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Verified duplicate files from replicate sequencing were removed from the pool to reduce perceived cluster depth and improve data analysis.
If the a priori perceived cluster pertained to a specific site or category (e.g. brain tumors or leukemia), the cluster was considered confirmed in the presence of a documented statistically significant increase for that cancer site or category.
On the other hand, a perceived cluster of all cancers was considered confirmed if there was a statistically significant excess of the overall cancer incidence even if none of the individual site- or subpopulation-specific rates were significantly elevated.
However, some states (e.g. Missouri) limited their initial assessment to an examination of case series and would stop their investigation after determining that the reported cancer cases in a perceived cluster were too dissimilar or too spread over time and/ or space to warrant further study.
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The only category reported with greater frequency was the generic "all cancers" which accounted for 281 of the perceived clusters.
It is clear from Table 1 that some states (e.g. Illinois and Texas) conducted multiple investigations of perceived clusters for a wide array of cancers.
Investigations were categorized with respect to cancer type(s), hypothesized exposure, whether perceived clusters were confirmed (e.g. by elevated incidence), and conclusions about a link between cancer(s) of concern and hypothesized environmental exposure(s).
When evaluating reports from Texas, perceived clusters were considered "confirmed" when the agency stated in the report that the cluster warranted further investigation or observation (even though in some cases further investigation was proposed without clear evidence of elevated disease rates).
Based on these analyses, investigators will be able to perceive clustering of areas with high detection rate of VL.
Fetuses are known to be especially susceptible to environmental toxins and the public often perceives clusters of preterm births and frequently blames local pollution.
The issue noticed for members of Clusters 4 and 10 can also be perceived for Cluster 3 (hosted by Proteobacteria) which tends to mix within cluster 2 (hosted by Firmicutes) in the Portal-only tree (Additional file 1: Figure S5A).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com