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Pediatric clinicians should offer guidance on age-appropriate nutrition, physical activity, sleep and screen time for families of children and adolescents with obesity. They should build rapport with families, ask permission before discussing obesity-related health concerns, use preferred terminology, and recommend whole family change. Using principles of shared decision-making, pediatric clinicians and families should set individualized goals for lifestyle changes, prioritizing reducing sugar-sweetened beverage intake, increasing physical activity, and reducing screen time. Families of children and adolescents with obesity should be connected to the highest level of support accessible to and desired by the family, including intensive health behavior and lifestyle treatment programs.

Background Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature.Results Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature.Conclusion A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

This month: The Royal Guardsmen--Snoopy Versus The Red Baron Back in 1967 (when I was 11) I made the giant leap from Tubby The Tuba by Danny Kaye to this [...]

Study background Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries.Purpose This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students.Methods Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals.Results Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies.Conclusions Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Weight bias and discrimination are present in pediatric healthcare settings and can lead to negative health effects for children with obesity, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Scientific studies on development of methods to address weight bias among child healthcare professionals is limited. In this article, we describe how we measured weight bias among clinical providers and staff in a large pediatric teaching hospital, and how this helped us obtain approval from hospital leaders to create training to help these child healthcare professionals understand the harmful effects of weight bias.

Pandemic mitigation measures may lead to excess weight gain in children. Our objective was to assess weight gain during the COVID-19 pandemic in children of ages 4–12 years with overweight and obesity in San Francisco, CA. Children with BMI ≥85th percentile measured at a clinic visit from January to March 2020 were recruited. Follow-up BMI measurements were obtained between October 2020 and March 2021 from the electronic medical record or through a video study visit. Pre- and post-BMI measurements were obtained on n= 91 participants. The majority were Latino (85%) and publicly insured (91%). Mean monthly weight gain was 0.73 kg [standard deviation (SD) 0.47], equivalent to yearly weight gain of 8.8 kg. Mean monthly change in BMI z-score was 0.02 (SD 0.04) equivalent to yearly increase in BMI-zof 0.24. Weight gain among children in San Francisco with overweight and obesity during the COVID-19 pandemic far exceeded healthy weight gain for this age group.

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Our recording career began long ago in the charming little town of Montague, PEI. While other kids were watching Fraggle Rock, we were producing a radio program in the basement [...]

We conducted a secondary analysis of data from a trial of Lactobacillus rhamnosusGG (LGG) supplementation as a pilot study to assess whether LGG prevents infant colic. For the first 6 months of life, infants received a daily dose of 10 billion colony-forming units of LGG or a control (n = 184). We compared the likelihood of a diagnosis of colic before 4 months of age, based on parent-reported symptoms or a physician diagnosis of colic. Out of the 184 infants, 18 (9.8%) had colic. There were no differences between the 2 groups in the percentage of infants with colic based on symptoms (control 5.4% vs LGG 9.8%; P= 0.19); physician diagnosis (control 3.2% vs LGG 7.6%; P= 0.26); or either symptoms or diagnosis combined (control 6.5% vs LGG 13.0%; P= 0.13). In this pilot study, early infant LGG supplementation does not appear to prevent the later development of colic.

AbstractBackground:The current study compares the effectiveness of a condensed 12-week version and a 24-week version of the same pediatric behavioral weight management program.Methods:Children (n=162) between the ages of 8 and 18 years (baseline BMIz=2.39; standard deviation=0.29) were randomized to either a 12- or 24-week version of the same behavioral weight management program. Child anthropometric data were recorded at baseline, 6 weeks, 12 weeks, 24 weeks, and 12 months. A two-level longitudinal model was used to examine within- and between-group differences in BMIzchange over time.Results:A significant group-by-time interaction was found (β=−0.01; standard error, <0.01; p<0.01) with the 24-week group showing greater reductions in BMIz. Children in the 24-week group showed significant BMIzreductions over time (z=−5.18; p<0.01), but children in the 12-week group did not (z=−0.85; p=0.39).Conclusions:Children in the 24-week program demonstrated greater reductions in BMIzthan children in the 12-week group. Therefore, there may be additional benefit to sessions above and beyond the 8- to 12-week minimum suggested for pediatric weight management programs.

