Abstract
Background
Women from socioeconomically deprived areas have lower breast cancer (BC) incidence rates for screen-detected oestrogen receptor (ER) + tumours and higher mortality for select ...tumour subtypes. We aimed to determine if ipsilateral breast cancer recurrence (IBR) differs by Scottish Index of Multiple Deprivation (SIMD) quintile and tumour subtype in Scotland.
Methods
Patient data for primary invasive BC diagnosed in 2007–2008 in Scotland was analysed. Manual case-note review for 3495 patients from 10 years post-diagnosis was used. To determine the probability of IBR while accounting for the competing risk of death from any cause, cumulative incidence functions stratified by ER subtype and surgery were plotted. Multivariable Cox Proportional Hazards models were used to estimate the association of SIMD accounting for other predictors of IBR.
Results
Among 2819 ER + tumours, 423 patients had a recurrence and 438 died. SIMD was related to death (
p
= 0.018) with the most deprived more likely to have died in the 10-year period (17.7% vs. 12.9%). We found no significant differences by SIMD in prognostic tumour characteristics (grade, TNM stage, treatment, screen-detection) or risk of IBR. Among 676 patients diagnosed with ER- tumours, 105 died and 185 had a recurrence. We found no significant differences in prognostic tumour characteristics by SIMD except screen detection with the most deprived more likely than the least to have their tumours detected from screening (46.9% vs. 28%,
p
= 0.03). Among patients with ER- tumours, 50% had mastectomy and the most deprived had increased 5-year IBR risk compared to the least deprived (HR 3.03 1.41–6.53).
Conclusions
IBR is not a major contributor to mortality differences by SIMD for the majority of BC patients in our study. The lack of inequities in IBR are likely due to standardised treatment protocols and access to healthcare. The association with socioeconomic deprivation and recurrence for ER- tumours requires further study.
The addition of radiation therapy (RT) to surgery in retroperitoneal sarcoma (RPS) remains controversial. We examined practice patterns in the use of RT for patients with RPS over time in a large, ...national cohort.
Patients in the National Cancer Database (2004-2017) who underwent resection of RPS were included. Trends over time for proportions were calculated using contingency tables with Cochran-Armitage Trend test.
Of 7,485 patients who underwent resection, 1,821 (24.3%) received RT (adjuvant: 59.9%, neoadjuvant: 40.1%). The use of RT decreased annually by < 1% (p = 0.0178). There was an average annual increase of neoadjuvant RT by 13% compared to an average annual decrease of adjuvant RT by 6% (p < 0.0001). Treatment at high-volume centers (OR 14.795, p < 0.0001) and tumor > 10 cm (OR 2.009, p = 0.001) were associated with neoadjuvant RT. In contrast liposarcomas (OR 0.574, p = 0.001) were associated with adjuvant RT. There was no statistically significant difference in overall survival between patients treated with surgery alone versus surgery and RT (p = 0.07).
In the United States, the use of RT for RPS has decreased over time, with a shift towards neoadjuvant RT. However, a large percentage of patients are still receiving adjuvant RT and this mostly occurs at low-volume hospitals.
Although many scientists agree that evolution does not make claims about God/god(s), students might assume that evolution is atheistic, and this may lead to lower evolution acceptance. In study 1, we ...surveyed 1081 college biology students at one university about their religiosity and evolution acceptance and asked what religious ideas someone would have to reject if that person were to accept evolution. Approximately half of students wrote that a person cannot believe in God/religion and accept evolution, indicating that these students may have atheistic perceptions of evolution. Religiosity was not related to whether a student wrote that evolution is atheistic, but writing that evolution is atheistic was associated with lower evolution acceptance among the more religious students. In study 2, we collected data from 1898 students in eight states in the United States using a closed-ended survey. We found that 56.5% of students perceived that evolution is atheistic even when they were given the option to choose an agnostic perception of evolution. Further, among the most religious students, those who thought evolution is atheistic were less accepting of evolution, less comfortable learning evolution, and perceived greater conflict between their personal religious beliefs and evolution than those who thought evolution is agnostic.
Surgery and radiation therapy remain the standard of care for patients with high-grade extremity soft tissue sarcoma that are >5 cm. Radiation therapy is time and labor-intensive for patients, and ...social determinants of health may affect adherence. The aim of this study was to define demographic, clinical, and treatment factors associated with the completion of radiation therapy and determine if preoperative radiation therapy improved adherence compared to postoperative radiation therapy.
The cohort included patients in the National Cancer Database with high-grade extremity soft tissue sarcoma >5 cm without nodal or distant metastases who received limb-sparing surgery and radiation therapy with microscopically negative R0 margins. Multivariable logistic regression analyses identified factors associated with radiation therapy sequencing and adherence (defined as completion of 50 Gy preoperative radiation therapy or at least 60 Gy postoperative radiation therapy). A multivariable Cox Proportional Hazards model assessed overall survival.
Among 2,145 patients, 47.1% received preoperative radiation therapy (n = 1,010), and 52.9% (n = 1135) received postoperative radiation therapy. A greater proportion of patients treated with preoperative (77.2%) versus postoperative radiation therapy (64.9%, P < .0001) received the recommended dose. More patients with private insurance (49.8% vs 35.3% Medicaid vs 44.9% Medicare, P = .011) and patients treated at an academic medical center (52.6% vs 47.4%, P < .001) received preoperative radiation therapy. Patients who received preoperative radiation therapy had lower odds of receiving insufficient doses of radiation therapy (odds ratio 0.34 95% CI 0.27–0.47). Neither radiation therapy adherence nor sequencing were independent predictors of overall survival.
Patients who received preoperative radiation therapy were more likely to complete therapy and receive an optimal dose than patients treated with postoperative radiation therapy. Preoperative radiation therapy improves adherence and should be widely considered in patients with high-grade extremity soft tissue sarcoma, particularly in patients at risk for not completing therapy.
Ecological monitoring is crucial for tracking changes in the status of species over time. However, ensuring that monitoring programs possess adequate statistical power—capacity to detect changes in ...populations with a high level of confidence—remains a challenge for many wildlife managers globally. While new monitoring technologies potentially offer cost effective solutions to this problem, transitioning to these methods requires careful calibration with existing techniques, such that differences in power and cost can be measured and assessed accurately. Here, we compare new (camera traps) and conventional (live trapping) survey methods in terms of cost and statistical power in tracking occupancy declines in an endangered marsupial predator, the northern quoll (Dasyurus hallucatus). We show that camera trap monitoring designs can detect northern quoll occupancy declines of 30%, 50%, and 80% at reduced cost when compared to live trap designs, without compromising statistical power. Overall, we find support for the cost‐effectiveness of camera traps for species monitoring and its potential to replace existing live trap sampling of species when measuring changes in occupancy. Additionally, we offer a robust framework to compare new monitoring techniques against pre‐existing methods on the basis of statistical power.
Here, we apply a novel approach to compare new (camera traps) and conventional (live trapping) survey methods in terms of cost and statistical power in tracking occupancy declines in an endangered marsupial predator, the northern quoll (Dasyurus hallucatus). We demonstrate that optimized monitoring designs using camera traps is a substantially cheaper approach to detecting northern quoll declines with high statistical power when compared to existing live trap designs. Additionally, we offer a robust framework to compare new monitoring techniques with pre‐existing methods on the basis of statistical power.
The evolution education experiences of students of color represent an emerging area of research, because past inquiries indicate these students have differential outcomes, such as lower evolution ...acceptance and severe underrepresentation in evolutionary biology. Religion is often an important support for students of color who are navigating a science, technology, engineering, and mathematics culture that privileges White nonreligious students. For instance, religion helps mitigate the negative effects of racism, but religious students are also more likely to experience conflict when learning evolution. In this nationwide study, we examined the extent to which strong religiosity among students of color can explain their lower evolution acceptance. We surveyed students in 77 college biology courses across 17 states and found that Black/African American students tend to be more religious and less accepting of evolution than any other racial/ethnic identity group and that Hispanic students tend to be slightly more religious and slightly less accepting of evolution than White students. Importantly, we find that religious background is an important factor associated with Black and Hispanic students' lower levels of evolution acceptance. This study suggests that the biology community should become more inclusive of Christian religious students if it wishes to foster inclusive evolution education for Black and Hispanic students.
Based on the NCCN Guidelines for Soft Tissue Sarcoma (STS), treatment of extremity STS (ESTS) includes radiation therapy (RT) and surgical resection for tumors that are high-grade and >5 cm. The ...aim of this study was to describe the association between neighborhood socioeconomic status (nSES), concordance with NCCN Guidelines recommendations, and outcomes in patients with ESTS.
Patients with ESTS diagnosed from 2006 through 2018 were identified in SEER registries. The analytic cohort was restricted to patients with high-grade tumors >5 cm without nodal or distant metastases who received limb-sparing surgery. Patient demographics and tumor characteristics associated with receipt of RT were analyzed using adjusted regression analyses. Kaplan-Meier curves and adjusted accelerated failure time models were used to examine disparities in cancer-specific survival.
