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Simple Summary: Randomized clinical trials show a survival benefit associated with immuno-molecular therapy (IMT) use in metastatic or recurrent cervical cancer. This study investigated IMT use and survival in stage IVB cervical cancer patients in Commission on Cancer® (CoC)®-accredited facilities. Patients diagnosed with stage IVB cervical cancer in the National Cancer Database and treated with first-line therapy with chemotherapy alone or with radiotherapy ± IMT were studied. Adjusted risks of death were estimated in patients treated with ±IMT after applying a propensity score analysis to balance the clinical covariates. There were 3164 evaluable patients, including 31% who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. In propensity-score-balanced patients, the median survival was 5 months longer with vs. without IMT. The adjusted risk of death was 28% lower following treatment with vs. without IMT. IMT was associated with a consistent survival benefit in real-world patients in (CoC)®-accredited facilities with stage IVB cervical cancer. Purpose: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. Methods: Patients diagnosed with stage IVB cervical cancer during 2013–2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. Results: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64–0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. Conclusions: IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationships among mean combined relative grip strength (MCRGS), the metabolic syndrome (MetS), and the individual MetS criterion using a nationally representative sample of U.S. adults (≥20 years of age). The study sample included subjects from the 2011-2014 National Health and Nutrition Examination Study (NHANES). Subject MCRGS, using an average of 3 attempts per hand, was measured by a trained examiner using a handgrip dynamometer. All anthropometric, blood pressure, and serum blood measures used to diagnose the MetS were obtained in a Mobile Examination Center using a subsample of NHANES subjects (N = 4,664). Results suggest a favorable inverse dose-response relationship exists across quartiles of increased MCRGS and likelihood of MetS in both men and women (p < 0.0001 for trend). In analyses adjusted for age, race, education, and meeting aerobic physical activity recommendations, when compared with a referent group in the lowest quartile of MCRGS (MCRGS <2.66 kg/body mass index [BMI] in men; MCRGS <1.58 kg/BMI in women), those in the third (MCRGS >3.20-3.77 kg/BMI in men; MCRGS >1.99-2.38 kg/BMI in women) and fourth quartile (MCRGS >3.77 kg/BMI in men; MCRGS >2.38 kg/BMI in women), were significantly less likely to have the MetS, independent of gender (p ≤ 0.05 for all). Similar findings varied according to individual MetS criterion. These findings provide the first data suggesting that increased MCRGS may be inversely related to the MetS or the individual MetS criterion in a nationally representative sample of U.S. adults. [ABSTRACT FROM AUTHOR]

Background To examine the associations between levels of severity of mental distress (MD) and meeting the 2008 physical activity (PA) recommendations using the MD Severity Index (MDSI). Methods Participants (n = 431 313) were adults (≥18 years of age) who responded to the 2011 Behavioral Risk Factor Surveillance System (BRFSS). MD was categorized into five levels of severity: 0–4, 5–10, 11–16, 17–22 and ≥23 days/month. The dependent variable was self-reported PA volume of at least 150 min/wk (or vigorous equivalent, 75 min/wk). Results Following adjustment for age, gender, race/ethnicity, education and body mass index, the odds of reporting meeting the PA recommendations were significantly lower among those reporting the following days per month of MD: 5–10 (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.87–0.96), 11–16 (OR = 0.76, 95% CI: 0.71–0.82), 17–22 (OR = 0.69, 95% CI: 0.62–0.76) and ≥23 (OR = 0.64, 95% CI: 0.60–0.67). An inverse dose–response (P < 0.01) was observed between the severity of MD and meeting the current PA recommendations. Conclusions An inverse dose–response relationship was found between the severity of MD and volumes of PA meeting the 2008 recommendation. These findings lend support for the epidemiological utility of the MDSI when examining the relationship between MD and PA. [ABSTRACT FROM AUTHOR]

Several proposals for addressing religious literacy or including religious content in American public schools point to potential advantages for intellectual and moral development. These proposals include moral arguments, which suggest that religious literacy is an individual and social good. Although the proposals selected for this analysis span the previous two decades, it appears that little progress has been made toward addressing religious literacy in American public school contexts. In this theoretical article, I examine several of these proposals using a philosophical contrast between weak and strong relationality. It is argued that although these proposals include strong relational assumptions, weak relational assumptions remain that could inhibit the successful implementation of these proposals—or perhaps even undermine their ultimate goals. [ABSTRACT FROM PUBLISHER]

Objectives: To evaluate the difference in oral human papillomavirus (HPV) positive prevalence among heterosexual men and women in the United States between 2011 and 2016. Methods: Data on respondents were obtained from the National Health and Nutrition Examination Survey from 2011-2016. Sexual orientation was self-reported by respondents. Oral rinse specimens obtained from the mobile examination centers were used to determine whether the respondents tested positive or negative for any of the 37 HPV strains and 14 high-risk HPV strains. Results: Of 7,333 respondents, 3530 (48.8%) identified as heterosexual males and 3803 (51.2%) as heterosexual females. Among the respondents, 9.1% (n =345) of males had oral HPV compared to 2.6% (n =119) of females (p<0.001). On multivariate analysis, we found that being divorced/separated (OR: 1.83, 95% CI: 1.05-3.2) and being a current smoker (OR: 1.56, 95% CI: 1.15-2.11) were independent predictors of testing positive for any oral HPV. On subset analysis of high-risk HPV strains, we found that 5.1% of men compared to 1.1% of women tested positive for any high-risk strain (p<0.0001). On multivariate analysis, we found that being male (OR: 4.45, 95% CI: 2.94-6.74), having five or more lifetime sexual partners (OR:7.15, 95% CI: 1.94-26.3), and having three to four alcoholic drinks per day (OR: 1.63, 95% CI: 1.05-2.55) were independent predictors of testing positive for any high-risk oral HPV. Other factors, such as age, education, smoking, and marital status, were not predictive of HPV infection. Conclusions: There is a higher prevalence of any and high-risk oral HPV in men compared to women. Given the increasing incidence of head and neck cancers, screening for high-risk individuals warrants consideration. [ABSTRACT FROM AUTHOR]

