Assessment of Excess Thyroid Cancer Risk Following a Hypothetical Radiological Incident in Louisiana and Best-Case Risk Reduction Achieved by Thyroid Blockade

Radioactive isotopes of iodine are produced by nuclear power plants as a byproduct of nuclear fission reactions. If these isotopes are released into the environment, such as during a breach of containment, they constitute a health risk to exposed individuals. To mitigate the risk of thyroid cancer due to exposure to radioactive iodine, “iodide prophylaxis,” also known as “thyroid blockade,” can be used, usually by administration of potassium iodide (KI). In some areas of the world, KI has been provided to the general public by their governments as a precautionary measure against potential nuclear power plant incidents. However, in the state of Louisiana, only evacuation and sheltering of the general public are the planned response to such incidents. The question of whether Louisiana’s government should provide KI to the public is a question of risk management. This project’s risk assessment provides a framework for determining radiation risk from radioiodine release from a nuclear power plant, enabling an assessment of the potential benefit of providing KI to the general public in Louisiana. In this assessment, a hypothetical radiological incident of similar severity to the Fukushima accident was modeled for a nuclear power plant in Louisiana. Environmental transport of discharged radioactive iodine was modeled with a Gaussian plume model. Thyroid dose was calculated using representative parameters from International Commission on Radiological Protection Publication 71. Age- and sex-specific values of excess relative risk, lifetime attributable risk, and excess lifetime thyroid cancers were calculated. Lastly, the number of excess lifetime thyroid cancers mitigated by thyroid blockade was estimated through two separate approaches. This assessment found that a plume traveling over highly populated parishes near the power plant could result in approximately 200 excess lifetime thyroid cancers over all age groups. The largest number would likely occur in females exposed as children. Thyroid blockade could potentially mitigate 80 or more of the excess cancers. These results suggest that more comprehensive assessments of KI distribution in Louisiana may be warranted

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer fiveoriginal research questions related to moral judgments, negotiations, and implicit cognition. Participants from two separate large samples (total N > 15,000) were then randomly assigned to complete one version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: materials from different teams renderedstatistically significant effects in opposite directions for four out of five hypotheses, with the narrowest range in estimates being d = -0.37 to +0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for two hypotheses, and a lack of support for three hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, while considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim.</div

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadImportance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, setting, and participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main outcomes and measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.Patient-Centered Outcomes Research Institute - PCOR

HAVING A BABY

This analysis tests the influence of personal, job, and family status characteristics on maternal employment. We use the Merged Child/Mother File from the National Longitudinal Survey of Youth to examine employment patterns of mothers who gave birth between 1979 and 1986. Logistic regression is used to estimate the probabilities; proportional hazards techniques are used to estimate rates of leaving and return to employment after childbirth. We find that family status factors and the proportion of the family income the mother earns are consistently important in predicting maternal employment. Human capital factors are more significant in predicting employment exits and the rate of exit than the rate of return or employment status one year after a birth.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline