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Background: Adolescents with Down syndrome (DS) are two to three times more likely to be obese than their typically developing peers. When preventing or treating obesity, it is useful for clinicians to understand an individual's energy intake needs. Predictive resting energy expenditure (REE) equations are often recommended for general use in energy intake recommendations; however, these predictive equations have not been validated in youth with DS. The aim of this study was to compare the accuracy of seven commonly used predictive equations for estimating REE in adolescents who are typically developing to REE measured by indirect calorimetry in adolescents with DS. Methods: Adolescents with DS participated in a 90‐min laboratory visit before 10:00 a.m. after a 12‐h overnight fast and a 48‐h abstention from aerobic exercise. REE was measured via indirect calorimetry, and estimated REE was derived using the Institute of Medicine, Molnar, Muller and World Health Organization equations. Mean differences between the measured and predicted REE for each equation were evaluated with equivalency testing, and P‐values were adjusted for multiple comparisons using the Holm method. Results: Forty‐six adolescents with DS (age: 15.5 ± 1.7 years, 47.8% female, 73.9% non‐Hispanic White) completed the REE assessment. Average measured REE was 1459.5 ± 267.8 kcal/day, and the Institute of Medicine equations provided the most accurate prediction of REE with a 1.7 ± 11.2% (13.9 ± 170.3 kcal/day) overestimation. This prediction was not statistically different from the measured REE [P‐value = 0.582; 95% confidence interval (CI): −64.5, 36.7], and the difference between the measured and predicted REE was statistically equivalent to zero (P‐value = 0.024; 90% CI: −56.1, 28.3). Conclusions: The results suggest that the Institute of Medicine equation may be useful in predicting REE in adolescents with DS. Future research should confirm these results in a larger sample and determine the utility of the Institute of Medicine equation for energy intake recommendations during a weight management intervention. [ABSTRACT FROM AUTHOR]

We have utilized a recently developed human tumor cloning system to screen for antitumor effects in vitro of a new anthracene derivative, CL216,942. The object was to determine whether the system is useful for pinpointing the types of tumors in patients which should be studied in early phase II clinical trials. Tumors from 684 patients were placed in culture (27 different histologic tumor types). Two hundred seventy-three tumors both grew and formed enough colonies for drug sensitivity assays. In vitro antitumor activity was noted for CL216,942 against human breast cancer, ovarian cancer, renal cancer, squamous cell, small cell and large cell lung cancer, lymphoma, acute myelogenous leukemia, melanoma, adenocarcinoma of unknown origin, adrenal cancer, gastric cancer, pancreatic cancer, and head and neck cancer. The drug definitely showed no in vitro activity against colon cancer. These data indicate that CL216,942 has a wide spectrum of in vitro antitumor activity. A comparison of these in vitro results with the results of phase II clinical trials with the drug should allow an evaluation of the utility of the human cloning system for predicting clinical activity of a new compound. [ABSTRACT FROM AUTHOR]

Objective: Cognitive-behavioral (CBT) interventions combined with either a physical activity (CBT+PA) or exercise intervention (CBT+Ex) are becoming more common in pediatric populations. Considering the independent effects of PA and exercise on health and psychological outcomes, it is unclear whether CBT alone differs from CBT+PA or CBT+Ex in efficacy. The main objective of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to assess the efficacy of CBT+PA and CBT+Ex interventions in pediatric chronic disease., Method: This review included RCTs in children (≤18 years) with a chronic condition, a CBT+Ex or CBT+PA intervention, and an objective measure of PA&Ex. Seven databases were searched using MeSH terms and key terms and included studies published before July 1, 2023. Abstracts were reviewed for inclusion by two independent reviewers, data was extracted by three independent reviewers. Risk of bias (RoB 2) and study quality were coded. Random effect meta-analyses of differences in between-group change in PA&Ex were conducted., Results: Eligible studies (k = 5) reported outcomes for a combined 446 children. A small, nonsignificant overall effect was found (d = 0.10, 95% CI -0.16, 0.35) indicating intervention groups (CBT+PA or CBT+Ex) increased engagement in PA&Ex more than comparator groups (CBT). Additional analyses were inconclusive due to the small number of eligible studies., Discussion: Additional RCTs are needed with integrated PA&Ex interventions targeting pediatric chronic disease. Future trials should report more detailed PA&Ex data. The full protocol for this analysis was prospectively registered in Open Science Framework (project ID: osf.io/m4wtc)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: There have been mixed findings on the relationships between childhood obesity and macroscale retail food environments. The current study investigates associations of the neighborhood retail food environment with changes in children's weight status over 6 years in the Kansas City Metropolitan area. Methods: Anthropometrics and home addresses were collected during routine well-child visits in a large pediatric hospital ( n = 4493; >75% were Black or Latinx children). Children had measures collected during two time periods ([Time 1] 2012-2014, [Time 2] 2017-2019). Establishment-level food environment data were used to determine the number of four types of food outlets within a 0.5-mile buffer from the children's residence: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Children who moved residences between periods were "movers" ( n = 1052). Associations of baseline and changes in food environment status with Time 2 weight status were assessed using mixed-effects models. Results: Movers who experienced no change in the number of convenience stores or small grocery stores within a 0.5-mile of their home had increased likelihoods of having overweight/obesity and less favorable BMIz changes, compared with movers who experienced a decrease in convenience stores/small grocery stores within a 0.5-mile distance. No associations were observed among nonmovers. Conclusion: Findings suggest that moving to an area with fewer unhealthy retail food outlets (e.g., convenience stores) is associated with a lower risk of obesity in children. Future research is needed to determine whether larger-scale changes to the retail food environment within a neighborhood can support children's healthy weight.