Objective: To use gender-stratified logistic regression analysis to examine the associations between elevated C-reactive protein (CRP; >3-10 mg/L) and sleep duration.Methods: The study sample included male (n = 5033) and female (n = 4917) adult (20 years old and older) participants in the 2007-2010 National Health and Nutrition Examination Survey. Sleep duration was categorized as short (≤6 hours/day), adequate (7-8 hours/day), or long (≥9 hours/day). Logistic regression models were adjusted for age, race, smoking status, physical activity, and waist circumference.Results: Analysis revealed significantly (P = 0.0151) higher odds of elevated CRP in men reporting ≤6 hours/day of sleep (odds ratio 1.26, 95% confidence interval 1.05-1.52) when compared with a referent group of men reporting 7 to 8 hours/day of sleep. Similar associations were not revealed in women.Conclusions: Short sleep duration was significantly associated with elevated serum CRP concentration independent of waist circumference and moderate physical activity in men but not in women. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the difference in HPV positive prevalence in heterosexual women compared to lesbian and bisexual women in the United States between 2011 and 2016. Methods: Data on female respondents were obtained from the National Health and Nutrition Examination Survey from 2011 to 2016. Sexual orientation was self-reported by respondents. HPV infection was detected through vaginal swab samples and analyzed using the Roche Linear Array HPV genotyping test. Results: Of 3,656 respondents, 3,461 (94.5%) self-identified as straight/heterosexual and 195 (5.5%) as lesbian or bisexual. A total of 35.7% (n =1,379) of heterosexual women tested positive for any genital HPV compared to 41.6% (n =91) of lesbian or bisexual women (p=0.2). For heterosexual respondents, factors associated with positive HPV status included young age versus old age (40.0% vs 31.6%, p=0.002), more than four lifetime partners (47.1% vs 25.2%, p<0.0001), lower education (41.9% vs 33.2%, p<0.0001), below poverty line and low income versus middle and high income (44.3% and 43.5% vs 33.8% and 28.3%, p<0.0001), and divorced/separated and single versus married/living with partner (57.3% and 48.6% vs 27.8%, p<0.0001). For lesbian or bisexual respondents, the only factor associated with positive HPV was four or more lifetime partners (49.4% vs 29.9%, p=0.02). On multivariate analysis, we found that younger age (OR: 1.52, 95% CI: 1.2-1.93), divorced/separated (OR: 1.71, 95% CI: 1.21-2.43), and more than four lifetime sexual partners (OR: 2.5, 95% CI: 2.04-3.17) were independent predictors for testing positive for genital HPV. There was no difference by self-identified sexual orientation. On intersection analysis, we found that younger women who were divorced/separated and had more than four lifetime sexual partners were at the highest risk, with a prevalence of 72.3% testing positive for any genital HPV and 35.2% for any high-risk HPV. Conclusions: There was no difference in the prevalence of HPV infection based on sexual orientation. Age, marital status, and the number of lifetime sexual partners were independent factors associated with HPV infection. [ABSTRACT FROM AUTHOR]

To evaluate the incidence and genetic profiling trends in uterine cancer for women younger than 50 years of age in the United States. Incidence rates were estimated from the United States Cancer Statistics (USCS) program for uterine cancers diagnosed at < 50 years old between 2001 and 2016 after correcting for hysterectomy and pregnancy prevalence from the Behavioral Risk Factor Surveillance System. SEER*Stat and Joinpoint regression were used to calculate the incidence rate (per 100,000) and average annual percent change (AAPC). Data from National Cancer Institute Genomic Data Commons Data Portal including The Cancer Genome Atlas Program (TCGA) were obtained to compare genomic profiles by age. There were 93,693 eligible women diagnosed <50 years old with uterine cancer between 2001 to 2016. The highest incidence was reported for women between the ages of 45 and 49 years old (33.84/100,000) compared with the younger cohorts (<45 years old). In addition, uterine cancer incidence per 100,000 increased between 2001 and 2016 for each age group<45 years of age including those 30-34 years old (3.8 to 5.8), 35-39 years old (7.7 to 11.4) and 40-44 years old (15.8 to 19.9, all p<0.001). The highest annual increase in uterine cancer diagnosed in the 30-34 year old age group was 4.4% for Hispanic women compared with 3.5% for Black women and 1.5% for White women. We then evaluated a panel of targetable molecular markers in young women diagnosed with uterine cancer at <50 years old (n=96) relative to older women diagnosed ≥50 years old (n=1,005). Tumors from younger women were more likely to express BRCA1 (11% vs. 4%; P=0.004), BRCA2 (14% vs. 8%; P=0.06), CDK12 (9% vs 4%; P=0.02), POLE (15% vs 8%; P=0.02), and less likely to express TP53 (14% vs 27%; P=0.005). The incidence of uterine cancer in young women is increasing in the United States, especially for Black and Hispanic women. Tumors from younger patients may have molecular markers associated with targetable agents and may portend better prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Much of the excessive morbidity and mortality from cardiovascular disease among African Americans results from low adherence to anti-hypertensive medications. Therefore, we examined the association between weight-based discrimination and medication adherence. Methods: We used cross-sectional data from low-income African Americans with hypertension. Ordinal logistic regression estimated the odds of medication non-adherence in relation to weight-based discrimination adjusted for age, sex, education, income, and weight. Results: Of all participants (n = 780), the mean (SD) age was 53.7 (9.9) years and the mean (SD) weight was 210.1 (52.8) lbs. Reports of weight-based discrimination were frequent (28.2%). Weight-based discrimination (but not weight itself) was associated with medication non-adherence (OR: 1.94; 95% CI: 1.41-2.67). A substantial portion 38.9% (95% CI: 19.0%-79.0%) of the association between weight-based discrimination and medication non-adherence was mediated by medication self-efficacy. Conclusion: Self-efficacy is a potential explanatory factor for the association between reported weight-based discrimination and medication non-adherence. Future research should develop and test interventions to prevent weight-based discrimination at the societal, provider, and institutional levels. [ABSTRACT FROM AUTHOR]

The article focuses on the issue of monopoly on digital distribution and examines the divergent relationship between contract law, copyright law and property law when applied to tangible personal property as opposed to intangible digital property. Topics include current state of U.S. law on digital property stated to prohibit end users from acquiring ownership of digital property due to its reliance on contracts of adhesion and the role played by contracts of adhesion in digital transfers.

