Enabling identification of component processes in perceptual learning with nonparametric hierarchical Bayesian modeling.

Perceptual learning is a multifaceted process, encompassing general learning, between-session forgetting or consolidation, and within-session fast relearning and deterioration. The learning curve constructed from threshold estimates in blocks or sessions, based on tens or hundreds of trials, may obscure component processes; high temporal resolution is necessary. We developed two nonparametric inference procedures: a Bayesian inference procedure (BIP) to estimate the posterior distribution of contrast threshold in each learning block for each learner independently and a hierarchical Bayesian model (HBM) that computes the joint posterior distribution of contrast threshold across all learning blocks at the population, subject, and test levels via the covariance of contrast thresholds across blocks. We applied the procedures to the data from two studies that investigated the interaction between feedback and training accuracy in Gabor orientation identification over 1920 trials across six sessions and estimated learning curve with block sizes L = 10, 20, 40, 80, 160, and 320 trials. The HBM generated significantly better fits to the data, smaller standard deviations, and more precise estimates, compared to the BIP across all block sizes. In addition, the HBM generated unbiased estimates, whereas the BIP only generated unbiased estimates with large block sizes but exhibited increased bias with small block sizes. With L = 10, 20, and 40, we were able to consistently identify general learning, between-session forgetting, and rapid relearning and adaptation within sessions. The nonparametric HBM provides a general framework for fine-grained assessment of the learning curve and enables identification of component processes in perceptual learning.

Estimating the Trial-by-Trial Learning Curve in Perceptual Learning with Hierarchical Bayesian Modeling.

The learning curve serves as a crucial metric for assessing human performance in perceptual learning. It may encompass various component processes, including general learning, between-session forgetting or consolidation, and within-session rapid relearning and adaptation or deterioration. Typically, empirical learning curves are constructed by aggregating tens or hundreds of trials of data in blocks or sessions. Here, we devised three inference procedures for estimating the trial-by-trial learning curve based on the multi-component functional form identified in Zhao et al. (submitted): general learning, between-session forgetting, and within-session rapid relearning and adaptation. These procedures include a Bayesian inference procedure (BIP) estimating the posterior distribution of parameters for each learner independently, and two hierarchical Bayesian models (HBMv and HBMc) computing the joint posterior distribution of parameters and hyperparameters at the population, subject, and test levels. The HBMv and HBMc incorporate variance and covariance hyperparameters, respectively, between and within subjects. We applied these procedures to data from two studies investigating the interaction between feedback and training accuracy in Gabor orientation identification across about 2000 trials spanning six sessions (Liu et al., 2010, 2012) and estimated the trial-by-trial learning curves at both the subject and population levels. The HBMc generated best fits to the data and the smallest half width of 68.2% credible interval of the learning curves compared to the BIP and HBMv. The parametric HBMc with the multi-component functional form provides a general framework for trial-by-trial analysis of the component processes in perceptual learning and for predicting the learning curve in unmeasured time points.

Development of a model for studying the developmental consequences of oxidative sperm DNA damage by targeting redox-cycling naphthoquinones to the Sertoli cell population.

Oxidative stress can be induced in the testes by a wide range of factors, including scrotal hyperthermia, varicocele, environmental toxicants, obesity and infection. The clinical consequences of such stress include the induction of genetic damage in the male germ line which may, in turn, have serious implications for the health and wellbeing of the progeny. In order to confirm the transgenerational impact of oxidative stress in the testes, we sought to develop an animal model in which this process could be analysed. Our primary approach to this problem was to induce Sertoli cells (robust, terminally differentiated, tissue-specific testicular cells whose radioresistance indicates significant resistance to oxidative stress) to generate high levels of reactive oxygen species (ROS) within the testes. To achieve this aim, six follicle-stimulating hormone (FSH) peptides were developed and compared for selective targeting to Sertoli cells both in vitro and in vivo. Menadione, a redox-cycling agent, was then conjugated to the most promising FSH candidate using a linker that had been optimised to enable maximum production of ROS in the targeted cells. A TM4 Sertoli cell line co-incubated with the FSH-menadione conjugate in vitro exhibited significantly higher levels of mitochondrial ROS generation (10-fold), lipid peroxidation (2-fold) and oxidative DNA damage (2-fold) than the vehicle control. Additionally, in a proof-of-concept study, ten weeks after a single injection of the FSH-menadione conjugate in vivo, injected male mice were found to exhibit a 1.6 fold increase in DNA double strand breaks and 13-fold increase in oxidative DNA damage to their spermatozoa while still retaining their ability to initiate a pregnancy. We suggest this model could now be used to study the influence of chronic oxidative stress on testicular function with emphasis on the impact of DNA damage in the male germ line on the mutational profile and health of future generations.