Of 2,249 patients, 29.0% (n=648) received neoadjuvant RT, 49.7% (n=1,111) received adjuvant or intraoperative RT, and 21.3% (n=476) did not receive RT. In adjusted analyses, lower nSES was associated with lower likelihood of receiving RT (odds ratio, 0.70 95% CI, 0.57-0.87; P<.001). Low nSES was associated with worse cancer-specific survival (hazard ratio, 1.19 95% CI, 1.01-1.40; P=.04). Race and ethnicity were not significant predictors of receipt of RT or cancer-specific survival in the fully adjusted models.
Patients from lower nSES areas were less likely to receive NCCN Guideline-recommended RT for their ESTS and had worse cancer-specific survival. Efforts to better define and resolve disparities in the treatment and survival of patients with ESTS are warranted.
Background
Despite widespread concern about the differential measurement of evolution acceptance among researchers, no one has systematically explored how instrument choice can impact research ...results and conclusions in evolution education studies. In this study, we administered six evolution acceptance instruments in a single survey to students in undergraduate biology courses at universities in Arizona, Colorado, and Utah. We conducted separate analyses with the same students for the six different evolution acceptance instruments to understand how different results and conclusions may arise based on different evolution acceptance instruments used.
Results
We found statistically significant differences in levels of evolution acceptance across the three student populations when using a human evolution acceptance instrument, but not when using a microevolution acceptance instrument. Further, significance/effect sizes of variables associated with evolution acceptance differed beyond sampling variation depending on the evolution acceptance instrument used. The results of analyses using different evolution acceptance instruments were most often dissimilar when examining the effect of evolution understanding and identifying as Protestant/Mormon on evolution acceptance.
Conclusions
We found that different instruments used to measure evolution acceptance sometimes led to different research results and conclusions. The extent to which variables predicted evolution acceptance was dependent on the instrument used to measure acceptance, which has the potential to explain over 30 years of conflicting research on the relationship between evolution acceptance and understanding. These results indicate that before researchers may be able to determine how to best improve evolution acceptance, the evolution education community may need to articulate a consistent definition of evolution acceptance and identify a singular valid and reliable instrument to quantify evolution acceptance so results can be compared across studies.
Non-occupational Post-Exposure Prophylaxis (nPEP) is an effective HIV prevention strategy in gay and bisexual men (GBM) taken after possible exposure. HIV Pre-Exposure Prophylaxis (PrEP) is also a ...highly effective HIV prevention strategy.
A retrospective audit of medical records of GBM presenting to a sexual health centre and provided with nPEP compared two periods to determine if nPEP usage changed following availability of PrEP. In the first period (P1) PrEP was available through extended trials. In the second period (P2) PrEP became more accessible through the Australian Pharmaceutical Benefits Scheme (PBS). Period comparisons were performed using a two-population test of proportions with one-tailed testing and significance set at P < .05 using SPSS Statistics Version 25.
There were 232 GBM provided with nPEP in P1, and 202 in P2. A two-population test of proportions demonstrated that GBM presentations for nPEP decreased significantly from 302/4779 (6.3%) of GBM visits in P1 to 221/7205 (3.1%) in P2 when PrEP was more accessible (Z=8.53, P < .001). PrEP uptake after presenting for nPEP increased from 30 (12.9%) of total GBM visits in P1 to 69 (34.2%) in P2 (Z=5.26,
< .001).
GBM accessing nPEP decreased with statistical significance post introduction of PBS PrEP.
Kaposi sarcoma (KS) is a low-grade vascular malignancy caused by human herpesvirus-8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV). There are four established subtypes of KS, ...which are described by unique risk factors, presentation, and disease course. A “non-epidemic” variant to describe HIV-negative men who have sex with men (MSM) is emerging as a fifth subtype. We retrospectively examined patients with KS at an academic medical center in central Ohio, USA. To our knowledge, this is the first US-based report to describe KS risk factors and outcomes in the context of HIV status. Data were extracted from patient charts including demographic information, history at time of KS diagnosis, and information about KS disease course. HIV-positive and HIV-negative patients were grouped into established categories. HIV-negative patients who did not fit an existing subtype were described as “Unclassified-KS-Type.” Demographic characteristics for AIDS-KS patients in our cohort match established trends in this subtype, such as male, MSM, and younger age at diagnosis compared to HIV-negative patients. Most Unclassified-KS-Type patients fit well into the emerging “non-epidemic KS” subtype. These patients are described as healthy, middle-aged, HIV-negative MSM with lower extremity lesions. This descriptive report provides an updated view of KS risk factors and outcomes to improve detection and treatment in dermatology.
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