Perinatal Patient Education on Substance Use Risk Factors in the Age of the Opioid Crisis

From 2014 to 2016, NH ranked first for fentanyl and all opioid-related overdose deaths per capita in the United States (Moore et al., 2021). In 2016 the New Hampshire Department of Health and Human Services (NH DHHS) found that there are many repercussions of this opioid crisis including overdose deaths, child and elder abuse, and newborns experiencing withdrawal. In utero substance exposure places a child at a higher risk for developmental, behavioral, and physical health concerns. To address this gap, a secondary data analysis using NH Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2013 to 2020 was conducted. PRAMS data identifies groups of infants and women at high risk for health problems (CDC, 2021). Variables from three domains were analyzed; what healthcare providers talked about with the patient during pregnancy, reported risk behaviors in pregnancy, and postpartum outcomes. The data analysis revealed that over time, more participants have reported conversations with their care providers regarding the substance use risk factors of smoking and abuse. This finding called for a further investigation as to what happened between 2014 and 2017 in terms of prenatal care and healthcare provider conversations. Perinatal care bundles from the Alliance for Innovation on Maternal Health (AIM) work to best address the leading causes of preventable maternal morbidity and mortality (AIM, 2020). The increase and improvement in risk assessment by perinatal providers continues due to the emergence of care bundles that improve the quality and safety of care provided to pregnant women with substance use disorders

Lurbinectedin in patients with pretreated endometrial cancer: results from a phase 2 basket clinical trial and exploratory translational study

Endometrial cancer; Lurbinectedin; Phase 2Càncer d'endometri; Lurbinectedina; Fase 2Cáncer de endometrio; Lurbinectedina; Fase 2Second-line treatment of endometrial cancer is an unmet medical need. Lurbinectedin showed promising antitumor activity in a phase I study in combination with doxorubicin in advanced endometrial cancer. This phase 2 Basket trial evaluated lurbinectedin 3.2 mg/m2 1-h intravenous infusion every 3 weeks in a cohort of 73 patients with pretreated endometrial cancer. The primary endpoint was overall response rate (ORR) according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS), safety and an exploratory translational study. Confirmed complete (CR) and partial response (PR) was reported in two and six patients, respectively (ORR = 11.3%; 95%CI, 5.0-21.0%). Median DoR was 9.2 months (95%CI, 3.4-18.0 months), median PFS was 2.6 months (95%CI, 1.4-4.0 months) and median OS was 9.3 months (95%CI, 6.1-12.8 months). Molecular subtypes showed differences in PFS rate at 6 months (p53abn 23.7% vs. "No Specific Molecular Profile" [NSMP] 42.9%) and median OS (p53abn 6.6 months vs. NSMP 16.1 months). The most common treatment-related adverse events (mostly grade 1/2) were fatigue (54.8% of patients), nausea (50.7%), vomiting (26.0%) decreased appetite (17.8%). and constipation, (19.2%). The most common grade 3/4 toxicity was neutropenia (43.8%; grade 4, 19.2%; febrile neutropenia, 4.1%). In conclusion, considering the exploratory aim of this trial and the hints of antitumor activity observed together with a predictable and manageable safety profile, further biomarker-based development of lurbinectedin is recommended in this indication in combination with other agents. Clinicaltrials.gov identifier: NCT02454972.The study was funded by Pharma Mar S.A, including partial funding by grants from the Centro para el Desarrollo Tecnológico Industrial (CDTI) during the conduct of the study (grant number IDI-20150006). VS is supported by a US National Institutes of Health (NIH) grant (no. R01CA242845 and R01CA273168); MD Anderson Cancer Center Department of Investigational Cancer Therapeutics is supported by the Cancer Prevention and Research Institute of Texas (no. RP1100584), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (no. 1U01 CA180964), NCATS (Center for Clinical and Translational Sciences) Grant (no. UL1 TR000371), and the MD Anderson Cancer Center Support Grant (no. P30 CA016672)

The Effect of iCook 4-H, a Childhood Obesity Prevention Program, on Blood Pressure and Quality of Life in Youth and Adults: A Randomized Control Trial