B lymphocytes in treatment-naive paediatric patients with lupus are epigenetically distinct from healthy children.

BACKGROUND: SLE is likely triggered by gene-environment interactions. We have shown that most SLE-associated haplotypes encompass genomic regions enriched for epigenetic marks associated with enhancer function in lymphocytes, suggesting genetic risk is exerted through altered gene regulation. Data remain scarce on how epigenetic variance contributes to disease risk in paediatric SLE (pSLE). We aim to identify differences in epigenetically regulated chromatin architecture in treatment-naive patients with pSLE compared with healthy children. METHODS: Using the assay for transposase-accessible chromatin with sequencing (ATACseq), we surveyed open chromatin in 10 treatment-naive patients with pSLE, with at least moderate disease severity, and 5 healthy children. We investigated whether regions of open chromatin unique to patients with pSLE demonstrate enrichment for specific transcriptional regulators, using standard computational approaches to identify unique peaks and a false discovery rate of <0.05. Further analyses for histone modification enrichment and variant calling were performed using bioinformatics packages in R and Linux. RESULTS: We identified 30 139 differentially accessible regions (DAR) unique to pSLE B cells; 64.3% are more accessible in pSLE than healthy children. Many DAR are found in distal, intergenic regions and enriched for enhancer histone marks (p=0.027). B cells from adult patients with SLE contain more regions of inaccessible chromatin than those in pSLE. In pSLE B cells, 65.2% of the DAR are located within or near known SLE haplotypes. Further analysis revealed enrichment of transcription factor binding motifs within these DAR that may regulate genes involved in pro-inflammatory responses and cellular adhesion. CONCLUSIONS: We demonstrate an epigenetically distinct profile in pSLE B cells when compared with healthy children and adults with lupus, indicating that pSLE B cells are predisposed for disease onset/development. Increased chromatin accessibility in non-coding genomic regions controlling activation of inflammation suggest that transcriptional dysregulation by regulatory elements controlling B cell activation plays an important role in pSLE pathogenesis.

Hierarchical Bayesian perceptual template modeling of mechanisms of spatial attention in central and peripheral cuing.

The external noise paradigm and perceptual template model (PTM) have successfully been applied to characterize observer properties and mechanisms of observer state changes (e.g. attention and perceptual learning) in several research domains, focusing on individual level analysis. In this study, we developed a new hierarchical Bayesian perceptual template model (HBPTM) to model the trial-by-trial data from all individuals and conditions in a published spatial cuing study within a single structure and compared its performance to that of a Bayesian Inference Procedure (BIP), which separately infers the posterior distributions of the model parameters for each individual subject without the hierarchical structure. The HBPTM allowed us to compute the joint posterior distribution of the hyperparameters and parameters at the population, observer, and experiment levels and make statistical inferences at all these levels. In addition, we ran a large simulation study that varied the number of observers and number of trials in each condition and demonstrated the advantage of the HBPTM over the BIP across all the simulated datasets. Although it is developed in the context of spatial attention, the HBPTM and its extensions can be used to model data from the external noise paradigm in other domains and enable predictions of human performance at both the population and individual levels.

Degradation of chondroitin sulfate A by a PUL-like operon in Tannerella forsythia.