After decades of refining their brand of educational system, China and the United States have recently embarked on extraordinary changes and modifications that could have long-term consequences. China is moving from a very controlled and disciplined education system, while the United States is rapidly changing to a very controlled and disciplined education system. Chinese education is becoming more innovative and creative, while the United States is becoming less expressive. The two countries are looking at each other and changing education to match their competitor. The long-term consequences are unknown but a few implications are obvious. [ABSTRACT FROM AUTHOR]

Bermudagrass (Cynodon spp.) and zoysiagrass [Zoysia spp. (Willd.)] are two of the most commonly used turfgrass species in the southern United States. Shade from trees is common on golf courses and limits turfgrass growth. Additionally, turfgrasses used on golf courses and sports fields are often subjected to traffic. The objective of this study was to evaluate shade and traffic effects on bermudagrass and zoysiagrass. Two shade treatments were imposed, full sun or 49% shade, using a light reducing fabric. A Cady Traffic Simulator was used to implement traffic stress. The cultivars with the highest coverage in shade without traffic were Cavalier', `Diamond', 'El Toro', 'Meyer', 'Palisades', and Zorro' zoysiagrass, as well as 'Princess 77' and `Riviera' bermudagrass. 'Patriot', `Tifsport', and Tifway' bermudagrass and `Zenith' zoysiagrass typically had the lowest coverage. Patriot bermudagrass and Zenith zoysiagrass consistently had the lowest coverage in shaded trafficked plots. El Toro, Palisades, and Zorro zoysiagrass as well as Princess 77, Riviera, Tifsport, and Tifway bermudagrass had the highest coverage (>72%) when trafficked under full sun for 4 wk. Coverage in shaded plots was decreased more from traffic than full-sun plots. Riviera and Tifway bermudagrass had the most coverage after 6 wk of traffic in full sun. These studies identified cultivars of bermudagrass and zoysiagrass that perform better under reduced light and traffic stress. [ABSTRACT FROM AUTHOR]

Few research studies have examined how screening outcomes may be different or similar for males and females, despite evidence that male students outnumber female students in special education populations and are more likely to experience school failure. During the 3 years of this study, 15,932 students in Grades 6 through 9 were screened with the use of a modified version of the Systematic Screening for Behavior Disorders (SSBD). Within this period, 1,065 nominations were collected for students identified as at risk for internalizing and externalizing problems, of which 77.4% were male. The average ratio of males to females nominated was approximately 5:1 for externalizing behaviors, 2:1 for internalizing behaviors, and 3:1 for total nominations. Reliability coefficients on the Adaptive and Maladaptive scales from the SSBD Stage 2 were comparable for both genders as determined by Fisher’s z tests. On the Adaptive scale, female students tended to be rated higher by their teachers. A multivariate analysis (general linear model) was conducted to examine gender socioeconomic status, and the internalizing—externalizing dimension at SSBD Stage 1 as predictors of scores on the three SSBD Stage 2 scales (Critical Events, Adaptive, and Maladaptive). [ABSTRACT FROM AUTHOR]

The use of music as a therapeutic tool in health and medicine dates back to ancient times. In modern Western medicine, music therapy has been available since the 1950s and is now often incorporated into conventional medicine care. Music therapy is a common modality that is used in hospital settings as part of complementary and integrative medicine programs. It is also a key therapeutic tool used within most integrative medicine programs at large cancer centers in the United States. When used in conjunction with conventional cancer treatments, music therapy has been found to help patients promote a better quality of life; better communicate their fear, sadness, or other feelings; and better manage stress, while alleviating physical pain and discomfort. In this article, we review the literature on the value of integrating music therapy in cancer care and describe the experience of music therapy at a large comprehensive cancer center and the benefits that patients with cancer obtain from this service. [ABSTRACT FROM AUTHOR]

This paper presents results and analysis from exercising an aquatic mine burial prediction (MBP) system based on deterministic models to simulate impact and scour burial experiments using operational or operational-like inputs. Based on nonparametric hypothesis testing of simulation results with empirical data, the statistics generated from simulations of impact burial appear to provide useful predictions and uncertainty estimates when the simulations account for geotechnical variations. Fur scour burial, the use of the simulating waves nearshore model to drive a scour model is examined. Model predictions qualitatively followed empirical burial trends, with variations in waveheight prediction appearing to be a more significant factor in determining the accuracy of the scour burial prediction than uncertainty in grain size. Overall, the tests provide encouragement for the use of new MBP models to provide reasonable predictions of burial from operational input data. [ABSTRACT FROM AUTHOR]

High-resolution multibeam sonar and state-of-the-art data processing and visualization techniques have been used to quantify the evolution of seafloor morphology and the degree of burial of instrumented mines and mine-shapes as part of the U.S. Office of Naval Research (ONR, Arlington, VA) mine burial experiment at the Martha's Vineyard Coastal Observatory (MVCO, Edgartown, MA). Four surveys were conducted over two years at the experiment site with a 455-kHz, Reson 8125 dynamically focused multibeam sonar. The region is characterized by shore-perpendicular alternating zones of coarse-grained sand with 5-25-cm-high, wave orbital-scale ripples, and zones of finer grained sands with smaller (2-5-cm-high) anorbital ripples and, on occasion, medium scale 10-20-cm-high, chaotic or hummocky bedforms. The boundaries between the zones appear to respond over periods of days to months to the predominant wave direction and energy. Smoothing and small shifts of the boundaries to the northeast take place during fair-weather wave conditions while erosion (scalloping of the boundary) and shifts to the north-northwest occur during storm conditions. The multibeam sonar was also able to resolve changes in the orientation and height of fields of ripples that were directly related to the differences in the prevailing wave direction and energy. The alignment of the small scale bedforms with the prevailing wave conditions appears to occur rapidly (on the order of hours or days) when the wave conditions exceed the threshold of sediment motion (most of the time for the fine sands) and particularly during moderate storm conditions. During storm events, erosional "windows" to the coarse layer below appear in the fine-grained sands. These "window" features are oriented parallel to the prevailing wave direction and reveal orbital-scale ripples that are oriented perpendicular to the prevailing wave direction. The resolution of the multibeam sonar combined with 3-D visualization techniques provided realistic looking images of both instrumented and noninstrumented mines and mine-like objects (including bomb, Manta, and Rockan shapes) that were dimensionally correct and enabled unambiguous identification of the mine type. In two of the surveys (October and December 2004), the mines in the fine-grained sands scoured into local pits but were still perfectly visible and identifiable with the multibeam sonar, in the April 2004 survey, the mines were not visible and apparently were completely buried. In the coarse-grained sand zone, the mines were extremely difficult to detect after initial scour burial as the mines bury until they present the same hydrodynamic roughness as the orbital-scale bedforms and thus blend into the ambient ripple field. Given the relatively large, 3-D, spatial coverage of the multibeam sonar along with its ability to measure the depth of the seafloor and the depth and dimensions of the mine, it is possible to measure directly, the burial by depth and burial by surface area of the mines. The 3-D nature of the multibeam sonar data also allows the direct determination of the volume of material removed from a scour pit. [ABSTRACT FROM AUTHOR]

