Frequency of naevus cells in lymph nodes of melanoma and breast cancer patients.

INTRODUCTION: We aimed to study the frequency (prevalence) and histology of benign melanocytic naevus cells in regional lymph nodes in relation to age and sex and nodal location. MATERIAL AND METHODS: Histopathology reports of sentinel lymph node (SLN) biopsies from melanoma patients, 2002 - 2014, and from breast cancer patients, 2010- 2019, were obtained from records of a single hospital in England. All sections were similarly processed and examined. For standardisation, presence of naevus cells was assessed in a single node per patient: the first SLN biopsied (melanoma) or the node nearest the first SLN (breast cancer). RESULTS: Associations were tested using Fisher's exact test. Naevus cells were found in 10% (60/585) of melanoma patients' index SLNs. Frequency varied significantly by anatomic region: 13% in axillary to 0% cervical SLNs (p = 0.03), but not by sex or age. Within nodes, naevus cells were present in capsular or pericapsular tissue (93%), or trabeculae (7%). In breast cancer patients' index axillary nodes, 6% (11/196) contained naevus cells, all intracapsular. In the predominant 40-69 years age-group, prevalence was similar in breast cancer (7%) and female melanoma (9%) patients, but in those aged 70-100, prevalence was lower in breast cancer (2%) than in female melanoma (15%) patients (p = 0.05). CONCLUSIONS: Standard methods of assessment yielded no clear pattern of naevus cell frequency in lymph nodes by age or sex, but confirmed naevus cell location as mostly intracapsular.

Prospective Association of Parenting Stress with Later Child Behavior Problems in Early Childhood Autism.

PURPOSE: Autistic children are reported to display higher levels of externalizing and internalizing behaviors than neurotypical children, and their parents report more stress than parents of neurotypical children. It is unclear whether child behavior difficulties contribute to increased parenting stress, whether parenting stress contributes to child behavior difficulties, or whether the relationship may be bidirectional. METHODS: We investigated prospective bidirectional associations between parenting stress and child externalizing and internalizing behaviors when autistic children were aged on average 3.5, 4.5, and 5.5 years. Data collected at these three timepoints were examined across two panels: Time 1 to Time 2 (n = 38 parent-child dyads) and Time 2 to Time 3 (n = 27 dyads). RESULTS: Across Time 1 to Time 2, early parenting stress was significantly associated with later child externalizing behavior, and cross-lagged panel analysis supported a uni- rather than a bidirectional association between these factors. There was some evidence of a bidirectional association between parenting stress and child internalizing behavior, though this was non-significant when the strong stability of child internalizing behavior was statistically controlled. In contrast, across Time 2 to Time 3, there were no significant prospective associations found between variables, highlighting the importance of considering the impact of parenting stress early in the course of childhood autism. CONCLUSION: Our results add to research indicating that support targeting parent characteristics, especially parenting stress, could ameliorate subsequent outcomes for both parents and children.

The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults.

OBJECTIVE: This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns. DESIGN: The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet. SETTING: New Zealand. PARTICIPANTS: Adults, aged ≥ 15 years (n 23 292). RESULTS: The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian. CONCLUSIONS: Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

Prognosis of naevoid melanomas.