Advanced periodontitis has been shown to have strong association with the residence of the bacterial consortia known as the red complex comprised by Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. T. forsythia shares a distant genetic linkage to Bacteroidetes thetaiotaomicron and may therefore produce analogous polysaccharide utilization loci (PUL) which enable complex carbohydrate degradation, import, and use, although this capacity has yet to be demonstrated. Chondroitin sulfate A is a linear, sulfated carbohydrate linked to periodontal disease as the principal species of glycosaminoglycan appended on the surface of cortical bone of teeth and in supporting dental ligaments. Through genomic comparisons with B. thetaiotaomicron, a new PUL-like operon (Bfo2285-Bfo2295, and Bfo3043) was identified in T. forsythia and the crystal structure of two proteins from this PUL-like operon, Bfo2290 and Bfo2294, were reported using X-ray crystallography. Enzyme kinetics for Bfo2290 were reported using a pH-dependent assay and suggested a Km of 0.75 mg/ml ± 0.60 mg/ml, Kcat of 3.74 min-1 ± 0.88 min-1, and Vmax of 7.48 µM/min ± 1.76 µM/min with partially degraded chondroitin sulfate A. Fluorophore-assisted carbohydrate electrophoresis was used to show the processive degradation of chondroitin sulfate A by the proteins encoded in T. forsythia PUL-like operon, and revealed Bfo2291 and Bfo2290 to be an endolytic chondroitin sulfate A lyase and exolytic ΔDi-4S chondroitin sulfate A sulfatase, respectively.

A model of lived experience leadership for transformative systems change: Activating Lived Experience Leadership (ALEL) project.

PURPOSE: This discursive paper presents a lived experience leadership model as developed as part of the Activating Lived Experience Leadership (ALEL) project project to increase the recognition and understanding of lived experience leadership in mental health and social sectors. The model of lived experience leadership was formulated through a collaboration between the South Australian Lived Experience Leadership & Advocacy Network and the Mental Health and Suicide Prevention Research and Education Group. DESIGN/METHODOLOGY/APPROACH: As one of the outcomes of the ALEL research project, this model incorporates findings from a two-year research project in South Australia using participatory action research methodology and cocreation methodology. Focus groups with lived experience leaders, interviews with sector leaders and a national survey of lived experience leaders provided the basis of qualitative data, which was interpreted via an iterative and shared analysis. This work identified intersecting lived experience values, actions, qualities and skills as characteristics of effective lived experience leadership and was visioned and led by lived experience leaders. FINDINGS: The resulting model frames lived experience leadership as a social movement for recognition, inclusion and justice and is composed of six leadership actions: centres lived experience; stands up and speaks out; champions justice; nurtures connected and collective spaces; mobilises strategically; and leads change. Leadership is also guided by the values of integrity, authenticity, mutuality and intersectionality, and the key positionings of staying peer and sharing power. ORIGINALITY/VALUE: This model is based on innovative primary research, which has been developed to encourage understanding across mental health and social sectors on the work of lived experience leaders in seeking change and the value that they offer for systems transformation. It also offers unique insights to guide reflective learning for the lived experience and consumer movement, workers, clinicians, policymakers and communities.

Efficiency of Equilume light mask on the resumption of early estrous cyclicity and ovulation in Thoroughbred mares.

Equilume light masks had no impact on hastening the resumption of estrous cyclicity in mares maintained in outdoor pastures on the mainland of Korea due to the cold weather conditions. Jeju Island is a major horse-breeding site in Korea and is warmer than the mainland during the winter season. Therefore, the primary objective of this study was to explore the efficiency of the Equilume light mask on the resumption of seasonal estrous cycles in Thoroughbred mares on Jeju Island. A total of 20 nonpregnant mares were randomly divided into the Equilume light mask (n = 9) and stable lighting (n =11) groups. The experiment was performed at seven different horse-breeding farms located on Jeju Island from November 15, 2020, to February 15, 2021. The mares were exposed to the respective lights from 16:00 to 23:00. Follicle size and uterine edema were measured by ultrasound scanning. Body condition scores (BCS) were also monitored during the experiment. Statistical analysis was conducted using the SAS and SPSS software, and p-values of < 0.05 were considered statistically significant. Two of the nine (22.2%) mares in the Equilume light mask group and three of the 11 (27.28%) mares in the stable lighting group were still cycling in December and January, which were considered as all-year-round cycling mares. On February 15, there was no difference between groups in the resumption of early seasonal estrus cycle, which was determined by follicles > 25 mm in addition to uterine edema. All mares in the Equilume light mask group and five of the eight mares (62.5%) in the stable lighting group had resumed cycling. Interestingly, six of the seven mares (87.5%) in the Equilume light mask and four of eight mares (50%) in the stable lighting group had already ovulated on February 15 (p > 0.05), as determined by the presence of a recent corpus luteum. No difference was observed in BCS and uterine edema between groups (p > 0.05). In conclusion, the Equilume light mask can be an effective approach to induce early seasonal estrus cycles of mares in Jeju Island, and it also enhances the efficiency of farm management by reducing labor.

