The Transformation of Adolescent and Young Adult Oncological and Supportive Care in Canada: A Mixed Methods Study.

BACKGROUND: Due to ongoing disparity in the specialized care available to adolescents and young adults (AYAs) with cancer, this study aimed to understand the gaps and barriers to accessing care and preferences on types of solutions at a national Canadian level. METHODS: A mixed-methods study involving an online survey and focus groups (FGs) was conducted among AYAs residing in different regions of Canada. RESULTS: There were a total of 174 survey respondents, of whom the majority were between 30-39 years of age (n = 125, 71.8%). Of the 174 respondents, 36 (20.7%) participated in one of seven FGs. Triangulation of the results illustrated that AYAs are not appropriately informed about the long-term health risks of being treated for cancer and where/how to seek support. These results culminated into three themes: (1) the need for AYA relevant and timely information about health risks; by (a) producing health risk-related content with the AYA life stage in mind; (b) providing a guided "map" to help AYAs anticipate what they may experience, and (c) providing checklists to help AYAs navigate their experience; (2) need for tailored and timely supportive care including (a) establishing ongoing check-ins and (b) receiving navigation support, and (3) need for enhanced connections by creating (a) a space to gather, connect and seek mentorship and (b) a hub to access information. CONCLUSION: AYAs continue to lack sufficient support both during and following cancer and mechanisms are required to ensure longitudinal support is provided across jurisdictions and in all stages of the cancer journey.

Theoretical false positive psychology.

A fundamental goal of scientific research is to generate true positives (i.e., authentic discoveries). Statistically, a true positive is a significant finding for which the underlying effect size (δ) is greater than 0, whereas a false positive is a significant finding for which δ equals 0. However, the null hypothesis of no difference (δ = 0) may never be strictly true because innumerable nuisance factors can introduce small effects for theoretically uninteresting reasons. If δ never equals zero, then with sufficient power, every experiment would yield a significant result. Yet running studies with higher power by increasing sample size (N) is one of the most widely agreed upon reforms to increase replicability. Moreover, and perhaps not surprisingly, the idea that psychology should attach greater value to small effect sizes is gaining currency. Increasing N without limit makes sense for purely measurement-focused research, where the magnitude of δ itself is of interest, but it makes less sense for theory-focused research, where the truth status of the theory under investigation is of interest. Increasing power to enhance replicability will increase true positives at the level of the effect size (statistical true positives) while increasing false positives at the level of theory (theoretical false positives). With too much power, the cumulative foundation of psychological science would consist largely of nuisance effects masquerading as theoretically important discoveries. Positive predictive value at the level of theory is maximized by using an optimal N, one that is neither too small nor too large.

Ensuring Equity and Inclusion in Virtual Care Best Practices for Diverse Populations of Youth with Chronic Pain.

Poor access to care is a top patient-oriented research priority for youth with chronic pain in Canada, and the COVID-19 pandemic has exacerbated these concerns. Our patient-oriented project team engaged with marginalized and racialized youth with chronic pain (Black youth with sickle cell disease, Indigenous youth and youth with complex medical needs) and their families to ensure that best practice recommendations for virtual care are inclusive and equitable. Input provided through virtual round-table discussions improved recommendations for leveraging, implementing and selecting best platforms for virtual care for youth with chronic pain and identified new gaps for future research, practice and policy change.

Science is not a signal detection problem.

The perceived replication crisis and the reforms designed to address it are grounded in the notion that science is a binary signal detection problem. However, contrary to null hypothesis significance testing (NHST) logic, the magnitude of the underlying effect size for a given experiment is best conceptualized as a random draw from a continuous distribution, not as a random draw from a dichotomous distribution (null vs. alternative). Moreover, because continuously distributed effects selected using a P < 0.05 filter must be inflated, the fact that they are smaller when replicated (reflecting regression to the mean) is no reason to sound the alarm. Considered from this perspective, recent replication efforts suggest that most published P < 0.05 scientific findings are "true" (i.e., in the correct direction), with observed effect sizes that are inflated to varying degrees. We propose that original science is a screening process, one that adopts NHST logic as a useful fiction for selecting true effects that are potentially large enough to be of interest to other scientists. Unlike original science, replication science seeks to precisely measure the underlying effect size associated with an experimental protocol via large-N direct replication, without regard for statistical significance. Registered reports are well suited to (often resource-intensive) direct replications, which should focus on influential findings and be published regardless of outcome. Conceptual replications play an important but separate role in validating theories. However, because they are part of NHST-based original science, conceptual replications cannot serve as the field's self-correction mechanism. Only direct replications can do that.

