess Margaret Cancer Centre.

Limitations of Prostate Biopsy in Detection of Cribriform and Intraductal Prostate Cancer.

Background: The presence of cribriform morphology and intraductal carcinoma (IDC) in prostate biopsies and radical prostatectomy specimens is an adverse prognostic feature that can be used to guide treatment decisions.

Objective: To assess how accurately biopsies can detect cribriform morphology and IDC cancer by examining matched biopsy and prostatectomy samples.

Design, Setting, And Participants: Patients who underwent radical prostatectomy at The Princess Margaret Cancer Centre between January 2015 and December 2022 and had cribriform morphology and/or IDC in the surgical specimen were included in the study.

Mesorectal nodal metastasis with seminal vesicle invasion in biochemically recurrent prostate cancer.

Objectives: To determine the prevalence and predictors of mesorectal lymph node (MLN) metastases on prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in patients with biochemically recurrent prostate cancer (PCa) following radical therapy.

Materials And Methods: This was a cross-sectional analysis of all PCa patients with biochemical failure following radical prostatectomy or radiotherapy who underwent an F-DCFPyL-PSMA-PET/CT at the Princess Margaret Cancer Centre between December 2018 and February 2021. Lesions with PSMA scores ≥2 were considered positive for PCa involvement (PROMISE classification).

Lymphotropic Pattern of Prostate-specific Membrane Antigen-detected Metastases Among Biochemically Recurrent Radical Prostatectomy Patients with Cribriform Disease.

Background: Cribriform morphology portends worse oncologic outcomes, and has unique cellular intrinsic pathway alterations and tumor microenvironments that may impact metastatic spread patterns.

Objective: To determine whether the presence of cribriform morphology in prostatectomy specimens of patients with biochemical recurrence after radical prostatectomy (RP) is associated with the presence of metastasis on prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and a distinct pattern of spread.

Design, Setting, And Participants: A cross-sectional analysis was conducted of all prostate cancer patients with biochemical recurrence after RP undergoing F-DCFPyL-PET/CT between December 2018 and February 2021 at the Princess Margaret Cancer Centre.

Mental health and self-determination profiles of the diverse population of medical students in Malaysia during the COVID-19 pandemic.

Introduction: Medical schools throughout the world were forced to modify their programming during the COVID-19 pandemic. In Malaysia, virtual learning plans were implemented for non-clinical programming, while clinical posting modifications were designed to meet local SOPs. The prolonged enforcement of these modifications to undergraduate medical education will have affected student experiences, including well-being.

Polycomb complex protein BMI1 confers resistance to tamoxifen in estrogen receptor positive breast cancer.

We report that BMI1 promotes tamoxifen resistance in estrogen receptor (ER)-positive breast cancer (BC). BMI1 overexpression conferred MCF7 and TD47 cells resistance to tamoxifen; BMI1 knockdown sensitized the process. In MCF7-derived tamoxifen resistant cells, BMI1 expression was upregulated and BMI1 knockdown reduced the resistance.

Differential roles of RET isoforms in medullary and papillary thyroid carcinomas.

The RET receptor tyrosine kinase mediates cell proliferation, survival and migration in embryogenesis and is implicated in the transformation and tumour progression in multiple cancers. RET is frequently mutated and constitutively activated in familial and sporadic thyroid carcinomas. As a result of alternative splicing, RET is expressed as two protein isoforms, RET9 and RET51, which differ in their unique C-terminal amino acids.

The effects of lymph node status on predicting outcome in ER+ /HER2- tamoxifen treated breast cancer patients using gene signatures.

Background: Lymph node (LN) status is the most important prognostic variable used to guide ER positive (+) breast cancer treatment. While a positive nodal status is traditionally associated with a poor prognosis, a subset of these patients respond well to treatment and achieve long-term survival. Several gene signatures have been established as a means of predicting outcome of breast cancer patients, but the development and indication for use of these assays varies.

Identification and evaluation of network modules for the prognosis of basal-like breast cancer.

Purpose: Basal-like breast cancer (BLBC) is a molecular subtype of breast cancer associated with poor clinical outcome, although some patients with BLBC experience long-term survival. Apart from nodal status, current clinical/histopathological variables show little capacity to identify BLBC patients at either high- or low-risk of disease recurrence. Accordingly, we sought to develop a network based genomic predictor for predicting the outcome of patients with BLBC.

Thyroid hormone receptor α in breast cancer: prognostic and therapeutic implications.

We determined the expression of two transcriptional variants of thyroid hormone receptor alpha (THRα1 and THRα2) in samples from a cohort of breast cancer patients and correlated expression levels with survival. 130 women who were diagnosed with invasive breast carcinoma between 2007 and 2008 were included. Representative sections of their tumours were analyzed in triplicate on a tissue microarray for expression of THRα1 and THRα2 by immunohistochemistry.

Multiple functional effects of RET kinase domain sequence variants in Hirschsprung disease.

The REarranged during Transfection (RET) gene encodes a receptor tyrosine kinase required for maturation of the enteric nervous system. RET sequence variants occur in the congenital abnormality Hirschsprung disease (HSCR), characterized by absence of ganglia in the intestinal tract. Although HSCR-RET variants are predicted to inactivate RET, the molecular mechanisms of these events are not well characterized.