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Julia C Durante,1,2 Jessica Sims,1,2 Jason Jarin,2,3 Melanie A Gold,4 Sarah E Messiah,5– 7 Jenny KR Francis1,2,8 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Children’s Health System of Texas, Dallas, TX, USA; 3Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA; 5University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA; 6Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA; 7Department of Pediatrics, McGovern Medical School, Houston, TX, USA; 8Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Jenny KR Francis, Department of Adolescent & Young Adult Medicine, University of Texas Southwestern/Children’s Health, 2350 N Stemmons Fwy, Ste F5200, Dallas, TX, 75207, USA, Tel +1 214-456-6790, Fax +1 214-456-2230, Email jenny.francis@utsouthwestern.eduAbstract: Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.Keywords: long-acting reversible contraception, LARC, Contraception, adolescent, pregnancy prevention, birth control, communication, contraception counseling

A comprehensive first visit with a gynecologist can lay the groundwork for positive health outcomes throughout a female adolescent's life. This visit gives the clinician the opportunity to gauge both the physical and psychosocial health and development of the adolescent patient. Physical screening should be combined with an assessment of the patient's environment and risk behaviors along with counseling on healthy behavior for both the patient and her parent or guardian. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The current indications for conization of the cervix include a 2-step discrepancy between cervical cytological and histological findings. We sought to determine the utility of a loop electrocautery excision procedure (LEEP) cone for a 2-step discrepancy. METHODS: A retrospective institutional review board-approved chart review was performed on all women recommended to undergo a LEEP secondary to a discrepancy between a referral high-grade squamous intraepithelial lesion cytological finding and a subsequent colposcopic biopsy result revealing either normal or cervical intraepithelial neoplasia (CIN) 1 histological finding; CIN 2 was excluded from the study. Statistical analysis was performed using SAS 9 (SAS Institute, Inc, Cary, NC). The results were considered significant if a p value less than or equal to.05 was demonstrated. RESULTS: Fifty-nine patients received a LEEP for a 2-step discrepancy between cytological and histological findings. Twenty-seven patients had a second pass or LEEP cone. Among the patients with a normal cervical biopsy result and a high-grade cytological finding, 10 (29%) of 34 had normal histological findings, as revealed by LEEP, and 14 (41%) of 34 had CIN 3; 16 (64%) of 25 patients with high-grade cytological finding and CIN 1 biopsy finding had CIN 3, as revealed by LEEP. Compared with patients with an initial normal cervical biopsy result, those with CIN 1 on initial biopsy were more likely to have CIN 3 on their LEEP findings (p =.08). Twenty-seven of 59 patients underwent a LEEP cone surgery; 1 of 27 had CIN 3 finding in the second-pass portion. This was associated with a CIN 3 identified on the first pass and associated with positive margins. The second pass of the LEEP cone failed to demonstrate CIN 96% of the time (p < .0001). Patients with a normal or a CIN 1 finding on the first pass had a normal finding on the second pass in 100% of cases. CONCLUSIONS: A LEEP cone is rarely indicated for the evaluation of a 2-step discrepancy. A randomized trial of this finding is warranted. [ABSTRACT FROM AUTHOR]

PURPOSE: We sought to determine the practices of physicians who prescribe for adolescents extended cycles of combined hormonal contraception, in which hormones are taken for longer than 21 days and menstruation is delayed. METHODS: Five hundred physicians from the membership rosters of the Society for Adolescent Medicine and the North American Society for Pediatric and Adolescent Gynecology were asked to complete an online 39-question survey. RESULTS: The 222 respondents (44% of those contacted) were mostly pediatricians (55%) and gynecologists (34%). Ninety percent reported having ever prescribed extended cycles of hormonal contraception to adolescents, and 33% said extended cycles make up more than 10% of their total combined hormonal contraceptive prescriptions. Respondents most commonly prescribed extended cycles to accommodate patients' requests to induce amenorrhea for specific events (82%) or for fewer menses per year (72%), and to treat menorrhagia (68%), dysmenorrhea (65%), and endometriosis (62%). The most commonly prescribed extended regimen was 84 continuous hormone days followed by 7 hormone-free days (46%), most often with an oral contraceptive containing 30 mug of ethinyl estradiol. Gynecologists were more likely than other physicians to prescribe extended cycles frequently, to prescribe hormone-free intervals shorter than 7 days, and to prescribe continuous regimens that eliminate the hormone-free interval completely. CONCLUSIONS: Physicians prescribe extended cycles of combined hormonal contraceptives to adolescents to accommodate patient requests and to treat common gynecologic conditions. Currently, a variety of extended cycling regimens are prescribed, suggesting that further study is needed to determine the optimal regimen for this subset of patients and their individual needs. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe the use of impulse response measures and observations in Florida classrooms. As a result of measures and observations in 'healthy' and poor acoustical environments, 10 practical recommendations are proposed for improving the acoustical environment in schools. The primary research for these recommendations consisted of recording acoustical measurements of reverberation time and background noise, as well as newer acoustical measurements based on impulse response techniques, in 56 actual classrooms. Observations of classroom situations occurred in a subset of these schools. Computer and physical models of eight classrooms were constructed and tested with varying room finish materials and background noise levels to study the combined effects of these architectural items on speech perception in the model rooms. The primary recommendations all relate to school design and planning. These include air-conditioning system selection and noise control techniques to minimize interference with listening, interior classroom acoustical design principles for maximizing speech perception, and the documentation of teaching methods and classroom arrangements that result in improving speech intelligibility and other factors affecting speech perception. [ABSTRACT FROM AUTHOR]

