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Identifying sustainable approaches to improving the physical activity (PA) and nutrition environments in schools is an important public health goal. This study examined the impact of Energy Balance for Kids with Play (EB4K with Play), a school-based intervention developed by the Academy of Nutrition and Dietetics Foundation and Playworks, on students' PA, dietary habits and knowledge, and weight status over 2 years.This cluster-randomized, controlled trial took place in four intervention and two control schools over 2 years (n=879; third- to fifth-grade students). PA (fourth and fifth grades only), dietary knowledge and behaviors, school policies, and BMI z-score were assessed at baseline (fall 2011), midpoint (spring 2012), and endpoint (fall 2012 for accelerometers; spring 2013 for all other outcomes).At endpoint, there were no group differences in change in PA or dietary behaviors, although BMI z-score decreased overall by -0.07 (p=0.05). Students' dietary knowledge significantly increased, as did the amount of vegetables schools served. Post-hoc analyses stratified by grade revealed that, relative to control students, fourth-grade intervention students reduced school-day sedentary time by 15 minutes (p=0.023) and third-grade intervention students reduced BMI z-score by -0.2 (0.05; p0.05). There were no signicifant differences for older students.EB4K with Play, which leverages the existing infrastructure of two national programs, increases children's dietary knowledge and may improve weight status and decrease sedentary behaviors among younger children. Future iterations should examine programming specific for different age groups.

Introduction The Alliance for a Healthier Generation’s Healthy Schools Program (HSP) is a national evidence-based obesity-prevention initiative aimed at providing the schools in greatest need with onsite training and technical assistance (TTA) and consultation with national experts (HSP national advisors) to create sustainable healthy change in schools’ nutrition and physical activity environments. The objective of this study was to evaluate the impact of HSP on the prevalence of overweight and obesity in California schools, from HSP’s inception in 2006 through 2012. Methods We used statewide body mass index (BMI) data collected annually from 5th-, 7th-, and 9th-grade students to determine whether enrolling in the HSP’s onsite intervention reduced the prevalence of overweight and obesity in intervention schools (n = 281) versus propensity-score matched control schools (n = 709) and whether increasing exposure to the program (TTA and contact with HSP national advisors) was associated with reductions in the prevalence of overweight and obesity. Results Analyses showed no difference between HSP schools and control schools in overweight or obesity prevalence. However, program exposure varied widely among participating schools, and each additional contact with TTA or HSP national advisors was associated with a 0.3% decline in overweight and obesity prevalence (P < .05). Conclusion HSP appears to be an important means of supporting schools in reducing obesity. Although participation in HSP alone was not sufficient to improve weight status in California schools, there was a clear dose–response relationship to the program. HSP serves as an effective model for addressing childhood obesity among engaged schools.

Since 2011 we have taught a public health innovations course at the University of California, Berkeley. Students gain skills in systematic innovation, or human-centered design, while working in small interdisciplinary teams on domestic and global health projects with client organizations. To support acquisition of meaningful problem-solving skills, we structured the course so that the majority of learning happens in scenarios that do not involve faculty. Taken by students representing 26 graduate programs (as diverse as epidemiology, city planning, and mechanical engineering), it is one of the 10 highest-rated courses offered by the School of Public Health. We present the blueprints for our course with the hope that other institutions whose students could benefit will borrow from our model.

Background— The 6-minute walk test (6MWT) independently predicts congestive heart failure severity, death, and heart failure hospitalizations, but must be administered in clinic by qualified staff on a premeasured course. As part of the Health eHeart Study, we sought to develop and validate a self-administered 6MWT mobile application (SA-6MWTapp) for independent use at home by patients. Methods and Results— We performed a validation study of an SA-6MWTapp in 103 participants. In phase 1 (n=52), we developed a distance-estimation algorithm for the SA-6MWTapp by comparing step counts from an Actigraph and measured distance on a premeasured 6MWT course with step counts and estimated distance obtained simultaneously from our SA-6MWTapp (best estimation algorithm, r=0.89 [95% confidence interval 0.78–0.99]). In phase 2, 32 participants (including those with congestive heart failure and pulmonary hypertension) used the SA-6MWTapp independently in clinic, and the distance estimated by the SA-6MWTapp was compared with the measured distance (r=0.83 [95% confidence interval 0.79–0.92]). In phase 3, 19 patients with congestive heart failure and pulmonary hypertension consecutively enrolled from clinic performed 3.2±1 SA-6MWTapp tests per week at home over 2 weeks. Distances estimated from the SA-6MWTapp during home 6MWTs were highly repeatable (coefficient of variation =4.6%) and correlated with in-clinic–measured distance (r=0.88 [95% confidence interval 0.87–0.89]). Usability surveys performed during the second (in-clinic) and third (at-home) phases demonstrated that the SA-6MWTapp was simple and easy to use independently. Conclusions— An SA-6MWTapp is easy to use and yields accurate repeatable measurements in the clinic and at home.

