At a high level, the tidyverse is a language for solving data science challenges with R code. Its primary goal is to facilitate a conversation between a human and a computer about data. Less abstractly, the tidyverse is a collection of R packages that share a high-level design philosophy and low-level grammar and data structures, so that learning one package makes it easier to learn the next.
The diagnostic value of tumor markers, CEA, CA 15-3, CA 19-9, CA 125, CYFRA, and NSE in pleural fluid to differentiate between benign and malignant pleural effusion (MPE) has not yet been clearly established. A review of English language studies using human subjects was performed. Sensitivity and specificity values of the chosen tumor markers were pooled using a random effects model to generate hierarchical summary receiver-operator curves to determine the diagnostic performance of each tumor marker. A total of 49 studies were included in the final analysis. Pooled sensitivity and specificity values for chosen tumor markers for diagnosing MPE are as follows: CEA, 0.549/0.962; CA 15-3, 0.507/0.983; CA 19-9, 0.376/0.980; CA 125, 0.575/0.928; CYFRA, 0.625/0.932; NSE, 0.613/0.884. The use of individual tumor markers in diagnosing MPE has many benefits (cost, invasiveness, etc.). While these tumor markers exhibit high specificity, the low sensitivity of each marker limits the diagnostic value. We conclude that tumor markers used individually are of insufficient diagnostic accuracy for clinical use. Tumor markers used in various combinations or from serum may have some potential worth further investigation.
Medical journal publishers have recently taken steps to improve public access to research findings. 1,2 While these changes have been credited with promoting patient empowerment, 3,4 accessing research related to particular health conditions may carry privacy risks for patients. For-profit companies use website tracking tools to capture information about individuals based on their online activity. These tools raise privacy concerns when they are used on health-related websites where users' browsing behavior may reveal sensitive information. 5,6 One step patients can take to protect their privacy when accessing research findings is to adjust their browser settings to block cookies, the data stored on a user's computer that may be used to identify and track users across multiple websites. However, websites may deny access to users who block cookies, forcing users to choose between accepting privacy risks or foregoing access to content. If medical journal websites employ such practices, it may undermine efforts to improve public access to research findings. We investigated medical journal websites to assess the prevalence of and factors associated with access denial to users blocking browser cookies.
MethodsThis study investigated public websites and therefore was not subject to institutional review board approval because it did not meet the Common Rule's definition of human subjects research. The study was preregistered on the AsPredicted platform (submission 33300) and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies.
Data CollectionWe obtained a census of all journals with an impact factor greater than 2.0 in clinically relevant subcategories of the citation research aid Web of Science's life sciences and biomedicine category.We assessed clinical relevance and identified journals' open access status, publisher, and website URL address using the protocol described in eMethods in the Supplement.We used crowdsourcing task website Amazon Mechanical Turk to assess the extent to which journal websites denied access to users blocking cookies. From December 26, 2019, to February 10, 2020, 3 Mechanical Turk workers reviewed the website of each journal included in the study. With browsers set to block cookies, they attempted to access each journal's homepage, the current issue's table of contents, and the abstract of a research article. They recorded the level, if any, at which access was denied. Disagreements were resolved by the study team.
Statistical AnalysisWe calculated the percentage and 95% confidence intervals of websites that denied access to users blocking browser cookies, overall and by open access status. Our primary hypothesis was that over 10% of journal websites would deny access to users blocking cookies, assessed by a 2-sided, 1-sample Wilcoxon signed rank test with finite population correction. Our secondary hypothesis was that
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