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Background: Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). Although studies have documented lower cancer screening rates, there is limited epidemiological evidence quantifying potential diagnostic delays. This study explores the risk of metastatic cancer stage for people with IDD compared to those without IDD among breast (female), colorectal, and lung cancer patients in Canada. Methods: Separate population‐based cross‐sectional studies were conducted in Ontario and Manitoba by linking routinely collected data. Breast (female), colorectal, and lung cancer patients were included (Manitoba: 2004–2017; Ontario: 2007–2019). IDD status was identified using established administrative algorithms. Modified Poisson regression with robust error variance models estimated associations between IDD status and the likelihood of being diagnosed with metastatic cancer. Adjusted relative risks were pooled between provinces using random‐effects meta‐analyses. Potential effect modification was considered. Results: The final cohorts included 115,456, 89,815, and 101,811 breast (female), colorectal, and lung cancer patients, respectively. Breast (female) and colorectal cancer patients with IDD were 1.60 and 1.44 times more likely to have metastatic cancer (stage IV) at diagnosis compared to those without IDD (relative risk [RR], 1.60; 95% confidence interval [CI], 1.16–2.20; RR, 1.44; 95% CI, 1.24–1.67). This increased risk was not observed in lung cancer. Significant effect modification was not observed. Conclusions: People with IDD were more likely to have stage IV breast and colorectal cancer identified at diagnosis compared to those without IDD. Identifying factors and processes contributing to stage disparities such as lower screening rates and developing strategies to address diagnostic delays is critical. People with intellectual or developmental disabilities were more likely to be diagnosed with metastatic breast and colorectal cancer compared to those without. Action toward more timely cancer diagnoses is needed to avoid unnecessary morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between surgeons thyroidectomy case volume and disease‐free survival (DFS) for patients with well‐differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors. Methods: In this retrospective population‐based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital‐level and surgeon‐level administrative data between 1993 and 2017 (N = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS. Results: A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles (p < 0.001) and higher hospital volume quartiles (p < 0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18–39/year) and low (0–17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI]: 1.09–1.39 and HR: 1.34, 95% CI: 1.17–1.53 respectively) remained an independent statistically significant negative predictor of DFS. Conclusion: Both high‐volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year. Level of Evidence: 3 Laryngoscope, 133:S1–S15, 2023 [ABSTRACT FROM AUTHOR]

Background: A positive relationship between an individual surgeon's operative volume and clinical outcomes after pediatric and adult thyroidectomy is well-established. The impact of a hospital's pediatric operative volume on surgical outcomes and healthcare utilization, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilization outcomes following pediatric thyroidectomy in Canada's largest province, Ontario. Methods: Retrospective analysis of administrative and health-related population-level data from 1993 to 2017. A cohort of 1908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates. Results: Hospitals with the lowest volume of pediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0–1 thyroidectomies/year. The highest-volume hospitals performed 19–60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality. Conclusions: Increased hospital pediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centers. In this cohort, low-volume hospitals were not associated with poorer healthcare utilization outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Performance of thyroidectomy on an outpatient basis has gained popularity although many jurisdictions have not shifted their practice despite a strong safety profile. We sought to assess the uptake and safety of outpatient thyroidectomy in Ontario. Study Design: Retrospective cohort study. Methods: This was a population‐based retrospecive cohort of adult patients undergoing hemithyroidectomy or total thyroidectomy between 1993 and 2017 in Ontario, Canada. Outpatient surgery was defined as discharge home on the same day of surgery. Outcomes of interest include 30‐day all cause death, hematoma, emergency department use, and readmission. To adjust for confounding, propensity scores were calculated. Logistic regression models with inverse probability of treatment weighting (IPTW) were then used to estimate the exposure‐outcome relationship. Results: The final cohort consisted of 81,199 patients: 8,442 underwent same day surgery and 72,757 were admitted. The proportion of patients undergoing outpatient thyroidectomy increased overtime (2.3% in 1993–1994 to 17.8% in 2016–2017). Factors associated with higher odds of outpatient thyroidectomy included: younger age, less material deprivation, less comorbidities, and higher surgeon volume. The absolute number of deaths (≤5) and hematomas (64, 0.8%) in the outpatient cohort was low. After IPTW adjustment, patients with outpatient management had lower odds of neck hematoma (OR 0.73[95CI% 0.58–0.93)], but higher odds of emergency department use (OR 1.67[95%CI 1.56–1.79]). Conclusions: Outpatient thyroidectomy is not associated with an increased mortality risk. Less than one in five patients undergo outpatient thyroidectomy in Ontario, despite a well‐established safety profile. Level of Evidence: 3 Laryngoscope, 131:2625–2633, 2021 [ABSTRACT FROM AUTHOR]

