BACKGROUND With the advent of the prostate specific antigen (PSA) assay, an increased detection rate of prostate carcinoma has ensued. This has been associated with a downward stage migration. In contrast, grade has shifted heavily toward moderate differentiation. The authors sought to test the hypothesis that such changes in grade in part may be because of trends among pathologists to upgrade similar specimens over time. METHODS Two expert genitourinary pathologists regraded 23 prostate biopsies and 15 radical prostatectomy specimens during a 3‐year period (1989–1991). Each pathologist then regraded 32 prostate biopsies and 15 radical prostatectomies from 1998 to 2000. For both time periods, each pathologist regraded only specimens that they personally had graded initially. All specimens were scored using the Gleason system, the predominant system used in describing prostate carcinoma grade. In evaluating original and regraded scores, the authors classified score changes between less than or equal to 6 and greater than or equal to 7 or between 7 and greater than or equal to 8 as significant because such changes have a high probability of altering clinical management. The results were analyzed using the two‐tailed Fisher exact test. RESULTS Of 23 prostate biopsies from 1989 to 1991, 10 of 23 (44%) had a clinically significant Gleason score change when regraded, whereas 2 of 15 (13%) radical prostatectomy specimens from the same period had a clinically significant Gleason score change. A significant change in the distribution of biopsy Gleason scores on regrading was observed (P < 0.04). In comparison, when the prostate biopsies from 1998–2000 were regraded, 10 of 32 (31%) had a clinically significant grade change. Radical prostatectomy specimens from the same period revealed 3 of 15 (20%) with a clinically significant grade change. After regrading the biopsies from 1989–1991, 8 of 23 (35%) of were upgraded, whereas 2 of 23 (9%) were downgraded. In comparison, of the biopsies with significant changes from 1998 to 2000, 3 of 32 (9%) were upgraded, whereas 7 of 32 (22%) were downgraded. Of the radical prostatectomy specimens with significant change, only 2 of 15 from each period were upgraded. Significant upgrading (P < 0.005) occurred only in the biopsy specimens from 1989 to 1991. CONCLUSIONS The authors' data suggest that rates of upgrading and downgrading of biopsy specimens differ between the 1989–1991 cases and the 1998–2000 cases, with the 1989–1991 samples exhibiting a significant change toward higher grades. Although not excluding the possibility of a change in the biology of prostate carcinoma over time, these findings suggest that the apparent trend toward higher biopsy grades in part may be because of how pathologists interpret these specimens today as compared with 10 years ago. Therefore, outcome studies including a biopsy Gleason score from older specimens as a risk variable have a significant chance of being vulnerable to this phenomenon. Based on the authors' data, all such specimens should...

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Ecological Society of America is collaborating with JSTOR to digitize, preserve and extend access to Ecology.Abstract. The banks of Brine Pool NR1, a brine-filled pockmark in the Gulf of Mexico, are host to a population of Bathymodiolus childressi, a hydrocarbon seep mussel with methanotrophic endosymbionts. The mussel community surrounds the pool, covering an area of -540 m2 and can be divided into two distinct zones separated by a transitional area. The inner zone extends inward from the edge of the pool --1 m. The water among the mussels in this zone has high methane concentrations (>200 imol/L) and moderate oxygen concentrations (nondetectable to 161 pxmol/L). Hydrogen sulfide was rarely detected in this zone. The outer zone extends -1 m inward from the outer edge of the mussel bed. This zone also has high methane concentrations in the water among the mussels (>200 jimol/L), but lower average oxygen levels and areas with very high levels of hydrogen sulfide. The two zones are linked with a transitional area, the middle zone, ranging in width from 1 to 4 m, where intermediate environmental conditions are found. The inner zone was relatively homogenous, while spatial heterogeneity was high in the middle and outer zones, both in the characteristics of the mussel population and in their environment. Size-frequency distributions indicate that the inner zone is an area of active recruitment, with very little recruitment occurring in either the middle or outer zones. Physiological condition indices of the mussels were significantly higher in the inner zone than in the outer zone in some years. Comparisons of growth parameters also indicate better growth conditions in the inner zone. Physiological condition and growth did not change between the first two years of the study. However, a significant change in both was detected between 1994 and 1995, suggesting that this deep-sea community is exposed to an unexpected temporal variability in environmental conditions.

No abstract

Medical science liaisons (MSLs) are field-based pharmaceutical or biomedical industry professionals whose role demands specialized product knowledge and skill in executing customer-facing activities. This report describes a survey of key opinion leaders (KOLs) to identify MSL skills most highly valued and those in need of enrichment with the objective of designing an advanced training curriculum for experienced MSLs. A total of 66 MSLs representing diverse therapeutic areas verbally administered a 9-question survey at the conclusion of a routine MSL-KOL interaction. There were 296 surveys completed, with most respondents (239 of 281; 82%) indicating that they meet with MSLs from other companies. Ninety-five percent (218 of 230) responded that the value provided by MSLs was comparable to that offered by other companies. When asked about top MSL attributes, KOLs mentioned product knowledge, scientific credibility, therapeutic area knowledge, timeliness of response, and communication skills. In terms of resources provided by MSLs, KOLs most often mentioned scientific information, unbiased product information, therapeutic area developments (including pipeline discussions), disease state information, and potential involvement in research or as an advisor. Based on the quantitative and qualitative results of this survey, a workshop curriculum focusing on advanced communication skills and networking techniques was developed and conducted successfully.