Objective: Obesity increases the risk of developing hypertension and from population-based samples with estimations that of 2-4% of the U.S. pediatric population has hypertension, which may affect quality of life. This study examined the effects of an obesity prevention program on blood pressure and quality of life in youth and adult participants. Methods: A multi-state research team recruited treatment dyads (youth and their adult meal preparer) to participate in a 12-week randomized control trial and follow-up through 24 months. The treatment group received a cooking and physical activity intervention, followed by booster sessions and mailed newsletters over the remaining two-year period. The control group received no intervention. Resting blood pressure and health related quality of life (HRQOL) surveys were administered at 0,4,12 and 24 months. Results: 228 dyads were recruited (n=77 control and n=151 for treatment). Youth and adult systolic blood pressure (SBP) increased over the 24 months (p=0.003 and p=0.03, respectively) with no differences between groups. From baseline to 24 months both control and treatment youths’ physical and psychological HRQOL increased (p=0.01 and p=0.002, respectively). At 0 and 4 months, youth and adult SBP was positively correlated (r=0.24, p=0.003 and r=0.33, p\u3c0.001, respectively). In the treatment group, there was an inverse association between adult SBP and youth psychological HRQOL at 4 months (r=-0.20, p=0.04), and a similar trend in adult SBP and youth physical HRQOL at 4 months in the treatment group (r=-0.19, p=0.05). Conclusion: A youth-adult dyad obesity prevention program consisting of culinary, mealtime and physical activity education, elicited improvements in HRQOL in youth participants

Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study

OBJECTIVES: To investigate the trajectory of maternal intake of sugar-sweetened beverages (SSB) during the first five years of their child's life and its effect on the child's dental caries at five years-of-age. METHODS: This is an ongoing prospective population-based birth cohort study in Adelaide, Australia. Mothers completed questionnaires on their SSB intake, socioeconomic factors and health behaviors at the birth of their child and at the ages of one, two and five years. Child dental caries measured as decayed, missing, or filled tooth surfaces was collected by oral examination. Maternal SSB intake was used to estimate the trajectory of SSB intake. The trajectories then became the main exposure of the study. Dental caries at age five years were the primary outcomes. Adjusted mean- and prevalence-ratios were estimated for dental caries, controlling for confounders. RESULTS: 879 children had dental examinations at five years-of-age. Group-based trajectory modeling identified three trajectories of maternal SSB intake: 'Stable low' (40.8%), 'Moderate but increasing' (13.6%), and 'High early' trajectory (45.6%). Multivariable regression analysis found children of mothers in the 'High early' and 'Moderate but increasing' groups to have greater experience of dental caries (MR: 1.37 (95%CI 1.01-1.67), and 1.24 (95%CI 0.96-1.60) than those in the 'Stable low' trajectory, respectively. CONCLUSION: Maternal consumption of SSB during pregnancy and in the early postnatal period influenced their offspring's oral health. It is important to create a low-sugar environment from early childhood. The results suggest that health promotion activities need to be delivered to expecting women or soon after childbirth

The Kenya eCookBook: Beans & cereals edition

This edition of the eCookBook was produced in Nairobi and focusses on one of the most energy intensive popular food groups: beans and cereals. The ceramic jiko full of red hot charcoal simmering away beside the kitchen door, with a pot of beans ontop is a familiar sight across Nairobi. Even in 2019, many households with a kerosene, gas or electric stove still cook ‘heavy foods’ like beans on charcoal because most people believe it’s cheaper – as you will see in this eCookBook, it is not

Antitumor activity and safety of the PARP inhibitor rucaparib in patients with high grade ovarian carcinoma and a germline or somatic BRCA1 or BRCA2 mutation: integrated analysis of data from Study 10 and ARIEL2