Abstract As populations age, most industrialized nations are seeking to review the structure for their long term care programs with the goal of allocating better limited public resources to meet expanding needs. In this Commentary, I examine critical questions that define the way individual nations provide for the long term care needs of their aging populations. As examined by Asiskovitch, Israel’s programs appear, in cross-national context, to have a broader reach and rely more heavily on community based services. In the future, the challenge Israel may face involves maintaining aspects of its programs that probably account for its popular support and stability while it identifies better the extent of potential gaps in care for those with greater needs and how best to meet them.

Abstract Background Allergy to peanuts results in severe anaphylactic responses in affected individuals, and has dramatic effects on society and public policy. Despite the health impacts of peanut-induced anaphylaxis (PIA), relatively little is known about immune mechanisms underlying the disease. Using a mouse model of PIA, we evaluated mice with deletions in four distinct immune molecules (IL7Rα, L-selectin, CD34, CD103), for perturbed responses. Methods PIA was induced by intragastric sensitization with peanut antigen and cholera toxin adjuvant, followed by intraperitoneal challenge with crude peanut extract (CPE). Disease outcome was assessed by monitoring body temperature, clinical symptoms, and serum histamine levels. Resistant mice were evaluated for total and antigen specific serum IgE, as well as susceptibility to passive systemic anaphylaxis. Results PIA responses were dramatically reduced in IL7Rα−/− and L-selectin−/− mice, despite normal peanut-specific IgE production and susceptibility to passive systemic anaphylaxis. In contrast, CD34−/− and CD103−/− mice exhibited robust PIA responses, indistinguishable from wild type controls. Conclusions Loss of L-selectin or IL7Rα function is sufficient to impair PIA, while CD34 or CD103 ablation has no effect on disease severity. More broadly, our findings suggest that future food allergy interventions should focus on disrupting sensitization to food allergens and limiting antigen-specific late-phase responses. Conversely, therapies targeting immune cell migration following antigen challenge are unlikely to have significant benefits, particularly considering the rapid kinetics of PIA.

Abstract Background The U.S. Agency for Healthcare Research and Quality's (AHRQ) Integrated Delivery Systems Research Network (IDSRN) program was established to foster public-private collaboration between health services researchers and health care delivery systems. Its broad goal was to link researchers and delivery systems to encourage implementation of research into practice. We evaluated the program to address two primary questions: 1) How successful was IDSRN in generating research findings that could be applied in practice? and 2) What factors facilitate or impede such success? Methods We conducted in-person and telephone interviews with AHRQ staff and nine IDSRN partner organizations and their collaborators, reviewed program documents, analyzed projects funded through the program, and developed case studies of four IDSRN projects judged promising in supporting research implementation. Results Participants reported that the IDSRN structure was valuable in creating closer ties between researchers and participating health systems. Of the 50 completed projects studied, 30 had an operational effect or use. Some kinds of projects were more successful than others in influencing operations. If certain conditions were met, a variety of partnership models successfully supported implementation. An internal champion was necessary for partnerships involving researchers based outside the delivery system. Case studies identified several factors important to success: responsiveness of project work to delivery system needs, ongoing funding to support multiple project phases, and development of applied products or tools that helped users see their operational relevance. Factors limiting success included limited project funding, competing demands on potential research users, and failure to reach the appropriate audience. Conclusion Forging stronger partnerships between researchers and delivery systems has the potential to make research more relevant to users, but these benefits require clear goals and appropriate targeting of resources. Trade-offs are inevitable. The health services research community can best consider such trade-offs and set priorities if there is more dialogue to identify areas and approaches where such partnerships may have the most promise. Though it has unique features, the IDSRN experience is relevant to research implementation in diverse settings.

Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs) and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.