Developmentally restricted differentiation antigens or cancer-placental antigens, tastin and bystin, are components of an adhesion molecule that plays a critical role in the implantation of the embryo to the uterus. Cell adhesion molecules have been implicated in the metastasis of carcinomas and could be critical targets for immunotherapy in epithelial ovarian carcinomas (EOCs). Our objectives were to define the expression of tastin and bystin proteins in EOCs. Expression of tastin and bystin mRNA in a panel of human tissues and 70 EOC specimens was investigated using qualitative polymerase chain reaction. Amplification products were confirmed by sequencing. Validation of results was performed using immunohistochemical analysis of tastin and bystin applied on a tissue microarray of 202 EOC tissues. The distribution of tastin and bystin expression and clinicopathologic variables were analyzed. Survival probabilities were estimated using the Kaplan–Meier method and statistical significance was determined by performing the logrank test. Expression of tastin and bystin was restricted to placental and testis tissue by qualitative polymerase chain reaction. Of the 70 EOC specimens tested with polymerase chain reaction, 89 and 94 expressed tastin and bystin, respectively. Immunoexpressions of tastin and bystin protein were observed in 69 and 80 of the ovarian tumors, respectively. Tastin and bystin expression in Stage III disease were 66 and 67 compared with 69 and 81 in Stage IIIIV disease, respectively. The tissue-restricted expression of tastin and bystin and their abundant expression in EOCs and advanced-stage disease make these developmentally restricted antigens attractive targets for antigen-specific immunotherapy in EOCs.

To determine trends in the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice by California children ages 2 to 11 years from 2003 to 2009.

PARP, poly (adenosine diphosphate-ribose) polymerase, is a damage-sensing protein, which is essential for the repair of DNA single-strand breaks. PARP and p53 function synergistically in repairing DNA damage and suppressing chromosomal rearrangements. The aim of this study was to determine the expression of PARP and p53 in epithelial ovarian cancer (EOC) and to correlate their expression with clinicopathologic characteristics. PARP and p53 were evaluated using immunohistochemistry applied on a tissue microarray of 189 EOC and their expressions were correlated to clinicopathologic variables, including the age of diagnosis, stage, grade, histologic type, optimal debulking, progression-free survival, and overall survival (OS). PARP and p53 expressions were shown in 61 and 54 of cases, respectively. PARP-positive tumors are more likely to have higher grade (P=0.03) and complete response to initial first-line chemotherapy (P=0.009). Patients with positive p53 staining are more likely to be at the advanced stage disease (P=0.004). Finally, there were no significant associations between PARP and p53 expression and no differences in progression-free survival and OS for PARP or p53 expressions. The overexpression of PARP and p53 in high grade, and advanced stage tumors indicated that these 2 markers might serve as an indicator of aggressive disease behavior. Additional studies are warranted to evaluate the role of PARP and PARP inhibitors in the setting of adjuvant chemotherapy.

OBJECTIVES:We tested the hypothesis that co-coordinated up-regulation or down-regulation of several ovarian cell surface kinases may provide clues for better understanding of the disease and help in rational design of therapeutic targets. STUDY DESIGN:We compared the expression signature of 69 surface kinases in normal ovarian surface epithelial cells (OSE), with OSE from patients at high risk and with ovarian cancer. RESULTS:Seven surface kinases, ALK, EPHA5, EPHB1, ERBB4, INSRR, PTK, and TGFβR1displayed a distinctive linear trend in expression from normal, highrisk, and malignant epithelium. We confirmed these results using semiquantitative reverse transcription-polymerase chain reaction and tissue array of 202 ovarian cancer samples. A strong correlate was shown between disease-free survival and the expression of ERBB4. DNA sequencing revealed two novel mutations in ERBB4in two cancer samples. CONCLUSIONS:A distinct subset of the ovarian surface kinome is altered in the transition from high risk to invasive cancer and genetic mutation is not a dominant mechanism for these modifications. These results have significant implications for early detection and targeted therapeutic approaches for women at high risk of developing ovarian cancer.