This chapter describes observed changes in sea level and wind waves in the Baltic Sea basin over the past 200 years and the main climate drivers of this change. The datasets available for studying these are described in detail. Recent climate change and land uplift are causing changes in sea level. Relative sea level is falling by 8.2 mm year−1 in the Gulf of Bothnia and slightly rising in parts of the southern Baltic Sea. Absolute sea level (ASL) is rising by 1.3–1.8 mm year−1, which is within the range of recent global estimates. The 30-year trends of Baltic Sea tide gauge records tend to increase, but similar or even slightly higher rates were observed around 1900 and 1950. Sea level in the Baltic Sea shows higher values during winter and lower values during spring and this seasonal amplitude increased between 1800 and 2000. The intensity of storm surges (extreme sea levels) may have increased in recent decades in some parts of the Baltic Sea. This may be linked to a long-term shift in storm tracks.

Background We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care. Methods This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of 1 h Bollywood dance classes offered twice per week. The primary outcome was change in HbA1c. The effect of attendance on this outcome was also examined. Results The intervention group demonstrated a decrease in HbA1c from baseline (−0.18% (0.2%); p=0.018) compared with a non-significant increase in the usual care group (+0.03% (0.2%)); p value for difference between groups was 0.032. Participants attending at least 10 of 16 sessions had a statistically significant reduction in weight (−0.69 kg (0.76 kg)) compared with those attending fewer sessions (+0.86 kg (0.71 kg)). Conclusions These results support culturally relevant dance as a successful exercise intervention to promote HbA1c control, compared with usual care. Trial registration number NCT02061618.

Objectives. We assessed the short-term ability to increase retail prices of the first US 1-cent-per-ounce excise tax on the distribution of sugar-sweetened beverages (SSBs), which was implemented in March 2015 by Berkeley, California. Methods. In 2014 and 2015, we examined pre- to posttax price changes of SSBs and non-SSBs in a variety of retailers in Berkeley and in the comparison cities Oakland and San Francisco, California. We examined price changes by beverage, brand, size, and retailer type. Results. For smaller beverages (≤ 33.8 oz), price increases (cents/oz) in Berkeley relative to those in comparison cities were 0.69 (95% confidence interval [CI] = 0.36, 1.03) for soda, 0.47 (95% CI = 0.08, 0.87) for fruit-flavored beverages, and 0.47 (95% CI = 0.25, 0.69) for SSBs overall. For 2-liter bottles and multipacks of soda, relative price increases were 0.46 (95% CI = 0.03, 0.89) and 0.49 (95% CI = 0.21, 0.77). We observed no relative price increases for nontaxed beverages overall. Conclusions. Approximately 3 months after the tax was implemented, SSB retail prices increased more in Berkeley than in nearby cities, marking a step in the causal pathway between the tax and reduced SSB consumption.