Objective: An integrated analysis was undertaken to characterize the antitumor activity and safety profile of the oral poly(ADP-ribose) polymerase inhibitor rucaparib in patients with relapsed high-grade ovarian carcinoma (HGOC). Methods: Eligible patients from Study 10 (NCT01482715) and ARIEL2 (NCT01891344) who received a starting dose of oral rucaparib 600 mg twice daily (BID) with or without food were included in these analyses. The integrated efficacy population included patients with HGOC and a deleterious germline or somatic BRCA1 or BRCA2 (BRCA1/2) mutation who received at least two prior chemotherapies and were sensitive, resistant, or refractory to platinum-based chemotherapy. The primary endpoint was investigator-assessed confirmed objective response rate (ORR). Secondary endpoints included duration of response (DOR) and progression-free survival (PFS). The integrated safety population included patients with HGOC who received at least one dose of rucaparib 600 mg BID, irrespective of BRCA1/2 mutation status and prior treatments. Results: In the efficacy population (n = 106), ORR was 53.8% (95% confidence interval [CI], 43.8–63.5); 8.5% and 45.3% of patients achieved complete and partial responses, respectively. Median DOR was 9.2 months (95% CI, 6.6–11.6). In the safety population (n = 377), the most frequent treatment-emergent adverse events (AEs) were nausea, asthenia/fatigue, vomiting, and anemia/hemoglobin decreased. The most common grade ≥ 3 treatment-emergent AE was anemia/hemoglobin decreased. Treatment-emergent AEs led to treatment interruption, dose reduction, and treatment discontinuation in 58.6%, 45.9%, and 9.8% of patients, respectively. No treatment-related deaths occurred. Conclusions: Rucaparib has antitumor activity in advanced BRCA1/2-mutated HGOC and a manageable safety profile

Integrated genomic analyses identify ARID1A and ARID1B alterations in the childhood cancer neuroblastoma

Neuroblastomas are tumors of peripheral sympathetic neurons and are the most common solid tumor in children. To determine the genetic basis for neuroblastoma we performed whole-genome sequencing (6 cases), exome sequencing (16 cases), genome-wide rearrangement analyses (32 cases), and targeted analyses of specific genomic loci (40 cases) using massively parallel sequencing. On average each tumor had 19 somatic alterations in coding genes (range, 3–70). Among genes not previously known to be involved in neuroblastoma, chromosomal deletions and sequence alterations of chromatin remodeling genes, ARID1A and ARID1B, were identified in 8 of 71 tumors (11%) and were associated with early treatment failure and decreased survival. Using tumor-specific structural alterations, we developed an approach to identify rearranged DNA fragments in sera, providing personalized biomarkers for minimal residual disease detection and monitoring. These results highlight dysregulation of chromatin remodeling in pediatric tumorigenesis and provide new approaches for the management of neuroblastoma patients

Meeting Report of the Third Annual Tri-Service Microbiome Consortium Symposium

The Tri-Service Microbiome Consortium (TSMC) was founded to enhance collaboration, coordination, and communication of microbiome research among U.S. Department of Defense (DoD) organizations and to facilitate resource, material and information sharing among consortium members. The 2019 annual symposium was held 22–24 October 2019 at Wright-Patterson Air Force Base in Dayton, OH. Presentations and discussions centered on microbiome-related topics within five broad thematic areas: 1) human microbiomes; 2) transitioning products into Warfighter solutions; 3) environmental microbiomes; 4) engineering microbiomes; and 5) microbiome simulation and characterization. Collectively, the symposium provided an update on the scope of current DoD microbiome research efforts, highlighted innovative research being done in academia and industry that can be leveraged by the DoD, and fostered collaborative opportunities. This report summarizes the presentations and outcomes of the 3rd annual TSMC symposium

Avelumab Alone or in Combination With Chemotherapy Versus Chemotherapy Alone in Platinum-Resistant or Platinum-Refractory Ovarian Cancer (JAVELIN Ovarian 200): An Open-Label, Three-Arm, Randomised, Phase 3 Study

The majority of patients with ovarian cancer will experience relapse and develop platinum-resistant disease after being treated with frontline platinum-based chemotherapy. Treatment options for platinum-resistance or platinum-refractory disease are very limited, usually involving nonplatinum chemotherapy, and they are associated with poor objective response rates and life expectancy