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This qualitative descriptive study analyzed the role that natural mentors had in cultivating a sense of purpose and meaning among 38 diverse male and female high school students. The "types" of mentoring support provided and the students' perceived "experiences" of receiving the support were considered in the analysis. Directed content analysis revealed four initial overarching types of supportive actions that were provided by mentors: emotional, instrumental, informational, and appraisal support. The types of support offered were further categorized across three dimensions of perceived support by the mentees: (a) affirmation (e.g., the experience of emotional and appraisal support), (b) cultivation (e.g., the experience of being challenged and obtaining skills), and (c) guidance (e.g., the experience of receiving information and advice). In order for mentees to perceive and accept cultivation and guidance support, they first needed to experience an affirming relationship with their mentors. Findings may inform best practices for mentoring youth toward lives of meaning and purpose.

Background The role of tyrosine kinase inhibitors (TKIs) in early-stage and metastatic oncogene-driven non–small cell lung cancer (NSCLC) is established, but it remains unknown how best to integrate TKIs with concurrent chemoradiotherapy (cCRT) in locally advanced disease. The phase 2 ASCENT trial assessed the efficacy and safety of afatinib and cCRT with or without surgery in locally advanced epidermal growth factor receptor (EGFR)-mutant NSCLC. Patients and Methods Adults ≥18 years with histologically confirmed stage III (AJCC 7th edition) NSCLC with activating EGFR mutations were enrolled at Mass General and Dana-Farber/Brigham Cancer Centers, Boston, Massachusetts. Patients received induction afatinib 40 mg daily for 2 months, then cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 IV every 3 weeks during RT (definitive or neoadjuvant dosing). Patients with resectable disease underwent surgery. All patients were offered consolidation afatinib for 2 years. The primary endpoint was the objective response rate (ORR) to induction TKI. Secondary endpoints were safety, conversion to operability, progression-free survival (PFS), and overall survival (OS). Analyses were performed on the intention-to-treat population. Results Nineteen patients (median age 56 years; 74% female) were enrolled. ORR to induction afatinib was 63%. Seventeen patients received cCRT; 2/9 previously unresectable became resectable. Ten underwent surgery; 6 had a major or complete pathological response. Thirteen received consolidation afatinib. With a median follow-up of 5.0 years, median PFS and OS were 2.6 (95% CI, 1.4-3.1) and 5.8 years (2.9-NR), respectively. Sixteen recurred or died; 6 recurrences were isolated to CNS. The median time to progression after stopping consolidation TKI was 2.9 months (95% CI, 1.1-7.2). Four developed grade 2 pneumonitis. There were no treatment-related deaths. Conclusion We explored the efficacy of combining TKI with cCRT in oncogene-driven NSCLC. Induction TKI did not compromise subsequent receipt of multimodality therapy. PFS was promising, but the prevalence of CNS-only recurrences and rapid progression after TKI discontinuation speak to unmet needs in measuring and eradicating micrometastatic disease. [ABSTRACT FROM AUTHOR]

Background: In 2009, the Institute of Medicine published revised gestational weight gain (GWG) guidelines with changes notable for altered body mass index (BMI) categorization as per World Health Organization criteria and a stated range of recommended gain (11-20 pounds) for obese women. The goal of this study was to evaluate associations between maternal BMI-specific GWG adherence in the context of these new guidelines and risk of small for gestational age (SGA) and large for gestational age (LGA) neonates. Methods: Subjects were a retrospective cohort of 11,203 live birth singletons delivered at 22-44 weeks at a Massachusetts tertiary care center between April 2006 and March 2010. Primary exposure was GWG adherence (inadequate, appropriate, or excessive) based on BMI-specific recommendations. SGA and LGA were defined as <10th and ≥90th percentiles of U.S. population growth curves, respectively. The association between GWG adherence and SGA and LGA was examined in polytomous logistic regression models that estimated adjusted odds ratios (AOR) stratified by prepregnancy weight status, controlling for potential confounders. Results: Before pregnancy, 3.8% of women were underweight, 50.9% were normal weight, 24.6% were overweight, and 20.6% were obese. Seventeen percent had inadequate GWG, and 57.2% had excessive GWG. Neonates were 9.6% SGA and 8.7% LGA. Inadequate GWG was associated with increased odds of SGA (AOR 2.51, 95% confidence interval [CI] 1.31-4.78 for underweight and AOR 1.78, 95% CI 1.42-2.24 for normal weight women) and decreased odds of LGA (AOR 0.5, 95% CI 0.47-0.73 for normal weight and AOR 0.56, 95% CI 0.34-0.90 for obese women). Excessive GWG was associated with decreased odds of SGA (AOR 0.59, 95% CI 0.47-0.73 for normal weight and AOR 0.64, 95% CI 0.47-0.89 for overweight women) and increased odds of LGA (AOR 1.76, 95% CI 1.38-2.24 for normal weight, AOR 2.99, 95% CI 1.92-4.65 for overweight, and AOR 1.55, 95% CI 1.10-2.19 for obese women). Conclusions: Efforts to optimize GWG are essential to reducing the proportion of SGA and LGA neonates, regardless of prepregnancy BMI. [ABSTRACT FROM AUTHOR]

Background: Our objective was to quantify how the 2009 revisions of the 1990 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines change women's body mass index (BMI) categorization and BMI-specific GWG adherence categories. The goal was to identify how provider counseling practices need to change on a population level. Methods: A retrospective review of automated labor and delivery records from a tertiary care hospital in Central Massachusetts was performed. The study cohort included women who delivered singleton, live birth gestations from from April 1, 2006, to September 30, 2009. Records missing weight, height, GWG, gestational age (GA), and/or GA <22 or >43 weeks were excluded. BMI groups and GWG adherence were categorized according to IOM 1990 and 2009 recommendations. Adherence analyses included full-term gestations only. Results: The cohort consisted of 11,688 women, mean age 28.9 (±6.1) years and mean parity 1.0 (±1.1). By 1990 recommendations, 10.1%, 52.5%, 14.1%, and 23.3% gravidas were low weight, normal weight, high weight, and obese; and 19.8%, 33.3%, and 46.9% were undergainers, appropriate gainers, and overgainers, respectively. By 2009 recommendations, 3.9%, 51.3%, 24.5%, and 20.3% gravidas were underweight, normal weight, overweight, and obese, and 16.7%, 30.8%, and 52.6% were undergainers, appropriate gainers, and overgainers, respectively. Differences in categorization by guideline year was significant for BMI category ( p<0.0001) and GWG adherence ( p<0.0001). Compared to 1990 guidelines, 16.7% of women were classified differently using 2009 guidelines, with fewer classified as underweight, normal weight, or obese and more as overweight; 17.1% of 1990 appropriate gainers would be classified as overgainers, given new guidelines. Conclusions: Changes in IOM GWG recommendations alter gravidas' BMI categories and, thus, the recommended GWG. As the amount advised is associated with actual gain, accuracy is paramount. GWG is a modifiable parameter associated with immediate and long-term maternal/neonatal health outcomes, and counseling can have a significant public health impact and should involve BMI determination, followed by BMI-specific GWG recommendations in accordance with current guidelines. [ABSTRACT FROM AUTHOR]