The U.S. Navy is supporting the research to develop and validate stochastic, time-dependent, mine burial prediction models to aid the tactical decision making process. This research requires continuous monitoring of both mine behavior during burial, and the near-field processes responsible for burial. A new instrumented mine has been developed that far exceeds the capabilities of the earlier optically instrumented mine in terms of the burial processes that can be measured. The acoustic-instrumented mine (AIM) utilizes acoustic transducers to measure burial and scour, localized flow rates, and sediment size and concentration in the water column. The AIM also includes sensors for measuring mine orientation and movement, as well as oceanographic information such as significant waveheights, wave period, and water temperature. Four AIMs were constructed and deployed during the Indian Rocks Beach (IRB, FL) and Martha's Vineyard Coastal Observatory (MVCO, Edgartown, MA) mine burial experiments. The results from the field experiments have proven that the sensor suite is viable in providing a wealth of data that are critical in understanding and modeling the complex subsequent burial process. [ABSTRACT FROM AUTHOR]

Naval mines have been in use for over 200 years. They are a cheap and effective way to significantly affect naval operations. Bottom mines in shallow water are particularly difficult to find when they are partially or wholly buried. The U.S. Office of Naval Research (Arlington, VA) and the Naval Research Laboratory (Stennis Space Center, MS) sponsored a six-year-long program to upgrade the capability to predict mine burial. The program consisted of laboratory studies, computer modeling, and field observation programs. Results of the studies have been combined into stochastic predictive programs that utilize state of the art process models and incorporate uncertainty in model capability and in our ability to know the correct values of model inputs. [ABSTRACT FROM AUTHOR]

The demand for water treatment chemicals in the United States is expected to rise at a five percent annual rate between 2000 and 2005, almost double that commonly projected for GDP. Higher value formulations are replacing low-cost, commodity compounds in almost all markets and applications. The nominal price of water treatment chemicals is expected to increase by over three percent per year from 2000 to 2010. Current market breakdown, which should remain stable, shows manufacturing industries accounting for about fifty percent of shipments, followed by municipalities, electricity generators, commercial, and residential users. Applications or end-uses include cooling, supply, waste, process, and boiler water. There are over 300 suppliers of water treatment chemicals in the United States., an eclectic mix of large and small, diversified and specialty firms. Three firms (Suez/Ondeo-Nalco, GE Betz, and Ashland Specialty Chemical) hold about thirty-five percent of the U.S. market, and further consolidation is likely. [ABSTRACT FROM AUTHOR]

Background: Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations. We sought to examine differences in aerobic activity (AA) and muscle strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States.Methods: The sample (n = 9,597) included pregnant women, age 18-44 years, who participated in the 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS include: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or pre-diabetes, and overt diabetes due to self-reported, clinically diagnosed diabetes (DM). Odds ratios (ORs) and 95% confidence intervals (CI) for meeting PA recommendations were obtained. Covariates included age, race, education, household child count, alcohol consumption, and smoking status.Results: Findings revealed that on average, DM had 46.5 fewer minutes of weekly AA compared to ND. Furthermore, a significantly lower OR (0.39; CI 0.19-0.82) for meeting both recommendations was observed in DM as compared to ND after adjustment.Conclusions: We observed that pregnant women with overt diabetes had a lower odds of engaging in PA, while those at high risk were similar in their PA engagement to ND. Future studies aimed at assessing determinants of PA behavior may help guide efforts to promote exercise in pregnant women with diabetes. [ABSTRACT FROM AUTHOR]

Past experiments on sand-based putting greens have frequently used randomized complete blocked designs (RCBD), even though these experimental areas are relatively uniform with regard to external variables. Consequently, completely randomized designs (CRD) may have had better precision with which to estimate treatment effects compared with RCBD. The objective of this study was to estimate the relative efficiency (ERE) of a RCBD compared with a CRD when evaluating common parameters on sand-based putting greens. Uniformity trials were conducted in Arkansas and Nebraska on sandbased putting greens established with creeping bentgrass (Agrostis palustris Huds.). Estimated relative efficiency values were calculated for varying blocking schemes when measuring canopy temperature, soil temperature, soil moisture, clipping yield, and macronutrient content in plant tissues. Since canopy temperatures were time dependent, when those measurements were collected by a blocking scheme, the associated RCBD was approximately nine times more efficient than a CRD. For the remaining parameter and blocking scheme combinations, ERE values indicated that the precision between RCBD and CRD was similar. Therefore, it is likely that the precision with which treatment effects are estimated is not compromised from the use of RCBD on sand-based putting green trials. [ABSTRACT FROM AUTHOR]

Objective: Examine the mode of physical activity (PA) participation in United States adults by US Census region.Methods: The study sample (N = 323,435) included adult (18 years of age and older) participants from the 2019 Behavioral Risk Factor Surveillance System. Participants reported meeting both aerobic and muscle strengthening activity (MSA) guidelines, the aerobic-only guideline, the MSA only guideline, or neither.Results: The greatest prevalence estimate of meeting the mutually exclusive aerobic and MSA guideline was found in the West Census Region (24.3, 95% confidence interval 23.6-24.9) and the greatest prevalence estimate of meeting neither aerobic nor MSA guideline was found in the South Census Region (38.1%, 95% confidence interval 37.5-38.7). Physical and mental health were found to be positively associated with PA and non-Hispanic Blacks and Hispanics reported the greatest levels of meeting neither federal PA recommendation.Conclusions: These data suggest that mode of PA participation varies by demographics and census region in US adults. State and local health departments should communicate between and within regions and disseminate information to raise awareness of the health benefits of meeting the federal PA guidelines. [ABSTRACT FROM AUTHOR]

The article discusses trends in the transnational protest movement. It states that international organizations and governments such as the U.S. should respond to the trends in the protest movements through avoidance. It also emphasizes that the movements can be stopped by allowing non-governmental organizations (NGO) to voice their concerns in the policymaking process.

