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Abstract Background Clinician adherence to obesity screening guidelines from United States health agencies remains suboptimal. This study explored how personal and career demographics influence pediatricians' weight assessment and management practices. Methods A web-based survey was distributed to U.S. pediatricians. Respondents were asked to identify the weight status of photographed children and about their weight assessment and management practices. Associations between career and personal demographic variables and pediatricians' weight perceptions, weight assessment and management practices were evaluated using univariate and multivariate modeling. Results 3,633 pediatric medical providers correctly identified the weight status of children at a median rate of 58%. The majority of pediatric clinicians were white, female, and of normal weight status with more than 10 years clinical experience. Experienced pediatric medical providers were less likely than younger colleagues to correctly identify the weight status of pictured children and were also less likely to know and use BMI criteria for assessing weight status. General pediatricians were more likely than subspecialty practitioners to provide diverse interventions for weight management. Non-white and Hispanic general practitioners were more likely than counterparts to consider cultural approaches to weight management. Conclusion Pediatricians' perceptions of children's weight and their weight assessment and management practices are influenced by career and personal characteristics. Objective criteria and clinical guidelines should be uniformly applied by pediatricians to screen for and manage pediatric obesity.

We compared processing and fate of dissolved NO3- in two New England salt marsh ecosystems, one receiving natural flood tide concentrations of approximately 1-4 micromol NO3-/ L and the other receiving experimentally fertilized flood tides containing approximately 70-100 micromol NO3-/ L. We conducted simultaneous 15NO3- (isotope) tracer additions from 23 to 28 July 2005 in the reference (8.4 ha) and fertilized (12.4 ha) systems to compare N dynamics and fate. Two full tidal cycles were intensively studied during the paired tracer additions. Resulting mass balances showed that essentially 100% (0.48-0.61 mol NO3-N.ha(-1).h(-1)) of incoming NO3- was assimilated, dissimilated, sorbed, or sedimented (processed) within a few hours in the reference system when NO3- concentrations were 1.3-1.8 micromol/L. In contrast, only 50-60% of incoming NO3- was processed in the fertilized system when NO3- concentrations were 84-96 micromol/L; the remainder was exported in ebb tidewater. Gross NO3- processing was approximately 40 times higher in the fertilized system at 19.34-24.67 mol NO3-N.ha(-1).h(-1). Dissimilatory nitrate reduction to ammonium was evident in both systems during the first 48 h of the tracer additions but <1% of incoming 15NO3- was exported as 15NH4+. Nitrification rates calculated by 15NO3- dilution were 6.05 and 4.46 mol.ha(-1).h(-1) in the fertilized system but could not be accurately calculated in the reference system due to rapid (<4 h) NO3- turnover. Over the five-day paired tracer addition, sediments sequestered a small fraction of incoming NO3-, although the efficiency of sequestration was 3.8% in the reference system and 0.7% in the fertilized system. Gross sediment N sequestration rates were similar at 13.5 and 12.6 mol.ha(-1).d(-1), respectively. Macrophyte NO3- uptake efficiency, based on tracer incorporation in aboveground tissues, was considerably higher in the reference system (16.8%) than the fertilized system (2.6%), although bulk uptake of NO3- by plants was lower in the reference system (1.75 mol NO3-.ha(-1).d(-1)) than the fertilized system (approximately 10 mol NO3-.ha(-1).d(-1)). Nitrogen processing efficiency decreased with NO3- load in all pools, suggesting that the nutrient processing capacity of the marsh ecosystem was exceeded in the fertilized marsh.