Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents and young adults

OBJECTIVE: Differentiated thyroid cancer (DTC), including papillary (PTC) and follicular (FTC) variants, is unusual in children and accounts for only 10% of all cases. For that reason, knowledge of the clinical features which predict recurrence is limited. We reviewed 170 cases of childhood DTC to determine if specific clinical or pathological findings were associated with increased risk of recurrence. DESIGN: This was a retrospective study of children and adolescents with DTC registered in the Department of Defense Automated Centralized Tumor Registry. PATIENTS: We reviewed 137 cases of PTC and 33 cases of FTC diagnosed between 1953 and 1996 at < or = 21 years of age. RESULTS: In the PTC group (median follow-up 6.6 years, range 2 month-39.5 years), only one patient died, but 21 developed local and 6 developed distant recurrence. By univariate analysis, recurrence was more common in patients with multifocal (odds ratio 7.5) or large tumours (odds ratio 4.1), and in those with palpable cervical lymphadenopathy (odds ratio 3.0) or metastasis at diagnosis (odds ratio 2.8). By multivariate analysis focality was the best predictor of recurrence (P = 0.0019). In the FTC group (median follow-up 5 years, range 6 month-38.1 years), no patient died of disease, but 5 developed recurrence. As with PTC, recurrence was more likely in patients with multifocal tumours (odds ratio 22.0). CONCLUSIONS: Differentiated thyroid cancer in children and adolescents has low mortality, but a high risk of recurrence. Young patients with large, multifocal tumours that are already metastatic at diagnosis have the greatest risk of recurrence.     

Effect of receiving environment on the transport and fate of polybrominated diphenyl ethers near two submarine municipal outfalls

The fate of contaminants entering the marine environment through wastewater outfalls depends on the contaminant's persistence and affinity for particles. However, the physical characteristics of the receiving environment, for example, current velocity and sedimentary processes, may be even more important. Because of the complexity of natural settings and the lack of appropriate comparative settings, this is not frequently evaluated quantitatively. The authors investigated the near-field accumulation of particle-reactive polybrominated diphenyl ethers (PBDEs) entering coastal waters by way of two municipal outfalls: one discharging into a high-energy, low-sedimentation environment near Victoria, BC, Canada; the other into a low-energy, high-sedimentation environment, near Vancouver, BC. The authors used 21?Pb profiles in box cores together with an advection-diffusion model to determine surface mixing and sedimentation rates, and to model the depositional history of PBDEs at these sites. Surprisingly, 88 to 99% of PBDEs were dispersed beyond the near-field at both sites, but a greater proportion of PBDEs was captured in the sediment near the Vancouver outfall where rapid burial was facilitated by inorganic sediment supplied from the nearby Fraser River. Although the discharge of PBDEs was much lower from the Victoria outfall than from Vancouver, some sediment PBDE concentrations were higher near Victoria.     

Anatomy and dimensions of rotator cuff insertions

The purpose of this study was to devise and implement an accurate and reproducible method of measuring the area and dimensions of the rotator cuff tendon insertions and their distance from the articular surface. Twenty fresh-frozen cadaveric upper-extremity specimens were divided into 2 groups of 10. In group 1 the specimens were dissected, leaving only the most distal rotator cuff tendons attached to the humerus. The periphery of the insertion onto the greater tuberosity was marked at 3-mm intervals. The specimens were then mounted onto a custom jig, and the insertion was mapped by a 3-space digitizer. In group 2 the specimens were prepared by removing all tissues except the rotator cuff muscles and tendons and the joint capsule. The interval between the muscles of the rotator cuff was identified and marked. The rotator cuff muscles and tendons were then removed, leaving only the most distal tendons attached to the tuberosities. The periphery of the individual cuff insertions was then marked as in group 1 and mapped in the same fashion. The articular margin also was marked at similar intervals and mapped with the same technique. The area of insertion of the 3 tendons on the greater tuberosity averaged 6.24 cm(2) (SD, 2.04 cm(2)) in group 1. The mean minimum transverse dimension across the cuff insertion occurred in the mid portion of the supraspinatus, with a mean distance of 14.7 mm (SD, 3.22 mm). In group 2 the mean area of insertion of the supraspinatus was 1.55 cm(2) (range, 0.68-2.64 cm(2); SD, 0.66 cm(2)) and the mean area of insertion for the infraspinatus was 1.76 cm(2) (range, 1.23-2.53 cm(2); SD, 0.40 cm(2)). The distance from the articular margin to the most medial rotator cuff fibers was less than 1 mm along the anterior-most 2.1 cm of the cuff insertion onto the greater tuberosity. No correlation could be made between humeral head dimension and the dimensions of the rotator cuff insertions. The mean minimum medial-to-lateral distance across the rotator cuff insertion was sizeable, at 14.7 mm. This represents the minimum possible distance, as the mathematical calculation to determine the dimensions used a perpendicular measurement. The rotator cuff inserts very closely to the articular margin along the anterior 2.1 cm of the greater tuberosity. These anatomic measurements may be useful in evaluating and reattaching the rotator cuff to the humerus.     