Study Design: This was a cross-sectional study.Objective: The primary aim of the study was to examine the association between low back pain (LBP) and muscle-strengthening activity (MSA) among U.S. adults using gender-stratified analyses.Summary Of Background Data: LBP is a common medical condition that impacts quality of life and professional productivity and increases the financial burden on the health care system by augmenting medical treatment costs. Previous studies analyzing gender-dependent relationships between MSA and LBP have produced mixed results.Methods: Our sample included 12,721 participants from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into one of three levels of self-reported MSA: no MSA, insufficient MSA (1 day/wk), or meeting the 2008 Department of Health and Human Services (DHHS) recommendation for MSA (≥2 days/wk).Results: Gender-stratified analyses revealed significantly lower odds of reporting LBP among women [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70-0.96, P = 0.03] and men (OR 0.86; 95% CI 0.70-0.96, P = 0.01) who reported amounts of MSA that met the DHHS recommendation compared with those reporting no MSA. Following adjustment for smoking status, the odds remained significant among women (P = 0.03) but not among men (P = 0.21).Conclusion: These findings indicate that engaging in MSA at least 2 days/wk is associated with lower odds of LBP and that smoking may be an important mediating factor that should be considered in future LBP research.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives: Examine the odds of adults reporting physical inactivity (PI) across six body mass index (BMI) categories.Methods: We used data from the 2013 Behavioral Risk Factor Surveillance System. Six BMI categories were used.Results: The odds of reporting PI in underweight men and men in the class I, II, and III obesity categories were 1.65 (95% confidence interval [CI] 1.35-2.02), 1.30 (95% CI 1.21-1.39), 1.73 (95% CI 1.58-1.90), and 2.44 (95% CI 2.17-2.75), respectively, compared with men of desirable weight (odds ratio [OR] 1.00, 18.5-24.9 kg/m2; referent, OR 1.00). The odds of reporting PI in underweight men were similar to class II and class III obese men. The odds of reporting PI in underweight women, overweight women, and women in the class I, II, and III obesity categories were 1.57 (95% CI 1.36-1.81), 1.20 (95% CI 1.14-1.27), 1.65 (95% CI 1.56-1.75), 2.23 (95% CI 2.07-2.40), and 2.89 (95% CI 2.66-3.15), respectively, compared with women of desirable weight (≥18.5-24.9 kg/m2; referent, OR 1.00). The odds of reporting PI were similar in underweight and class I obese women. Women were found to have greater odds than men of reporting PI in four of the five nondesirable BMI categories (P < 0.05).Conclusions: The within- and between-sex differences in the odds of reporting PI vary significantly by BMI category. Future research needs to include the underweight BMI category when investigating PI and sedentary time because of the potential clinical relevance. [ABSTRACT FROM AUTHOR]

Objectives: To characterize race and ethnicity reporting and representation in United States (US) gynecologic oncology (Gyn-Onc) clinical trials and compare reporting and representation across gynecology subspecialties. Methods: In this cross-sectional study, we investigated all US-based gynecology clinical trials that reported results on ClinicalTrials.gov from October 2007-March 2020, with a focus on Gyn-Onc. We evaluated two outcomes: (1) reporting of participant race/ethnicity and (2) representation (proportion of trial enrollees of a given race/eth- nicity). We analyzed associations of trial funding and subspecialty with each outcome using descriptive and multivariable logistic regression analyses. We modeled representation using logistic regression with a binary outcome (> or <20% Black, Indigenous, and People of Color [BIPOC] enrollment) controlling for a trial year, phase, and funder. [Display omitted] Results: Of 8,515 registered gynecology trials, 3,214 were based in the US. Only 888 of 3,214 (27.6%) reported trial results, of which 505 (56.9%; 190,147 participants) included participant race/ethnicity data. There was a significant increase in race/ethnicity reporting over the study period (p<0.001). Race/ethnicity reporting varied by funder (government/academic 14.2%, industry 19.4%, p<0.001) and subspecialty (Gyn-Onc 13.9%, Benign Gynecology 16.6%, p=0.002), but these reporting differences were not persistent in multivariable analysis. Among trials that reported race/ethnicity, all BIPOC groups were underrepresented relative to their national population representation (Table). No significant difference in representation was seen by funding status. However, differences by subspecialty were noted; in aggregate, Benign Gynecology trials had more than twice as much diversity as Gyn-Onc trials (39.6% vs 17.7% average BIPOC representation per trial). Compared with Gyn-Onc clinical trials, REI (aOR: 2.78, 95% CI: 1.36-6.47), family planning (aOR: 3.68, 95% CI 1.87-8.16), and other benign gynecology trials (aOR: 1.79, 95% CI: 1.26-2.55) all had greater odds of enrolling at least 20% BIPOC participants. No difference was demonstrated between Gyn-Onc and Urogynecology trials. Conclusions: Reporting of race/ethnicity in US gynecology clinical trials is poor but improving. Among trials with race-ethnicity reporting, BIPOC participants were consistently underrepresented. Gyn-Onc trials demonstrated the least diversity of all gynecology subspecialties. This trend excludes BIPOC communities from health innovation conferred through trial participation, biases medical evidence, and worsens disparities in gynecology. [ABSTRACT FROM AUTHOR]

