Invited African-American Radiation Oncology Grand Rounds Speakers: DEI or Die?

PURPOSE/OBJECTIVE(S)

Invitations for grand rounds/visiting professor speakership are a sign of national expertise and are used to evaluate faculty promotion and advancement in Radiation Oncology. Consequently, evaluation of the demographics of faculty receiving such invitations may play a role in elucidating barriers to career advancement. We performed this study to assess the demographic racial and gender representation of invited Radiation Oncology speakerships, as well as the proportion of diversity, equity and inclusion (DEI)-related talks among invited African-American radiation oncology speakers.

MATERIALS/METHODS

Radiation oncology programs in the United States were contacted by telephone and e-mail to obtain a list of speakers (grand rounds speakers and/or visiting professor) invited to their institution along with their speaking topics presented between January 2021 and December 2022. Speakers were categorized demographically by race and gender; speaker demographics were determined by a previously validated combination of facial recognition and internet investigation (PubMed.gov identification numbers 30996695 and 34919411). Speakers who were not faculty (i.e., residents, medical students) were eliminated from analysis. Talk topics were categorized as either DEI or non-DEI talks from the presence/absence of DEI-related content in the speaker's talk title. The Fisher's exact test was used for statistical analysis, with significance set at p < 0.05.

RESULTS

A total of 252 invited speakers and their associated talk topics were obtained from 51 radiation oncology programs. Of these speakers, 98 were female (38.9%) and 16 were African-American race (6.3%). The invited talk topic was DEI-related in 7% of total cases. Among speakers not of African-American race, this was 4.2% (10/236); among African-American speakers, it was 50% (8/16). This difference reached statistical significance (p<0.0001).

CONCLUSION

A significant proportion of invited African-American radiation oncology grand rounds/visiting professor talks are focused on the topic of diversity, equity, and inclusion (DEI), compared with less than 5% of non-African-American invited speakers. Targeted efforts to expand African-American representation in non-DEI topics are needed to ensure and expand diversity in Radiation Oncology.

Periodontitis, Porphyromonas, and the pathogenesis of rheumatoid arthritis

Epidemiological data indicate a link between rheumatoid arthritis (RA) and periodontal disease (PD). In vitro and in vivo studies have sought to dissect potential mechanisms by which PD may contribute to initiation and progression of RA. However, these are both multifactorial, chronic diseases, and their complex etiologies and pathogenesis themselves remain incompletely understood. Could there really be an etiological link or does this simply represent a statistical coincidence muddied by common risk factors? This review seeks to provide background on these two diseases in the context of recent discoveries suggesting that their pathogenesis may be related. In particular, the process of citrullination, a post-translational protein modification, has been highlighted as a process common to both diseases. The evidence for a relationship between the diseases is explored and its potential mechanisms discussed.

Renal-coloboma syndrome: prenatal detection and clinical spectrum in a large family

Renal-coloboma syndrome includes abnormalities in the urogenital and ocular systems as its primary manifestations, although it can be associated with abnormalities in other systems as well. This syndrome is caused by mutations in the PAX2 gene and is transmitted as an autosomal dominant trait. We report a family in which at least 7 members have manifestations of renal-coloboma syndrome, including two in whom renal disease was diagnosed prenatally by ultrasound examination. A pathogenic frame-shift mutation (619insG) was found in the PAX2 gene in affected family members, who show remarkable variability in both the ocular and renal manifestations of the syndrome.

Induction of labour: a continuous quality improvement and peer review program to improve the quality of care

This article describes a program developed to improve the process of planned induction of labour and to reduce the rates of inappropriate induction. The setting is a tertiary-care maternity hospital in urban Vancouver, BC, in which 7000 deliveries take place annually. Approximately 65% of these can be considered primary care; the remainder are secondary- or tertiary-level cases. Continuous quality improvement (CQI) methods were used by a multidisciplinary team, which included nursing staff, physicians, health records personnel and a CQI facilitator. Interventions included the development of a new induction-booking process, clear criteria for induction, feedback to caregivers about changes and a peer review system to oversee and maintain improvement. The overall induction rate for the institution decreased, and this change has been maintained.

Identification of arterio-venous anastomoses in vivo in monochorionic twin pregnancies: preliminary report

OBJECTIVE

To determine whether it is possible to identify in vivo placental arterio-venous anastomoses (AVAs) by color Doppler flow mapping.

METHODS

Three monochorionic twin pregnancies (one with and two without twin-to-twin transfusion syndrome) underwent placental mapping by color Doppler ultrasound. Placental vessels along the chorionic plate were recorded together with the direction of blood flow and their location in relation to the cord insertions and to superficial arterio-arterial anastomoses. Suggestive AVAs were mapped topographically and results were compared with the findings of formal postnatal placental injection studies.