INTRODUCTION: There appear to be several variants of naevoid melanoma suspected as having different outcomes, but follow-up studies have been few. We aimed to assess the prognosis of naevoid melanomas in a multi-centre study. MATERIAL AND METHODS: From histopathology records we ascertained patients in the UK, Australia and Italy diagnosed with maturing naevoid melanoma (n = 65; 14; 7 respectively) and nodular/papillomatous naevoid melanoma (12; 6; 0), and patients with superficial spreading melanoma (SSM) from UK (73) and Australia (26). Melanoma deaths in UK patients were obtained from NHS Digital; in Australia, via the National Death Index and cancer registry; and in Italy, through clinical records. For maturing naevoid vs. SSM, we used Cox-proportional hazard regression models to compare survival adjusted for age, sex, tumour thickness, and ulceration, and additionally Fine-Gray regression analysis, to calculate sub-hazard ratios (SHR) in the UK cohort, accounting for competing causes of death. RESULTS: Among UK patients, there was a non-significantly lower risk of melanoma death in maturing naevoid vs SSM, including after accounting for competing causes of death (SHR 0.40, 95% confidence interval (CI) 0.12-1.31), while among nodular/papillomatous naevoid melanoma patients, there were no melanoma deaths on follow-up. Two melanoma deaths occurred in Australian SSM patients, and none in maturing or nodular/papillomatous naevoid melanoma patients, after 5 years' minimum follow-up. None of the 7 Italian patients with maturing naevoid melanoma died of melanoma after nearly 12 years' average follow-up. CONCLUSIONS: There was no significant difference in risk of death from melanomas with naevoid features, and SSM. Nodular/ papillomatous naevoid melanoma patients did not carry higher risk of death than SSM patients though the very few cases of the papillomatous naevoid variant limited our assessment.

New Methods for the Quantification of Ingested Nano- and Ultrafine Plastics in Seabirds.

Plastic ingestion has been documented in a plethora of taxa. However, there is a significant gap in the detection of nano- and ultrafine particles due to size limitations of commonly used techniques. Using two Australian seabird species as case studies, the flesh-footed shearwater (FFSH) Ardenna carneipes and short-tailed shearwater (STSH) A. tenuirostris, we tested a novel approach of flow cytometry to quantify ingested particles <70 µm in the fecal precursor (guano; colon and cloacal contents) of both species. This method provided the first baseline data set for these species for plastics in the 200 nm-70 µm particle size ranges and detected a mean of 553.50 ± 91.21 and 350.70 ± 52.08 plastics (count/mg fecal precursor, wet mass) in STSH and FFSH, respectively, whereas Fourier transform infrared spectroscopy (FT-IR) provided accurate measurements of polymer compositions and quantities in the size range above 5.5 × 5.5 µm2. The abundance of nano- and ultrafine particles in the guano (count/mg) was not significantly different between species (p-value = 0.051), suggesting that foraging distribution or prey items, but not species, may contribute to the consumption of small plastics. In addition, there was no correlation between macroplastics in the stomach compared to the fecal precursor, indicating that small particles are likely bioaccumulating (e.g., through shedding and digestive fragmentation) and/or being directly ingested. Combining flow cytometry with FT-IR provides a powerful quantitative and qualitative analysis tool for detecting particles orders of magnitude smaller than that are currently explored with wider applications across taxa and marine environments.

The one-two punch of plastic exposure: Macro- and micro-plastics induce multi-organ damage in seabirds.

Plastic pollution in the world's oceans is ubiquitous and increasing. The environment is inundated with microplastics (< 1 mm), and the health effects of these less conspicuous pollutants is poorly known. In addition, there is now evidence that macroplastics can release microplastics in the form of shedding or digestive fragmentation, meaning there is potential for macroplastic exposure to induce direct and indirect pathology through microplastics. Therefore, there is an urgent need for data from wild populations on the relationship between macro- and microplastic exposure and the potential compounding pathological effects of these forms of plastics. We investigated the presence and impact of microplastics in multiple tissues from Flesh-footed Shearwaters Ardenna carneipes, a species that ingests considerable quantities of plastics, and used histopathological techniques to measure physiological responses and inflammation from the plastics. All organs examined (kidney, spleen, proventriculus) had embedded microplastic particles and this correlated with macroplastic exposure. Considerable tissue damage was recorded, including a significant reduction in tubular glands and rugae in the proventriculus, and evidence of inflammation, fibrosis, and loss of organ structures in the kidney and spleen. This indicates macroplastics can induce damage directly at the site of exposure, while microplastics can be mobilised throughout the body causing widespread pathology. Collectively, these results indicate the scope and severity of the health impacts of plastic pollution may be grossly underestimated.

