Neoadjuvant tyrosine kinase inhibitor therapy in locally advanced differentiated thyroid cancer: a single centre case series.

OBJECTIVE: Primary surgical resection remains the mainstay of management in locally advanced differentiated thyroid cancer. Tyrosine kinase inhibitors have recently shown promising results in patients with recurrent locally advanced differentiated thyroid cancer. This study discussed four patients with locally advanced differentiated thyroid cancer managed with tyrosine kinase inhibitors used prior to surgery in the 'neoadjuvant' setting. METHOD: Prospective data collection through a local thyroid database from February 2016 identified four patients with locally advanced differentiated thyroid cancer unsuitable for primary surgical resection commenced on neoadjuvant tyrosine kinase inhibitor therapy. RESULTS: All cases had T4a disease at presentation. Three cases tolerated tyrosine kinase inhibitor therapy for more than 14 months while the last case failed to tolerate treatment at 1 month. All patients subsequently underwent total thyroidectomy to facilitate adjuvant radioactive iodine treatment. Disease-specific survival remains at 100 per cent currently (range, 29-75 months). CONCLUSION: Neoadjuvant tyrosine kinase inhibitors in locally advanced differentiated thyroid cancer can be effective in reducing primary tumour extent to potentially facilitate a more limited surgical resection for local disease control.

Exhaust ventilation in attached garages improves residential indoor air quality.

Previous research has shown that indoor benzene levels in homes with attached garages are higher than homes without attached garages. Exhaust ventilation in attached garages is one possible intervention to reduce these concentrations. To evaluate the effectiveness of this intervention, a randomized crossover study was conducted in 33 Ottawa homes in winter 2014. VOCs including benzene, toluene, ethylbenzene, and xylenes, nitrogen dioxide, carbon monoxide, and air exchange rates were measured over four 48-hour periods when a garage exhaust fan was turned on or off. A blower door test conducted in each garage was used to determine the required exhaust fan flow rate to provide a depressurization of 5 Pa in each garage relative to the home. When corrected for ambient concentrations, the fan decreased geometric mean indoor benzene concentrations from 1.04 to 0.40 µg/m3 , or by 62% (P<.05). The garage exhaust fan also significantly reduced outdoor-corrected geometric mean indoor concentrations of other pollutants, including toluene (53%), ethylbenzene (47%), m,p-xylene (45%), o-xylene (43%), and carbon monoxide (23%) (P<.05) while having no impact on the home air exchange rate. This study provides evidence that mechanical exhaust ventilation in attached garages can reduce indoor concentrations of pollutants originating from within attached garages.

Can changing the timing of outdoor air intake reduce indoor concentrations of traffic-related pollutants in schools?

Traffic emissions have been associated with a wide range of adverse health effects. Many schools are situated close to major roads, and as children spend much of their day in school, methods to reduce traffic-related air pollutant concentrations in the school environment are warranted. One promising method to reduce pollutant concentrations in schools is to alter the timing of the ventilation so that high ventilation time periods do not correspond to rush hour traffic. Health Canada, in collaboration with the Ottawa-Carleton District School Board, tested the effect of this action by collecting traffic-related air pollution data from four schools in Ottawa, Canada, during October and November 2013. A baseline and intervention period was assessed in each school. There were statistically significant (P < 0.05) reductions in concentrations of most of the pollutants measured at the two late-start (9 AM start) schools, after adjusting for outdoor concentrations and the absolute indoor-outdoor temperature difference. The intervention at the early-start (8 AM start) schools did not have significant reductions in pollutant concentrations. Based on these findings, changing the timing of the ventilation may be a cost-effective mechanism of reducing traffic-related pollutants in late-start schools located near major roads.

Impromptu everyday disclosure dances: how women with fibromyalgia respond to disclosure risks at work.

PURPOSE: Findings from a study examining how women with fibromyalgia remain employed are used to explicate a conceptualization that adds to literature on workplace disclosure of stigmatized illnesses and impairments: disclosure dances that employees improvise in response to workplace-relationships needs and disclosure risks. METHODS: Critical-discourse-analysis (CDA) methodology framed the study. Data were collected through 26 semi-structured, individual interviews with participant triads or dyads comprising women with fibromyalgia, family members and supervisors or co-workers. Interviews with managers who supervised disabled employees other than the women supplemented these data. Following coding, data were compared within and across triads/dyads through code-dimension summaries, narrative summaries and relational diagrams. RESULTS: Women with fibromyalgia and other stigmatized illnesses improvised everyday disclosures when they needed to explain fluctuating work ability, when others needed reminding about invisible impairments, and when workplace relationships changed. These impromptu disclosures comprised three dimensions: exposing oneself to scrutiny by disclosing both illness and impairments, divulging stigmatized illness, and revealing invisible impairments selectively. CONCLUSION: Through impromptu disclosure dances, women tailored disclosure to changing immediate circumstances. While assumptions from psychological theories of risk underlie current conceptualizations of disclosure as planned in advance, this article examines disclosure through a different lens: social theories of everyday risk. Implications for rehabilitation For women with fibromyalgia, disclosing illness and impairments at work may entail risks to their jobs and workplace relationships. Rehabilitation professionals need to consider these risks when advising women with fibromyalgia about disclosing their illness and impairments at work. Professionals may first want to learn from clients about their workplace cultures and relationships, and their perceptions of disclosure risk. Professionals can then suggest a range of disclosure responses, depending on the relationship and risk.