Validating published risk models in a different time and setting can be a labor-intensive process. Data in electronic format provide the potential to test the validity of risk models without labor-intensive chart reviews and data capture. The authors attempted to use readily available electronic data to find appropriate cases and to validate and refine a previously developed risk model for predicting bacteremia in children with cancer who had fever and neutropenia.By applying a largely automated case-finding algorithm to linked, electronic clinical and administrative data systems, the authors identified and acquired data regarding 157 episodes of fever and neutropenia in children with cancer admitted to a children's hospital during an 11-month period in 1997. The authors applied a previously developed and validated risk model for bacteremia to this 1997 cohort by assessing the odds ratios among risk groups. The model assigns encounters with absolute monocyte count of 100 cells or more/mm3 to a low-risk group and encounters with an absolute monocyte count of less than 100 cells/mm3 to intermediate-risk (temperature39.0 degrees C) or high-risk (or = 39.0 degrees C) groups. In addition, the authors explored whether the new data would have generated the same model. Univariate and multivariable analyses were performed to determine whether there were additional independent predictors of bacteremia. Recursive partitioning of admission absolute monocyte count and temperature was used to assess whether similar cutpoints would be found.There were 12 episodes of bacteremia (7.6%) among the 157 encounters. The previously developed model correctly predicted increasing rates of bacteremia in this 1997 cohort, ranging from 2.5% in the low-risk group (one episode in a child with an infected central line) to 24% in the high-risk group. The odds ratio for the high-risk versus intermediate-risk group was 4.09 (95% confidence interval 1.05-15.91), comparable to the odds ratio of 3.96 in the previously published derivation cohort (95% confidence interval 1.4-11.1). Multivariate analysis of the new data revealed no independent risk factors for bacteremia other than admission absolute monocyte count and temperature. Recursive partitioning of absolute monocyte count and temperature generated risk categories that were somewhat different from those of the original model. The new data yielded three categories: low risk (temperatureor = 39.5 degrees C and absolute monocyte count10/mm3), intermediate risk (temperatureor = 39.5 degrees C and absolute monocyte countor = 10/mm3), and high risk (temperature39.5 degrees C).Existing electronic data provide an efficient means for case-finding and model validation and refinement. The previously developed bacteremia model had good but not optimal predictive performance in the new data set. Admission absolute monocyte count and temperature remain significant risk factors for bacteremia. Redefining the risk categories, including a much lower cutpoint for admission absolute monocyte count, improved the model's discrimination, which suggests that predictive models need periodic updating.

Objective There is a critical need for culturally relevant interventions to address obesity among Latino children, who have a greater risk of obesity and diabetes than non-Hispanic white children. To test the impact of a family-centered, culturally tailored obesity intervention delivered through group medical appointments on body mass index (BMI) and other measures of cardiovascular risk among Latino children. Methods In a randomized controlled trial, 55 parent-child dyads were assigned to Active and Healthy Families (AHF) or a usual care wait-list control condition. Dyads were eligible if they spoke Spanish and if the child received care in a federally qualified health center, was aged 5 to 12 years, had a BMI in the 85th percentile or higher, and had not participated in AHF. The 10-week AHF intervention included biweekly group sessions delivered by a registered dietitian, physician, and promotora triad. Sessions covered topics such as parenting, screen time, healthy beverages, physical activity, and stress due to immigration. Results Child BMI (kg/m 2 ) decreased (−0.50) in the AHF group and increased (+0.32) in the control group, yielding an adjusted difference in change of −0.78 (95% confidence interval [CI] −1.28, −0.27). Children assigned to AHF also exhibited relative improvements over controls in BMI z score (−0.10; 95% CI −0.19, −0.02) and triglycerides (−26.8 mg/dL; 95% CI −50.1, −3.6), but no significant between-group differences were observed for blood pressure or other fasting blood measures. Conclusions AHF resulted in reductions in child BMI, BMI z score, and triglycerides. AHF, which was designed for low-income Latino families, has potential to reduce health disparities, but future studies are needed to determine long-term impact.

Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youth's nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data.The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection.An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages.End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.