To evaluate the demographic and HPV status in relation to the increasing incidence of adenocarcinoma in the United States. Data were obtained from the United States Cancer Statistics from 2001 to 2016. SEER*Stat and Joinpoint regression were used to calculate average annual percent change (AAPC). Incidence rates were corrected for hysterectomy using the Behavioral Risk Factor Surveillance System. THe National Health and Nutrition Examination Survey (NHANES) was used to evaluate HPV genotypes in a healthy cohort. Of 201,609 patients with cervical adenocarcinoma between 2001-2016, White, Black, Hispanic, Asian and others comprised 62%, 15.4%, 16.3%, 4.4% and 1.8% of patients. Overall the 40-44 year-old age groups had the highest incidence (2.97 / 100,000). We also found an average annual increase of 2.4% in this age group. (p<0.001). Blacks were more likely to be diagnosed with distant or metastatic disease compared to Whites with corresponding age-adjusted incidences of (0.23 vs 0.13 / 100,000). We then evaluated HPV genotypes in a healthy cohort from NHANES survey and biomarker study as HPV 18 is recognized as the predominant viral serotype for adenocarcinoma. Of 7,532 healthy patients, the median number of lifetime sexual partners was 5, with 55.9% having > or =5 partners. Although HPV 16 was the predominant HPV genotype at 18.4%, HPV 18 comprised 9.1% of the HPV positive patients within the study group. Blacks have a two-fold higher rate of HPV 18 infection (3.2% vs 1.3%; p<0.001) and 70% higher risk in the non-16 high risk HPV (31, 33, 35, 39, 45, 51, 52) (18.1% vs 11.2%; p<0.001); however the rate of HPV 16 was comparable (4.1% vs 4.2%; p=0.54). [Display omitted] The incidence of adenocarcinoma is increasing in the United States. Blacks have a higher incidence of metastatic disease compared to Whites and other races. HPV 18 genotypes were more prevalent in Blacks compared to Whites with no difference HPV 16. [ABSTRACT FROM AUTHOR]

Background: The transplantation of the right lobe of a liver from a living adult donor into an adult recipient has been performed increasingly frequently in the United States. Although the use of grafts from living donors is standard practice in transplantation in children, their use in adults remains controversial. Methods: To study the use of liver transplantation from a living donor, we sent a 24-item questionnaire to all liver-transplantation programs in the United States. Data on indications, evaluation, and outcomes were analyzed with the use of univariate and multivariate methods. Data on recent transplantations were gathered from the Scientific Registry of Transplant Recipients and directly from the transplantation programs. Results: Questionnaires were returned by 84 of the 122 programs (69 percent) describing the results of 449 adult-to-adult transplantations of partial livers from living donors that were performed in 42 centers. Fourteen centers had performed more than 10 such transplantations each and together accounted for 80 percent of such transplantations. Centers that performed such transplantations also performed more transplantations of livers from cadaveric donors and more transplantations from living donors in children than centers that did not perform the adult-to-adult procedure (P=0.002 and P=0.001, respectively). A total of 45 percent of potential donors who were evaluated eventually donated a lobe of their liver; 99 percent of these donors were genetically or emotionally related to the recipient. Complications in the donor were more frequent in the centers performing the fewest transplantations from living donors in adults and included biliary complications requiring intervention (in 6.0 percent), reoperation (in 4.5 percent), and death (in one donor [0.2 percent]). Among the recipients, 1.6 percent did not meet criteria for receipt of a cadaveric transplant; cancer, retransplantation, and acute liver failure were uncommon indications for transplantation from a living donor. Biliary complications occurred in 22.0 percent of recipients, and vascular complications occurred in 9.8 percent. Conclusions: Adult-to-adult liver transplantation from a living donor is increasingly performed in the United States but is concentrated in a few large-volume centers. Mortality among donors is low, but complications in the donor are relatively common. N Engl J Med 2003;348:818-25. [ABSTRACT FROM AUTHOR]

Objectives: Current evidence describing physical activity (PA) and sedentary time (ST) in people with and without heart failure (HF) is limited. This study examines PA participation and ST in a nationally representative sample of US adults with and without self-reported HF., Methods: The study sample (N = 21,633) included US adult (40 years old and older) participants from the 2007-2018 National Health and Nutrition Examination Survey. PA participation, ST, and HF status were assessed via a questionnaire., Results: Compared with participants without HF (68%), 84% of participants with HF reported not meeting PA recommendations ( P < 0.05). Compared with participants without HF (63%), 75% of participants with HF reported >4.5 hours/day of ST ( P < 0.05). Unadjusted analysis suggests that participants with HF had 60% ( P < 0.05) lower odds of reporting meeting PA recommendations when compared with those without HF. In a fully adjusted model, these odds were attenuated (odds ratio 0.74, P < 0.05). Similarly, unadjusted analysis illustrated those individuals with HF had 42% ( P < 0.05) lower odds of reporting ≤4.5 hours/day of ST. In a fully adjusted model, these odds also were attenuated (odds ratio 0.66, P < 0.05)., Conclusions: Our findings suggest that US adults with HF report significantly less PA and greater amounts of ST than those without HF.

