Cancers Attributable to Infections in the US in 2017: A Meta-Analysis.

Importance: Infections are largely modifiable causes of cancer. However, there remains untapped potential for preventing and treating carcinogenic infections in the US.

Objective: To estimate the percentage and number of incident cancers attributable to infections in the US among adults and children for the most recent year cancer incidence data were available (2017).

Design and analysis of factorial clinical trials: The impact of one treatment's effectiveness on the statistical power and required sample size of the other.

Factorial allow for the simultaneous evaluation of more than one treatment, by randomizing patients to their possible combinations, including control. However, the statistical power of one treatment can be influenced by the effectiveness of the other, a matter that has not been widely recognized. In this paper, we evaluate the relationship between the observed effectiveness of one treatment and the implied power for a second treatment in the same trial, under a range of conditions.

Taking a chance: How likely am I to receive my preferred treatment in a clinical trial?

Researchers should ideally conduct clinical trials under a presumption of clinical equipoise, but in fact trial patients will often prefer one or other of the treatments being compared. Receiving an unblinded preferred treatment may affect the study outcome, possibly beneficially, but receiving a non-preferred treatment may induce 'reluctant acquiescence', and poorer outcomes. Even in blinded trials, patients' primary motivation to enrol may be the chance of potentially receiving a desirable experimental treatment, which is otherwise unavailable.

A method was developed for correcting the bias in the usual study weights in meta-analyses.

Objectives: Our goal was to evaluate the bias in the usual method of estimating study weights in a meta-analysis and to develop a suitable bias correction.

Study Design And Setting: In meta-analyses, it is standard practice to weight studies by the inverse variance of their treatment effects. Weights are usually calculated by taking reciprocals of the estimated variances, but we show that this approach is biased.

Unified approach to optimal estimation of mean and standard deviation from sample summaries.

Recently, various methods have been developed to estimate the sample mean and standard deviation when only the sample size, and other selected sample summaries are reported. In this paper, we provide a unified approach to optimal estimation that can be easily adopted when only some summary statistics are reported. We show that the proposed estimators have the lowest variance among linear unbiased estimators.

The epidemic volatility index, a novel early warning tool for identifying new waves in an epidemic.

Early warning tools are crucial for the timely application of intervention strategies and the mitigation of the adverse health, social and economic effects associated with outbreaks of epidemic potential such as COVID-19. This paper introduces, the Epidemic Volatility Index (EVI), a new, conceptually simple, early warning tool for oncoming epidemic waves. EVI is based on the volatility of newly reported cases per unit of time, ideally per day, and issues an early warning when the volatility change rate exceeds a threshold.

Estimation of standard deviations and inverse-variance weights from an observed range.

A variety of methods have been proposed to estimate a standard deviation, when only a sample range has been observed or reported. This problem occurs in the interpretation of individual clinical studies that are incompletely reported, and also in their incorporation into meta-analyses. The methods differ with respect to their focus being either on the standard deviation in the underlying population or on the particular sample in hand, a distinction that has not been widely recognized.

Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures.

Background: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons.

Methods: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft.

Simulation study on the validity of the average risk approach in estimating population attributable fractions for continuous exposures.

Background: The population attributable fraction (PAF) is an important metric for estimating disease burden associated with causal risk factors. In an International Agency for Research on Cancer working group report, an approach was introduced to estimate the PAF using the average of a continuous exposure and the incremental relative risk (RR) per unit. This 'average risk' approach has been subsequently applied in several studies conducted worldwide.

Estimation of diagnostic test accuracy: A "Rule of Three" for data with repeated observations but without a gold standard.

This article considers how to estimate the accuracy of a diagnostic test when there are repeated observations, but without the availability of a gold standard or reference test. We identify conditions under which the structure of the observed data is rich enough to provide sufficient degrees of freedom, such that a suitable latent class model can be fitted with identifiable accuracy parameters. We show that a Rule of Three applies, specifying that accuracy can be evaluated as long as there are at least three observations per individual with the given test.

Estimating the future cancer management costs attributable to modifiable risk factors in Canada.