Background During pregnancy women are at increased risk of severe complications to influenza infection, including death of mother or fetus, especially if chronic comorbid medical conditions such as diabetes mellitus are present. Case presentation A 36 years old Caucasian pregnant woman with type 1 diabetes underwent mechanical ventilation in gestation week 27 for severe respiratory failure due to influenza and pneumonia. For three weeks during and following her most severe illness, fetal growth could not be detected and the umbilical flows and amniotic fluid volumes were affected too. The possibility of preterm delivery and extracorporeal membrane oxygenation (ECMO) treatment were considered, however the patient and her fetus recovered gradually on conservative treatment. Under close surveillance the pregnancy continued until term, with delivery of an infant with appropriate weight for gestational age. Conclusion Preterm delivery and decreased birth weight were reported for women with antepartum pneumonia. Mechanical ventilation and ECMO treatment for severe respiratory failure in pregnancy are life threatening conditions and have been associated with preterm delivery. It remains uncertain if delivery improves the respiratory status of a critically ill woman, and the fetal condition is likely to improve, if the maternal condition is stabilized. Severe respiratory insufficiency requiring mechanical ventilation in a diabetic pregnant woman with influenza was successfully treated conservatively. Despite clear signs of impaired fetal condition in the acute phase, watchful waiting resulted in delivery of a normal weight infant at term.

Cesarean section is a common operation and one of the first surgeries performed independently by trainees/residents in obstetrics and gynecology. Determination of trainees' technical skills level is dependent upon subjective faculty assessment. Based on three studies on learning curves in cesarean section, it is recommended that trainees perform between 10-15 and 40 supervised cesarean sections before operating independently. Surgical technical skills of trainees/residents may be assessed by Objective Structured Assessment of Technical Skills (OSATS), which provides a foundation for constructive feedback during surgical training. The Danish, Swedish and British Obstetric and Gynecological Societies' guidelines on cesarean section were reviewed regarding cesarean section surgical technique. Placental removal by traction on the umbilical cord is recommended uniformly; however, the Danish guidelines recommend one-layer uterine incision closure, whereas the Swedish and British guidelines recommend two-layer closure. Maternal complications at cesarean section increase when the primary surgeon is a trainee/resident rather than an experienced surgeon. Basic surgical proficiencies regarding instruments, sutures and surgical technique as well as basic anatomy, should be verified before entering a training program for cesarean section. Such a training program for technical and non-technical skills in cesarean section should include theoretical instruction, video tutorials, practical experience and direct supervision. Development of a specific OSATS for cesarean section is recommended. Training must be individually structured accommodating the differences in trainees' competencies. Before clinical training in the operating room begins, all trainees must attain standardized cognitive and technical skills.

Introduction We present a comprehensive picture of state requirements and recommendations for body mass index (BMI) and body composition screening of children and explore the association between pediatric obesity prevalence and state screening policies. Methods Researchers completed telephone interviews with contacts at the departments of education for all 50 states and reviewed state content standards for physical education. Results Twenty states (40%) require BMI or body composition screening, and 9 states (18%) recommend BMI screening or a formal fitness assessment that includes a body composition component. The prevalence of adolescent obesity was higher in states that require BMI screening or fitness assessments with body composition than in states without requirements (16.7% vs 13.6%, P = .001). Conclusion Future studies should evaluate the effect and cost-effectiveness of BMI and body composition screening on child obesity.

BACKGROUND: This study sought to elucidate students' perceptions of school food environments and to assess correlations between perceptions and purchasing and consumption behaviors at school. METHODS: Seventh and ninth graders (n = 5365) at 19 schools in multiethnic, low-income California communities participating in the Healthy Eating Active Communities program completed questionnaires assessing their attitudes and behaviors regarding school food environments during spring 2006. RESULTS: Most students (69%) reported that fresh fruit was important to be able to buy at school; more than chips (21%), candy (28%), or soda (31%). Reported importance of food offerings was correlated with the consumption of those items. Most students did not perceive foods/beverages offered at school to be healthy; fewer than a quarter reported eating fruits or vegetables (FV) at school. Students eating school lunch were more than twice as likely to consume FV, though if they also purchased from competitive venues, their consumption of candy, chips, and soda was similar to their peers who purchased only competitive foods. CONCLUSION: Students report healthy foods to be important to be able to buy at school, but do not perceive their school food environment to be healthy and consume more unhealthy foods at school. Students served healthy items via school lunch are more likely to consume them; however, they also purchase and consume unhealthy items if available. Findings suggest that modifying school food environments to facilitate consumption of healthy foods and limit unhealthy foods will better match students' preferences and could lead to improved dietary intake.

