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Background Peak SARS-CoV-2 viral replication occurs in the upper respiratory tract in presymptomatic and early symptomatic phases. Administration of a monoclonal antibody may be most beneficial in the early time period immediately after symptom onset. Here we describe the effect of early therapy on efficacy in patients receiving ADI. Methods High risk patients with mild or moderate COVID-19 were enrolled in the ADI treatment study (STAMP), with primary endpoint of COVID-19 related hospitalization or all-cause death through Day 29 in patients with disease due to confirmed or suspected SARS-CoV-2 variants other than Omicron. Patients were randomized 1:1 to receive ADI or placebo administered by a single intramuscular (IM) injection. For this subgroup analysis, patients that had received therapy within 3 days of symptom onset were evaluated. Results In the overall population, the study met the primary endpoint demonstrating 66% relative risk reduction of COVID-19 hospitalization or all cause death in 336 patients. Among 261 patients receiving therapy within 3 days of symptom onset (n=133 ADI, n=128 placebo), ADI was associated with a statistically significant reduction in the risk of COVID-19-related hospitalization or all-cause death through Day 29 compared with placebo (4 [3%] vs. 15 [11.7%], standardized risk difference -8%, 95% CI: -14.11, -1.86, p=0.0106), demonstrating a 72% standardized relative risk reduction in favor of ADI. When given as early therapy, ADI provided a greater reduction in viral load from baseline to Day 5 compared with placebo as assessed by saliva samples, with an adjusted least-squares mean difference of -0.97 log10 copies/mL (95% CI: -1.540, -0.391; p=0.0011). No study drug related SAEs, including deaths, and no hypersensitivity reactions were reported. Conclusion Early therapy with a single dose of ADI 300 mg IM provided a 72% reduction in the risk of COVID-19 related hospitalization and all-cause death compared to placebo in high-risk ambulatory patients with mild to moderate COVID-19. Therapy within the first 3 days also led to a greater reduction in viral load compared to placebo and favorable outcomes in patients who are at high risk for progression of disease. Disclosures Kathryn Mahoney, PharmD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Kristin Narayan, PhD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Natalia Betancourt, MS, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Yong Li, PhD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Deepali Gupta, B.Sc, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Pamela Hawn, PharmD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Pete Schmidt, MD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds Myra Popejoy, PharmD, Adagio Therapeutics: Employee|Adagio Therapeutics: Stocks/Bonds.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

Objective. This plain language summary serves as an overview in explaining benign paroxysmal positional vertigo, abbreviated BPPV. This summary applies to patients ≥18 years old with a suspected or potential diagnosis of BPPV and is based on the 2017 “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).” The evidence-based guideline includes research to support more effective diagnosis and treatment of BPPV. The guideline was developed as a quality improvement opportunity for managing BPPV by creating clear recommendations to use in medical practice.

The most common methods of assessing degree of obesity in humans are reviewed. These include anthropometry, somatotyping, bodyweight, skinfold calipering, densitometry, and several nondensitometric procedures. The evidence suggests that bodyweight may often be an unreliable and invalid index of obesity. The parameters influencing its inaccuracy are discussed. These include age, height, sex, muscularity, and degree of obesity or amount of recent weight loss. The most reliable and valid measures of human bodyfat are generally the most complicated and impractical. Compromise assessment procedures involving nonintrusive measurement of subcutaneous fat and selected anthropometric dimensions may offer an incomplete but welcome improvement over sole reliance on bodyweight as an index of obesity.

Kathryn Mahoney, MS W, is a doctoral candidate in psychology, and Michael J. Mahoney, Ph.D., is Assistant Professor, Department of Psychology, Pennsylvania State University, University Park, Pennsylvania. The authors thank Joy Williams Moore and Carol A. Cartwright for their valu able assistance in the preparation of this article. Child placement presents what may well be one of the most difficult contemporary chal lenges to both judicial reform and psycho logical knowledge. The dedication and commitment of child placement profession als are probably equaled only by the monu mental task they face—a task imbued with issues of legal equity, parental and govern mental responsibility, and psychological well-being. Unfortunately, that task has been exacerbated by the absence of long awaited judicial reforms and scientifically founded psychological guidelines. In Beyond the Best Interests of the Child, Goldstein, Freud, and Solnit offer strong suggestions for the reform of child place ment statutes and practices.1 Although such a critical evaluation of judicial guide lines and cultural precedents is long over due, it is important to test empirically the assumptions and recommendations pre sented in this book to see if there is scien