Background: Thers is limited research examining modifiable cardiometabolic risk factors with a single-item health behavior question obtained during a clinic visit. Such information could support clinicians in identifying patients at risk for adverse cardiometabolic health. We investigated if children meeting physical activity or screen time recommendations, collected during clinic visits, have better cardiometabolic health than children not meeting recommendations. We hypothesized that children meeting either recommendation would have fewer cardiometabolic risk factors., Methods and Findings: This cross-sectional study used data from electronic medical records (EMRs) between January 1, 2013 through December 30, 2017 from children (2-18 years) with a well child visits and data for ≥1 cardiometabolic risk factor (i.e., systolic and diastolic blood pressure, glycated hemoglobin, alanine transaminase, high-density and low-density lipoprotein, total cholesterol, and/or triglycerides). Physical activity and screen time were patient/caregiver-reported. Analyses included EMRs from 63,676 well child visits by 30,698 unique patients (49.3% female; 41.7% Black, 31.5% Hispanic). Models that included data from all visits indicated children meeting physical activity recommendations had reduced risk for abnormal blood pressure (odds ratio [OR] = 0.91, 95%CI 0.86, 0.97; p = 0.002), glycated hemoglobin (OR = 0.83, 95%CI 0.75, 0.91; p = 0.00006), alanine transaminase (OR = 0.85, 95%CI 0.79, 0.92; p = 0.00001), high-density lipoprotein (OR = 0.88, 95%CI 0.82, 0.95; p = 0.0009), and triglyceride values (OR = 0.89, 95%CI 0.83, 0.96; p = 0.002). Meeting screen time recommendations was not associated with abnormal cardiometabolic risk factors., Conclusion: Collecting information on reported adherence to meeting physical activity recommendations can provide clinicians with additional information to identify patients with a higher risk of adverse cardiometabolic health., Competing Interests: "The authors have read the journal’s policy and have the following competing interests: BF received salary support from the National Institutes of Health for research not directly related to this project (F32DK128982). This does not alter our adherence to PLOS ONE policies on sharing data and materials.", (Copyright: © 2024 Forseth et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary., Objective: This paper evaluates the effectiveness of iAmHealthy, a family-based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control., Methods: Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post-treatment (8 months) and follow-up (20 months). Multilevel modeling estimated the effect of treatment at both time points., Results: Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow-up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow-up. Child dietary intake, physical activity and parent BMI results are also discussed., Conclusions: This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long-term health behaviour for youth., (© 2024 World Obesity Federation.)

This study examined factors influencing rural caregivers' decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n=16) resulted in 5 saturated themes: (1) rural families' household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health., Competing Interests: Declaration of Interest Statement The authors report there are no competing interests to declare.

Research provides evidence on the benefits and safety of prenatal yoga as well as hot yoga among nonpregnant individuals. However, limited literature on hot yoga during pregnancy exists. The present study aims to (1) describe knowledge, attitudes, and beliefs of hot yoga studio management regarding hot yoga during pregnancy; and (2) examine how management teams rank the credibility of information sources (e.g., obstetricians) regarding the safety of hot yoga during pregnancy. Inclusion criteria included being at least 18 years of age and on the management team at a U.S. hot yoga studio. Studios were recruited via emails from publicly accessible websites of major hot yoga studio communities. Thirty-five participants completed a cross-sectional online survey addressing the study aims, and 10 (28.57%) participants reported trying hot yoga themselves while pregnant. Participants reported a median of 4 (interquartile range 1.5-8.5) pregnant individuals at their studio in the past year. All participants reported at least one hot yoga class type that they would recommend to pregnant individuals. Three qualitative themes emerged regarding deciding whether a pregnant individual may practice hot yoga: (1) integration of healthcare and individual knowledge, (2) emphasis on prior practice, and (3) individual bodily intuition and choice. Obstetricians were ranked the highest for credibility, although inferential tests suggested that their rankings were equivalent to those for academic journals, one's own knowledge/experiences, and a friend/acquaintance who had practiced hot yoga during pregnancy. These findings suggest recommendations for future yoga teacher trainings to include specific needs and considerations for pregnant individuals who choose to practice hot yoga.