Making emergency contraception available is not harmful, does not discourage other contraceptive use, and may prevent the physical, psychological, and medical consequences of unintended pregnancy. [ABSTRACT FROM AUTHOR]

PURPOSE: This article describes adolescents' attitudes and practices toward body piercing and their awareness of associated health risks. METHODS: An anonymous, 32-item, random, convenience-sample survey was administered to 225 participants, ages 12-21 years, at an urban, hospital-based, adolescent clinic. RESULTS: The mean participant age was 16.5 +/- 2.1 years; 78% were female; and 58% were African-American and 30% were Caucasian. Forty-eight percent had a body piercing. About half of participants (range, 45%-62%) endorsed each site as accepted by the public, except for nipple and genital sites, which fewer than 10% endorsed as accepted. African-Americans were more likely to have pierced noses, and to find that site acceptable, whereas Caucasians were more likely to have pierced navels and nipples, and to find those sites acceptable (odds ratio [OR] range, 3.05-19.37). Youth tended to see their own pierced site as more acceptable and less risky than others did (OR range, 8.99-23.61; effect sizes [r] range, .15-.60). The most common health problems from body piercing reported by participants from their personal experience were infection (10%), allergic reaction (1%), and bruising (1%). The most common health problems from body piercing reported by participants based on others' experiences were infection (74%), bleeding (30%), allergic reaction (26%), bruising (19%), and keloids (19%). Those who were pierced in a body-piercing shop reported more infections (18.4%) than those pierced in other places (1.9%) (OR, 11.49; 95% confidence interval [CI], 1.39-90.91). Youth who had pierced themselves perceived less risk from piercing from a nonprofessional (50%) compared with those pierced by a professional (77%) (p = .003). CONCLUSIONS: Youth from this hospital-based urban adolescent clinic considered body piercings to be generally accepted by the public. Pierced youth in our survey often participated in body piercing practices that they perceived as minimally risky and that they defined as normative. Based on these findings, clinicians should discuss body piercing in the context of providing routine anticipatory guidance to adolescents and should educate adolescents about safer piercing strategies to help minimize associated health risks. [ABSTRACT FROM AUTHOR]