Ingested plastics in beach-washed Fairy Prions Pachyptila turtur from Tasmania.

Plastic is an omnipresent pollutant in marine ecosystems and is widely documented to be ingested among seabird species. Procellariiformes are particularly vulnerable to plastic ingestion, which can cause internal damage, starvation, and occasionally mortality. In this study, 34 fledgling Fairy Prions (Pachyptila turtur) recovered during a wreck event in south-eastern Tasmania in 2022 were examined for ingested plastics and body condition (e.g., wing chord length). While many of the birds exhibited poor body condition, this was not correlated with the count or mass of ingested plastics. We hypothesise the marine heatwave event, and resulting lack of prey, contributed to bird body condition and subsequent mortality. We provide some of the first data on the size of individual plastic particles ingested by seabirds and make recommendations for future studies to report this important metric in a consistent manner that ensures data are comparable.

Unilateral Cystic Kidney Disease in a Young Female.

Unilateral renal cystic disease has been mostly reported in older male patients; however, this case is novel as the youngest reported case in the literature and in a female patient. We present a 22-year-old female with no past medical history and no family history of renal disease that was incidentally found to have unilateral renal cystic disease on computed tomography imaging. The patient's renal function was not impaired and the cystic kidney was found to be functioning appropriately on an intravenous pyelogram. The unilateral cystic disease is benign but must be differentiated from autosomal dominant polycystic disease to prevent morbidity and mortality.

The influence of seabirds on their breeding, roosting and nesting grounds: A systematic review and meta-analysis.

Seabird species world-wide are integral to both marine and terrestrial environments, connecting the two systems by transporting vast quantities of marine-derived nutrients and pollutants to terrestrial breeding, roosting and nesting grounds via the deposition of guano and other allochthonous inputs (e.g. eggs, feathers). We conducted a systematic review and meta-analysis and provide insight into what types of nutrients and pollutants seabirds are transporting, the influence these subsidies are having on recipient environments, with a particular focus on soil, and what may happen if seabird populations decline. The addition of guano to colony soils increased nutrient levels compared to control soils for all seabirds studied, with cascading positive effects observed across a range of habitats. Deposited guano sometimes led to negative impacts, such as guanotrophication, or guano-induced eutrophication, which was often observed where there was an excess of guano or in areas with high seabird densities. While the literature describing nutrients transported by seabirds is extensive, literature regarding pollutant transfer is comparatively limited, with a focus on toxic and bioaccumulative metals. Research on persistent organic pollutants and plastics transported by seabirds is likely to increase in coming years. Studies were limited geographically, with hotspots of research activity in a few locations, but data were lacking from large regions around the world. Studies were also limited to seabird species listed as Least Concern on the IUCN Red List. As seabird populations are impacted by multiple threats and steep declines have been observed for many species world-wide, gaps in the literature are particularly concerning. The loss of seabirds will impact nutrient cycling at localized levels and potentially on a global scale as well, yet it is unknown what may truly happen to areas that rely on seabirds if these populations disappear.

Hypothesised cutaneous sites of origin of stage III melanomas with unknown primary: A multicentre study.

Based on molecular evidence that melanomas with unknown primary (MUPs) arise from the skin, we hypothesised that sites of MUPs are disproportionately on trunk and lower limbs, sites that are not readily visible to patients and clinicians. We tested this hypothesis by inferring the anatomic site of origin of MUPs from the corresponding known cutaneous sites of melanoma patients with known primary tumours (MKPs). We analysed data from three separate cohorts of patients from Brisbane, Australia (n = 236); Manchester, UK (n = 51) and Padova, Italy (n = 33), respectively, who first presented with stage III melanoma with lymph node metastases. We matched two MKP patients to each MUP patient based on lymph node dissection (LND) site, age and sex, and imputed cutaneous sites of origin of MUPs from their two matched MKPs for study countries, giving two possible sites for each MUP per centre. Overall, results showed that MUP patients were predominantly male, and trunk was the most likely origin, comprising around a third to a half of MUPs across the three cohorts. The remaining MUP inferred sites varied by country. In the Australian cohort, the legs accounted for a third of imputed sites of MUPs, while in the UK and Italian cohorts, the most frequent site was the arms followed by the legs. Our findings suggest the need for regular and thorough skin examination on trunk and limbs, especially in males, to improve early detection of cutaneous melanoma and reduce the risk of metastatic disease at the time of presentation.