Current directions in visual perceptual learning.

The visual expertise of adult humans is jointly determined by evolution, visual development, and visual perceptual learning. Perceptual learning refers to performance improvements in perceptual tasks after practice or training in the task. It occurs in almost all visual tasks, ranging from simple feature detection to complex scene analysis. In this Review, we focus on key behavioral aspects of visual perceptual learning. We begin by describing visual perceptual learning tasks and manipulations that influence the magnitude of learning, and then discuss specificity of learning. Next, we present theories and computational models of learning and specificity. We then review applications of visual perceptual learning in visual rehabilitation. Finally, we summarize the general principles of visual perceptual learning, discuss the tension between plasticity and stability, and conclude with new research directions.

Visual attention in spatial cueing and visual search.

To characterize internal processes of an observer conducting perceptual tasks, we developed an observer model that combines the perceptual template model (PTM), the attention mechanisms in the PTM framework (Lu & Dosher, 1998), and uncertainty of signal detection theory (Green & Swets, 1966). The model was evaluated with a visual search experiment conducted in a range of external noise, signal contrast, and target-distractor similarity conditions. In each trial, eight Gabor patches were shown in each of two brief intervals, with one target at a different orientation from the distractors in one of the presentations. Subjects were precued to a subset of the stimuli (1, 2, 4, or 8) and asked to report (a) which interval contained the target and (b) where the target was. Individual roles of uncertainty and of attention in visual search were investigated by comparing models with and without an attention component. The results showed that decision uncertainty alone was sufficient to account for the set-size effect, even in conditions with high target-distractor similarity. Our theoretical model and empirical results provide a coherent picture regarding how visual information is selected and processed during feature search.

Phylum Synergistetes in the oral cavity: A possible contributor to periodontal disease.

Microbial contributions to periodontal disease have been under renewed scrutiny with the advent of newer technologies to identify their presence and gene expression at the molecular level. Members of the phylum Synergistetes are some of the more recent bacteria to be associated with periodontal disease. Bacteria classified in this phylum can be found in a wide variety of habitats including both inside and outside of a mammalian host. Members of this phylum have been identified as part of the human microbiome. Indeed, many of the identified phylotypes have yet to be cultivated. Here we consider contributions of three named and formally described species to the oral microbial community and to pathogenesis of periodontal disease.

Performance and psychometric properties of lupus impact tracker in assessing patient-reported outcomes in pediatric lupus: Report from a pilot study.

OBJECTIVE: To evaluate the reliability, validity, feasibility and psychometric performance of the Lupus Impact Tracker (LIT) as a patient reported outcome (PRO) measure tool in pediatric systemic lupus erythematosus (pSLE). METHODS: This is a prospective, observational, pilot study where patients aged between 12 and 25 years, fulfilling the 1997 ACR classification criteria for SLE, were enrolled. Over 3 consecutive, routine, clinical visits, the patients completed the LIT alongside the Patient-Reported Outcomes Measurement Information System-Short Forms (PROMIS-SFs), Childhood Health Assessment Questionnaire (CHAQ). Rheumatologists completed the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC-ACR) Damage Index. Demographic, clinical and laboratory data were also collected. RESULTS: Of 46 patients enrolled, 38 patients completed 2 visits and 31 completed all 3 visits. Seventy-eight percent were female, 33% African American, 28% Asian, 15% Caucasian and 17% Hispanic. The mean (SD) age was 17.2 (2.7) years, with a mean (SD) disease duration of 4.6 (3.1) years. The mean (SD) SLEDAI-2K at enrollment was 3.54 (2.96). In the 38 patients who completed two or more visits, intra-class correlation coefficient and Cronbach alpha were calculated to be 0.70 and 0.91 respectively, signifying good reliability of LIT. The LIT showed positive correlation with CHAQ-Disability Index and majority of the PROMIS-SFs parameters. Construct validity was established against clinical disease activity (SLEDAI-2K). CONCLUSION: The preliminary results indicate that the LIT is a reliable and valid instrument to capture PRO in p-SLE. Prospective validation with a larger, multicenter cohort is the next step.