Routine Axillary Ultrasound for Patients with T1-T2 Breast Cancer Does Not Increase the Rate of Axillary Lymph Node Dissection Based on Predictive Modeling.

BACKGROUND: Since publication of the American College of Surgeons Oncology Group Z0011 trial results, demonstrating that many patients with nonpalpable axillary lymph nodes and one or two positive sentinel nodes do not require axillary lymph node dissection (ALND), preoperative axillary ultrasound (AUS) has become controversial. Clinicians are concerned that AUS may lead to unnecessary ALND. The authors developed an algorithm (Algorithm 1) in which the number of AUS-suspicious nodes and tumor biology direct management. For estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer with a single AUS-suspicious node and a positive lymph node needle biopsy (LNNB), sentinel lymph node biopsy (SLNB) is performed with a specimen X-ray documenting retrieval of the clipped node. Other patients with positive LNNB receive neoadjuvant chemotherapy. The authors hypothesized that routine AUS and this algorithm could decrease ALND compared with a strategy of no preoperative AUS. METHODS: Decision-tree analysis and Monte Carlo simulation were used to assess the expected number of ALNDs under two strategies (routine AUS vs no AUS). Probabilities were drawn from a literature review and an institutional database. The authors assumed nodal pathologic complete response rates as reported in the literature. Four additional algorithms were created to assess whether any other treatment model could decrease the rate of ALND. RESULTS: Using the routine AUS and the authors' algorithm, the predicted ALND rate was 9%, versus 10% for a strategy of no AUS, with overlapping uncertainty intervals. The remaining treatment algorithms showed similar results. DISCUSSION: Use of AUS may help to tailor patient care without leading to overutilization of ALND, as long as neoadjuvant chemotherapy is administered when appropriate.

Positive Ultrasound-guided Lymph Node Needle Biopsy in Breast Cancer may not Mandate Axillary Lymph Node Dissection.

BACKGROUND: The ACOSOG Z0011 (Z11) trial demonstrated that in patients with nonpalpable axillary lymph nodes (LN) and one to two positive sentinel LN (SLN), axillary LN dissection (ALND) is unnecessary.JAMA 305:569-575, [2011], Ann Surg 264:413-42, [2016] The Z11 trial did not require preoperative axillary ultrasound (axUS). In many centers, preoperative axUS is part of the standard workup of a newly diagnosed breast cancer patient, but in light of the Z11 results, its role is now questioned. METHODS: We retrospectively analyzed newly diagnosed breast cancer patients at two institutions. Inclusion criteria were patients with (1) no palpable lymphadenopathy, (2) abnormal axUS, (3) axillary LN metastasis confirmed preoperatively by axUS-lymph node needle biopsy, (4) no neoadjuvant therapy, and (5) ALND. LN disease burden was dichotomized as N1 versus N2-3. We examined relationships between clinicopathologic factors, including axUS characteristics, and LN disease burden. RESULTS: Of 129 included cases, 67 had N1 disease (51.9%) and 62 had N2-3 disease (48.1%). Factors significantly associated with N1 disease were tumor size ≤2 cm (p = 0.012), nonlobular histology (p = 0.013), and one suspicious LN on axUS (p = 0.008). For patients with both tumor size on imaging ≤2 cm and one abnormal LN on axUS, only 27% had N2-3 disease (p = 0.007). CONCLUSIONS: More than half of patients without palpable adenopathy but with preoperative US-guided biopsy proven axillary LN metastases had N1 disease. For patients with both tumor size ≤2 cm and only 1 abnormal LN on axUS, 73% had N1 disease. This suggests that such patients, if they are otherwise analogous to Z11 patients, may undergo attempt at SLNB.

