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Practice Editing Here (Nov 15th in-class Wiki session work)
Assigned article: Chronic Lymphocytic Leukemia.
 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!
Proposed Changes:


 * 1) In the Epidemiology section, substitute “Rates of CLL are somewhat elevated in people exposed to certain chemicals. Under U.S. Department of Veterans Affairs regulations, Vietnam veterans who served in-country or in the inland waterways of Vietnam and who later develop CLL are presumed to have contracted it from exposure to Agent Orange and may be entitled to compensation.” with “People who live near areas with considerable industrial pollution have an elevated risk of developing leukemia, particularly CLL.”
 * 2) Also in the Epidemiology section, modify “CLL is primarily a disease of older adults, with a median age of 70 years at the time of diagnosis. Though less common, CLL sometimes affects people between 30 and 39 years of age. The incidence of CLL increases very quickly with increasing age.” to “CLL is primarily a disease of older adults, with 9 out of 10 cases occurring after the age of 50 years. The median age of diagnosis is 70 years.” and add “In young people, new cases of CLL are twice as likely to be diagnosed in men than in women. In older people, however, this difference becomes less pronounced: after the age of 80 years, new cases of CLL are diagnosed equally between men and women.”

Rationale for Proposed Changes:


 * 1) The Wikipedia article for chronic lymphocytic leukemia (CLL) contains a sentence on the epidemiology of chemical exposure to Agent Orange, but lacks a citation. The latest article to substantiate this claim is a retrospective observational study from 2018. This makes the citation both outdated and a potentially biased primary source. However, the epidemiological question of whether chemical exposure is associated with an elevated risk of CLL is worth expanding on. Following a search strategy using ((CLL) AND (“chemical exposure”)) as search terms, Boonhat and Lin’s (2020) systematic review on the association between leukemia incidence and mortality and residential petrochemical exposure is an appropriate source of biomedical information to replace the existing sentence on exposure epidemiology of CLL. Multiple studies over the past few decades have consistently suggested that there is an increased leukemia incidence and mortality for residents living close to PICs. The only potential varied opinion to consider is that another meta-analysis (Lin et al., 2019) on residential exposure to PICs found a lower CLL risk than the pooled measure reported in Boonhat and Lin (2020), though this discrepancy may be explained by Lin et al. (2019) incorporating a study that included residential exposure to industries other than PICs. The suggested sentence does not need to be changed given that the citation for it is more recent than Lin et al. (2019) and does not challenge the overarching finding that CLL risk is elevated when living in proximity to PICs.
 * 2) The Wikipedia article states that the median age at the time of diagnosis for CLL is 70 years, but lacks a current source to support this claim; the article presently cited dates to 2012.  Statements claiming that CLL sometimes affects people between 30 and 39 years of age and that the incidence of CLL increases very quickly with increasing age lack medical citations altogether. Furthermore, pertinent information relating the epidemiology of CLL to gender is absent. As such, an advanced literature search of the PubMed database was conducted using the search terms, “chronic lymphocytic leukemia” and “gender.” Search results were constrained to English meta-analyses and systematic reviews published in the last five years. Seven results were returned by this search. “Epidemiology” was then included in the search terms (using the AND operator), further narrowing results, returning four reports. Upon appraising search results, none were found to include nor comment upon the epidemiology of CLL as it relates to gender or age. Through reviewing the cited material for one of the search results, the SEER Cancer Statistics Review, was identified. This resource provides the age-adjusted SEER incidence statistics for CLL, with separate statistics for men and women; however, this resource is a primary evidence source (collection of census results), and was thus rejected for the purpose of this assignment. Medical textbooks were then consulted, and two critical resources were identified: Harrison's Principles of Internal Medicine, 20e (published in 2018) and Current Medical Diagnosis & Treatment 2022. The former indicated that the incidence ratio between men and women is 2:1, leveling with age, being almost equal over the age of 80 years across genders. The latter indicated that 90% of CLL cases present after the age of 50 years, with the median age being 70 years. No significant controversies exist regarding these statistics. Potential ambiguity, however, exists in the male:female ratio provided by Harrison's Principles of Internal Medicine, 20e as the source does not specify whether this ratio is based on gender identity or biological sex.

Critique of Sources:


 * 1) Some limitations of Boonhat & Lin (2020) were identified by the authors, namely that the 13 included studies did not consistently adjust for confounders like socioeconomic status and smoking. More importantly, the studies in the meta-analysis had two diverging methods of defining exposure: some looked at the distance between residents and PICs while others based exposure on the administrative area of residents and PICs (i.e. distance-based vs. area-based). However, these limitations were reasonably addressed by doing a random-effects model that accounted for moderate heterogeneity in the pooled RR estimate. Lastly, the article looked at both incidence and mortality measures of leukemia, however the meta-analysis only had 2 studies with data on leukemia mortality which is far too small a sample size. As such, the suggested sentence for the Wikipedia page only refers to incidence of CLL, not mortality.
 * 2) While Wikipedia states that textbooks are often “several years behind the current state of evidence,” this concern is mitigated given that the 2018 and 2022 versions Harrison's Principles of Internal Medicine and Current Medical Diagnosis & Treatment are available and in use, respectively. Potential publication and English language bias could exist in either textbook; neither source declares whether purely published and/or English literature was consulted in compiling presented evidence. However, such concerns are entirely speculative and thus did not significantly impact source selection. Nonetheless, both books are strong resources, appropriate for use in Wikipedia. To elaborate, the sources are secondary, as opposed to primary, literature; they are summaries of scientific consensus with significant weight and minimal risks associated with reliability, stability, and external validity. Secondly, the textbooks are high quality and medical-grade, produced by third-party sources, with no explicit conflicts of interest and were recently published (within the last 5 years). Lastly, minimal apparent bias places these resources high on the pyramid of evidence.

Citations:

Boonhat, H., & Lin, R.-T. (2020). Association between leukemia incidence and mortality and residential petrochemical exposure: A systematic review and meta-analysis. Environment International, 145, 106090. https://doi.org/10.1016/j.envint.2020.106090

Damon L.E., & Andreadis C (2022). Chronic lymphocytic leukemia. Papadakis M.A., & McPhee S.J., & Rabow M.W., & McQuaid K.R.(Eds.), Current Medical Diagnosis & Treatment 2022. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3081&sectionid=258963318

Woyach J.A., & Byrd J.C. (2018). Chronic lymphocytic leukemia. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.), Harrison's Principles of Internal Medicine, 20e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192017

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template