RESULTS

An AVA was identified in each of the three cases. Injection studies showed multiple AVAs. Each antenatally identified AVA was confirmed at placental injection study. Their placental location correlated to other landmarks as predicted by ultrasound.

CONCLUSIONS

This preliminary report demonstrates that AVAs can be identified using color Doppler ultrasound. This may facilitate planning for highly selective ablation of AVAs, and shorter procedure times. Formal studies are now indicated to determine the accuracy of this technique.

Amnioinfusions in renal agenesis

BACKGROUND

Renal agenesis causes severe oligohydramnios, which results in compression effects, lung hypoplasia, and rapid neonatal death.

CASE

We report a case of renal agenesis identified in a fetus in which serial amnioinfusions were employed to prevent pulmonary hypoplasia and compression effects. A total of ten amnioinfusions were performed between 17-33 weeks' gestation. Chorioamnionitis led to preterm delivery at 33 weeks. The infant had no significant pulmonary hypoplasia and none of the compression effects usually associated with the oligohydramnios sequence. Peritoneal dialysis was provided for the infant with a long-term aim of eventual renal replacement therapy, but dialysis was unsuccessful and the infant died at the age of 23 days. Autopsy revealed slightly small lungs and extensive cavitating lesions in the brain, which were presumed to be of peripartum or antenatal origin. The chain of events leading to this unusual course of action is described, and the ethical aspects are outlined.

CONCLUSION

At present, this type of procedure is not an appropriate intervention in cases of renal agenesis, and such management is strongly discouraged.

Delayed delivery of second twin: report of four cases and review of the literature

In four cases of delayed delivery of a twin pregnancy with survival of the second twin, the interval ranged at 41-143 days. Review of the literature and our cases supports the following approach: high ligation of the umbilical cord with an absorbable suture, cervical suture in the presence of cervical dilatation, and serial monitoring of fetal growth and maternal coagulation indices. Disseminated intravascular coagulation has not been reported in such cases.

Neonatal outcome after prolonged preterm rupture of the membranes

Pulmonary hypoplasia was diagnosed in 14 of 88 infants (16%) delivered in 1983 to 1986 after rupture of the membranes of greater than or equal to 7 days with onset before 29 weeks' gestation. Logistic regression analysis applied to examine the relative importance of perinatal risk factors in the prediction of pulmonary hypoplasia showed that gestational age at onset of rupture of the membranes had a significant effect (p = 0.002) on the odds that pulmonary hypoplasia developed in the neonate, whereas the duration of rupture of the membranes (p = 0.11) and the degree of oligohydramnios (p = 0.65) did not. Postnatally, the presence of pulmonary hypoplasia was associated with the severity of skeletal compression deformities (p less than 0.0001). The development of skeletal compression deformities was associated with severe oligohydramnios (p = 0.05) and duration of rupture of the membranes (p = 0.02) but not gestational age at rupture of the membranes (p = 0.77). Gestational age at onset of rupture of the membranes being the best single predictor of pulmonary hypoplasia suggests that the stage of lung development at rupture of the membranes may be important.

ITP in pregnancy: use of the bleeding time as an indicator for treatment

ITP is a relatively common disorder seen in pregnancy. Current recommendations for management of patient with ITP recommend maintaining the platelet count above 50 x 10(9)/L and the bleeding time less than 20 min. It has been well documented that the bleeding time in ITP is disproportionately shortened in many patients relative to the platelet count. We present a prospective study of 24 ITP patients in whom the bleeding time was used as an indicator for therapeutic intervention in pregnancy. Indications for therapy with prednisone and/or intravenous gammaglobulin were the following: significant clinical hemorrhage due to thrombocytopenia; bleeding time of greater than 20 min at the baseline platelet count; for normalization of hemostasis prior to delivery or surgical procedure. Caesarean section was performed only in cases in which there were obstetrical indications for this mode of delivery or when the fetal platelet count (obtained by fetal scalp vein sample) was less than 50 x 10(9)/L. Of 24 patients with ITP, eight had significant thrombocytopenia (platelet count less than 50 x 10(9)/L) throughout pregnancy. Only two patients required prolonged prednisone therapy. Both suffered side effects of chronic prednisone administration. Four patients were treated with prednisone for a short course (10-14 days) at term to improve hemostasis for delivery. One patient was treated with intravenous gammaglobulin at term in an effort to prevent severe neonatal thrombocytopenia. Seven patients required caesarean section; the remaining 17 patients underwent vaginal delivery. Only one minor bleeding complication was seen - a small wound hematoma post caesarean section. In summary, using the bleeding time as an indicator for therapeutic intervention, treatment of ITP in pregnancy can be minimized. Thus, therapy related toxicity can be avoided.