Comparing methods for monitoring nest debris using silver gulls as a case study.

Global plastics production is increasing exponentially and contributing to significant pollution of the marine environment. Of particular concern is ingestion and entanglement risks for marine wildlife, including when items such as rope are incorporated into nest structures. These events are commonly documented using photographic and visual surveys, and each presents a number of challenges and benefits for species conservation and monitoring. Here we compare an invasive (i.e., removing debris from nests) and non-invasive (i.e., photographs) sampling method for quantifying nest debris using the silver gull (Chroicocephalus novahollandiae) as a case study. Overall, 17 debris items were detected in 9% of gull nests. While the use of photographs to monitor nest debris is increasingly popular, the invasive method detected one additional debris item not identified using photography. We therefore recommend caution for nest debris and other monitoring programs where identifying small or cryptic items may require a high level of skill.

Evolution of superficial spreading melanoma to resemble desmoplastic melanoma: case report.

Desmoplastic melanoma commonly occurs on the head and neck in a pure form, but occasionally, it occurs in a mixed tumor with another type, usually superficial spreading melanoma (SSM), and rarely as a metastasis from a primary SSM. We report here a primary SSM on the leg of a 32-year-old male which metastasised to lymph nodes, and 10 years later recurred at the primary site initially with mixed features but evolving to resemble a uniformly desmoplastic, deeply invasive melanoma. This unusual case has implications for clinical management and is additionally notable for its reversal in behavior, from metastatic to local infiltrative type, correlating with the change in morphology.

Is skipped nodal metastasis a phenomenon of cutaneous melanoma?

BACKGROUND AND METHODS: Skipped nodal metastasis (SNM) is a recognized phenomenon of visceral cancers when metastases bypass the regional basin and skip to a distant nodal basin without evidence of distant metastases. Its occurrence is undocumented in cutaneous melanoma patients but of potential prognostic significance. We therefore assessed the frequency of SNM in a large series of patients with limb melanomas. PATIENTS AND METHODS: We studied melanoma patients attending a tertiary oncology hospital in northwest England using two approaches. First, we systematically searched medical records of an unselected patient sample treated 2002-2015, and second, we studied lymphoscintigrams of all patients with limb melanoma who underwent sentinel node biopsy 2008-2019. RESULTS: Of 672 melanoma patients whose clinical records were examined, 16 had regional nodal metastases without apparent visceral spread and one appeared to have SNM but further scans were uncovered that showed concurrent pulmonary metastases. Of 667 limb melanoma patients with lymphoscintigrams, 7 showed dual lymphatic drainage patterns to distal as well as regional nodal basins, but none had micro-metastases solely in the distant basin. CONCLUSION: Occurrence of SNM in cutaneous melanoma is highly unlikely.

Seroprevalence of SARS-CoV-2 Among Firefighters/Paramedics in San Francisco, CA.

OBJECTIVES: Despite having close contact with the general public, members of the San Francisco Fire Department (SFFD) reported relatively few cases of COVID-19 during the first half of 2020. Our objective was to explore evidence for prior undetected infections by conducting a seroprevalence survey, and to document both risk and protective factors for prior COVID-19 infection. METHODS: This cross-sectional study assessed workplace practices and exposures of SFFD personnel during the first 6 months of 2020 via questionnaire and documented prior COVID-19 infections by serologic antibody testing using an orthogonal testing protocol. RESULTS: Of 1231 participating emergency responders, three (0.25%) had confirmed positive COVID-19 antibody results. CONCLUSIONS: Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.

Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis.

Importance: Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. Objective: To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. Design, Setting, and Participants: This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. Interventions: Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. Main Outcomes and Measures: Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of .05. Results: Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P = .04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P = .02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. Conclusions and Relevance: Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. Trial Registration: http://anzctr.org.au identifier: ACTRN12616000819426.

A standardised method for estimating the level of visible debris in bird nests.

Unlike records of plastic ingestion and entanglement in seabirds which date back to the 1960s, the literature regarding debris in bird nests is comparatively limited. It is important to identify standardised methods early so that data are collected in a consistent manner, ensuring that future studies can be comparable. Here, we outline a method that can be applied to photographs for estimating the proportion of visible debris at the surface of a nest. This method uses ImageJ software to superimpose a grid onto a photograph of a nest/s. The number of cells with and without debris are then counted. Our proposed method is repeatable, straightforward, and accessible. We optimised the method to estimate the level of visible debris in Northern Gannet (Morus bassanus) nests, however, with some modification (i.e., adjustment of grid cell size), it could be applied to other seabird species, and terrestrial birds, that incorporate debris within nests.

Sunbed Use among 11- to 17-Year-Olds and Estimated Number of Commercial Sunbeds in England with Implications for a 'Buy-Back' Scheme.

Prior to 2011 legislation prohibiting children from using commercial sunbeds, the prevalence of sunbed use in 15- to 17-year-olds in some areas in England was as high as 50%. Despite significant decreases since 2011, children today still practice indoor tanning. We estimated current sunbed use in 11- to 17-year-olds in England, the number of available commercial sunbed units, and the associated cost of a 'buy-back' scheme to remove commercial sunbeds under a potential future policy to ban sunbeds. We undertook a calibration approach based on published prevalence rates in English adults and other sources. Internet searches were undertaken to estimate the number of sunbed providers in Greater Manchester, then we extrapolated this to England. Estimated mean prevalence of sunbed use was 0.6% for 11- to 14-year-olds and 2.5% for 15- to 17-year-olds, equating to 62,130 children using sunbeds in England. A predicted 2958 premises and 17,865 sunbeds exist nationally and a 'buy-back' scheme would cost approximately GBP 21.7 million. Public health concerns remain greatest for 11- to 17-year-olds who are particularly vulnerable to developing skin cancers after high ultraviolet exposure.

Seabird breeding islands as sinks for marine plastic debris.

Seabirds are apex predators in the marine environment and well-known ecosystem engineers, capable of changing their terrestrial habitats by introducing marine-derived nutrients via deposition of guano and other allochthonous inputs. However, with the health of the world's oceans under threat due to anthropogenic pressures such as organic, inorganic, and physical pollutants, seabirds are depositing these same pollutants wherever they come to land. Using data from 2018 to 2020, we quantify how the Flesh-footed Shearwater (Ardenna carneipes) has inadvertently introduced physical pollutants to their colonies on Lord Howe Island, a UNESCO World Heritage site in the Tasman Sea and their largest breeding colony, through a mix of regurgitated pellet (bolus) deposition and carcasses containing plastic debris. The density of plastics within the shearwater colonies ranged between 1.32 and 3.66 pieces/m2 (mean ± SE: 2.18 ± 0.32), and a total of 688,480 (95% CI: 582,409-800,877) pieces are deposited on the island each year. Our research demonstrates that seabirds are a transfer mechanism for marine-derived plastics, reintroducing items back into the terrestrial environment, thus making seabird colonies a sink for plastic debris. This phenomenon is likely occurring in seabird colonies across the globe and will increase in severity as global plastic production and marine plastic pollution accelerates without adequate mitigation strategies.