Triple-Negative Apocrine Carcinomas: Toward a Unified Group With Shared Molecular Features and Clinical Behavior.

Triple-negative apocrine carcinomas (TNACs) are rare breast tumors with limited studies evaluating their molecular characteristics and clinical behavior. We performed a histologic, immunohistochemical, genetic, and clinicopathologic assessment of 42 invasive TNACs (1 with a focal spindle cell component) from 41 patients, 2 pure apocrine ductal carcinomas in situ (A-DCIS), and 1 A-DCIS associated with spindle cell metaplastic carcinoma (SCMBC). All TNACs had characteristic apocrine morphology and expressed androgen receptor (42/42), gross cystic disease fluid protein 15 (24/24), and CK5/6 (16/16). GATA3 was positive in most cases (16/18, 89%), and SOX10 was negative (0/22). TRPS1 was weakly expressed in a minority of tumors (3/14, 21%). Most TNACs had low Ki67 proliferation (≤10% in 67%, 26/39), with a median index of 10%. Levels of tumor infiltrating lymphocytes were low (≤10% in 93%, 39/42, and 15% in 7%, 3/42). Eighteen percent of TNACs presented with axillary nodal metastasis (7/38). No patients treated with neoadjuvant chemotherapy achieved pathologic complete response (0%, 0/10). Nearly all patients with TNAC (97%, n = 32) were without evidence of disease at the time of study (mean follow-up of 62 months). Seventeen invasive TNACs and 10 A-DCIS (7 with paired invasive TNAC) were profiled by targeted capture-based next-generation DNA sequencing. Pathogenic mutations in phosphatidylinositol 3-kinase pathway genes PIK3CA (53%) and/or PIK3R1 (53%) were identified in all TNACs (100%), including 4 (24%) with comutated PTEN. Ras-MAPK pathway genes, including NF1 (24%), and TP53 were mutated in 6 tumors each (35%). All A-DCIS shared mutations, such as phosphatidylinositol 3-kinase aberrations and copy number alterations with paired invasive TNACs or SCMBC, and a subset of invasive carcinomas showed additional mutations in tumor suppressors (NF1, TP53, ARID2, and CDKN2A). Divergent genetic profiles between A-DCIS and invasive carcinoma were identified in 1 case. In summary, our findings support TNAC as a morphologically, immunohistochemically, and genetically homogeneous subgroup of triple-negative breast carcinomas and suggest overall favorable clinical behavior.

Conservative Media Use and Childhood COVID-19 Vaccine Information: A Test of the Contradictory Health Information Processing Model.

The Contradictory Health Information Processing (CHIP) model explains individuals' processing of conflicting health claims. Tests of the model, while highly supportive, have been experimental and have relied upon low-familiar topics. Accordingly, a survey of parents with a child aged <12 years (N = 510) was conducted to test the application of the CHIP model to the controversial issue of childhood COVID-19 vaccination; such a vaccine had not yet been approved for this age group at the time of the survey. As hypothesized, reliance upon conservative news was associated with the perception that media information contradicted official guidance to vaccinate children, which led to issue uncertainty. Issue uncertainty prompted negative appraisals and decision uncertainty. Specifically, decision uncertainty partially mediated the effect of issue uncertainty on negative appraisals of vaccination, which in turn aroused threat emotions. However, threat emotions did not predict information-seeking, as specified in the model. This result may have been due to respondents having already decided to vaccinate their child, or not - a reflection of the partisan nature of the topic and the extensive coverage it had received. Theoretical and practical implications are discussed.

A comparison of three methods to determine the subject matter in textual data.

This study compares three different methods commonly employed for the determination and interpretation of the subject matter of large corpuses of textual data. The methods reviewed are: (1) topic modeling, (2) community or group detection, and (3) cluster analysis of semantic networks. Two different datasets related to health topics were gathered from Twitter posts to compare the methods. The first dataset includes 16,138 original tweets concerning HIV pre-exposure prophylaxis (PrEP) from April 3, 2019 to April 3, 2020. The second dataset is comprised of 12,613 tweets about childhood vaccination from July 1, 2018 to October 15, 2018. Our findings suggest that the separate "topics" suggested by semantic networks (community detection) and/or cluster analysis (Ward's method) are more clearly identified than the topic modeling results. Topic modeling produced more subjects, but these tended to overlap. This study offers a better understanding of how results may vary based on method to determine subject matter chosen.