Objectives: Part 1 of the RUBY trial (NCT03981796) demonstrated improved survival in patients with primary advanced or recurrent endometrial cancer (EC) treated with dostarlimab plus carboplatin-paclitaxel versus placebo plus carboplatin-paclitaxel. Here, we examine additional efficacy and safety data from patients with mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) EC in the RUBY trial., Methods: Patients were randomized 1:1 to dostarlimab 500 mg or placebo plus carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab or placebo every 6 weeks for up to 3 years. In the dMMR/MSI-H population of RUBY Part 1, analysis of progression-free survival by investigator assessment compared with blinded independent central review, sensitivity analyses of the source-verified population compared with the randomized population, and analysis of safety in this population were completed., Results: In total, 118 patients with dMMR/MSI-H were enrolled in the RUBY trial (53, dostarlimab arm; 65, placebo arm). At the first interim analysis, a 72% reduction in the risk of progression or death (P < 0.0001) was seen with dostarlimab plus carboplatin-paclitaxel by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1), which was consistent with blinded independent central review per RECIST v1.1. Likewise, sensitivity analyses of the source-verified dMMR/MSI-H population compared with the randomized dMMR/MSI-H population were consistent for progression-free survival and overall survival. Safety results seen in the dMMR/MSI-H population were similar to those previously reported for the overall population., Conclusions: All primary and secondary efficacy assessments demonstrate the consistent benefit of dostarlimab plus carboplatin-paclitaxel. The improvements seen in survival and the manageable safety profile support the favorable benefit-risk profile for dostarlimab plus carboplatin-paclitaxel in patients with dMMR/MSI-H primary advanced or recurrent EC., Competing Interests: Declaration of competing interest Matthew A. Powell reports grants/research support from GSK and honoraria/consultation fees from AstraZeneca, Clovis Oncology, Eisai, GSK, ImmunoGen, and Merck. David Cibula reports participation on an advisory board from Akesobio, AstraZeneca, GSK, MSD, Novocure, Roche, Seagen, and Sotio. David M. O'Malley reports grants from Ajinomoto, BMS, Cerulean Pharma, GOG Foundation, INC Research, InVentiv Health Clinical, Iovance Biotherapeutics, Ludwig Cancer Research, New Mexico Cancer Care Alliance, PRA International, Serono, Stemcentrx, Tracon Pharmaceuticals, and Yale University; has been a consultant/advisory board member for AbbVie, Ambry, Amgen, Array Biopharma, Clovis Oncology, EMD Serono, Ergomed, Janssen/Johnson & Johnson, Myriad Genetics, Novocure, Regeneron, Tarveda, and VentiRx; was a member of a steering committee for Genentech/Roche and Merck; and received personal fees from Agenus, Eisai, GSK and ImmunoGen. Ingrid Boere reports institutional research grant from GSK and institutional advisory board meeting fees from AstraZeneca and GSK. Mark S. Shahin reports institutional grants from AstraZeneca, GSK, and Merck; honoraria from AstraZeneca, GSK, Merck, and Seagen; expert testimony fees from Robinson & Havens PSC, Lexington, KY; advisory board fees from Seagen; and board member for Unite for Her. Antonella Savarese reports institutional funding and provision of study materials from GSK and MSD; institutional funding and provision of study material for other clinical trials from GSK and MSD; honoraria from GSK and MSD; support for attending meetings and/or travel from GSK, MSD, and PharmaMar; and advisory board honoraria from Eisai and MSD. Dana M. Chase reports consultant fees from AstraZeneca and GSK and honoraria from AstraZeneca, GSK, ImmunoGen, and Seagen/Genmab. Lucy Gilbert reports institutional grants from Alkermes, AstraZeneca, Clovis Oncology, Corcept Therapeutics, Esperas, GOG Foundation, GSK, ImmunoGen, IMV, K-Group Beta, Karyopharm Therapeutics, MSD, Mersana Therapeutics, Novocure GmbH, OncoQuest Pharmaceuticals, Roche, Shattuck Labs, Sutro BioPharma, and Tesaro; consulting fees from GSK and Merck; honoraria from CanariaBio, Eisai, Eisai-Merck, GOG Foundation, GSK, ImmunoGen, Kora Healthcare, and Merck; travel support from EndomEra, GOG Foundation, GSK, Merck, and Zentalis; and participation on a data safety monitoring board or advisory board from CanariaBio, Eisai, Eisai-Merck, GOG Foundation, GSK, ImmunoGen, Kora Healthcare, and Merck. Destin Black reports institutional grant fees from GSK; fees for being a member of GOG Partners Investigational Council; and medical director/owner of Trials365, LLC. Jørn Herrstedt reports consultant fees from Elsai. Sudarshan Sharma has nothing to disclose. Stefan Kommoss reports grants from GSK; consulting fees from AstraZeneca, Eisai, GSK, MSD, and Roche; and participating on a data safety monitoring board or advisory board for AstraZeneca, GSK, MSD, and Roche. Michael A. Gold has nothing to disclose. Anna M. Thijs has nothing to disclose. Kari Ring has nothing to disclose. Magnus Frödin Bolling reports press-release comment fees from GSK. Joseph Buscema reports honorarium for participation in an advisory committee from GSK. Sarah E. Gill has nothing to disclose. Paul Nowicki has nothing to disclose. Nicole Nevadunsky has nothing to disclose. Michael Callahan has nothing to disclose. Lyndsay Willmott reports speakers' bureau fees from AstraZeneca, Eisai, ImmunoGen, Merck, and Seagen and advisory board fees from AstraZeneca, ImmunoGen, and Seagen. Carolyn McCourt reports personal royalties <$200 annually from UpToDate and personal honoraria of $200 from the Washington University OB/Gyn annual symposium. Caroline Billingsley has nothing to disclose. Sharad A. Ghamande reports institutional fees from the Georgia Cancer Center for trial and consulting and speakers' bureau fees from GSK and Eisai. Zangdong He, Morad Marco Balas, and Shadi Stevens are employees of GSK. Evelyn Fleming has nothing to disclose. Mansoor Raza Mirza reports reports consulting fees from AstraZeneca, Biocad, GSK, Karyopharm Therapeutics, Merck, Roche, and Zailab; speakers' bureau fees from AstraZeneca and GSK; research funding (to institution) from Apexigen, AstraZeneca, Deciphera (trial chair), GSK, and Ultimovacs; and personal financial interest in Karyopharm Therapeutics (stocks/shares, member of board of directors)., (Copyright © 2024. Published by Elsevier Inc.)

Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.