Several ecosystem models with different complexity have previously been developed and applied either to the North Sea or the Baltic Sea. However, no attempts have been made to develop and validate a common ecological model covering both areas. In the present study, we applied a modified version of the Baltic Sea ecological model ERGOM (Ecological ReGional Ocean Model) coupled to the 3D circulation model DMI-BSHcmod with a two-way nested fine grid in the Danish straits. ERGOM was adapted to the North Sea by (1) adding silicate, (2) introducing two zooplankton groups and modifying their grazing impact and (3) adjusting light parameterisations. The recalibrated ERGOM model was validated against climatologically surface data of nutrients and measurements from nine monitoring stations in 2004–2006. The validation showed in general a ‘good’ to ‘very good’ agreement with measurements of surface temperature, salinity, DIN, PO 4 , SiO 2 and Chl a and bottom O 2 based on cost function values and correlation analysis. However, some deviations were found between model results and observations emphasizing that the descriptions of oxygen dynamics, light attenuation, remineralisation and nutrient loadings in the ecosystem model should be improved in future studies. In conclusion, the modified ecosystem model could reproduce the seasonal and regional patterns in the whole North Sea – Baltic Sea area and can be applied in future studies in these areas.

The last few years have witnessed the foundation and development of a new discipline, coastal altimetry, and the coalescence of an active community of researchers who are now enthusiastically developing the topic. In the present community white paper, we summarize the technical challenges that satellite altimetry faces in the coastal zone, and the research that is currently being carried out to overcome those challenges. We introduce the new coastal altimetry data that are becoming available, and describe how we can calibrate/validate those data. Then we show several of the possible applications of coastal altimetry and conclude by looking at the future of the discipline, and at how we can build capacity in coastal altimetry.

This study compared measures of sleep from an accelerometer worn on the hip to measures obtained from an accelerometer worn on the wrist, the gold standard measure of sleep behavior in community research. The accelerometer worn on the hip provides a measure of total sleep time in 10- to 11-year-old children comparable to the wrist-worn unit. We provide an alternate method to ascertain bedtime and final wake time when diary data are missing. A hip-worn accelerometer may provide a cost-effective means of gathering physical activity and sleep data simultaneously in large samples of children with or without an accompanying sleep diary.

Objective To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis. Methods By using 2005–2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data, outpatient preventive visits made by obese (body mass index ≥95%) 2- to 18-year-old patients were examined for frequencies of obesity diagnosis, diet, exercise, or weight reduction counseling, and glucose or cholesterol testing. Multivariable logistic regression was used to examine whether patient-level (gender, age, race/ethnicity, insurance type) and provider/practice-level (geographic region, provider specialty, and practice setting) factors were associated with physician obesity diagnosis. Results Physicians documented an obesity diagnosis in 18% (95% confidence interval, 13–23) of visits made by 2- to 18-year-old patients with a body mass index ≥95%. Documentation of an obesity diagnosis was more likely for non-white patients (odds ratio 2.87; 95% confidence interval, 1.3–6.3). Physicians were more likely to provide obesity-related counseling (51% of visits) than to conduct laboratory testing (10% of visits) for obese pediatric patients. Conclusion Rates of documented obesity diagnosis, obesity-related counseling, and laboratory testing for comorbid conditions among obese pediatric patients seen in US outpatient preventive visits are suboptimal. Efforts should target enhanced obesity diagnosis as a first step toward improving pediatric obesity management.

To identify physical activity opportunities linked to fitness and weight status among adolescents in low-income communities.Cross-sectional, ecological analysis of 9268 seventh- and ninth-grade students in 19 public schools participating in The California Endowment's Healthy Eating Active Communities program.Cardiorespiratory fitness (mile time) and body mass index. Independent variables included students' perceptions and behaviors related to daily physical activity opportunities, assessed via anonymous survey. Ecological analysis was used to link survey data with fitness and body mass index data within each school. Linear regression identified associations between youths' perceptions/behaviors and fitness/body mass index.As the proportion of students reporting enjoying physical education, walking to school, and spending 20 minutes or longer in exercise during physical education increased from 0% to 100%, mile time decreased overall (-2.7 minutes; P = .03), mile time decreased among seventh graders (-3.3 minutes; P = .02), and body mass index z scores decreased among ninth graders (-0.7; P = .045), respectively. Each additional day students reported being active on school grounds outside school hours was associated with decreased mile time (-0.5 minute; P = .02). Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit (odds ratio = 1.5; P.001).Physical education is a valuable policy opportunity to improve student health. Promoting active transport may improve fitness but must be done in conjunction with community partnerships to improve the food environment in the vicinity of schools. Promoting the use of school grounds outside school hours (such as after-school programs) should also be prioritized in response to youth obesity.