Background: Adolescents with intellectual and developmental disabilities (IDD) experience overweight and obesity (OW/OB) up to 1.8 times the rate of their typically developing peers. Parents may influence adolescent weight management behaviors in this population, but the association between parent factors and adolescent weight management behaviors is unclear., Objective: To examine the associations between parent BMI and sociodemographic characteristics with adolescents' BMI, diet quality, daily energy intake, moderate to vigorous physical activity (MVPA), and sedentary behavior., Methods: This study analyzed baseline data from an 18-month randomized controlled weight loss trial for adolescents with IDD. We assessed parent BMI (kg/m 2 ) and sociodemographic factors, and adolescent BMI z-score, MVPA, sedentary time, daily energy intake, and diet quality. Associations between parent and adolescent factors were assessed with Pearson, Spearman or Kendall Tau-b correlations; mean differences for categorical outcomes were assessed with independent samples t-tests/Mann-Whitney U tests or ANOVA/Kruskall-Wallis tests., Results: Ninety-five adolescent and parent dyads were included. Parent BMI was positively correlated with adolescent BMI z-score (n = 94: r s  = 0.37, p < 0.01). Household income was inversely correlated with adolescent BMI z-score (n = 95: T b  = -0.18, p = 0.02). Parents with less than a bachelor's degree had adolescents with higher BMI z-scores than those with bachelor's or higher (2.1 ± 0.5 vs. 1.8 ± 0.5, p = 0.02) as well as higher sedentary behavior (n = 28, 515.2 ± 102.6 min/day vs. n = 40, 463.9 ± 148.1 min/day, p = 0.02)., Conclusion: We found parent BMI, income, and education associated with adolescent BMI z-score. These findings contribute to the sparse literature on parental factors associated with OW/OB in this population., Clinical Trials Number: NCT02561754., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Most neighborhood food and activity related environment research in children has been cross-sectional. A better understanding of prospective associations between these neighborhood environment factors and children's weight status can provide stronger evidence for informing interventions and policy. This study examined associations of baseline and changes in neighborhood healthy food access and walkability with changes in children's weight status over 5 years., Methods: Height, weight, and home address were obtained for 4,493 children (> 75% were Black or Latinx) from primary care visits within a large pediatric health system. Eligible participants were those who had measures collected during two time periods (2012-2014 [Time 1] and 2017-2019 [Time 2]). Data were integrated with census tract-level healthy food access and walkability data. Children who moved residences between the time periods were considered 'movers' (N = 1052; 23.4%). Mixed-effects models, accounting for nesting of children within census tracts, were conducted to model associations of baseline and changes in the neighborhood environment variables with Time 2 weight status (BMIz and overweight or obese vs. healthy weight). Models adjusted for weight status and child and neighborhood sociodemographics at baseline., Results: Children living in a neighborhood with [ample] healthy food access at Time 1 had a lower BMIz at Time 2, regardless of mover status. A decrease in healthy food access was not significantly associated with children's weight status at Time 2. Baseline walkability and improvements in walkability were associated with a lower BMIz at Time 2, regardless of mover status., Conclusions: Findings provide evidence that residing in a neighborhood with healthy food access and walkability may support a healthy weight trajectory in children. Findings on changes in the neighborhood environment suggested that improved walkability in the neighborhood may support children's healthy weight. The greater and more consistent findings among movers may be due to movers experiencing greater changes in neighborhood features than the changes that typically occur within a neighborhood over a short period of time. Future research is needed to investigate more robust environmental changes to neighborhoods., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background There is limited evidence on the potential negative metabolic health impacts of prolonged and uninterrupted sedentary bouts in structurally disadvantaged youth. This study investigated associations between sedentary bout variables and metabolic health markers in the Hispanic Community Health Study/SOL Youth (Study of Latino Youth). Methods and Results SOL Youth was a population-based cohort of 1466 youth (age range, 8-16 years; 48.5% female); 957 youth were included in the analytic sample based on complete data. Accelerometers measured moderate-to-vigorous physical activity (MVPA), total sedentary time, and sedentary bout patterns (daily time spent in sedentary bouts ≥30 minutes, median sedentary bout duration, and number of daily breaks from sedentary time). Clinical measures included body mass index, waist circumference, fasting glucose, glycated hemoglobin, fasting insulin, and the homeostasis model assessment of insulin resistance. After adjusting for sociodemographics, total sedentary time, and MVPA, longer median bout durations and fewer sedentary breaks were associated with a greater body mass index percentile (b bouts =0.09 and b breaks =-0.18), waist circumference (b bouts =0.12 and b breaks =-0.20), and fasting insulin (b bouts =0.09 and b breaks =-0.21). Fewer breaks were also associated with a greater homeostasis model assessment of insulin resistance (b=-0.21). More time in bouts lasting ≥30 minutes was associated with a greater fasting glucose (b=0.18) and glycated hemoglobin (b=0.19). Conclusions Greater accumulation of sedentary time in prolonged and uninterrupted bouts had adverse associations with adiposity and glycemic control over and above total sedentary time and MVPA. Findings suggest interventions in Hispanic/Latino youth targeting both ends of the activity spectrum (more MVPA and less prolonged/uninterrupted sedentary patterns) may provide greater health benefits than those targeting only MVPA.

Introduction: The purpose of this study is to evaluate two recruitment strategies on schools and participant participation rates and representativeness (reach) within a pediatric obesity treatment trial tailored for families who live in rural areas., Methods: Recruitment of schools was evaluated based on their progress toward enrolling participants. Recruitment and reach of participants were evaluated using (1) participation rates and (2) representativeness of demographics and weight status of participants compared to eligible participants (who did not consent and enroll) and all students (regardless of eligibility). School recruitment, as well as participant recruitment and reach, were evaluated across recruitment methods comparing opt-in (i.e., caregivers agreed to allow their child to be screened for eligibility) vs. screen-first (i.e., all children screened for eligibility)., Results: Of the 395 schools contacted, 34 schools (8.6%) expressed initial interest; of these, 27 (79%) proceeded to recruit participants, and 18 (53%) ultimately participated in the program. Of schools who initiated recruitment, 75% of schools using the opt-in method and 60% of schools using the screen-first method continued participation and were able to recruit a sufficient number of participants. The average participation rate (number of enrolled individuals divided by those who were eligible) from all 18 schools was 21.6%. This percentage was higher in schools using the screen-first method (average of 29.7%) compared to schools using the opt-in method (13.5%). Study participants were representative of the student population based on sex (female), race (White), and eligibility for free and reduced-price lunch. Study participants had higher body mass index (BMI) metrics (BMI, BMIz, and BMI%) than eligible non-participants., Conclusions: Schools using the opt-in recruitment were more likely to enroll at least 5 families and administer the intervention. However, the participation rate was higher in screen-first schools. The overall study sample was representative of the school demographics., Competing Interests: The 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 © 2023 Forseth, Lancaster, Olalde, Befort, Swinburne Romine, Dreyer Gillette, Dean, Nelson and Davis.)

