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OBJECTIVE: To estimate associations of residential mobility with body mass index (BMI), physical activity and diet and whether associations differ across demographics. DESIGN: Longitudinal cohort with four waves of survey follow-up over 15 years. PARTICIPANTS AND SETTING: 2110 adolescents and young adults originally from the Twin Cities of Minnesota that responded to at least 2 waves of follow-up, beginning at ages 15 to 23. MAIN OUTCOME MEASURE(S): Self-reported BMI, physical activity, fast food consumption, breakfast frequency, sugary drink consumption, fruit and vegetable consumption, and screen-time. ANALYSIS: Each outcome was modeled as a continuous variable using hierarchical linear regression. Residential mobility – change in residential address – was the main effect of interest. Models adjusted for demographics, marriage during follow-up and previous level of the outcome. Inverse propensity weights accounted for loss to follow-up. RESULTS: No weight-related outcomes differed between movers and non-movers in the whole sample. When examining effect modification by age, as participants aged moving was increasingly associated with improvements in weight-related outcomes, particularly BMI. CONCLUSIONS AND IMPLICATIONS: Results suggest that moving may be associated with poorer weight-related outcomes during a brief window from late teens and early-20s, and less associated with weight related outcomes in the mid-20s and 30s.

PURPOSE Infants treated for CNS malignancies experience a significantly poorer response to treatment and are particularly at risk for neuropsychological deficits. The literature is limited and inconsistent regarding cognitive outcomes among this group. We investigated predictors of cognitive outcomes in children treated for brain tumors during infancy as part of a large, prospective, multisite, longitudinal trial. PATIENTS AND METHODS One hundred thirty-nine infants with a newly diagnosed CNS tumor were treated with chemotherapy, with or without focal proton or photon radiation therapy (RT). Cognitive assessments were conducted at baseline, 6 months, 1 year, and then annually for 5 years. The median length of follow-up was 816 days (26.8 months). Neurocognitive testing included assessment of intellectual functioning (intellectual quotient [IQ]), parent ratings of executive functioning and emotional and behavioral functioning, and socioeconomic status. RESULTS At baseline, IQ, parent-reported working memory, and parent-reported adaptive functioning were worse than normative expectations. Baseline cognitive difficulties were associated with younger age at diagnosis and lower socioeconomic status. Linear mixed models did not demonstrate a decline in IQ over time. There were increased parent-reported attention and executive problems over time. Increased concerns were related to supratentorial tumor location and CSF diversion. There were no differences in cognitive outcomes based on treatment exposure (chemotherapy-only v chemotherapy with RT and proton v photon focal RT). CONCLUSION Even before adjuvant therapy, young children with brain tumors experience cognitive difficulties that can affect quality of life. Changes in cognitive functioning over time were dependent on tumor location and surgical factors rather than adjuvant therapy. These findings may serve to guide treatment planning and indicate targets for cognitive monitoring and intervention.

To describe sociodemographic disparities in caregiver beliefs about the COVID-19 vaccine for their children.This was a cross-sectional study, linking caregiver-reported data to geocoded sociodemographic data from child EHRs. Caregivers of children receiving care in a Delaware pediatric healthcare system were invited to complete a survey about COVID-19 vaccine beliefs from March 19 to April 16, 2021.1499 caregivers participated (18% Black, 11% Hispanic, 32% public insurance, 12% rural). 54% of caregivers intended to vaccinate their children, while 34% were unsure and 12% would not. Caregivers of younger children (aOR 3.70, CI 2.36-5.79), Black children (aOR 2.11, CI 1.50-2.96), and from disadvantaged communities (aOR 1.59, CI 1.05-2.42) were more likely to be unsure and not vaccinate their children. Caregivers from rural communities were more likely not to vaccinate their children (aOR 2.51, CI 1.56-4.05). Fewer caregivers of younger children, Black children, and from disadvantaged communities believed in the safety or efficacy of the vaccines (p0.001), while fewer caregivers of younger children and from rural communities believed in their children's susceptibility to COVID-19 or risk of getting severe disease from COVID-19 (p0.05). While the majority (72%) of caregivers were influenced by health experts, fewer from communities of color and disadvantaged communities were (p0.001).Caregivers of younger children and from communities of color, rural communities, and disadvantaged communities in Delaware expressed more COVID-19 vaccine hesitancy.This study explores beliefs of different communities in Delaware, which are important to tailoring public health messaging and strategies to increase vaccine uptake in these communities.

The tremendous success of vaccination programs worldwide over the past two centuries has produced a paradoxical effect whereby a lack of exposure to the devastating consequences of vaccine-preventable diseases has created an environment in which fear of the side effects of vaccines can overshadow concerns about the impact of the diseases they are meant to prevent. As vaccine hesitancy grew over the past twenty years, states passed legislation, such as non-medical exemptions from vaccination, that have cultivated pockets of poor vaccine uptake allowing for the return of vaccine-preventable diseases such as measles and pertussis. The COVID-19 pandemic has further intensified mistrust of vaccines, impacting both the reasons for vaccine hesitancy and the attributes of vaccine hesitant parents. Because unimmunized children are at increased risk for vaccine-preventable diseases and associated cancers, as well as reduced access to adequate healthcare, they are a particularly vulnerable population warranting special protections and support. A comprehensive approach to combat vaccine hesitancy and promote uptake should include a focus on evidence-based initiatives at the legislative, practice, and provider levels. These strategies can substantively inform health policy, from upstream legislation strengthening school mandates and eliminating non-medical exemptions to downstream policies that impact provider conversations about immunization.

Recent studies have increased the known diversity and distribution of kinorhynchs in the Gulf of Mexico. For this study, sediment was sampled from Alabama coastal waters at shallow depths ranging f...