Background: Part 1 of the RUBY trial (NCT03981796) evaluated dostarlimab plus carboplatin-paclitaxel compared with placebo plus carboplatin-paclitaxel in patients with primary advanced or recurrent endometrial cancer (EC). At the first interim analysis, the trial met one of its dual primary endpoints with statistically significant progression-free survival benefits in the mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations. Overall survival (OS) results are reported from the second interim analysis., Patients and Methods: RUBY is a phase III, global, double-blind, randomized, placebo-controlled trial. Part 1 of RUBY enrolled eligible patients with primary advanced stage III or IV or first recurrent EC who were randomly assigned (1 : 1) to receive either dostarlimab (500 mg) or placebo, plus carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. OS was a dual primary endpoint., Results: A total of 494 patients were randomized (245 in the dostarlimab arm; 249 in the placebo arm). In the overall population, with 51% maturity, RUBY met the dual primary endpoint for OS at this second interim analysis, with a statistically significant reduction in the risk of death [hazard ratio (HR) = 0.69, 95% confidence interval (CI) 0.54-0.89, P = 0.0020] in patients treated with dostarlimab plus carboplatin-paclitaxel versus carboplatin-paclitaxel alone. The risk of death was lower in the dMMR/MSI-H population (HR = 0.32, 95% CI 0.17-0.63, nominal P = 0.0002) and a trend in favor of dostarlimab was seen in the mismatch repair-proficient/microsatellite stable population (HR = 0.79, 95% CI 0.60-1.04, nominal P = 0.0493). The safety profile for dostarlimab plus carboplatin-paclitaxel was consistent with the first interim analysis., Conclusions: Dostarlimab in combination with carboplatin-paclitaxel demonstrated a statistically significant and clinically meaningful OS benefit in the overall population of patients with primary advanced or recurrent EC while demonstrating an acceptable safety profile., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Long-acting reversible contraceptives (LARCs) are effective contraceptive methods for adolescents. This study describes the initiation and continuation of LARC care to adolescents at school-based health centers (SBHCs) during the COVID-19 pandemic. Participants received contraceptive care in New York City SBHCs from April 2021-June 2022. LARC initiation, LARC discontinuation, and total contraceptive visits were measured monthly. During the study period, the SBHCs provided 1,303 contraceptive visits, including 77 LARC initiations. Among LARC initiations, six-month continuation probability was 79.3 % (95 %CI: 69.0-91.1). SBHCs play an important role in providing adolescents contraceptive services, particularly LARC care, when other health care systems are disrupted., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Emergency-department (ED) staff may experience psychologic distress due to the stressful nature of their work. The COVID-19 pandemic exacerbated this distress. Emotional Freedom Techniques (EFT) tapping, a somatic psychophysiologic intervention combining vibratory acupressure with elements of cognitive-behavioral and exposure therapies, can reduce psychologic distress. This study tested the short-term effect of 10-minute EFT tapping on the psychologic distress of pediatric ED staff responding to COVID-19., Materials and Methods: During the COVID-19 pandemic, diverse staff in the pediatric ED of a New York City teaching hospital participated in this single-group study. A licensed creative arts therapist led participants in 10-minute EFT tapping sessions. A self-report questionnaire with 7 items based on the Trauma Exposure Response framework was administered immediately pre- and postintervention. Standardized mean differences between both timepoints were calculated., Results: There were statistically significant reductions for 6 of the 7 items studied, including stress (3.32-2.14), obsessive and intrusive thoughts (2.50-1.85), feelings of pressure (3.20-2.17), loneliness (1.84-1.44), and emotional and physical pain (2.28-1.70); all P  < 0.001. No significant changes in professional satisfaction were reported following the intervention., Conclusions: Despite the limitations of a single-arm study design, a 10-minute brief EFT tapping session was a promising way to reduce short-term psychologic distress in pediatric ED health care workers. Future studies, including rigorous randomized controlled trials, are needed to evaluate the effectiveness of brief EFT tapping interventions in other settings., Competing Interests: Dr. Gold has been a member of the scientific advisory board of the Tapping Solution App since 2020 (an uncompensated role). No financial conflicts of interest exist for the other authors., (Copyright 2024, Mary Ann Liebert, Inc., publishers.)

Purpose: Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease., Methods: This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control., Results: Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents., Conclusion: Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer.

