Critical realism methodology as a guiding framework for interdisciplinary theory enrichment: Reflections on a study of empowerment.

Philosophy of science and ontological assumptions underpin our work as scholars, explicitly, or implicitly. In this paper, we develop empowerment theory with a critical realism (CR) lens. Through the example of a study of empowerment, we examine how can it be used as a guiding paradigm for research in community psychology (CP). We sought to increase theoretical rigor by using a CR approach to interdisciplinarity. We put empowerment into conversation with Social Reproduction Theory and Black, Indigenous, People of Color feminisms, because both represent situated knowledge that address experiences with oppression and focus on dismantling systems of oppression. We illustrate how a CR approach shaped our understanding of empowerment, and in turn, provided an analysis that was (a) more nuanced and actionable, (b) more aligned with CP values and definitions of social justice, and (c) more likely to contribute to the field by developing an intersectional anticapitalist and feminist intervention into empowerment literature. This paper highlights how, aligned with an interdisciplinary CR approach, we questioned assumptions about empowerment theory, which influenced our empirical work so that we could provide a more focused critique of unjust social arrangements, and with it, the possibility to act upon those arrangements.

Synchronous dual hematological malignancies: new or underreported entity?

BACKGROUND: Patients with a single hematological malignancy may be unexpectedly diagnosed with a clonally unrelated synchronous dual hematological malignancy (SDHM). The presence of a secondary hematological malignancy may be overlooked and only identified in situations presenting with discordant clinical or laboratory findings. Clinical management of these patients can be challenging, in part due to the relatively unknown etiopathology of SDHM and the impact of therapy on the secondary malignancy. OBJECTIVES: To assess, characterize patients with synchronous double hematological malignancies and share our experience with this challenging group of patients. METHODS: We performed a retrospective chart review of 3036 patients with hematological malignancy at our cancer center between February 2013 and July 2017. RESULTS AND DISCUSSION: We identified 46 patients with SDHM, a prevalence of 1.51% among patients diagnosed with any hematological malignancy. We identify several heterogeneous combinations of SDHM comprised of myeloid and/or lymphoid lineages and provide our experience with managing patients with these underreported conditions. CONCLUSION: SDHMs are not uncommon and should be suspected in situations presenting with unusual or unexpected findings.

Sensitive Topics, Missing Data, and Refusal in Social Network Studies: An Ethical Examination.

We describe our ethics-driven process of addressing missing data within a social network study about accountability for racism, classism, sexism, heterosexism, cis-sexism, ableism, and other forms of oppression among social justice union organizers. During data collection, some would-be participants did not return emails and others explicitly refused to engage in the research. All refusals came from women of color. We faced an ethical dilemma: Should we continue to seek participation from those who had not yet responded, with the hopes of recruiting more women of color from within the network so their perspectives would not be tokenized? Or, should we stop asking those who had been contacted multiple times, which would compromise the social network data and analysis? We delineate ways in which current discussions of the ethics of social network studies fell short, given our framework and our community psychology (CP) values. We outline literature that was helpful in thinking through this challenge; we looked outside of CP to the decolonization literature on refusal. Lessons learned include listening for the possible meanings of refusals and considering the level of engagement and the labor required of participants when designing research studies.

Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision?

To evaluate whether biopsy with vacuum-assisted biopsy (VAB) devices improves histologic underestimation rates of benign papillomas when compared to smaller bore core needle biopsy (CNB) devices. Patients with biopsy-proven benign papillomas with surgical resection or minimum 12 months follow-up were selected. Two breast pathologists reviewed all pathology slides of percutaneous and excisional biopsy specimens. Histologic underestimation rates for lesions biopsied with 10-12 Gauge (G) VAB were compared to those with 14G CNB. A total of 107 benign papillomas in 107 patients from two centers were included. There were 60 patients (mean age 57 years, SD 10.3 years) diagnosed with VAB and 47 patients (mean age 57.6 years, SD 11.3 years) with 14G CNB who underwent surgical excision or imaging follow-up. The upgrade rate to ductal carcinoma in situ or invasive carcinoma was 1.6% (1/60) with VAB and 8.5% (4/47) with 14G. Upgrade to atypia was 3.3% (2/60) after VAB and 10.6% (5/47) with CNB. The total underestimation rates were 5% (3/60) with VAB and 19.1% (9/47) with CNB. The odds of an upgrade to malignancy was 5.5 times higher with a 14G needle than VAB (95% CI: 0.592-50.853, p = 0.17). We observed a lower but not statistically significant upgrade rate to malignancy and atypia with the use of the 10-12 G VAB as compared with 14G CNB. When a papilloma without atypia is diagnosed with vacuum biopsy there is a high likelihood that it is benign; however, if surgical excision is not performed, long-term follow-up is still required.