Regarding HER-2/ neuexpression (gene or protein level) in lung cancer, several studies with inconsistent results have been recently reported, partially due to variable techniques used and/or heterogeneous populations examined. The objective of this study was to examine HER-2/ neuexpression in a well-defined cohort of non–small-cell lung cancers (NSCLC) and in nonneoplastic lung tissue utilizing a combination of high-density tissue microarray, immunohistochemistry (IHC), and fluorescent in situ hybridization (FISH) under uniform test conditions. One hundred forty stage I-IIIA primary NSCLCs and 38 non-neoplastic lung samples were examined. IHC, using an FDA-approved Hercept monoclonal antibody kit, was performed and HER-2/ neugene alteration was assessed by FISH. The association of expression of HER-2/ neuwith clinicopathologic parameters was analyzed. Ninety-four percent of tumor samples (131/140) were fully interpretable after tissue processing. Twenty-five of them (19) overexpressed (2, 3) HER-2/ neu, while 106 (81) had no or weak expression. All thirty-four interpretable non-neoplastic lung samples were negative for HER-2/ neualteration at protein and gene level. HER-2/ neuprotein overexpression correlated well with HER-2/ neugene amplification (r .83, P< 0.001). HER-2/ neuoverexpression was significantly associated with histologic subtype 19 adenocarcinomas (19/82, 23) versus 4 squamous cell carcinomas (4/44, 9) overexpressed Her-2/ neu(P0.04). Statistical significance was observed between HER-2/ neuexpression and tumor differentiation, with strong positive (3) expression observed more frequently in poorly differentiated tumors (P0.01). Patients with HER-2/ neuabnormalities, particularly HER-2/ neugene amplification, exhibited a shorter survival (P0.043). The statistically significant difference (P< 0.005) between HER-2/ neualteration in tumor samples(25/131, 19) and in the nonneoplastic tissue (0/34, 0) implies that HER-2/ neumay have a role in the carcinogenesis of NSCLC. The findings provide evidence supporting the hypothesis that the HER-2/ neureceptor may represent a useful molecular target in the treatment of NSCLC. The significant association of HER-2/ neuexpression and gene amplification with poorly differentiated carcinoma compared with well differentiated carcinoma suggests that HER-2/ neumay be involved in NSCLC tumor evolution. Patients with HER-2/ neugene amplification and strong positive expression of HER-2/ neuprotein showed a strong tendency toward shorter survival.

Cancer biology as seen from chromosome 11 involves a plethora of mechanisms for chromosomal changes. The high frequency of repeated elements, the presence of active retrotransposons, the appearance of fragile sites, and the presence (and amplification) of drug resistance genes are all expected to destabilize the integrity of this chromosome. Thus, it is not unexpected that chromosome 11 is often mutated in a variety of tumors. Here, we review genes relevant to lung carcinogenesis and progression. Numerous loci and genes will be omitted since their role appears to be restricted to organ sites other than lung (i.e., the KAI gene at 11p11.2 which is involved in metastatic prostate cancer; the EXT2 gene at 11p11.2, which is one of the genes responsible for hereditary multiple exostoses; the WT1 gene at 11p13, which is frequently mutated in nephroblastoma; the TSG101 gene at 11p15.1-2, which may play a role in breast cancer; the ST5 (HTS1) gene at 11p15.3-4, which may be responsible for suppression of HeL a cell somatic cell hybrids). These genes may represent tissue-specific alterations that push certain types of cells into uncontrolled growth. In contrast, chromosome 11 also has genes for basic metabolic processes that are integral to the proliferation of cells (i.e., RRM1) and these are expected to be involved in a broad range of tumors. This review specifically focuses on HRAS, RRM1, MEN1, PPP2R1B, and ATM. Studies of the chromosomal abnormalities that underly cancer has produced a greater understanding of the normal patterns of gene regulation in healthy cells. Imprinting is one example of this, and the future promises to reveal much more.