Background: The purpose of this study is to describe and assess a remote height and weight protocol that was developed for an ongoing trial conducted during the SARS COV-2 pandemic., Methods: Thirty-eight rural families (children 8.3 ± 0.7 years; 68% female; and caregivers 38.2 ± 6.1 years) were provided detailed instructions on how to measure height and weight. Families obtained measures via remote data collection (caregiver weight, child height and weight) and also by trained staff. Differences between data collection methods were examined., Results: Per absolute mean difference analyses, slightly larger differences were found for child weight (0.21 ± 0.21 kg), child height (1.53 ± 1.29 cm), and caregiver weight (0.48 ± 0.42 kg) between school and home measurements. Both analyses indicate differences had only minor impact on child BMI percentile (- 0.12, 0.68) and parent BMI (0.05, 0.13). Intraclass coefficients ranged from 0.98 to 1.00 indicating that almost all of the variance was due to between person differences and not measurement differences within a person., Conclusion: Results suggest that remote height and weight collection is feasible for caregivers and children and that there are minimal differences in the various measurement methods studied here when assessing group differences. These differences did not have clinically meaningful impacts on BMI. This is promising for the use of remote height and weight measurement in clinical trials, especially for hard-to reach-populations., Trial Registration: Clinical. Registered in clinicaltrials.gov ( NCT03304249 ) on 06/10/2017., (© 2022. The Author(s).)

Aim: Sedentary behavior (SB) is widely studied as it is associated with cardiometabolic health and obesity issues. However, children with Intellectual and Developmental Disabilities (IDD) have been understudied. Accelerometers are commonly used to measure SB in typically developing populations but may be inappropriate for IDD populations due to differences in body movement and physiologic responses to the activity. The use of Evenson sedentary cut-points, created based on typically developing children, has yet to be applied and/or examined in children with IDD., Purpose: A descriptive cross-sectional study was conducted to (1) Assess the feasibility of applying Evenson sedentary cut-points in children with IDD (2) Describe SB over a two-week period between diagnosis groups., Methods: The SB of 22 participants (8 children with Down syndrome, 6 children with spina bifida, 8 children with no chronic illness) was assessed on two separate occasions: (1) during a 7-minute sedentary protocol, and (2) over a two-week period., Results: The study supports the preliminary efficacy of using Evenson cut-points for this population, with 100% of participants being within the Evenson counts per minute (0-100 cpm) during the 7-minute sedentary protocol. The total volume of SB over a two-week period was not significantly different between diagnosis groups (8.8 h, 8.6 h, and 7.1 h of SB for children with Down syndrome, spina bifida, or those with no chronic illness, respectively; p  = 0.36)., Conclusions: Evenson sedentary cut-points can be used for children with IDD. Preliminary data suggest that children with IDD do not engage in significantly different SB than children without a chronic illness. Further study is warranted.Implications for rehabilitationObjective measures of physical activity and sedentary behavior for children with Down syndrome or spina bifida are rarely used due to potential differences in body movement (e.g., gait) during ambulation compared to typically developing peers that may influence the accuracy of cut-points.This study supports that Evenson sedentary cut-points can be used in children with Down syndrome or spina bifida to assess sedentary activity.Preliminary findings from this study demonstrate similarities in patterns of sedentary behaviors exhibited by our sample of children with Down syndrome, spina bifida, or no chronic illness.

Background: Participating in yoga may be ideal for college students to increase physical activity and improve mental health., Purpose: To investigate the feasibility and impact of an 8-week yoga intervention within a university setting on mental and physiologic heath., Methods: This 8-week yoga intervention included twelve yoga-naïve adults, (23.8 ± 4.6 years; 71% female). Participants attended two 60-min yoga classes/week in addition to baseline, mid- and post-lab visits., Results: 83% of participants attended ≥75% of yoga classes. Stress and depression symptoms decreased by 11% and 25%, respectively and erythrocyte sedimentation rate (ESR) reduced by 28%. Participants who did not meet physical activity recommendations observed greater improvements in stress, depression symptoms, ESR, and C-reactive protein compared to participants who met recommendations., Conclusion: The majority of participants attended ≥12 of 16 yoga classes. Exploratory analyses provide preliminary support for the impact of yoga on reducing stress, symptoms of depression, and ESR. Participants who were not meeting physical activity guidelines prior to starting the intervention received greater benefits., Competing Interests: Declaration of competing interest Disclosures: Dr. Lawlor is a member of advisory boards for Audentes Therapeutics, Solid Biosciences, and Ichorion Therapeutics, and has received research support from these entities. He is also a consultant for Dynacure and AGADA Biosciences; these relationships did not impact the methodology or results of this study. No other authors have disclosures., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The purpose of the current study is to understand how the early portion of COVID-19 pandemic impacted the health behaviors of rural families participating in a healthy lifestyles intervention. Caregivers of rural children participating in a healthy lifestyles intervention were invited to participate in a structured interview regarding how the COVID-19 pandemic affected their family and family health behaviors. Interviews were transcribed and the research team conducted a rigorous inductive thematic analysis. Structured qualitative interviews with caregivers (n=30) resulted in 5 saturated themes: (a) caregivers reported new or exacerbated mental health concerns and stress among family members, largely due to social isolation and external stressors, (b) caregivers reported feeling out of control of positive health behaviors for themselves and their children, (c) families reported variability in how they handled reductions in schedule demands, ranging from filling time with positive activities to negative behaviors such as snacking, (d) families continuously re-adjusted their approach to parenting, routines, and health behaviors due to internal and external factors, (e) families ate foods that were accessible and convenient, which impacted the health of the family diet. Despite being asked primarily about lifestyle behavior changes, families reported concerns around mental health. Implications are that professionals working with rural children and families, even those without mental health training, may be called upon to help address these concerns especially in these underserved, rural families., Competing Interests: Conflict of interest statement: We have no conflicts of interest to disclose.