Parental COVID-19 Vaccine Hesitancy in the United States.

OBJECTIVE: Little is known about parents' willingness to vaccinate their children against COVID-19. We assessed the prevalence of vaccine hesitancy among parents with a child or adolescent aged 12-15 years, examined predictors of parents' COVID-19 vaccine hesitancy, their reasons for resisting a pediatric COVID-19 vaccine, and the correlation between parents' intentions to vaccinate their child and the acceptance of a vaccine for themselves. METHODS: We conducted a national online survey of 637 parents of a child or adolescent aged 12-15 years in March 2021, before COVID-19 vaccines had been approved for this age group. We assessed univariate predictors of vaccine hesitancy, and we used logistic regression analysis to assess independent effects of variables on vaccine hesitancy. RESULTS: Nearly one-third (28.9%; 95% CI, 25.5%-32.5%) of respondents reported pediatric vaccine hesitancy. Vaccine-hesitant parents were less knowledgeable about vaccines, more accepting of vaccine conspiracies, and less worried about COVID-19 risks to their child's health than vaccine-accepting parents were. Vaccine hesitancy was higher among female (vs male), single (vs married/living as married), older (vs younger), low income (vs high income), non-college graduates (vs college graduates), and Republican (vs Democrat) parents. The primary concerns expressed by vaccine-hesitant parents pertained to vaccine safety rather than vaccine effectiveness. One-quarter of vaccine-hesitant parents preferred that their child obtain immunity through infection rather than vaccination. Non-vaccine-hesitant parents' reasons for vaccinating focused on protecting the health of their child and others. Childhood COVID-19 vaccine acceptance was strongly associated with parents' intentions to get the vaccine for themselves. CONCLUSION: A messaging strategy for effective public health interventions that includes educating the public about vaccination, countering misinformation about vaccine development and safety, and stressing the safety of approved COVID-19 vaccines may boost vaccine acceptance among vaccine-hesitant parents.

Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey.

BACKGROUND: Public polling indicates that vaccine uptake will be suboptimal when COVID-19 vaccines become available. Formative research seeking an understanding of weak vaccination intentions is urgently needed. METHODS: Nationwide online survey of 804 U.S. English-speaking adults. Compensated participants were recruited from the U.S. through an internet survey panel of 2.5 million residents developed by a commercial survey firm. Recruitment was based on quota sampling to produce a U.S. Census-matched sample representative of the nation with regard to region of residence, sex, and age. RESULTS: COVID-19 vaccination intentions were weak, with 14.8% of respondents being unlikely to get vaccinated and another 23.0% unsure. Intent to vaccinate was highest for men, older people, individuals who identified as white and non-Hispanic, the affluent and college-educated, Democrats, those who were married or partnered, people with pre-existing medical conditions, and those vaccinated against influenza during the 2019-2020 flu season. In a multiple linear regression, significant predictors of vaccination intent were general vaccine knowledge (ß = 0.311, p < .001), rejection of vaccine conspiracies (ß = -0.117, p = .003), perceived severity of COVID-19 (ß = 0.273, p < .001), influenza vaccine uptake (ß = 0.178, p < .001), having ≥ 5 pre-existing conditions (ß = 0.098, p = .003), being male (ß = 0.119, p < .001), household income of ≥ $120,000 (ß = 0.110, p = .004), identifying as a Democrat (ß = 0.075, p < .029), and not relying upon social media for virus information (ß = -0.090, p ã€ˆ002). Intent to vaccinate was lower for Fox News (57.3%) than CNN/MSNBC viewers (76.4%) (χ2(1) = 12.68, p < .001). Political party differences in threat appraisals and vaccine conspiracy beliefs are described. CONCLUSIONS: Demographic characteristics, vaccine knowledge, perceived vulnerability to COVID-19, risk factors for COVID-19, and politics likely contribute to vaccination hesitancy.

Relationship of people's sources of health information and political ideology with acceptance of conspiratorial beliefs about vaccines.