Objectives: An estimated 33-37% of incident cancers in Canada are attributable to modifiable risk factors. Interventions targeting these risk factors would minimize the substantial health and economic burdens Canadians face due to cancer. We estimate the future health and economic burden of cancer in Canada by incorporating data from the Canadian Population Attributable Risk of Cancer (ComPARe) study into OncoSim, a web-based microsimulation tool.

Shifting the focus away from binary thinking of statistical significance and towards education for key stakeholders: revisiting the debate on whether it's time to de-emphasize or get rid of statistical significance.

There has been a long-standing controversy among scientists regarding the appropriate use of P-values and statistical significance in clinical research. This debate has resurfaced through recent calls to modify the threshold of P-value required to declare significance, or to retire statistical significance entirely. In this article, we revisit the issue by discussing: i) the connection between statistical thinking and evidence-based practice; ii) some history of statistical significance and P-values; iii) some practical challenges with statistical significance or P-value thresholds in clinical research; iv) the on-going debate on what to do with statistical significance; v) suggestions to shift the focus away from binary thinking of statistical significance and towards education for key stakeholders on research essentials including statistical thinking, critical thinking, good reporting, basic clinical research concepts and methods, and more.

Incorporating Portfolio Uncertainty in Decision Rules for Healthcare Resource Allocation.

Cost-effectiveness analysis is widely adopted as a means to inform policy and decision makers in setting priorities for healthcare resource allocation. In resource-constrained settings, decision makers are confronted with healthcare resource reallocation decisions, e.g.

The current burden of non-melanoma skin cancer attributable to ultraviolet radiation and related risk behaviours in Canada.

Purpose: Ultraviolet radiation (UVR) is an established cause of non-melanoma skin cancer (NMSC)-basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study was to estimate the current burden of BCC and SCC associated with UVR and modifiable UVR behaviours (sunburn, sunbathing, and indoor tanning) in Canada in 2015.

Methods: The current burden of BCC and SCC associated with UVR was estimated by comparing 2015 incidence rates with rates of less exposed body sites (trunk and lower limbs) after adjusting for estimated surface areas.

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial.

Background: Low health literacy is associated with poorer health outcomes. A key strategy to address health literacy is a universal precautions approach, which recommends using health-literate design for all health interventions, not just those targeting people with low health literacy. This approach has advantages: Health literacy assessment and tailoring are not required.

Fragility of clinical trials across research fields: A synthesis of methodological reviews.

Background: Randomized controlled trials (RCTs) are often used to inform clinical practice and it is desirable that their results be robust. A fragility index (FI), defined as the smallest number of participants in whom an outcome change from non-event to event would turn a statistically significant result to a non-significant result, can be computed to measure robustness. We sought to determine the distribution of fragility indices across various research areas and summarized the factors associated with fragility.

The fragility of trial results involves more than statistical significance alone.

Objectives: The fragility of clinical trial findings has been previously defined as the number of changes in outcomes that are required to change their statistical significance. We show that reliance on statistical significance alone provides only a limited and potentially misleading perspective, and an enhanced approach is developed.

Methods: Clinical importance of trial results and their quantitative stability are incorporated into an enhanced framework to assess fragility.

Correction to: Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice.

In the original publication of this article [1], the number "- 0.49" in the below sentence in the Results section should be changed to "-3.23", and this typo does not affect the wider conclusions.

Age-standardized cancer-incidence trends in Canada, 1971-2015.

Background: Although cancer incidence over time is well documented in Canada, trends by birth cohort and age group are less well known. We analyzed age- and sex-standardized incidence trends in Canada for 16 major cancer sites and all cancers combined.

Methods: We obtained nationally representative population-based cancer incidence data in Canada between 1971 and 2015 from the National Cancer Incidence Reporting System (1969-1992) and the Canadian Cancer Registry (1992-2015).

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture.

Background: Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty.

Methods: We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty.

The crossover design for studies of infertility employing in-vitro fertilization: A methodological survey.

Background: Infertility has become increasingly common worldwide. There is a need for the infertility literature to evaluate new interventions with IVF. The crossover design presents many methodological advantages for IVF trials.