Background: No cut-points have been developed for youth with Down syndrome; there is concern that altered gait patterns, decreased energy expenditure and exercise capacity of individuals with Down syndrome may produce inaccurate physical activity data if accelerometer data are analyzed using cut-points from populations with typical development and other IDD diagnoses., Aim: To compare physical activity and sedentary time across existing accelerometer cut-point methods in adolescents with Down syndrome., Methods: In this cross-sectional analysis, participants diagnosed with Down syndrome (n = 37; 15.5 ± 1.9 years; 57 % female) wore an accelerometer on their non-dominant hip for seven-days. Data were analyzed and compared across four physical activity intensity cut-points: Evenson, Freedson 4-MET, McGarty, and Romanizi., Outcomes & Results: Differences in time spent in each intensity across cut-point methods were evident for sedentary (448-615 min/day), light (72-303 min/day) and moderate-to-vigorous (12-77 min/day) activities. Between 0.0-67.6 % of the sample met the physical activity guidelines, depending on the cut-point method selected., Conclusions & Implications: This study presents the wide variation of accumulated physical activity minutes when different cut-points are applied to individuals with Down syndrome. There is a critical need to establish Down syndrome-specific measures of physical activity assessment rather than applying methods developed for their peers with typical development., What This Paper Adds: This paper highlights concerns over the application of objective measurements of physical activity in youth with Down syndrome from measurement methods derived from populations with typical development. This is the first manuscript to examine this issue in a sample comprised solely of youth with Down syndrome. Results demonstrate the large variation in time spent in each activity intensity that arise due to the application of different cut-point methods., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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.

To examine the early impact of the COVID-19 pandemic on rural parental stress and family behaviors, parents who participated in a 2 nd -4 th grade pediatric obesity intervention completed a survey in May 2020. Parents (N=77) experienced 7.8±2.7 events on the COVID-19 Exposure and Family Impact Scales (CEFIS) with an average impact of 2.5±0.5, with many parents reporting moderate stress (73%). Parental stress was predictive of personal well-being getting 'worse' while loss of income events were predictive of family routines getting 'better.' Professionals working with rural families may want to assess for these factors when promoting positive changes in family health behaviors.

Remotely delivered interventions are promising for reaching large numbers of people, though few have targeted multiple levels of influence such as schools and families. This study evaluated two versions (arms) of a remotely delivered classroom-based physical activity (CBPA) intervention. One arm solely included remote CBPA; the other included remote CBPA and mobile health (mHealth) family supports. Six schools were randomized to CBPA or CBPA+Family. Both arms were remotely delivered for seven weeks. CBPA+Family added behavior change tools delivered via text messages and newsletters to caregiver/child dyads. Garmin devices measured moderate-to-vigorous activity (MVPA) in both arms and were used for goal setting/monitoring in the CBPA+Family arm (integrated with the text messages). Caregivers completed surveys evaluating intervention acceptability. 53 participants (CBPA n=35; CBPA+Family n=18; 9.7±0.7 years) were included. Increases in MVPA were similar between arms, showing a pre-post effect of the CBPA but no additional effect of family supports. MVPA was low at baseline and during the first 3 weeks (CBPA 7.5±3.1 minutes/day; CBPA+Family 7.9±2.7 minutes/day) and increased by Weeks 6-8 (CBPA 56.8±34.2 minutes/day; CBPA+Family 49.2±18.7 minutes/day). Approximately 90% of caregivers reported high satisfaction with the added family support content. CBPA+Family participants wore the Garmin later into the study period. Remote delivery of CBPA appears feasible and effective for supporting increases in children's MVPA. Adding family supports to school-based interventions appears acceptable and may support engagement, demonstrating promise for more multilevel/multi-setting interventions, though the multilevel intervention was not more effective than the single-level intervention in increasing children's MVPA., Competing Interests: Conflicts of interest All authors report no conflicts of interest., (© JHEAL, 2021.)

Background: Children with developmental disabilities have a high prevalence of overweight and obesity. The role and contribution of their diet to weight status is poorly understood., Objectives: This pilot study describes the dietary quality of children with spina bifida and Down syndrome compared with typically developing peers., Methods: Dietary intakes of 8 children with spina bifida or Down syndrome and 4 children without developmental disabilities, aged 8 to 18 years, were collected using six 24-hour dietary recalls through Facetime. Dietary quality was assessed by application of the Healthy Eating Index (HEI)., Results: Children with spina bifida and Down syndrome had higher HEI scores when compared to typically developing peers (48.3, 52.9, and 46.2, respectively) and vegetable consumption (1.9, 2.6, and 1.4, respectively). All groups had undesirable intakes of saturated fat, added sugar, and sodium. Within this small sample, children with spina bifida and Down Syndrome had similar diet quality to their typically developing peers., Conclusions: Further investigation in a larger sample is recommended to support the development of methods to optimize weight management in children with developmental disabilities., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Purpose: To compare markers of health associated with chronic diseases between yoga and non-yoga participants., Methods: 30 participants were categorized as either: 1) "Yoga" engaging in yoga ≥2 times/week for ≥6 months, or 2) "Non-yoga" not engaging in yoga., Results: Perceived Stress Scale (PSS) and Beck Depression Inventory-II (BDI-II) scores were significantly different between the yoga and non-yoga groups (PSS: 8.0 vs. 17.5, respectively, p < 0.05; BDI-II: 1.0 vs. 5.5, respectively, p < 0.05). No significant differences were evident between groups for inflammatory markers nor Complex V of the mitochondrial electron transport chain. The erythrocyte sedimentation rate values differed between groups based on clinical cutoffs, with yoga participants categorized as normal (11.0 mm) and non-yoga above normal (21.5 mm)., Conclusion: This research supports that yoga participation is associated with lower PSS and BDI-II scores but does not support a relationship with markers of inflammation. Further research is warranted., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: To identify the accuracy of Body Mass Index (BMI) to categorize body weight in a sample of children with spina bifida and Down syndrome as compared to typically developing peers., Methods: A secondary analysis of 32 children with spina bifida, Down syndrome or no chronic illness. A calculated BMI was plotted on the Centers for Disease Control and Prevention age- and sex-specific BMI growth charts to determine each child's weight status. Percentage of body fat, obtained by labeled water, was plotted on two different body fat percentile reference curves, one derived from a whole body measure (DXA) of body fat and one by skin-fold measure. Differences in weight categories between calculated BMI and body fat percentile curves were reported., Results: The calculated BMI for children with a disability had significant misclassifications as a screening tool for body fat when compared to children without a disability. Misclassifications were increased with the body fat percentile reference curve derived from skin-fold measures and for children who primarily used a wheelchair., Conclusion: The current recommendation to use BMI to categorize weight status is not useful for many children with disabilities. Further research to identify an alternative pragmatic strategy is necessary.