Roving: The causes of interference and re-enabled learning in multi-task visual training.

People routinely perform multiple visual judgments in the real world, yet, intermixing tasks or task variants during training can damage or even prevent learning. This paper explores why. We challenged theories of visual perceptual learning focused on plastic retuning of low-level retinotopic cortical representations by placing different task variants in different retinal locations, and tested theories of perceptual learning through reweighting (changes in readout) by varying task similarity. Discriminating different (but equivalent) and similar orientations in separate retinal locations interfered with learning, whereas training either with identical orientations or sufficiently different ones in different locations released rapid learning. This location crosstalk during learning renders it unlikely that the primary substrate of learning is retuning in early retinotopic visual areas; instead, learning likely involves reweighting from location-independent representations to a decision. We developed an Integrated Reweighting Theory (IRT), which has both V1-like location-specific representations and higher level (V4/IT or higher) location-invariant representations, and learns via reweighting the readout to decision, to predict the order of learning rates in different conditions. This model with suitable parameters successfully fit the behavioral data, as well as some microstructure of learning performance in a new trial-by-trial analysis.

The effects of extended photoperiod and warmth on hair growth in ponies and horses at different times of year.

Photoperiod is considered the most dominant environmental cue allowing animals to anticipate and adapt to seasonal changes. In seasonally breeding mammals, changes in daylength alter pineal melatonin secretion and pituitary prolactin secretion. During the seasonal transition to shorter winter daylengths, increased production of melatonin and declining prolactin are associated with triggering winter coat growth in many animals. Similarly, studies have shown that artificial extension of photoperiod suppresses melatonin secretion and lifts prolactin inhibition to activate moulting. Four longitudinal cohort studies were conducted to determine if extended photoperiod and warmth, provided by mobile light masks and rugs (horse blankets), could reverse the onset of winter coat growth, maintain the summer coat and accelerate winter coat shedding in horses and in ponies. Studies began at dates corresponding to the autumnal equinox, one month post-summer solstice, one month pre-winter solstice and one month post-winter solstice, respectively. To extend photoperiod to approximately 15h of light, commercially available head-worn light masks provided low intensity blue light to one eye until 11pm daily. Coat condition and shedding rate were scored and hair samples collected, measured and weighed bi-weekly. Data from control and treatment groups were analysed by repeated measures ANOVA. Results revealed that extended photoperiod 1) did not reverse winter coat growth when initiated at the autumnal equinox, 2) effectively maintained the summer coat in stabled horses when initiated one month post-summer solstice, 3) accelerated shedding in outdoor living horses when initiated one month pre-winter solstice and 4) did not accelerate shedding in indoor or outdoor living ponies when initiated one month post-winter solstice. To successfully manage equine coat growth while also preserving optimal thermoregulation in both competition and breeding stock correct timing of light application is crucial and requires careful monitoring of environmental temperature. Further studies are needed where variations in breed and management are considered.

Evaluating the performance of the staircase and quick Change Detection methods in measuring perceptual learning.