Prospective Study Comparing Surgeons' Pain and Fatigue Associated with Nipple-Sparing versus Skin-Sparing Mastectomy.

BACKGROUND: Nipple-sparing mastectomy (NSM) is more technically challenging than skin-sparing mastectomy (SSM) but offers quality-of-life and cosmetic advantages. However, surgeon physical symptoms related to NSM workload have not been documented. METHODS: This was a prospective study using questionnaires to compare surgeon-reported physical symptoms before, during, and after NSM versus SSM. Surgeons also answered general questions about each mastectomy. Bilateral cases were performed simultaneously by two surgeons, who completed independent questionnaires. RESULTS: Questionnaires were completed after 82 SSMs and 44 NSMs. On a 0-10 scale, surgeons reported NSM was more physically demanding than SSM (7.0 vs. 4.5, p < 0.001). Mean visualization was more difficult (5.7 vs. 3.2, p < 0.001) and mean fatigue score was greater (5.6 vs. 3.1, p < 0.001) after NSM than SSM. The mean increase in neck pain (on a 0-4 scale) was greater for NSM than SSM, both from before-to-during surgery (0.8 vs. 0.2, p = 0.003) and before-to-after surgery (0.9 vs. 0.2, p = 0.002). The mean increase in lower back pain was greater for NSM than SSM, both from before-to-during surgery (0.7 vs. 0.2, p = 0.008) and before-to-after surgery (0.9 vs. 0.2, p = 0.003). Surgeons reported that NSM was more mentally demanding (p < 0.001), complex (p = 0.01), and difficult (p < 0.001) than SSM. CONCLUSION: Surgeons experienced greater physical symptoms, mental strain, and fatigue with NSM than SSM. This raises concern that mild but repetitive pain over the course of a breast surgeon's career may lead to repetitive stress injury.

Meningococcal Disease in Patients With Human Immunodeficiency Virus Infection: A Review of Cases Reported Through Active Surveillance in the United States, 2000-2008.

BACKGROUND: Although human immunodeficiency virus (HIV) infection is an established risk factor for several bacterial infections, the association between HIV infection and meningococcal disease remains unclear. METHODS: Expanded chart reviews were completed on persons with meningococcal disease and HIV infection reported from 2000 through 2008 from 9 US sites participating in an active population-based surveillance system for meningococcal disease. The incidence of meningococcal disease among patients meeting Centers for Disease Control and Prevention acquired immune deficiency syndrome (AIDS) surveillance criteria was estimated using data from the National HIV Surveillance System for the participating sites. RESULTS: Thirty-three cases of meningococcal disease in individuals with HIV infection were reported from participating sites, representing 2.0% of all reported meningococcal disease cases. Most (75.8%) persons with HIV infection were adult males aged 25 to 64 years old. Among all meningococcal disease cases aged 25 to 64 years old, case fatality ratios were similar among HIV-infected and HIV-uninfected persons (13.3% vs 10.6%; P = .6). The cumulative, mean incidence of meningococcal disease among patients aged 25 to 64 years old with HIV infection ever classified as AIDS was 3.5 cases per 100000 person years (95% confidence interval [CI], 2.1-5.6), compared with 0.3 cases per 100000 person years (95% CI, 0.3-0.3) for persons of the same age group not reported to have AIDS (relative risk = 12.9; 95% CI, 7.9-20.9). CONCLUSIONS: Individuals with HIV infection meeting the AIDS surveillance case definition have a higher incidence of meningococcal disease compared with the general adult population.

The Peer Reviewers' Openness Initiative: incentivizing open research practices through peer review.