Background: There is limited research examining the intensity of yoga and intensity variations between different styles. The purpose of this review is to examine the intensity of yoga based on different physiologic responses both between different yoga styles and within styles of yoga., Methods: Articles were searched for on the PubMed database in early 2019. Inclusion criteria were as follows: (1) written in English, (2) cite a specific style of yoga and include whole yoga session, and (3) measure metabolic or heart rate response., Results: Ten articles were reviewed; articles reported oxygen consumption (n = 1), heart rate (n = 4), or both variables (n = 5). Yoga styles assessed included ashtanga (n = 2), Bikram (n = 3), gentle (n = 1), hatha (n = 3), Iyengar (n = 1), power (n = 1), and vinyasa (n = 1). Oxygen consumption commonly categorized yoga as a light-intensity activity, while heart rate responses classified different yoga into multiple intensities., Conclusion: This review demonstrates that large differences in intensity classifications are observed between different styles of yoga. Furthermore, metabolic and heart rate responses can be variable, leading to inconsistent intensity classifications. This is likely due to their nonlinear relationship during yoga. Thus, it is imperative that the field of yoga research works together to create a standard for reporting yoga.

Objective: Opioids are the primary therapy for cancer-related pain in patients receiving palliative care. More states are legalizing medical cannabis, which may provide a pain management alternative for some of these patients. This study aimed to estimate the effect of cannabis on opioid use in patients with cancer receiving palliative care., Methods: This was a retrospective cohort study of patients with cancer at an academic medical center palliative care clinic. The primary outcome was change in morphine equivalent daily dose (MEDD) from baseline to 84-day follow-up in the cannabis plus opioid group compared to that in the opioid-only group., Results: A total of 83 patients were included: 61 in the opioid monotherapy group and 22 in the cannabis plus opioid group. An increase in MEDD from the baseline to 84 days was seen in both the opioid monotherapy and opioid plus cannabis group (28.8 vs. 10.8); however, the study lacked power to detect a statistical difference., Conclusion: A possibly meaningful difference in MEDD increase was seen when comparing the opioid monotherapy group with the opioid plus cannabis group. However, the study was not powered to test this hypothesis; the findings suggest that further research is warranted to determine the impact of cannabis use on opioid dosing in patients receiving palliative care for cancer., (Published by Elsevier Inc.)

This study was conducted to examine the feasibility and acceptability of a self-report activity diary completed by parents and older children to assess the child's daily activity in children with and without special needs. The study included 36 child/parent dyads stratified by child age and diagnosis. Parents (n = 36) and children ≥13 years (n = 12) were asked to report on the child's daily activity using an activity diary. Feasibility was determined based on successfully returned diaries and acceptability via post-study interview. Activity diaries were submitted by 94% of the parents and 100% of the children, with 83% and 80%, respectively, successfully completed. Comments provided post-study regarding the diaries were primarily on the format and were generally negative. The activity diary was feasible to use, but not well accepted within our sample of children with and without special needs or their parents. Further research is needed to create valid physical activity assessment measures that are population specific for individuals with special needs.