Introduction: This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19., Method: Sequential mixed methods included post-LARC insertion surveys and in-depth interviews., Results: Survey respondents (n = 45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n = 15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits., Discussion: Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome., (Copyright © 2023 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic led to emotional and behavioral challenges for hospitalized pediatric patients, their families, and staff. Visitor restrictions, closure of patient lounges and playrooms, masking requirements, and enhanced isolation rules resulted in limited access to typical sources of psychosocial support during this traumatic event. Complementary and integrative health therapies such as acupuncture and related therapies are well suited to provide the humanitarian support patients and families need during times of crisis., Objective: The Multidisciplinary Support Network (i.e., Network) was formed to redesign the delivery of acupuncture and other integrative therapies alongside psychosocial support for hospitalized children, their families, and staff., Intervention: Network members represented a broad range of previously siloed disciplines including integrative therapies, art therapy, child life, nursing, pastoral care, adolescent medicine, pediatric hospital medicine, psychology, and child and adolescent psychiatry. The Network aimed to identify gaps in service and create resources to support children and families during this challenging time., Results: The Network compiled existing complementary and integrative services, provided training on integrative therapies to staff, pediatric trainees, and faculty, developed the Comfort Box containing items to provide symptom relief including pain, anxiety and difficulty sleeping, as well as closed-circuit programming, a pediatric companionship program connecting medical student volunteer companions with pediatric patients, and a well-being workbook., Conclusion: Collaborative teamwork across disciplines using integrative therapies was key to humanitarian efforts to support hospitalized children and their families during this crisis., Competing Interests: No competing financial interests exist., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Background: Dostarlimab is an immune-checkpoint inhibitor that targets the programmed cell death 1 receptor. The combination of chemotherapy and immunotherapy may have synergistic effects in the treatment of endometrial cancer., Methods: We conducted a phase 3, global, double-blind, randomized, placebo-controlled trial. Eligible patients with primary advanced stage III or IV or first recurrent endometrial cancer were randomly assigned in a 1:1 ratio to receive either dostarlimab (500 mg) or placebo, plus carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) and paclitaxel (175 mg per square meter of body-surface area), every 3 weeks (six cycles), followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. The primary end points were progression-free survival as assessed by the investigator according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and overall survival. Safety was also assessed., Results: Of the 494 patients who underwent randomization, 118 (23.9%) had mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors. In the dMMR-MSI-H population, estimated progression-free survival at 24 months was 61.4% (95% confidence interval [CI], 46.3 to 73.4) in the dostarlimab group and 15.7% (95% CI, 7.2 to 27.0) in the placebo group (hazard ratio for progression or death, 0.28; 95% CI, 0.16 to 0.50; P<0.001). In the overall population, progression-free survival at 24 months was 36.1% (95% CI, 29.3 to 42.9) in the dostarlimab group and 18.1% (95% CI, 13.0 to 23.9) in the placebo group (hazard ratio, 0.64; 95% CI, 0.51 to 0.80; P<0.001). Overall survival at 24 months was 71.3% (95% CI, 64.5 to 77.1) with dostarlimab and 56.0% (95% CI, 48.9 to 62.5) with placebo (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.87). The most common adverse events that occurred or worsened during treatment were nausea (53.9% of the patients in the dostarlimab group and 45.9% of those in the placebo group), alopecia (53.5% and 50.0%), and fatigue (51.9% and 54.5%). Severe and serious adverse events were more frequent in the dostarlimab group than in the placebo group., Conclusions: Dostarlimab plus carboplatin-paclitaxel significantly increased progression-free survival among patients with primary advanced or recurrent endometrial cancer, with a substantial benefit in the dMMR-MSI-H population. (Funded by GSK; RUBY ClinicalTrials.gov number, NCT03981796.)., (Copyright © 2023 Massachusetts Medical Society.)