Openness is one of the central values of science. Open scientific practices such as sharing data, materials and analysis scripts alongside published articles have many benefits, including easier replication and extension studies, increased availability of data for theory-building and meta-analysis, and increased possibility of review and collaboration even after a paper has been published. Although modern information technology makes sharing easier than ever before, uptake of open practices had been slow. We suggest this might be in part due to a social dilemma arising from misaligned incentives and propose a specific, concrete mechanism-reviewers withholding comprehensive review-to achieve the goal of creating the expectation of open practices as a matter of scientific principle.

Do subtle reminders of money change people's political views?

A number of researchers have reported studies showing that subtle reminders of money can alter behaviors and beliefs that are seemingly unrelated to money. In 1 set of studies published in this journal, Caruso, Vohs, Baxter, and Waytz (2013) found that incidental exposures to money led subjects to indicate greater support for inequality, socioeconomic differences, group-based discrimination, and free market economies. We conducted high-powered replication attempts of these 4 money priming effects and found no evidence of priming (weighted Cohen's d = 0.03). We later learned that Caruso et al. also found several null effects in their line of research that were not reported in the original article. In addition, the money priming effect observed in the first study of Caruso et al. was included in the Many Labs Replication Project (Klein et al., 2014), and only 1 of the 36 labs was able to find the effect.

Elastic analysis procedures: an incurable (but preventable) problem in the fertility effect literature. Comment on Gildersleeve, Haselton, and Fales (2014).

Gildersleeve, Haselton, and Fales (2014) presented a meta-analysis of the effects of fertility on mate preferences in women. Research in this area has categorized fertility using a great variety of methods, chiefly based on self-reported cycle length and time since last menses. We argue that this literature is particularly prone to hidden experimenter degrees of freedom. Studies vary greatly in the duration and timing of windows used to define fertile versus nonfertile phases, criteria for excluding subjects, and the choice of what moderator variables to include, as well as other variables. These issues raise the concern that many or perhaps all results may have been created by exploitation of unacknowledged degrees of freedom ("p-hacking"). Gildersleeve et al. sought to dismiss such concerns, but we contend that their arguments rest upon statistical and logical errors. The possibility that positive results in this literature may have been created, or at least greatly amplified, by p-hacking receives additional support from the fact that recent attempts at exact replication of fertility results have mostly failed. Our concerns are also supported by findings of another recent review of the literature (Wood, Kressel, Joshi, & Louie, 2014). We conclude on a positive note, arguing that if fertility-effect researchers take advantage of the rapidly emerging opportunities for study preregistration, the validity of this literature can be rapidly clarified.

Jealousy in dogs.

It is commonly assumed that jealousy is unique to humans, partially because of the complex cognitions often involved in this emotion. However, from a functional perspective, one might expect that an emotion that evolved to protect social bonds from interlopers might exist in other social species, particularly one as cognitively sophisticated as the dog. The current experiment adapted a paradigm from human infant studies to examine jealousy in domestic dogs. We found that dogs exhibited significantly more jealous behaviors (e.g., snapping, getting between the owner and object, pushing/touching the object/owner) when their owners displayed affectionate behaviors towards what appeared to be another dog as compared to nonsocial objects. These results lend support to the hypothesis that jealousy has some "primordial" form that exists in human infants and in at least one other social species besides humans.

Pediatric fasting times before surgical and radiologic procedures: benchmarking institutional practices against national standards.

Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients. Findings demonstrate that pediatric patients experienced prolonged fasting before procedures and that the majority of NPO orders were non-compliant with national guidelines. We have developed strategies to reduce fasting times and ensure compliance with recommended national fasting standards.

Top tips for child protection for the GDP.

UNLABELLED: Knowledge of child protection is essential in everyday practice for the whole dental team as they are well placed to take part in the shared responsibility of protecting children. Physical abuse, neglect, sexual abuse and emotional abuse may all present to the dental team in various ways. This article aims to provide some top tips for general dental practitioners who have concerns regarding possible child abuse/neglect and remind them of what observations to make and what questions to ask themselves when they are concerned about a child's welfare. CLINICAL RELEVANCE: Abuse and neglect are areas in child protection that the dental team can provide important information about to the local child protection team. All members of the dental team need to be aware of the signs and symptoms of child abuse/neglect and where to go for help.