The staircase method has been widely used in measuring perceptual learning. Recently, Zhao, Lesmes, and Lu (2017, 2019) developed the quick Change Detection (qCD) method and applied it to measure the trial-by-trial time course of dark adaptation. In the current study, we conducted two simulations to evaluate the performance of the 3-down/1-up staircase and qCD methods in measuring perceptual learning in a two-alternative forced-choice task. In Study 1, three observers with different time constants (40, 80, and 160 trials) of an exponential learning curve were simulated. Each simulated observer completed staircases with six step sizes (1%, 5%, 10%, 20%, 30%, and 60%) and a qCD procedure, each starting at five levels (+50%, +25%, 0, -25%, and -50% different from the true threshold in the first trial). We found the following results: Staircases with 1% and 5% step sizes failed to generate more than five reversals half of the time; and the bias and standard deviations of thresholds estimated from the post hoc segment-by-segment qCD analysis were much smaller than those from the staircase method with the other four step sizes. In Study 2, we simulated thresholds in the transfer phases with the same time constants and 50% transfer for each observer in Study 1. We found that the estimated transfer indexes from qCD showed smaller biases and standard deviations than those from the staircase method. In addition, rescoring the simulated data from the staircase method using the Bayesian estimation component of the qCD method resulted in much-improved estimates. We conclude that the qCD method characterizes the time course of perceptual learning and transfer more accurately, precisely, and efficiently than the staircase method, even with the optimal 10% step size.

Comparison of wait times across the breast cancer treatment pathway among screened women undergoing organized breast assessment versus usual care.

OBJECTIVE: The benefit of organized breast assessment on wait times to treatment among asymptomatic women is unknown. The Ontario Breast Screening Program (OBSP) offers screening and organized assessment through Breast Assessment Centres (BAC). This study compares wait times across the treatment pathway among screened women diagnosed with breast cancer through BAC and usual care (UC). METHODS: A retrospective design identified two concurrent cohorts of postmenopausal women aged 50-69 within the OBSP diagnosed with screen-detected invasive breast cancer and assessed in BAC (n = 2010) and UC (n = 1844) between 2002 and 2010. Demographic characteristics were obtained from the OBSP. Medical chart abstraction provided prognostic and treatment data. Multinomial logistic regression examined associations of assessment type with wait times from abnormal mammogram to surgery, chemotherapy or radiotherapy. RESULTS: Compared with through UC, postmenopausal women diagnosed through BAC were significantly less likely to have longer wait times (days) from an abnormal mammogram to definitive surgery (> 89 vs. ≤ 47; OR = 0.63; 95% CI = 0.52-0.77), from final surgery to radiotherapy (> 88 vs. ≤ 55; OR = 0.71; 95% CI = 0.54-0.93) and from final chemotherapy to radiotherapy (> 41 vs. ≤ 28; OR = 0.52; 95% CI = 0.36-0.76). Conversely, women assessed through BAC compared with through UC were more likely to experience longer wait times from final surgery to chemotherapy (> 64 vs. ≤ 40; OR = 1.49; 95% CI = 1.04-2.14). CONCLUSION: Shorter wait times to most treatments for postmenopausal women diagnosed in BAC further supports that women with an abnormal mammogram should be managed through organized assessment. Continued evaluation of factors influencing wait times to treatment is essential for quality improvement and patient outcomes.

Assessing the detailed time course of perceptual sensitivity change in perceptual learning.

The learning curve in perceptual learning is typically sampled in blocks of trials, which could result in imprecise and possibly biased estimates, especially when learning is rapid. Recently, Zhao, Lesmes, and Lu (2017, 2019) developed a Bayesian adaptive quick Change Detection (qCD) method to accurately, precisely, and efficiently assess the time course of perceptual sensitivity change. In this study, we implemented and tested the qCD method in assessing the learning curve in a four-alternative forced-choice global motion direction identification task in both simulations and a psychophysical experiment. The stimulus intensity in each trial was determined by the qCD, staircase or random stimulus selection (RSS) methods. Simulations showed that the accuracy (bias) and precision (standard deviation or confidence bounds) of the estimated learning curves from the qCD were much better than those obtained by the staircase and RSS method; this is true for both trial-by-trial and post hoc segment-by-segment qCD analyses. In the psychophysical experiment, the average half widths of the 68.2% credible interval of the estimated thresholds from the trial-by-trial and post hoc segment-by-segment qCD analyses were both quite small. Additionally, the overall estimates from the qCD and staircase methods matched extremely well in this task where the behavioral rate of learning is relatively slow. Our results suggest that the qCD method can precisely and accurately assess the trial-by-trial time course of perceptual learning.