Objective: Detection of lymph node metastases in cervical cancer patients is important for guiding treatment decisions, however accuracies of current detection methods are limited. We evaluated associations of abnormal glycosylation, represented by Tn and STn antigens on mucin (MUC) proteins, in primary tumor specimens with lymph node metastasis or recurrence of cervical cancer patients., Methods: Surgical specimens were prospectively collected from 139 patients with locally-advanced cervical cancer undergoing lymphadenectomy enrolled in a nation-wide clinical trial (NCT00460356). Of these patients, 133 had primary cervix tumor, 67 had pelvic lymph node (PLN) and 28 had para-aortic lymph node (PALN) specimens. Fixed tissue serial sections were immunohistochemically stained for Tn, STn, MUC1 or MUC4. Neuraminidase was used to validate Tn versus STn antibody specificity. Stain scores were compared with clinical characteristics., Results: Primary tumor STn expression above the median was associated with negative PLN status (p-value: 0.0387; odds ratio 0.439, 95% CI: 0.206 to 0.935). PLN had higher STn compared to primary tumor, while primary tumor had higher MUC1 compared to PALN, and MUC4 compared to PALN or PLN (p = 0.017, p = 0.011, p = 0.016 and p < 0.001, respectively). Tn and STn expression correlated in primary tumor, PALN, and PLN, Tn and MUC1 expression correlated in primary tumors only (Spearman correlation coefficient [r] = 0.301, r = 0.686, r = 0.603 and r = 0.249, respectively)., Conclusions: STn antigen expression in primary cervical tumors is a candidate biomarker for guiding treatment decisions and for mechanistic involvement in PLN metastases., Competing Interests: Declaration of Competing Interest Dr. Wei Deng, Dr. Christopher West, Dr. Rajani Rai, Dr. Rachel Conrad, Mrs. Hanke van der Wel, Dr. Sanam Husain, Dr. Mae Zakhour, Dr. Amanda Jackson and Dr. Doris Benbrook have no conflicts of interest to disclose. Dr. Michael Gold reports receiving honoraria from ASCCP as well as serving as a past member of the Board as well as serving as Secretary, Treasurer, Vice-President, and President for ASCCP. Dr. Moore reports personal fees and other from Astra Zeneca, grants, personal fees and other from Genentech/Roche, grants, personal fees and other from Immunogen, grants, personal fees and other from GSK/Tesaro, other from Pfizer, personal fees from Aravive, personal fees from VBL Therapeutics, personal fees and other from Onco Med, grants and other from Lilly, personal fees from Eisai, personal fees from Vavotar, personal fees from Abbvie, personal fees from Tarveda, personal fees from Myriad, personal fees from Rubius, personal fees from Elevar, personal fees from Merck, personal fees from Mersana, personal fees from Sorrento, personal fees from OncXerna, personal fees from Alkemeres, personal fees from blueprint pharmaceuticals, personal fees from Mereo, personal fees from IMab, outside the submitted work; and serves as the Associate Director for GOG Partners and a GOG Foundation Board of Directors member. Dr. Nick Spirtos would like to disclose receiving research funding to his Institution from AbbVie, AstraZeneca, Genentech/Roche, Clovis Oncology, and Seattle Genetics. With regard to Patents, Royalties, and Other Intellectual Property, Dr. Spirtos wishes to disclose Application No. PCT/US 2019/19465 Cannabis based therapeutic and method of use Application No. Title Country Status Filed Date Application No. Patent Ref. No.199236–701,611/EP Title: CANNABIS BASED THERAPEUTIC AND METHOD OF USE Country: European Patent Status: Published 2/25/2019 19,710,540.6 Patent Ref. No.199236–701,691/PCT-BR Title: CANNABIS BASED THERAPEUTIC AND METHOD OF USE Country Brazil Status: Application 2/25/2019 1,120,200,170,232 Patent Ref. No.199236–701,831/PCT-US Title: CANNABIS BASED THERAPEUTIC AND METHOD OF USE Country United States of America Status: Published 2/25/2019 16/971,781 Patent Ref. No.199236–701,891/HK Title: CANNABIS BASED THERAPEUTIC AND METHOD OF USE Country Hong Kong Status: Published 6/25/2021 62,021,033,676.9 Patent Ref. No. Title Country Status Filed Date Application No. Patent Ref. No.199237–701,601/PCT Title: COMPOSITIONS COMPRISING CANNABIDIOL AND FLAVANONES Country: Patent Cooperation Treaty Status: Application 7/1/2021 PCT/US21/40115 Patent Ref. No.199237–701,691/BR Title: COMPOSITIONS COMPRISING CANNABIDIOL AND FLAVANONES Country: Brazil Status: Application 11/19/2020 1,020,200,236,644 Patent Ref. No.199237–7,019,761/UY Title: COMPOSITIONS COMPRISING AND FLAVANONES Country: Uruguay Status: Application 11/20/2020 38,965. Dr. Cara Mathews reports receiving funding from the NCI to her institution. Dr. Mathews also reports funding from Syros, Decophera, Astellas Pharma, Tesaro/GSK, Seattle Genetics, Regeneron, Moderna, Laekna Therapeutics, outside of the submitted work. In addition, Dr. Mathews reports receiving support from GSK and Seattle Genetics to attend investigator meetings and served on an Advisory Board for IMAB Biopharma., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Context: Probiotics have been proposed as a prevention or treatment for pediatric overweight and obesity. Objective: Conduct a scoping review on probiotic use in children and adolescents with overweight or obesity and those with weight-related conditions and to identify knowledge gaps and research priorities. Data Sources: Seven databases using keywords and medical subject heading terms for articles reporting probiotic use in children or adolescents with overweight or obesity published from database conception until initiation of the study. Study Selection: Articles reporting primary data on probiotics use in children or adolescents with overweight or obesity. Data Extraction: We utilized the Arksey and O'Malley framework, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, followed a predetermined study protocol for level-one abstract and level-two full-text screenings, synthesized information into subject-area domains, and identified research gaps. Limitations: Heterogeneity of probiotic interventions, host factors, and genomics. Results: Database search yielded 1356 unique articles with 19 randomized placebo-controlled studies, 945 participants, duration of interventions from 8 weeks to 9 months. Disease indications included Nonalcoholic Fatty Liver Disease, insulin resistance, hypercholesterolemia, Prader-Willi Syndrome, metabolic syndrome, and obesity. Limited and heterogeneous evidence for probiotic use in children and adolescents with weight-related conditions noted. Heterogeneity among published articles in probiotic strains, doses, design, biomarkers, confirmation, and outcomes observed. Conclusions: Despite complex existing and limited data, studies to date of children and adolescents with overweight and obesity demonstrate potential beneficial treatment effects of probiotics on BMI, adiposity, metabolic parameters, inflammatory markers, fatty liver, transaminase levels, and glucose metabolism. Clinical trials to address heterogeneous results are needed.