Objective: To examine and compare the demographic, health behavior, and cardiometabolic risk factor characteristics of participants who report 1) participating in yoga, 2) not participating yoga, or 3) are inactive, using a nationally representative sample of U.S. adults., Design: Study participants were from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) who self-reported participation in yoga (n = 74), no-yoga (n = 3,753) or were inactive (n = 1,285). Participants in the no-yoga group did engage in other types of physical activity, while the inactive group reported no activity during the survey period., Results: Yoga participants were primarily female (80.7%), college educated (51.9%), mostly non-smokers (46.9%), and reported moderate alcohol consumption (72.1%). Yoga participants were found to be significantly less likely to have an elevated waist circumference (OR = 0.40, p < 0.01; OR = 0.30, p < 0.01), and a low HDL (OR = 0.43, p = 0.03; OR = 0.34, p < 0.05) compared to both non-yoga participants and inactive individuals, respectively. Yoga participants were 61% less likely to have elevated blood glucose compared to non-yoga participants (OR = 0.39, p < 0.05). Compared to inactive individuals, yoga participants were 52% (OR = 0.48, p < 0.05) and 66% (OR = 0.34, p < 0.05) less likely have an elevated body mass index and have elevated triglyceride levels, respectively., Conclusions: Given the emergence of yoga as a common form of physical activity, it is imperative to understand the characteristics of those who participate in yoga to further understand its relationship with cardiovascular risk. This study was one of the first to use nationally-representative data and objectively measured cardiometabolic variables. Key Words: complementary medicine, epidemiology, survey, population, physical activity, cardiovascular disease., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To develop a method that describes the physical activity completed during yoga, and to use this method to compare three different yoga video categories: weight loss, beginner, and stress relief/meditation., Design: This study conducted content analysis of commercially available yoga videos in which pre-determined characteristics of yoga routines were recorded. Outcome measures included the yoga routine characteristics of: duration of each yoga routine, number of completed poses, body position of each pose, and pose rate., Results: Twenty-two routines from yoga videos were analyzed. Duration of routine between the three different categories was not significantly different. There were significant differences between the video categories based on the characteristics of total number of poses and the pose rate, with weight loss routines having the highest values compare to beginner routines and stress relief/meditation (total number of poses: 74.1, 34.3, 25.6 poses, p < 0.05; Pose rate: 2.5m 1.5, 1.1 poses/min, p < 0.05, respectively). Additionally, differences were observed between body postures in poses with weight loss videos including more standing poses (38.8, 17.0, 5.7 poses, p < 0.05, respectively) and a lower percentage of seated (9.9%, 15.8%, 39.0%, p < 0.05, respectively) and supine poses (10.9%, 18.5%, 28.8%, p < 0.05, respectively) compared to the beginner and stress/meditation videos., Conclusions: The characteristics of total poses, pose rate, and total standing poses showed significant differences between different styles of yoga. Further research should be conducted to validate these characteristics as an intensity measures and to assess if these characteristics have variations between different yoga styles., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities., Objective: Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome., Methods/measures: This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups., Results: Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072)., Conclusions: Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Amplification of oncogenes in human tumors has been associated with a poor prognosis. Microscopically visible amplified oncogenes can be located either within chromosomes in homogeneously staining regions, or in an extrachromosomal compartment in double minutes (DMs). The DMs are composed of submicroscopic circular DNA (episomes), which have multimerized to form the microscopically visible DMs. When amplified oncogenes are located in an extrachromosomal location, they are vulnerable to loss from the cell. In this study we have found that the topoisomerase II inhibitor etoposide, in concentrations easily achievable clinically, causes a significant decrease in the number of DM-containing amplified oncogenes in three different human tumor cell lines. The elimination of amplified oncogenes from the cell could be accompanied by less aggressive tumor behavior.

Preparation of high molecular weight DNA from resected tumor tissues suitable for pulsed-field gel electrophoresis (PFGE) can be complicated by the presence of nonviable cells and lymphocytes. We have developed a simple procedure to reduce the level of degraded DNA in PFGE DNA samples prepared from resected tumor tissues. The procedure employs a single, three component Percoll step gradient centrifugation and can be performed on several tumor samples simultaneously. Analyses of DNAs from 15 tumor specimens (7 solid tumors and 8 aspirated fluids) demonstrate that the technique enriches the integrity of PFGE DNA samples. Morphologic evaluation of 9 specimens suggested that both cellular debris and contaminating normal lymphocytes are removed from starting cell populations during the enrichment procedure. Fractionation of cells also reduced cell clumping, allowing for the formation of more uniform PFGE DNA samples.

Gene amplification is one mechanism mediating the resistance of tumor cells to antineoplastic agents and the overexpression of a variety of oncogenes in diverse tumor types. There is mounting evidence that acentric extrachromosomal elements such as double minute chromosomes are common intermediates in the amplification process. These acentric structures partition unequally at mitosis and can be lost in the absence of selection. In the present study, we used human and hamster cell lines documented to contain extrachromosomally amplified drug resistance genes to investigate the feasibility of enhancing the loss rate of the extrachromosomally amplified genes to make the cells more sensitive to drug treatment. The results show that treatment of each of these lines with hydroxyurea accelerates the loss of the extrachromosomally amplified drug resistance genes. Loss of these extrachromosomal genes was associated with a corresponding increase in the drug sensitivity in the cases examined. The mechanism of accelerated loss does not appear to involve a differential effect on the replication of extrachromosomal DNA sequences. The results suggest that hydroxyurea treatment may provide a valuable tool for the general accelerated elimination of extrachromosomally amplified genes.

One hundred thirty-three patients with advanced metastatic cancer were randomized to receive single-agent chemotherapy selected by either a medical oncologist or an in vitro capillary cloning system. Thirty-six of the 65 patients (55%) who were randomly assigned to selection of a drug by the clinician actually received a drug; these patients were able to be evaluated for clinical response. Of these 36 patients, one had a partial tumor response (3%). Only 19 of the 68 patients (28%) who were randomly assigned to selection of a drug by the capillary system actually received a drug; these patients were able to be evaluated for clinical response. Of these 19 patients, four (21%) had partial tumor responses. In the assessable patients (36 in the clinician's choice group, 19 in the capillary cloning group), the partial response rate was superior for drug selection by the capillary cloning system (P = .04). For all patients randomly assigned to a group (65 in the clinician's choice group, 68 in the capillary cloning group), the response rate was not significantly different (1.5% and 5.9%, respectively; P = .37). When overall survival rates for patients in the two groups were compared, there was no difference. We conclude that drug sensitivity testing in capillary tubes can improve the response rate for patients with advanced malignancies. This improved response rate, however, does not translate into improved survival times for these patients.

We have used a radiometric method to screen for chemotherapy sensitivity among a panel of human breast cancer cell lines. This method utilizes the inhibition of conversion of [14C]glucose to 14CO2 as an index of cytotoxicity. Nine different breast cancer cell lines were exposed for 1 h to 4 different concentrations of several antineoplastic agents with and without documented clinical activity against breast cancer. Cytotoxic effects were analyzed as a function of the ratio of the concentration required to inhibit cell growth to 50% of control to 1/10 of the known peak plasma concentration in humans for each particular drug. The drug-induced inhibition of 14C production by breast cancer tumor cells correlated strongly with the drug-induced antiproliferative effect (P less than 0.002) and with the inhibition of colony formation in a soft agar cloning assay (P less than 0.05). The HS578T cell line and one of the MCF7 cell lines exhibited a chemosensitivity pattern consistent with the clinical responsiveness of human breast cancer to the agents tested. Most of the other cell lines exhibited resistance to clinically active agents, especially the cell lines obtained from patients exposed to prior chemotherapy. These results suggest that this radiometric method measures a drug-induced metabolic effect that correlates with the antiproliferative activity of antineoplastic agents on breast cancer cells. The HS578T and the MCF7-KO cell lines, tested in this system, could be a useful screen for new anticancer compounds with activity against human breast cancer.