SUMMARY: Heat stress occurring at reproductive stages can result in significant and permanent damage to crop yields. However, previous genetic studies in understanding heat stress response and signaling were performed mostly on seedling and plants at early vegetative stages. Here we identify, using a developmentally defined, gain‐of‐function genetic screen with approximately 18 000 Arabidopsis thaliana activation‐tagged lines, a mutant that maintained productive seed set post‐severe heat stress during flowering. Genome walking indicated this phenotype was caused by the insertion of 35S enhancers adjacent to a nuclear localized transcription factor AtMYB68. Subsequent overexpression analysis confirmed that AtMYB68 was responsible for the reproductive heat tolerance of the mutant. Furthermore, these transgenic Arabidopsis plants exhibited enhanced abscisic acid sensitivity at and post‐germination, reduced transpirational water loss during a drought treatment, and enhanced seed yield under combined heat and drought stress during flowering. Ectopic expression of AtMYB68 in Brassica napus driven either by 35S or by heat‐inducible promoter recapitulated the enhanced reproductive heat stress and drought tolerance phenotypes observed in the transgenic Arabidopsis. The improvement to heat stress is likely due to enhanced pollen viability observed in the transgenic plants. More importantly, the transgenic canola showed significant yield advantages over the non‐transgenic controls in multiple locations, multiple season field trials under various drought and heat stress conditions. Together these results suggest that AtMYB68 regulate plant stress tolerance at the most important yield determining stage of plant development, and is an effective target for crop yield protection under current global climate volatility. Significance Statement: There is a significant gap in our knowledge on how plants cope with heat and drought stresses at the reproductive stages, which is critical for seed yield. Using a developmentally defined, gain‐of‐function genetic screen in Arabidopsis, this study reveals a transcriptional factor for enhancing heat and drought tolerance at yield determining reproductive stages. [ABSTRACT FROM AUTHOR]

Background: Distant metastases (DM) are a leading cause of death for patients with oropharyngeal cancer (OPSCC). The objective of this study was to compare the rates of DM after chemoradiotherapy (CRT) and radiotherapy alone (RT) in patients with human papillomavirus (HPV)‐positive and HPV‐negative OPSCC. Method: In a retrospective population‐based study of 525 patients across Ontario, Canada, in 1998/99/03/04, we compared treatment effectiveness using cumulative incidence function curves and cause‐specific Cox regression models. Results: Sixty of 525 patients developed DM. There was no difference in rates (overall 10%‐15%) between HPV‐positive and HPV‐negative patients or between CRT‐ and RT‐treated patients. CRT reduced the risk of DM for the 15% of all HPV‐positive patients with higher risk (T4 and/or N3) and not for HPV‐negative patients (hazard ratio, 1.82 [0.65‐5.07]). Conclusion: The addition of platin‐based chemotherapy to conventional RT did not decrease the rates of DM in the majority of patients with HPV‐positive or in HPV‐negative OPSSC. [ABSTRACT FROM AUTHOR]

Abstract: Background: Preclinical and early‐phase clinical studies have suggested an oncoprotective role of statins in head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to determine whether incidental statin use in patients with human papillomavirus (HPV)‐negative HNSCC is predictive of improved oncologic outcomes. Methods: A retrospective cohort study of 1194 patients from the Ontario Cancer Registry diagnosed with HNSCC from 2007 to 2012 was performed using linked databases from the Institute for Clinical Evaluative Sciences. Overall survival (OS) and disease‐specific survival (DSS) were compared between patients taking statins and controls. Results: Patients with statin exposure demonstrated improved OS (hazard ratio [HR] 0.758; P = .0011; 95% confidence interval [CI] 0.642‐0.896), and DSS (HR 0.693; P = .0040; 95% CI 0.539‐0.889) compared with those not on statins at the time of diagnosis. Conclusion: Incidental statin use at the time of diagnosis of HPV‐negative squamous cell carcinoma (SCC) of the larynx, hypopharynx, and nasopharynx demonstrated improved OS and DSS. [ABSTRACT FROM AUTHOR]

Abstract: Background: Supraglottic laryngeal carcinoma has an entirely different etiology, clinical presentation, and prognosis compared to glottis cancer but the only evidence for the use of concurrent chemotherapy with radiotherapy (CRT) is the 5.4% 5‐year improvement in overall survival (OS) for the combined laryngeal site. Method: We conducted a retrospective population‐based study using administrative data to compare OS, disease‐specific survival (DSS), laryngectomy‐free survival, and laryngoesophageal dysfunction‐free survival over time and by treatment for all patients with supraglottic laryngeal carcinoma diagnosed between January 1, 1990, and December 31, 2014, in Ontario, Canada. Results: There was no improvement over time in OS (hazard ratio [HR] 1.006; P = .90), DSS (HR 1.031; P = .65), or laryngoesophageal dysfunction‐free survival (P = .39). The patients selected for CRT had similar OS (HR 1.04; P = .66), laryngectomy‐free survival (HR 0.95; P = .23), and laryngoesophageal dysfunction‐free survival (P = .79) compared with patients undergoing radiotherapy. Conclusion: The addition of CRT by head and neck oncologists in Ontario, Canada, did not improve outcomes for the “real world” patients with supraglottic laryngeal carcinoma. [ABSTRACT FROM AUTHOR]