Estimation of bias with the single-zone assumption in measurement of residential air exchange using the perfluorocarbon tracer gas method.

UNLABELLED: Residential air exchange rates (AERs) are vital in understanding the temporal and spatial drivers of indoor air quality (IAQ). Several methods to quantify AERs have been used in IAQ research, often with the assumption that the home is a single, well-mixed air zone. Since 2005, Health Canada has conducted IAQ studies across Canada in which AERs were measured using the perfluorocarbon tracer (PFT) gas method. Emitters and detectors of a single PFT gas were placed on the main floor to estimate a single-zone AER (AER(1z)). In three of these studies, a second set of emitters and detectors were deployed in the basement or second floor in approximately 10% of homes for a two-zone AER estimate (AER(2z)). In total, 287 daily pairs of AER(2z) and AER(1z) estimates were made from 35 homes across three cities. In 87% of the cases, AER(2z) was higher than AER(1z). Overall, the AER(1z) estimates underestimated AER(2z) by approximately 16% (IQR: 5-32%). This underestimate occurred in all cities and seasons and varied in magnitude seasonally, between homes, and daily, indicating that when measuring residential air exchange using a single PFT gas, the assumption of a single well-mixed air zone very likely results in an under prediction of the AER. PRACTICAL IMPLICATIONS: The results of this study suggest that the long-standing assumption that a home represents a single well-mixed air zone may result in a substantial negative bias in air exchange estimates. Indoor air quality professionals should take this finding into consideration when developing study designs or making decisions related to the recommendation and installation of residential ventilation systems.

Quantifying the contribution of ambient and indoor-generated fine particles to indoor air in residential environments.

UNLABELLED: Indoor fine particles (FPs) are a combination of ambient particles that have infiltrated indoors, and particles that have been generated indoors from activities such as cooking. The objective of this paper was to estimate the infiltration factor (Finf ) and the ambient/non-ambient components of indoor FPs. To do this, continuous measurements were collected indoors and outdoors for seven consecutive days in 50 non-smoking homes in Halifax, Nova Scotia in both summer and winter using DustTrak (TSI Inc) photometers. Additionally, indoor and outdoor gravimetric measurements were made for each 24-h period in each home, using Harvard impactors (HI). A computerized algorithm was developed to remove (censor) peaks due to indoor sources. The censored indoor/outdoor ratio was then used to estimate daily Finfs and to determine the ambient and non-ambient components of total indoor concentrations. Finf estimates in Halifax (daily summer median = 0.80; daily winter median = 0.55) were higher than have been reported in other parts of Canada. In both winter and summer, the majority of FP was of ambient origin (daily winter median = 59%; daily summer median = 84%). Predictors of the non-ambient component included various cooking variables, combustion sources, relative humidity, and factors influencing ventilation. This work highlights the fact that regional factors can influence the contribution of ambient particles to indoor residential concentrations. PRACTICAL IMPLICATIONS: Ambient and non-ambient particles have different risk management approaches, composition, and likely toxicity. Therefore, a better understanding of their contribution to the indoor environment is important to manage the health risks associated with fine particles (FPs) effectively. As well, a better understanding of the factors Finf can help improve exposure assessment and contribute to reduced exposure misclassification in epidemiologic studies.

Brain ethanol levels in rats after voluntary ethanol consumption using a sweetened gelatin vehicle.

A novel procedure for initiation of voluntary ethanol consumption in the rat was evaluated in terms of ease of initiation, consistency, and resulting brain ethanol levels. The "jello shot" consists of 10% ethanol in gelatin along with a caloric source (Polycose). Initiation of "jello shot" consumption in Sprague-Dawley rats required no food or water restriction and resulted in initial daily (8.4+/-0.6 g/kg body weight) and eventual hourly (1.1+/-0.1 g/kg body weight) intake of ethanol comparable to other procedures using either alcohol-preferring or non-genetically selected rats. Rat intake of ethanol via "jello shots" recovered quickly from environmental alterations and surgical implantation of a guide cannula. During 1-h free access sessions, consumption of the "jello shot" occurred during the initial 10 min and resulted in a dose-related increase in ethanol levels in nucleus accumbens measured using microdialysis. These brain ethanol levels were comparable to those achieved using other self-administration methods. However, when 0.5 g/kg ethanol was gavaged either in "jello shot" or saline, there was about a 20% decrease in brain ethanol concentrations after gavage of the "jello shot" compared to saline. Even so, lack of a need for initial food or water deprivation and the rapidity with which stable self-administration can be achieved both suggest utility of the "jello shot" as a completely voluntary ethanol procedure.