Tracing salmon-derived nutrients and contaminants in freshwater food webs across a pronounced spawner density gradient

Many have demonstrated that anadromous Pacific salmon are significant vectors of nutrients from the ocean to freshwaters. Recently. however, it has been recognized that salmon spawners also input significant quantities of contaminants. The objectives of this paper are to delineate the extent to which salmon-derived nutrients are integrated into the freshwater food web using delta(15)N and delta(13)C and to assess the influence of the salmon pathway in the accumulation of contaminants in rainbow trout (Oncorhynchus mykiss). We found that the delta(15)N and delta(13)C of food web components were related positively and significantly to sockeye salmon (Oncorhynchus nerka) spawner density. Contaminant concentrations in rainbow trout also positively and significantly were related to sockeye salmon spawner density. These data suggest that the anadromous salmon nutrient and contaminant pathways are related and significantly impact the contaminant burden of resident fish.     

Community Health Worker Perspectives on Engaging Unhoused Peer Ambassadors for COVID-19 Vaccine Outreach in Homeless Encampments and Shelters

BackgroundCOVID-19 vaccination is a priority for people experiencing homelessness. However, there are barriers to vaccine access driven in part by mistrust towards clinicians and healthcare. Community health workers (CHWs) and Peer Ambassadors (PAs) may be able to overcome mistrust in COVID-19 vaccine outreach. An unhoused PA program for COVID-19 vaccine outreach by CHWs was implemented in Los Angeles using a participatory academic-community partnership.ObjectiveThe purpose of this study was to evaluate CHW perspectives on an unhoused PA COVID-19 vaccine outreach program in Los Angeles.DesignThis study used a participatory community conference and qualitative focus groups to understand CHW perspectives on the PA program. The one-day conference was held in November 2021.ParticipantsOf the 42 conference participants, 19 CHWs participated in focus groups for two-way knowledge exchange between CHWs and researchers.ApproachFour focus groups were held during the conference, with 4-6 CHWs per group. Each group had a facilitator and two notetakers. Focus group notes were then analyzed using content analysis to derive categories of findings. CHWs reviewed the qualitative analysis to ensure that findings represented their experiences with the PA program.Key ResultsThe five categories of findings from focus groups were as follows: (1) PAs were effective liaisons to their peers to promote COVID-19 vaccines; (2) CHWs recognized the importance of establishing genuine trust and equitable working relationships within CHW/PA teams; (3) there were tradeoffs of integrating unhoused PAs into the existing CHW workflow; (4) CHWs had initial misgivings about the research process; and (5) there were lingering questions about the ethics of “exploiting” the invaluable trust unhoused PAs have with unhoused communities.ConclusionsCHWs were in a unique position to empower unhoused PAs to take a leadership role in reaching their peers with COVID-19 vaccines and advocate for long-term employment and housing needs.     

COVID-19 Vaccine Acceptability and Financial Incentives among Unhoused People in Los Angeles County: a Three-Stage Field Survey

Unhoused people have higher COVID-19 mortality and lower vaccine uptake than housed community members. Understanding vaccine hesitancy among unhoused people is key for developing programs that address their unique needs. A three-round, rapid, field-based survey was conducted to describe attitudes toward COVID-19 vaccination. Round 1 assessed vaccine brand preference, round 2 assessed intention to accept a financial incentive for vaccination, and round 3 measured vaccine uptake and assessed reasons for vaccine readiness during implementation of a financial incentive program. A total of 5177 individuals were approached at COVID-19 vaccination events for unhoused people in Los Angeles County from May through November 2021. Analyses included 4949 individuals: 3636 (73.5%) unsheltered and 1313 (26.5%) sheltered. Per self-report, 2008 (40.6%) were already vaccinated, 1732 (35%) wanted to get vaccinated, 359 (7.3%) were not yet ready, and 850 (17.2%) did not want to get vaccinated. Brand preference was evenly split among participants (Moderna 31.0%, J&J 35.5%, either 33.5%, p = 0.74). Interest in a financial incentive differed between those who were not yet ready and those who did not want to get vaccinated (43.2% vs. 16.2%, p < 0.01). After implementing a financial incentive program, 97.4% of participants who indicated interest in vaccination were vaccinated that day; the financial incentive was the most cited reason for vaccine readiness (n = 731, 56%). This study demonstrated the utility of an iterative, field-based assessment for program implementation during the rapidly evolving pandemic. Personal engagement, a variety of brand choices, and financial incentives could be important for improving vaccine uptake among unhoused people.