Two failures to replicate high-performance-goal priming effects.

Bargh et al. (2001) reported two experiments in which people were exposed to words related to achievement (e.g., strive, attain) or to neutral words, and then performed a demanding cognitive task. Performance on the task was enhanced after exposure to the achievement related words. Bargh and colleagues concluded that better performance was due to the achievement words having activated a "high-performance goal". Because the paper has been cited well over 1100 times, an attempt to replicate its findings would seem warranted. Two direct replication attempts were performed. Results from the first experiment (n = 98) found no effect of priming, and the means were in the opposite direction from those reported by Bargh and colleagues. The second experiment followed up on the observation by Bargh et al. (2001) that high-performance-goal priming was enhanced by a 5-minute delay between priming and test. Adding such a delay, we still found no evidence for high-performance-goal priming (n = 66). These failures to replicate, along with other recent results, suggest that the literature on goal priming requires some skeptical scrutiny.

Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis.

BACKGROUND: Chronic pulmonary aspergillosis (CPA) is an infectious disease that progressively destroys lung tissue. To date, no longitudinal data on the efficacy of antifungal treatment on health status in CPA patients exist. METHODS: Using the standardized St George's Respiratory Questionnaire, the health status of 122 patients with was assessed at baseline and quarterly over 12 months. The score range was 0-100, where higher score indicates worse heath status, and a change of ≥4 was deemed the minimal clinically important difference. Lung function, body mass index, Medical Research Council dyspnea scale, disease severity, and demographic data were reported. RESULTS: Mean age of patients was 59 years, and 45% were female. Overall, patients with CPA had substantial health status impairment at baseline. After treatment, 47%-50% gained substantial health improvement with a mean reduction of score of 14 at both 6 and 12 months, whereas 32% deteriorated with a mean rise of score of 11 and 14 after 6 and 12 months of treatment and observation, respectively, and 21% were not much different (stable). Patients gained therapeutic benefit irrespective of their illness severity where >50% of those who had "poor" and "very poor" status at baseline improved with score reduction of ≥4 after 6 months of treatment. Replicating this analysis using a health status category, we found that at least 50% of patients with a "poor/very poor" health status category at baseline improved significantly to "fair" or "good/very good" categories. Side effects burdened health status considerably. In multivariate analysis, dyspnea and disease severity significantly defined health status impairment. CONCLUSIONS: Antifungal therapy improved health status and prevented CPA progression in most patients.

Envy, politics, and age.

In the last 5 years, the phrase "politics of envy" has appeared more than 621 times in English-language newspapers, generally in opinion essays contending that political liberalism reflects and exploits feelings of envy. Oddly, this assertion has not been tested empirically. We did so with a large adult sample (n = 357). Participants completed a Dispositional Envy Scale and questions about political ideology, socioeconomic status, and age. Envy and age were moderately correlated; younger people reported greater envy. Political ideology and envy were weakly correlated; however, this relationship was not significant when controlling for age.

Major memory for microblogs.

Online social networking is vastly popular and permits its members to post their thoughts as microblogs, an opportunity that people exploit, on Facebook alone, over 30 million times an hour. Such trivial ephemera, one might think, should vanish quickly from memory; conversely, they may comprise the sort of information that our memories are tuned to recognize, if that which we readily generate, we also readily store. In the first two experiments, participants' memory for Facebook posts was found to be strikingly stronger than their memory for human faces or sentences from books-a magnitude comparable to the difference in memory strength between amnesics and healthy controls. The second experiment suggested that this difference is not due to Facebook posts spontaneously generating social elaboration, because memory for posts is enhanced as much by adding social elaboration as is memory for book sentences. Our final experiment, using headlines, sentences, and reader comments from articles, suggested that the remarkable memory for microblogs is also not due to their completeness or simply their topic, but may be a more general phenomenon of their being the largely spontaneous and natural emanations of the human mind.