Background: The highest rates of thyroid cancer are observed in Pacific Island nations as well as Australia and Asian countries bordering the Pacific. The objective of this study was to determine the risk for thyroid cancer among immigrants to Canada from Southeast and East Asia compared with immigrants from other regions and nonimmigrants.Methods: This was a population-based, longitudinal cohort study using health care administrative data to examine all residents of Ontario without pre-existing thyroid cancer. Individuals were followed from January 1997 or 5 years after they became eligible for health care coverage in Ontario, whichever came later. Patients were followed until March 2015 for incident-differentiated thyroid cancer, and then for recurrence.Results: The study followed 14,659,733 individuals for a median of 17 years. Thyroid cancer incidence was 43.8 cases per 100,000 person-years among Southeast Asian immigrants, 28.6 cases per 100,000 person-years among East Asian immigrants, 21.5 cases per 100,000 person-years among other immigrants, and 14.5 cases per 100,000 person-years among nonimmigrants. Incidence was highest among immigrants from the Philippines (52.7 cases per 100,000 person-years), South Korea (33.5 cases per 100,000 person-years), and China (30.0 cases per 100,000 person-years). Adjusted hazard ratios for thyroid cancer compared with nonimmigrants were 2.66 (95% confidence interval, 2.48-2.84) for Southeast Asian immigrants, 1.87 (95% confidence interval, 1.75-2.00) for East Asian immigrants, and 1.51 (95% confidence interval, 1.45-1.57) for other immigrants. Immigrants were more likely to have papillary histology and stage I cancer. East Asian immigrants, but not Southeast Asian immigrants, had a lower risk of recurrence (hazard ratio, 0.73 [95% confidence interval, 0.57-0.94] and 1.01 [95% confidence interval, 0.81-1.26], respectively).Conclusions: Immigrants from Southeast and East Asia had markedly higher thyroid cancer incidence than nonimmigrants. At particularly elevated risk were immigrants from the Philippines, South Korea, and China. Cancer 2017;123:3320-5. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: School-aged children with persisting speech sound disorders (SSDs) may show little improvement in speech accuracy following phonological or articulation therapy. Aims: To determine the effects of establishing consonant production in facilitative vowel contexts for a 7-year-old boy (CD) with persisting post-alveolar fronting. CD had received phonological awareness therapy and traditional articulation therapy as part of a community caseload. However, his post-alveolar fronting showed resistance to therapy. Methods & Procedures: CD received individual therapy for nine 45–55-min sessions. A checklist of quality indicators for single-subject research was used to explore the likelihood that a community clinic could meet quality indicators. Fifteen test words in each of target, generalization and control sets were measured at five times pre-, during and post-therapy. A trend analysis was used to measure the statistical significance of the results and to demonstrate the efficacy of therapy. Outcomes & Results: Therapy was successful. Gains on treatment and generalization test items were rapid and significantly higher than gains on control test items. Only three of 21 single-subject research quality indicators were not met in this research. Conclusions & Implications: Targeting facilitative vowel contexts was successful for this 7-year-old boy with persisting post-alveolar fronting which had been resistant to other therapy techniques. Speech and language therapists are encouraged to ensure that quality indicators for single-subject interventions are built into regular practice. [ABSTRACT FROM AUTHOR]

Canola is one of the most important oilseed crops, and its seed yield and quality are significantly affected by environmental stresses such as drought. The phytohormone abscisic acid (ABA) is induced by drought and triggers stomatal closure to reduce transpiration, which accounts for >90% of water loss in plants. The ABA-mediated stomatal response is a dosagedependent process that can be achieved by either increasing the endogenous ABA concentration or by sensitizing the responsiveness of guard cells to the hormone. We summarize the recent breakthroughs in the understanding of key molecular components that regulate the homeostasis and sensing of ABA, and their potential applications in genetic engineering for drought tolerant canola. In particular, the α and β subunits of protein farnesyltransferase have been identified as negative regulators of ABAmediated stomatal responses, and their effectiveness as the targets for engineering drought tolerance and yield protection has been confirmed in canola in the field. Further development of the drought stress tolerance property in the crop will likely have a fundamental impact on its productivity in many regions of the world. [ABSTRACT FROM AUTHOR]