AIM To examine efficacy and predictors of response to a lifestyle intervention for obese youth. METHODS Retrospective chart review of 214 children and adolescents aged 8-19 years. Linear regression identified baseline predictors of response (delta BMI z-score) at first and ultimate follow-up visits. RESULTS Mean delta BMI z-score from baseline was -0.04 (p < 0.001) at first follow-up and -0.09 (p < 0.001) at ultimate follow-up (median time 10 mo) among 156 children and adolescents. Higher baseline BMI z-score predicted poor response at first and ultimate follow-up, explaining 10% of variance in response. Fasting insulin explained 6% of response variance at first follow-up. delta BMI z-score at the first visit along with baseline BMI z-score explained up to 50% of variance in response at ultimate visit. CONCLUSION Clinic-based interventions improve weight status. Baseline variables predict only a small proportion of response; response at the first visit is a more meaningful tool to guide clinical decisions.

Objectives To determine whether parent modeling of physical activity (PA) has a differential impact on girls' PA by race, whether the association declines with time, and to assess the contribution of parent modeling to girls' activity relative to other potential predictors. Study design Longitudinal examination of parent modeling's impact on future log transformed metabolic equivalents (log METs) of leisure-time PA in 1213 African-American and 1166 Caucasian girls in the National Heart, Lung, and Blood Institute Growth and Health Study, from age 9 to 10 years through 18 to 19 years, using linear regression. Race interaction terms and time trends were examined. Results Girls' perceptions of parent modeling significantly predicted future log METs in each study year; associations remained stable with time and were similar by race. Girls' perception of parent PA better predicted girl log METs than did parent self-report. On average, girls reporting that their parents exercised ≥3x/week were about 50% more active than girls with sedentary parents. Conclusions Girls' perception of parent activity predicts PA for girls throughout adolescence, despite age-associated decreases in PA. We did not find differences in this association by race. Interventions designed to increase parental activity may improve parent health, positively influence daughters' activity, and begin to address disparities in cardiovascular health.

[1] The radiometer wet tropospheric correction is a limiting factor of the application of near-coastal altimetry observations in the North Sea – Baltic Sea area. Using an ECMWF model based correction instead, we increase the return rate from 70% to 95%, with observations as close as 10 km from the coast. The altimetry and 39 coastal tide gauges are referenced to the same state of the art regional geoid. The two data sets are highly correlated and reveal a consistent mean dynamic topography and two distinct correlation regimes separated by the Danish islands. The combination of the two data sets in a simple statistical model is shown to estimate the sea surface height with the same error level as state of the art operational models, indicating the potential for near-coastal applications of satellite altimetry observations.

OBJECTIVES. Recent analyses assessing the impact of the conjugate pneumococcal vaccine on the care of febrile children do not reflect the role parental preferences play in physicians' decisions. The objective of this study was to identify the management strategy that would best suit parents, on the basis of their values for possible outcomes of fever of ≥39°C without source among well-appearing, 3- to 36-month-old children.METHODS. A decision analysis was performed to compare the benefits and outcomes of 3 management options (treat: blood culture and antibiotics for all children; test: blood culture and complete blood count for all children, with antibiotics for selected children; observe: no immediate intervention). A hypothetical cohort of 100000 children with fever of ≥39°C with no obvious source of infection was modeled for each strategy. Using this model, we identified the treatment option that would best suit each parent's preferences, on the basis of parental utilities (from a prior study) for various interventions and outcomes at vaccine efficacies of 0% (ie, no vaccine) and 95%. In addition, we performed survival analyses to assess the morbidity and mortality rates associated with each treatment strategy at various vaccine efficacies.RESULTS. At a vaccine efficacy of 0%, the majority of parents' preferences suggested the treat option, the strategy with the lowest mortality rate. At a vaccine efficacy of 95%, mortality rates were similar for all 3 management options (∼1 in 100000), but parental preferences were still aligned with different options; 50% suggested observe, 42% suggested test, and 8% suggested treat.CONCLUSIONS. Like physicians, parents have different approaches to risk. With the conjugate pneumococcal vaccine, risks of complications from fever without source are low regardless of treatment strategy. Rather than having a “one size fits all” approach, it is reasonable to incorporate parental preferences into the treatment decision.