Purpose: We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities., Methods: Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC)., Results: This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97-1.06) or AC (AHR = 1.09, 95% CI = 0.96-1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively)., Conclusions: Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors., Competing Interests: Declaration of competing interest Chad A. Hamilton reported personal fees from GlaxoSmithKline outside the submitted work. Yovanni Casablanca cited personal fees from AstraZeneca outside the submitted work. John K. Chan reported personal fees from Agenus, AstraZeneca, Eisai, Genmab, GlaxoSmithKline, Immunogen, Mersana, Molecular Targeting Technologies, Myriad, Roche, and Seagen outside the submitted work. Thomas P. Conrads is a ThermoFisher Scientific, Inc. SAB member and receives research funding from AbbVie outside the submitted work. Charles A. Leath, III received funding from the NIH UG1 CA23330 and P50 CA098252, contracted research with Agenus and Seattle Genetics, and served on a scientific advisory board for Seattle Genetics, all outside of the submitted work. The other authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups., Methods: Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling., Results: There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology., Conclusions: Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants., Competing Interests: Declaration of competing interest Stuart S. Winkler, Chunqiao Tian, Nicholas W. Bateman, Suzanne Jokajtys, Calen W. Kucera, Christopher M. Tarney, Michael T. Richardson, Daniel Kapp, Cheng-I Liao, Megan Reddy, Michele L Cote, Timothy D. O'Connor, Nathaniel L. Jones, Matthew A. Powell, John Farley, Craig D. Shriver, Neil T. Phippen, G. Larry Maxwell and Kathleen M Darcy do not have any potential conflicts to disclose. Chad A. Hamilton reported personal fees from GlaxoSmithKline outside the submitted work. Yovanni Casablanca cited personal fees from AstraZeneca outside the submitted work. John K. Chan reported personal fees from Agenus, AstraZeneca, Eisai, Genmab, GlaxoSmithKline, Immunogen, Mersana, Molecular Targeting Technologies, Myriad, Roche, and Seagen outside the submitted work. Thomas P. Conrads is a ThermoFisher Scientific, Inc. SAB member and receives research funding from AbbVie outside the submitted work. Charles A. Leath, III received funding from the NIH UG1 CA23330 and P50 CA098252, contracted research with Agenus and Seattle Genetics, and served on a scientific advisory board for Seattle Genetics, all outside of the submitted work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC)., Methods: Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death., Results: Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87-2.23) for CRD and 1.22 (1.09-1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46-1.58) dropping to 1.29 (1.23-1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77-2.71) persisting to 1.32 (1.09-1.61) after matching for grade, stage, and treatment arm while balancing age and performance status., Conclusions: Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities., Competing Interests: Declaration of interests Zachary A. Kopelman, Chunqiao Tian, Jordyn Tumas, Neil T. Phippen, Christopher M. Tarney, Erica R. Hope, Stuart S. Winkler, Suzanne Jokajtys, Calen W. Kucera, Michael T. Richardson, Daniel S. Kapp, Nathaniel L. Jones, Rodney P. Rocconi, John H. Farley, Angeles Alvarez Secord, Casey M. Cosgrove, Matthew A. Powell, Ann Klopp, Joan L Walker, Gini F. Fleming, Nicholas W. Bateman, G. Larry Maxwell, and Kathleen M. Darcy do not have any conflicts to report. John K. Chan reported personal fees from Agenus, AstraZeneca, Eisai, Genmab, GlaxoSmithKline, Immunogen, Mersana, Molecular Targeting Technologies, Myriad, Roche, and Seagen outside the submitted work. Chad A. Hamilton reported personal fees from GlaxoSmithKline outside the submitted work. Charles A. Leath, III received funding from the NIH UG1 CA23330 and P50 CA098252, contracted research with GSK and Merck, and served on a scientific advisory board for GSK and Merck, all outside of the submitted work. Thomas P. Conrads is a ThermoFisher Scientific, Inc. SAB member and receives research funding from AbbVie outside the submitted work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate the patterns and trends of uterine cancer among Asian subgroups living in the U.S., Methods: Data were obtained from United States Cancer Statistics (2001-2017), National Cancer Database (2004-2015), and World Population Review (2023). SEER*Stat version 8.3.9.2, Joinpoint regression program 4.9.0.0, and SAS v 9.4 were employed for statistical analysis., Results: Based on data from 778,891 women in the United States Cancer Statistics database, Asians had a 3.4-fold higher rate of incident uterine cancer compared to White populations (2.14% vs. 0.63%; p < 0.001). Using the National Cancer Database, 7,641 Asian women from six subgroups were analyzed: Filipino, Korean, Indian/Pakistani, Vietnamese, Chinese, and Japanese. Indian and Pakistani women had the greatest increase in the proportion of cancer diagnoses (5.0% to 14.4%; p = 0.0003). Additionally, Indian and Pakistani patients had higher comorbidity scores while Koreans had the lowest (22.7% vs. 10.7%, p < 0.0001). Regarding stage of disease, 25.3% of Filipinos presented with advanced stage disease compared to 19.2% of Indians and Pakistanis (p = 0.0001). Furthermore, Filipinos had the highest proportion of non-endometrioid cancers at 18.4% compared to other subgroups (p = 0.0003). Using the World Population Review, female obesity was highest in Pakistan (8.6%) and the Philippines (7.5%) and lowest in Vietnam (2.6%)., Conclusion: Uterine cancer incidence increased at higher rates among Asians compared to White populations. Specifically, Indian and Pakistani uterine cancer patients were more likely to have higher comorbidity rates and Filipino patients had more advanced stage cancer with non-endometrioid histologies than other Asian subgroups. Further research is warranted to better understand these trends., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. John K Chan has consulted for AstraZeneca, GlaxoSmithKline, Genmab/Seagen, Immunogen, Karyopharm, Merck, Mersana, Myriad, and Roche. Dr. Chan has received payment/honoraria for lectures and traveling support from AstraZeneca, Eisai, Genmab/Seagen, GlaxoSmithKline, Immunogen, Merck, and Myriad. He has also participated on an advisory board for AstraZeneca, GlaxoSmithKline, and Myriad. The other authors have no conflicts of interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials., Methods: Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data., Results: 2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p < 0.0001)., Conclusion: Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials., Competing Interests: Declaration of Competing Interest Dario Roque reported grant funding from Robert A. Winn Diversity in Clinical Trials Award Program and from Robert A. Winn Diversity in Clinical Trials Award Program Sponsorship by Bristol Myers Squibb Foundation and pay to the institution, as well as personal fees from Myriad and GlaxoSmithKlein. John Chan reported personal fees from Agenus, AstraZeneca, Eisai, Genmab, GlaxoSmithKline, Immounogen, Merck, Mersana, Molecular Targeting Technologies, Myriad, Roche, and Seagen outside the submitted work. Ritu Salani reported royalties from UpToDate, leadership roles at the International Gynecologic Cancer Society Executive Committe, and personal fees from Eisai, Immunogen, Merck, Mersana, Regeron, and Seagen. All author authors reported no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Among women in the United States, cancer is the second leading cause of death. Prior studies have examined how lifestyle factors, such as diet and physical activity, influence cancer mortality. However, few have evaluated if diet or physical activity has a stronger protective effect for cancer mortality. Therefore, this study aims to evaluate and compare the impacts of diet and physical activity on women's cancer mortality., Methods: Prospective, cross-sectional data were abstracted from the Third US National Health and Nutrition Examination Survey (NHANES III) on female respondents from 1988 to 1994. Physical activity was derived from the CDC's metabolic equivalent (MET) intensity levels. Dietary classifications were derived from the USDA's healthy eating index (HEI). We utilized the National Death Index to obtain mortality follow-up information on our cohort until December 31, 2015. Chi-squared, multivariable Cox regression, and Kaplan-Meier estimates were employed for statistical analyses., Results: Of 3,590 women (median age: 57, range: 40-89), 30% had an obese BMI (BMI≥30 kg/m 2 ). Additionally, 22% of participants self-reported a healthy diet, 69% needed dietary improvement, and 9% had a poor diet. Furthermore, 21% reported physical inactivity, 44% did not meet physical activity guidelines, and 35% met guidelines. On multivariate analysis, healthy diet (HR: 0.70; 95% CI: 0.51-0.98; p = 0.04), but not physical activity (HR: 0.87; 95% CI: 0.55-1.38; p = 0.55), independently predicted for lower cancer mortality. Participants with a healthy diet but low exercise had decreased cancer mortality compared to participants with an unhealthy diet but high exercise ( p = 0.01)., Conclusions: A healthful diet was associated with lower cancer mortality in women, even after adjusting for obesity, inflammation, and other covariates. In addition, diet may play a stronger role in reducing cancer mortality in women than physical activity., Competing Interests: JohC has received non-specific funding from Denise Cobb Hale Chair and the Fisher Family Fund; consulted for AstraZeneca, Glaxosmithkline, and Myriad; received payment or honoraria from AstraZeneca, Clovis, Eisai, Glaxosmithkline, Merck, and Roche; and participated on a Data Safety Monitoring Board or Advisory Board for AbbVie, AstraZeneca, Clovis, Eisai, Glaxosmithkline, Immunogen, Myriad, Roche, and Seagen. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chan, Caesar, Mann, Koh-Bell, Richardson, Johnson, Kapp and Chan.)