Examining relational empowerment for elementary school students in a yPAR program.

This paper joins relational empowerment, youth empowerment, and Bridging Multiple Worlds frameworks to examine forms of relational empowerment for children in two intermediary institutions-school and a youth participatory action research after-school program (yPAR ASP). Participants were twelve children, most of whom were Latina/o and from im/migrant families, enrolled in a yPAR ASP for 2 years. A mixed-method approach was utilized; we analyzed children's interviews, self-defined goals, and their social networks to examine their experiences of relational empowerment. We conclude that children experienced each of the five relational empowerment factors-collaborative competence, bridging social divisions, facilitating others' empowerment, mobilizing networks, and passing on a legacy-in the yPAR ASP setting, and some factors in school. These experiences, however, were more pronounced in the yPAR ASP setting. Additionally, social network analyses revealed that a small but meaningful percentage of actors bridged worlds, especially home and family, but by year 2, also school and the yPAR ASP. Finally, most helpers for school-based goals came from school, but a sizable number came from family, friends, and home worlds, and by year 2, also came from the yPAR ASP. Implications range from theoretical to methodological development, including the use of social network analysis as a tool to descriptively examine relational power in context.

How we became the Schmams: conceptualizations of fairness in the decision-making process for Latina/o children.

The current study examines 16 Latina/o fifth grade children's desires for a decision-making structure within a youth participatory action research (yPAR) program. When given the choices of consensus, majority rule, authoritarian rule, delegation, and random choice models, children chose random choice. Procedural, distributive and emotional justice were heavily weighted in their reasoning around fairness and decision making. Many thought random choice offered the best alternative because it flattened power hierarchies so that each child would, at some point, have the power to make a decision. Additionally, children argued that the neutrality of random choice allowed them to sidestep interpersonal tensions. Implications include how social identities inform definitions of fairness and how yPAR programs should work with youth around how they will make decisions.

Metaanalysis of the accuracy of rapid prescreening relative to full screening of pap smears.

BACKGROUND: Efficient quality assurance and improvement measures are essential ingredients in a well organized cytology-based program for cervical carcinoma screening. Various pap smear review procedures, aiming for optimization of accuracy, are described throughout the literature. Evaluation and synthesis of those methods are needed. In a previous study, we pooled data on the diagnostic quality of rapid reviewing (RR) of cervical smears initially reported as normal or unsatisfactory. We now focus on rapid prescreening (RPS) of unreported smears. METHODS: Six published studies on the accuracy of RPS relative to subsequent full screening were pooled using metaanalytic methods. Individual and pooled sensitivity, specificity, and predictive values were assessed using forest plots. Random effect pooling methods were used for interstudy heterogeneity. Variation in sensitivity according to influencing factors was explored by metaregression. RESULTS: The pooled average sensitivity of RPS was 64.9% (95% confidence interval [CI] 50.7-79.1%) for all abnormalities, 72.6% (95% CI 60.6-85.2%) for low-grade lesions or more severe, and 85.7% (95% CI 77.8-93.6%) for high-grade lesions or more severe. The pooled specificity was estimated at 96.8% (CI 95.8-97.8%). The sensitivity increased significantly with duration of screening and decreased with workload. Almost 3% of all abnormal slides were detected only by RPS (2.8%; CI 0.0-5.8%). This is comparable to the proportion of false-negative smears detectable by RR. CONCLUSIONS: Rapid prescreening has a high yield for severe dysplasia and shows diagnostic properties that support its use as a quality control procedure in cytologic laboratories. We showed previously that RR is superior to full reviewing of a 10% random sample of negative slides (10% FR). Because the yield of additional abnormalities found by RR and RPS is comparable, we expect RPS to be more efficient than 10% FR as well.