We have utilized a recently developed human tumor cloning system to screen for antitumor effects in vitro of a new anthracenedione derivative, Mitoxantrone. The object was to determine if the system is useful for pinpointing the types of tumors in patients which should be studied in early Phase II clinical trials. Tumors from 267 patients were placed in culture (20 different histological tumor types). One hundred seventy tumors both grew and formed enough colonies for drug sensitivity assays. Excellent in vitro antitumor activity was noted for Mitoxantrone against human adenocarcinoma of the lung, small cell lung cancer, melanoma, and biliary tree cancer. Good antitumor activity was noted against breast cancer, ovarian cancer, non-Hodgkin's lymphoma, head and neck cancer, squamous cell lung cancer, soft tissue sarcoma, gastric cancer, and hepatomas. The drug showed no in vitro activity against colon cancer. These data indicate that Mitoxantrone has a wide spectrum of in vitro antitumor activity. A comparison of these in vitro results with the results of Phase II clinical trials with the drug should allow an evaluation of the utility of the human tumor cloning system for predicting clinical antitumor activity of a new compound.

The human tumor cloning assay as described by Hamburger and Salmon was utilized to study the direct antitumor effects of the hypoxic cell sensitizer misonidazole (MISO). Cells from 106 tumor specimens directly obtained from patients were exposed to MISO at clinically achievable drug concentrations (0.5 mM). Of 30 evaluable tumors, seven specimens (23%) showed a less than or equal to 50% decrease of TCFU's. In vitro sensitivity to MISO was noted in human breast cancer, renal cancer, non small-cell lung cancer, and adenocarcinoma of unknown primary site. A dose response relationship was demonstrated in a subset of experiments including 6 patient's tumors and one human breast cancer cell-line. An analysis relating MISO sensitivity or resistance to the results obtained with other, simultaneously tested standard anticancer drugs indicated that tumors exhibiting a less than or equal to 50% decrease of TCFU's in the presence of MISO were also likely to be sensitive to other cytotoxic drugs. In summary, our data suggest that the 'nitroimidazoles' may exert clinically significant direct antitumor effects in individual tumors. The human tumor cloning assay may have potential to evaluate these direct effects of MISO-analogues and other new radiosensitizers currently being tested in clinical trials.

A rapid, semiautomated radiometric system is described for screening for new antineoplastic agents. This radiometric system utilizes inhibition of conversion of [14C]glucose to 14CO2 as an index of cytotoxicity. In this study the radiometric system (BACTEC 460) was first optimized using a variety of human and animal tumor cell lines. Overall, there was a clear linear relationship between the number of cells seeded and the production of 14CO2 from [14C]glucose. The BACTEC System easily detected antitumor activity of compounds from all four classes of antineoplastic agents (doxorubicin, vinblastine, cis-platinum, and methotrexate.) Human tumor cell lines were used to compare the antitumor activity of the same four agents measured by the BACTEC System versus the antitumor activity of the same agents measured by a conventional cloning system. For all cell lines tested there was good agreement in comparison of percentage of survival measured by the BACTEC System versus the standard cloning system. This agreement was better for a continuous exposure to drug in both systems (r = 87, P = less than 0.001) than for a 1-h exposure to the drug (r = 0.35, P = 0.036). In addition to determining the effect of drugs on tumor cells, the BACTEC System was successfully utilized to determine the cytotoxic effect on normal bone marrow buffy coat cells. By utilizing a comparison of suppression of 14CO2 production by normal versus tumor cells, a measurement of differential cytotoxicity could be made. Based on these findings, the radiometric BACTEC System represents a simple and rapid method to detect cytostatic or cytocidal activity of new compounds. It is ideal for use as a prescreen for testing a large number of new chemical entities against a large number of human tumor cell lines.

Polypeptide growth factors bind to membrane receptors on human breast cancer cells and stimulate cell proliferation, suggesting that they may be important in growth regulation. Inhibition of the stimulatory effects of these factors might result in antineoplastic activity. Since cytotoxic drugs have been shown to alter cell membrane characteristics, we have examined the effects of a variety of antitumor drugs on the binding of epidermal growth factor (EGF) to the membrane receptor of human breast cancer cells. Twenty-four standard or investigational cytotoxic drugs were screened at a concentration of one-tenth the achievable peak plasma level for their ability to inhibit binding of 125I-EGF to its receptor in MCF-7 human breast cancer cells. Although at this concentration statistically significant inhibition of binding was observed with 11 drugs, the maximum inhibition observed was only 27%. Five agents, representing classes of drugs with different modes of action, were then studied in more detail. Of these, preincubation with 5-fluorouracil, 4-hydroperoxy-cylophosphamide and doxorubicin inhibited MCF-7 colony formation in a dose-dependent manner, but these drugs had no effect on EGF-binding even at a concentration of 10 times the peak plasma level. Preincubation of cells with vinblastine and cisplatin, however, resulted in both reduced colony survival and a parallel reduction in EGF receptor binding. Membrane integrity, as measured by trypan blue exclusion, was not altered. Scatchard analysis of EGF binding demonstrated that the major effect of cisplatin was a reduction in binding affinity. We conclude that cisplatin and vinblastine at high concentrations can inhibit the binding of EGF to human breast cancer cells offering an additional possible mechanism for their antiproliferative activity.