Purpose: Disordered eating is prevalent among obese adolescents. Little is known about how disordered eating behavior impacts the clinical course of obese adolescents undergoing treatment. We sought to determine if disordered eating behaviors at baseline predicted treatment response among adolescents seeking weight management.

To the Editor .— We applaud the American Academy of Pediatrics on the policy statement Children, Adolescents, and Advertising .1 Current advertising practices certainly deserve the careful scrutiny of all who care about our nation's children, as well as our nation's future. The American Academy of Pediatrics statement presents a critical opportunity to begin to change current advertising practices. An area that the policy statement did not address but is of equal concern is the use of licensed commercial characters to sell healthy foods and beverages to children. A 2005 Institute of Medicine report entitled Food Marketing to Children and Youth: Threat or Opportunity? recommended “that licensed commercial characters [be] used only to promote foods and beverages that support healthful diets for children and youth.”2 In addition, in an effort to build consensus on how to combat childhood obesity, the Federal Communications Commission recently formed a task force entitled Media and Childhood Obesity: Today and Tomorrow. 3 At the California Childhood Obesity …

Importance Identifying community-based programs that increase physical activity among diverse youth could yield sustainable tools to reduce obesity and obesity disparities. Objective To evaluate the impact of a community-based after-school soccer and youth development program, America SCORES, on students' physical activity, weight status, and fitness. Design Cluster-randomized trial. Study measures were collected in the fall (baseline), winter (midpoint), and spring (end point) of the 2009-2010 school year. Setting After-school programs in 6 schools within a large urban school district. Participants All 4th and 5th grade students in after-school programs at the study schools were eligible. Intervention Three schools were randomized to receive the SCORES after-school program, delivered via the train-the-trainer model. Main Outcome Measures Change in minutes of after-school moderate-to-vigorous physical activity (MVPA), fitness (maximal oxygen consumption), and body mass index over 1 school year. Results Participants (n = 156) were diverse (42% Latino, 32% Asian, and 12% African American) and 76 (49%) had a body mass index at or above the 85th percentile. There were no significant group differences in the change in physical activity, fitness, or weight status among all students. However, among students with a body mass index at or above the 85th percentile, SCORES significantly increased MVPA after school (3.4 min/d; 95% CI, 0.3-6.5) and on Saturdays (18.5 minutes; 95% CI, 3.4-33.6). Conclusions and Relevance Existing community-based programs such as SCORES can increase physical activity among low-income youth, particularly those most at risk for weight-related comorbidities. While evaluating existing programs presents special challenges, partnerships between communities, schools, and researchers are an important component of translational research to address obesity. Trial Registration clinicaltrials.gov Identifier: NCT01156103

We perform storm surge simulations for the Danish coast with the hydrodynamic model DMI-cmod operationally and for specific periods: Run 1: control, from 1960 to 1990 Run 2: scenario (IPCC A2), from 2070 to 2100 Run 3: hindcast, from 1960 to 2002 The model is forced by a regional climate model (RCM) to determine the effects of different emission scenarios and by HIRLAM, ERA40 and HIRHAM for more realistic real-time, hindcast and forecast simulations.

The investigators developed a 1-page chart abstraction tool to evaluate compliance with practice guidelines for attention deficit hyperactivity disorder. The tool had strong inter-rater reliability, with kappa of 0.81. Pilot testing for 57 children with attention deficit hyperactivity disorder showed only 12% documented full compliance with assessment guidelines and 44% with treatment guidelines.