Objective: The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants., Methods: The LIVES study (NRG Oncology/GOG 0225) is a Phase III diet plus physical activity intervention trial testing the hypothesis that ovarian cancer survivors in the lifestyle intervention will demonstrate better progression-free survival than those in the control condition. Study interventions were delivered via centralized telephone-based health coaching. Baseline descriptive statistics were computed for demographic, clinical, and lifestyle behavior characteristics., Results: The LIVES study exceeded its recruitment goals, enrolling 1205 ovarian cancer survivors from 195 NRG/NCORP-affiliated oncology practices across 49 states from 2012 to 2018. The mean age of enrollees was 59.6 years; the majority (69.4%) with stage III disease; 89% White, 5.5% Hispanic; 64% overweight/obese. Baseline self-reported diet showed a mean daily intake of 6.6 servings of fruit and vegetables, 62.7 fat grams, and 21.7 g of fiber. Physical activity averaged 13.0 MET-hours/week of moderate to vigorous physical activity; 50.9 h/week of sedentary time. Retention rates exceeded 88%., Conclusion: The LIVES study demonstrates efficiency in recruiting and retaining ovarian cancer survivors in a 24-month study of diet and physical activity intervention with a primary endpoint of progression free survival that will be reported., Trial Registration: ClinicalTrials.govNCT00719303., Competing Interests: Declaration of Competing Interest Dr. Austin Miller reports that his institution received grants from the following: Vascular Biogenics LTD, Advaxis, Abbvie. Dr. Miller also reports participating on the Steering Committee for AstraZeneca as well as receiving institutional support from both Regeneron and GSK. Dr. Michael Gold received honoraria from ASCCP as an Educational Course Speaker. Dr. Matthew Powell received support from the NIH/NIH to NCTN NRG Oncology Network. Dr. Powell also reports participating on Advisory Boards for the following entities: GSK/Tesaro, Clovis Oncology, Merck, AstraZeneca, Eisai and SeaGen. Dr. Kristin Bixel reports receiving intuitive unrestricted research grant to the GOG for funding of randomized controlled trial (ROCC). Additionally, Dr. Bixel reports serving on Advisory Boards for Intuitive and Merck and receiving honoraria from both of these entities. Dr. Ratner reports receiving consulting fees from Aspire and has stock in same. Dr. Warner Huh reports receiving consulting fees from AstraZeneca and receiving payment for expert testimony from Shook, Hardy & Bacon LLP. Dr. Basen-Engquist reports MPI, R01CA186700, Study of biomarkers in ovarian cancer: Modulation by activity & diet intervention, MD Anderson subcontract from University of Arizona. She also receives grant from NCI, R21CA239079, Reducing breast cancer risk through modifying boy composition and decreasing inflammation in normal weight women. Dr. Basen-Engquist also reports pilot study grant from NCI, R21 CA215410 as well as receiving funding from Cancer Prevention & Research Institute of Texas: PP170023 &PP200028, Active Living After Cancer: Combining a physical activity program with survivor navigation and she received honoraria for Speaking from the both NCI as well as the University of New Mexico Cancer Center, Gynecologic Oncology Group and Yale University for Faculty TREC training program. Dr. Basen-Engquist also reports receiving support for travel from the National Cancer Policy Forum, National Academies of Science, Engineering, and Medicine and Yale University. She also participated as an Independent Safety Monitor for Boston University, digital health supported weight management intervention delivered by community health workers among public housing residents (R01CA238335). Dr. Basen-Engquist reports serving as President of the American Society of Preventive Oncology. Dr. Walker reports serving in a leadership role for NCORP. Dr. Lisa Kachnic reports NCI NCORP Funding and serving as Associate NCORP PI Support and Chair of Cancer Control Support. All other authors have no conflict of interest related to this manuscript., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To inform the development of a combined sleep and mind-body integrative health (MBIH) intervention, we explored urban adolescents' sleep experiences and perceptions of MBIH techniques., Methods: We conducted eight focus groups with school-based health center patients in New York City, exploring sleep experiences; mindfulness, body awareness, tapping, acupressure, and self-hypnosis; and intervention delivery preferences. We recorded, transcribed, and analyzed the discussions applying methods from grounded theory., Results: Participants (n = 25) were ages 14-17, predominantly female (64%), Latino (60%), and Black (40%). Participants reported social, physical, and internal sleep barriers, but had limited success implementing sleep improvement strategies. Participants viewed MBIH techniques positively, noted audio-guided techniques' accessibility, and were intrigued by less-familiar techniques. Preferences varied around domains of intervention delivery., Conclusion: Results underscore the need for adolescent-informed interventions offering sleep improvement strategies. Participants' interest and willingness to engage in MBIH techniques present an opportunity for practitioners to develop and deliver sleep interventions incorporating MBIH components to urban adolescents. Varied intervention preferences highlight the need to be adaptable to adolescents' lived experiences, comfort levels, and learning styles., Innovation: This study elucidates the perspectives of underrepresented adolescents whose perspectives on MBIH have rarely been explored, an important first step in developing tailored interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)