High reward enhances perceptual learning.

Studies of perceptual learning have revealed a great deal of plasticity in adult humans. In this study, we systematically investigated the effects and mechanisms of several forms (trial-by-trial, block, and session rewards) and levels (no, low, high, subliminal) of monetary reward on the rate, magnitude, and generalizability of perceptual learning. We found that high monetary reward can greatly promote the rate and boost the magnitude of learning and enhance performance in untrained spatial frequencies and eye without changing interocular, interlocation, and interdirection transfer indices. High reward per se made unique contributions to the enhanced learning through improved internal noise reduction. Furthermore, the effects of high reward on perceptual learning occurred in a range of perceptual tasks. The results may have major implications for the understanding of the nature of the learning rule in perceptual learning and for the use of reward to enhance perceptual learning in practical applications.

The impact of organized breast assessment on survival by stage for screened women diagnosed with invasive breast cancer.

PURPOSE: Since 1998, the Ontario Breast Screening Program (OBSP) has offered organized assessment through Breast Assessment Centres (BAC). This study compares survival between screened women diagnosed with breast cancer who have undergone assessment through a BAC and usual care (UC). METHODS: A retrospective design identified two concurrent cohorts of women aged 50 to 69 within the OBSP diagnosed with screen-detected invasive breast cancer at a BAC (n = 2010) and UC (n = 1844) between 2002 and 2010 and followed until 2016. Demographic and assessment characteristics were obtained from the OBSP. Abstraction of medical charts provided prognostic and treatment data. Death data were assessed from the Registered Person's Database and the Ontario Registrar General All-Cause Mortality File. Multivariable Cox proportional hazards models compared overall survival by assessment type (BAC/UC), stratified by stage. RESULTS: There were 505 deaths during the study (BAC = 239; UC = 266). Among women with stage I screen-detected breast cancer, those diagnosed through a BAC had 31% reduced risk of all-cause mortality (HR = 0.69, 95% CI = 0.53-0.90) compared to UC. Diagnosis within 7 weeks of an abnormal mammogram reduced the hazard of death from all causes by 34% among all women with stage I breast cancers (HR = 0.66, 95% CI = 0.47-0.91), and was more likely in BAC (79.7%) than UC (66.9%). CONCLUSION: The significant improvement in overall survival for women with stage I screen-detected invasive breast cancer assessed through BACs further supports the recommendation that women with abnormal mammograms should be managed through organized assessment.

Validity of Administrative Databases in Comparison to Medical Charts for Breast Cancer Treatment Data.

OBJECTIVE: Medical chart abstraction is the gold standard for collecting breast cancer treatment data for monitoring and research. A less costly alternative is the use of administrative databases. This study will evaluate administrative data in comparison to medical charts for breast cancer treatment information. STUDY DESIGN AND SETTING: A retrospective cohort design identified 2,401 women in the Ontario Breast Screening Program diagnosed with invasive breast cancer from 2006 to 2009. Treatment data were obtained from the Activity Level Reporting and Canadian Institute of Health Information databases. Medical charts were abstracted at cancer centres. Sensitivity, specificity, positive and negative predictive value, and kappa were calculated for receipt and type of treatment, and agreement was assessed for dates. Logistic regression evaluated factors influencing agreement. RESULTS: Sensitivity and specificity for receipt of radiotherapy (92.0%, 99.3%), chemotherapy (77.7%, 99.2%), and surgery (95.8%, 100%) were high but decreased slightly for specific radiotherapy anatomic locations, chemotherapy protocols, and surgeries. Agreement increased by radiotherapy year (trend test, p < 0.0001). Stage II/III compared to stage I cancer decreased odds of agreement for chemotherapy (OR = 0.66, 95% CI: 0.48-0.91) and increased agreement for partial mastectomy (OR = 3.36, 95% CI: 2.27-4.99). Exact agreement in treatment dates varied from 83.0% to 96.5%. CONCLUSION: Administrative data can be accurately utilized for future breast cancer treatment studies.