The type of acidemia (umbilical arterial pH less than 7.2) occurring in newborns with second-stage baseline fetal heart rate (FHR) abnormalities was evaluated in 277 term gestations. Umbilical arterial acidemia occurred in 40 of the neonates with moderate to severe bradycardia (25 of 63), in 30 with mild bradycardia (16 of 531, and in 22 with tachycardia (seven of 32), compared with only 6 (eight of 129) of those with a normal FHR (P < .05 in each of the three comparisons). The majority (31 of 56, 55) of the acidemic neonates had a mixed respiratory-metabolic pattern, whereas 13 of 56 (23) had a respiratory pattern and 12 of 56 (21) had a metabolic pattern. The mean umbilical arterial buffer deficit (mEq/L) was significantly greater (P < .0005) in newborns with metabolic acidemia (-15.9 2 2.8) than in those with either mixed (-9.6 z? 2.5) or respiratory (-6.4 2 1.9) acidemia. We conclude that baseline second-stage FHR abnormalities can predict which newborns are at increased risk of having umbilical arterial pH below 7.2 at birth. Selective determination of umbilical arterial pH and blood gas analysis may be useful in assessing intrapartum management retrospectively. (ODstct Gyrzecol 70:291, 2987)

One hundred eighty-nine twin pregnancies were delivered at Wilford Hall United States Air Force Medical Center from July 1977 through December 1985. Among these, 57 were referred from distant bases and were excluded from further analysis. The remaining 132 pregnancies from our local population make up the study group. Sixty-seven women (51) followed our advice to be hospitalized at or before 28 weeks' gestation for prophylactic ward rest. The remaining 65 women (49) were not hospitalized until after 28 weeks' gestational age or until a pregnancy complication or labor occurred. Only three of 134 infants (2) whose mothers were admitted died, versus 11 of 130 infants (8.5) whose mothers were not admitted (P< .03). The results suggest that prophylactic ward rest, implemented at or before 28 weeks' gestational age, may reduce perinatal mortality in this condition.

To extend earlier findings, this pilot study explored the role of self-reported value of health as a moderator between age and scores on the Beck Depression Inventory. 157 undergraduate students completed the Health Value Scale and the Beck inventory. There was no significant main effect for age with scores on the Beck inventory; however, scores on the Health Value Scale and their interaction with age were significant contributors to scores on the Beck Depression Inventory. These results are consistent with earlier findings. Implications for research and development are discussed.

In the present study of the influence of health value as a potential moderator of age and life satisfaction, 157 undergraduate students (M= 20.8 yr.) completed a battery in which they provided demographic information and completed a number of different self-report measures, including the Satisfaction With Life Scale and the Health Value Scale. A 2 (younger vs older) × 2 (high vs low health value) analysis of variance with life satisfaction as the dependent variable showed a significant main effect for health value and a significant interaction between age and health value but no main effect for age. These findings support health value as a moderator of the relation between age and psychological well-being. Implications for research and practice are discussed.

Purpose:To assess the feasibility and acceptability of yoga incorporated into a pediatric weight management program (promoting health in teens; PHIT Yoga) to racially diverse caregivers and youth and to compare this program with a cohort that received a program that did not include yoga (PHIT Kids).Methods:Thirty children with obesity were enrolled in a 12-week pediatric weight management intervention (PHIT Kids, n= 17; PHIT Yoga, n= 13). Weight, BMI z-score (BMIz), BMI percent of the 95th percentile, and health habits assessment were obtained from both cohorts pre- and post intervention. Acceptability was assessed in the yoga cohort.Results:Fifty-four percent of children in the PHIT Yoga cohort and 65% of children in the PHIT Kids cohort attended ≥75% of the intervention sessions. Survey results support that the PHIT Yoga was acceptable to both caregivers and children. Improvements in BMIz were observed in 50% of children in each cohort and both groups improved on five of seven health habits; cohorts overlapped on three habits (breakfast, screen time, and sugar-sweetened drinks).Conclusion:Findings support that yoga classes added to a pediatric weight management program are feasible and acceptable in racially diverse children with severe obesity and their caregivers.