BACKGROUND: Conspiracies about vaccination are prevalent. We assessed how the health information sources people rely upon and their political ideologies are associated with acceptance of vaccine conspiracies. METHODS: Online survey (N = 599) on Amazon's Mechanical Turk crowdsource platform. Hypotheses were tested via structural equation modeling. RESULTS: Acceptance of vaccine conspiracy beliefs was associated positively with greater reliance on social media for health information (coef. = 0.42, p < .001), inversely related to use of medical websites (coef. = -0.21, p < .001), and not significantly related to use of providers for health information (coef. = -0.13, p = .061). In addition, liberal political orientation was negatively associated with acceptance of vaccine conspiracies (coef. = -0.29, p < .001). CONCLUSIONS: An understanding of vaccine conspiracy acceptance requires a consideration of people's health information sources. The greater susceptibility of political conservatives to conspiracy beliefs extends to the topic of vaccination.

Exploring the presentation of HPV information online: A semantic network analysis of websites.

CONTEXT: Negative vaccination-related information online leads some to opt out of recommended vaccinations. OBJECTIVE: To determine how HPV vaccine information is presented online and what concepts co-occur. METHODS: A semantic network analysis of the words in first-page Google search results was conducted using three negative, three neutral, and three positive search terms for 10 base concepts such as HPV vaccine, and HPV immunizations. In total, 223 of the 300 websites retrieved met inclusion requirements. Website information was analyzed using network statistics to determine what words most frequently appear, which words co-occur, and the sentiment of the words. RESULTS: High levels of word interconnectivity were found suggesting a rich set of semantic links and a very integrated set of concepts. Limited number of words held centrality indicating limited concept prominence. This dense network signifies concepts that are well connected. Negative words were most prevalent and were associated with describing the HPV vaccine's side-effects as well as the negative effects of HPV and cervical cancer. A smaller cluster focuses on reporting negative vaccine side-effects. Clustering shows the words women and girls closely located to the words sexually, virus, and infection. DISCUSSION: Information about the HPV vaccine online centered on a limited number of concepts. HPV vaccine benefits as well as the risks of HPV, including severity and susceptibility, were centrally presented. Word cluster results imply that HPV vaccine information for women and girls is discussed in more sexual terms than for men and boys.

Understanding vaccination resistance: vaccine search term selection bias and the valence of retrieved information.

CONTEXT: Dubious vaccination-related information on the Internet leads some parents to opt out of vaccinating their children. OBJECTIVES: To determine if negative, neutral and positive search terms retrieve vaccination information that differs in valence and confirms searchers' assumptions about vaccination. METHODS: A content analysis of first-page Google search results was conducted using three negative, three neutral, and three positive search terms for the concepts "vaccine," "vaccination," and "MMR"; 84 of the 90 websites retrieved met inclusion requirements. Two coders independently and reliably coded for the presence or absence of each of 15 myths about vaccination (e.g., "vaccines cause autism"), statements that countered these myths, and recommendations for or against vaccination. Data were analyzed using descriptive statistics. RESULTS: Across all websites, at least one myth was perpetuated on 16.7% of websites and at least one myth was countered on 64.3% of websites. The mean number of myths perpetuated on websites retrieved with negative, neutral, and positive search terms, respectively, was 1.93, 0.53, and 0.40. The mean number of myths countered on websites retrieved with negative, neutral, and positive search terms, respectively, was 3.0, 3.27, and 2.87. Explicit recommendations regarding vaccination were offered on 22.6% of websites. A recommendation against vaccination was more often made on websites retrieved with negative search terms (37.5% of recommendations) than on websites retrieved with neutral (12.5%) or positive (0%) search terms. CONCLUSION: The concerned parent who seeks information about the risks of childhood immunizations will find more websites that perpetuate vaccine myths and recommend against vaccination than the parent who seeks information about the benefits of vaccination. This suggests that search term valence can lead to online information that supports concerned parents' misconceptions about vaccines.

Chronic pain management strategies used by low-income overweight Latinos.

OBJECTIVE: The objective of this study is to examine the strategies used to manage chronic pain from the perspective of the individual in group interviews. METHODS: Sixteen low-income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. RESULTS: Participants' pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: pain-related life alterations, enduring the pain, trying different strategies, emotional suffering, and encounters with health care system/providers. DISCUSSION: Findings indicated that there are opportunities for providers to improve care for low-income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self-management strategies.