Objective: Gestational trophoblastic neoplasia are a group of diseases with few data given their rarity. The aim of this study was to determine the age and racial differences in the presentation and survival of patients with gestational trophoblastic neoplasia in the United States., Methods: Data were collected from the National Cancer Database from January 2004 to December 2014. Chi-square tests, Cox regression, and Kaplan-Meier models were performed. Demographic characteristics included age at diagnosis, race, insurance status, facility location and type, community median income, high school dropout rate, education, income, and population density data., Results: There were 1004 eligible patients including 64% white (n=645), 23% black (n=233), and 8.3% Asian patients (n=83). Median age was 30.8 (range 14-59) years. Stage I, II, III, IV, and unknown were diagnosed in 32%, 5.4%, 30%, 18%, and 15% of patients, respectively, with 5-year survival of 99%, 93%, 94%, 72%, and 95%, respectively (p<0.001). Compared with national birth rates, those with gestational trophoblastic neoplasia were overrepresented at younger (age 10-19 years: 8.2% vs 4.8%) and older ages (age 40-54 years: 17% vs 3.3%). The extremes of age at presentation were more pronounced in black patients with gestational trophoblastic neoplasia (age 10-19 years: 11% vs 6.9%, 40-54 years: 18% vs 3.2%), and black patients constituted 23% of patients compared with 15% of births nationwide. Some 59% of patients were treated at Academic/Research Programs. Only 6/448 (1.3%) facilities treated more than one patient per year, and only 9% (n=92) of patients were treated at one of these high-volume facilities. On multivariable analysis, older age, higher Charlson/Deyo co-morbidity score, and higher stage disease were independently associated with worse survival (all p<0.001)., Conclusions: Gestational trophoblastic neoplasia was disproportionately higher in those at extremes of age and in black women as compared with United States national data. The lack of centralization of care justifies the need to develop regional centers of excellence for this rare malignancy., Competing Interests: Competing interests: ED: personal fees from Clovis Oncology and Glaxosmithkline. JKC: personal fees from AbbVie, Acerta, Aravive, AstraZeneca, Clovis, Eisai, Glaxosmithkline, Merck, and Roche., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Obstetrical complications affect more than a third of women globally, but are underrepresented in clinical research. Little is known about the comprehensive obstetrical clinical trial landscape, how it compares with other fields, or factors associated with the successful completion of obstetrical trials., Objective: This study aimed to characterize obstetrical clinical trials registered on ClinicalTrials.gov with the primary objective of identifying features associated with early discontinuation and results reporting., Study Design: This is a cross-sectional study with descriptive, logistic regression and Cox regression analyses of clinical trials registered on ClinicalTrials.gov. Our primary exposure variables were trial focus (obstetrical or nonobstetrical) and trial funding (industry, United States government, or academic). We conducted additional exploratory analyses of other trial features including design, enrollment, and therapeutic focus. We examined the associations of exposure variables and other trial features with 2 primary outcomes: early discontinuation and results reporting., Results: We downloaded data for all studies (N=332,417) registered on ClinicalTrials.gov from October 1, 2007, to March 9, 2020, from the Aggregate Analysis of ClinicalTrials.gov database. We excluded studies with a noninterventional design (n=63,697) and those registered before October 1, 2007 (n=45,209). A total of 4276 obstetrical trials (1.9%) (ie, interventional studies) and 219,235 nonobstetric trials (98.1%) were compared. Among all trials, 2.8% of academic-funded trials, 1.9% of United States government-funded trials, and 0.4% of industry-funded trials focused on obstetrics. The quantity of obstetrical trials increased over time (10.8% annual growth rate). Compared with nonobstetrical trials, obstetrical trials had a greater risk of early discontinuation (adjusted hazard ratio, 1.40; 95% confidence interval, 1.21-1.62; P <.0001) and similar odds of results reporting (adjusted odds ratio, 0.89; 95% confidence interval, 0.72-1.10; P =.19). Among obstetrical trials funders after controlling for confounding variables, United States government-funded trials were at the lowest risk of early discontinuation (United States government, adjusted hazard ratio, 0.23; 95% confidence interval, 0.07-0.69; P =.009; industry reference; academic, adjusted hazard ratio, 1.04; 95% confidence interval, 0.62-1.74; P =.88). Academic-funded trials had the lowest odds of results reporting after controlling for confounding variables (academic institutions, adjusted odds ratio, 0.39; 95% confidence interval, 0.22-0.68; P =.0009; industry reference; United States government, adjusted odds ratio, 1.06; 95% confidence interval, 0.53-2.09; P =.87)., Conclusion: Obstetrical trials represent only 1.9% of all clinical trials in ClinicalTrials.gov and have comparatively poor completion. All stakeholders should commit to increasing the number of obstetrical trials and improving their completion and dissemination to ensure clinical research reflects the obstetrical burden of disease and advances maternal health., (© 2020 Elsevier Inc. All rights reserved.)