Cancer testis or cancer germline (CG) antigens are a group of genes whose usual expression is limited to embryonic or germ cell tissues and which can also be aberrantly expressed in a variety of malignancies (Fratta E et al. Mol Oncol. 2011;5:164). The CG antigen genes MAGE-A1, XAGE-1, NY-ESO-1, and PRAME (among others) are epigenetically regulated. Most adult non-germline tissues demonstrate dense CpG island promoter methylation, with no gene expression. Endogenous expression of CG genes in epithelial malignancy can be immunogenic and a number of vaccine strategies are currently underway, however studies in hematologic malignancy have shown limited baseline expression, and thus there has been limited interest in them as a target in AML. Recently, several groups have shown that treatment with the hypomethylating agents, azacitidine(Aza) and decitabine(Dac) are sufficient to re-induce gene expression in myeloid cell lines, prompting interest in these genes as a therapeutic target in myeloid malignancy (Almstedt M et al. Leuk Res 2010;34:899). Re-expression of these genes has also been observed in MDS/AML patients treated with Dac, albeit at higher doses (15–270mg/m2) than those currently in standard use (Sigalotti L et al. Blood 2003;101:4644).We hypothesized that conventional therapy with Aza(75mg/m2) and Dac(20mg/m2) induces CG promoter hypomethylation and gene expression, and that this may be sufficient to induce anti-CG antigen directed antibody responses.We obtained samples every 2–4 days from 2 AML patients during the first cycle of Aza or Dac treatment, and analyzed baseline and post-treatment samples for methylation (by pyrosequencing) and CG gene expression (by RT-PCR) of the above genes. We further tested serum from 10 patients for the presence of baseline and post treatment (following 1–10 cycles of Aza or Dac) anti-CG antibodies using an ELISA-based method.Both AML patients treated with hypomethylating agents demonstrated a time dependent decrease in global methylation (by LINE-1 pyrosequencing), and CG antigen promoter methylation which nadired at day 6 post treatment. Baseline methylation of MAGE-A1 (90%), XAGE-1 (85%), NY-ESO-1 (92%) and PRAME (50–60%) was similar and high in both patients pre-treatment. Both Dac and Aza induced hypomethylation of all the CG genes studies, and this hypomethylation correlated with changes in LINE-1 methylation. Low level expression of MAGE-A1, XAGE-1, and PRAME were induced in a time dependent fashion following treatment with both Aza and Dac, however only limited re-expression of NY-ESO-1 was observed. ELISA testing for antibodies against a panel of 25 CG antigens (including MAGE-A1, XAGE-1 and NY-ESO-1) was performed on 10 patients with either MDS or AML. Following hypomethylating agents there was evidence for increased antibody levels, most notably against MAGE proteins, compared to baseline.Conventional hypomethylating agent therapy can induce CG gene expression, which may be sufficient to induce anti-CG antigen antibody responses. Augmentation of anti-tumor immune responses may be possible in myeloid malignancies using a combination of hypomethylating agents and CG antigen-directed vaccines.Odunsi: Ludwig Institute for Cancer Reserach: Membership on an entity's Board of Directors or advisory committees, Research Funding.

The article presents several anecdotes from parents in line with their children. A story about a daughter who refused to take a cake from a neighbour is presented. It describes a child who assumed that the spider veins in her mother's legs are cracks. A story about a son who thought that a sanitary pad is a diaper is also stated.