Children requiring gastrostomy tubes (GT) have high resource utilization. In addition, wide variation exists in the decision to perform concurrent fundoplication, which can increase the morbidity of enteral access surgery. We implemented a hospital-wide standardized pathway for GT placement.The standardized pathway included mandatory preoperative nasogastric feeding tube (FT) trial, identification of FT medical home, and standardized postoperative order set, including feeding regimen and parent education. An algorithm to determine whether concurrent fundoplication was indicated was also created. We identified children referred for GT placement from 2015 to 2018 and compared concurrent fundoplication rates and outcomes pre- and postimplementation.We identified 332 patients who were referred for GT. Of these, 15 avoided placement. Concurrent fundoplication decreased postpathway (48% vs 22%, p 0.0001). After adjusting for reflux and cardiac disease, prepathway patients were 3.5 times more likely to undergo concurrent fundoplication. ED visits (46% vs 27%, p = 0.001) and postoperative LOS (median (IQR) 10 days (5-36) to 5.5 days (1-19), p = 0.0002) decreased.A standardized pathway for GT placement prevented unnecessary GT placement and fundoplication with reduction in postoperative LOS and ED visits. This approach can significantly reduce resource utilization while improving outcomes.Prognosis study.Level II.

Nearly half of the over 400 North American crayfish species are imperiled and need some level of protection to ensure sustainable populations, but the detailed life histories of only about 12% of these crayfishes have been published. We provide needed baseline information on the reproductive biology of the Sly Crayfish, Procambarus versutus (Hagen, 1870), through sampling a small stream monthly (N = 23 samples) in the Choctawhatchee River watershed, southeastern Alabama, USA for two years. We collected data on 2,026 individuals (mean 88 sample–1) over the duration of the study and found minimum size at sexual maturity to be 18.3 mm for both males and females. Life cycles were consistent across both years with a major peak in reproductively active males in June and reproductively active females in July. Reproductively-active males and females were nevertheless collected nearly year-round, suggesting continuous low levels of reproduction throughout a given year, with three peaks in reproduction that vary in magnitude. Only three ovigerous females were collected over the study period, possibly because ovigerous females become reclusive and inactive, therefore difficult to collect. The maximum brood size sampled was 242 eggs female–1. There was no evidence for distinct age classes, likely due to year-round reproduction. Similar regional species with detailed information on reproductive biology available have reproduction patterns similar to those in our data. The information herein contributes to the largely lacking information on the life history of North American crayfishes and emphasizes the need to further evaluate the reproductive biology of species lacking sufficient data to aid conservation efforts.

This is a Commentary on the manuscript titled “Ethical Dilemmas in the Management of Infants with Necrotizing Enterocolitis Totalis” by Pennington E, Javid P, Mueller C, et al.

Homeless populations have high rates of smoking and unique barriers to quitting. General cessation strategies have been unsuccessful in this population. Smoking reduction may be a good intermediate goal. We conducted a secondary analysis to identify predictors of smoking reduction in a cohort of homeless smokers enrolled in a 26-week randomized clinical trial (RCT) targeting smoking cessation.Data are from an RCT comparing motivational interviewing counseling plus nicotine replacement therapy (NRT) to brief advice to quit (standard care) plus NRT among homeless smokers. Using bivariate analyses and multinomial logistic regression, we compared demographics, health and psychosocial variables, tobacco use, substance use, and NRT adherence among those who reported: quitting; reducing smoking by 50-99%; and not reducing smoking by 50%.Of 324 participants who completed 26-week follow-up, 18.8% and 63.9% self-reported quitting and reducing, respectively. Compared to those who did not reduce smoking, participants reporting reducing indicated higher baseline cigarette use (OR=1.08; CI:1.04-1.12) and menthol use (OR=2.24; CI:1.05-4.77). Compared to participants who reduced, participants reporting quitting were more likely to be male (OR=1.998; CI:1.00-3.98), experience more housing instability (OR=1.97; CI:1.08-3.59), indicate higher importance of quitting (OR=1.27; CI:1.041.55), have higher NRT adherence (OR=1.75; CI:1.00-3.06), and lower odds of reported illicit drug use (OR=0.48; CI:0.24-0.95).Over half of participants reduced smoking by at least 50%, indicating reduction is feasible among homeless smokers. Further research is required to understand the impact of reduction on future cessation attempts in homeless smokers. This study shows that reduction is achievable and may be a valid intermediate goal.

OBJECTIVES: The fit of measured variables into a social-ecological model of correlates of physical activity is rarely tested. In this study, we examined the factor structure of correlates of moderate/vigorous physical activity (MVPA) within a hypothesized social-ecological model. METHODS: We measured 46 possible personal, social and environmental correlates of MVPA in 2779 adolescents participating in the Project EAT-2010 study. Confirmatory (CFA) and exploratory factor analyses (EFA) were used to determine the factor structure. Associations of factor scores with self-reported MVPA were calculated with linear regression. RESULTS: A 6-factor CFA model did not show adequate fit. Eight factors were identified using EFA (Root Mean Square Error [RMSEA] 90% CI: 0.053 to 0.055; CFI = 0.82). A factor representing the mix of personal and social correlates showed the strongest association with MVPA. CONCLUSIONS: The 8-factor model supports independent clustering of possible environmental correlates of MVPA, but indicates that social and personal correlates may not cluster independently. The factor most strongly correlated with MVPA represented a mix of personal and social correlates. Future work will be needed to better understand how mechanisms for developing physical activity work within and across levels of the social-ecological framework.

Background Self-weighing is widespread among young adults and is sometimes recommended by healthcare providers for weight management. The present study aims to deepen our understanding of who is frequently self-weighing among young adults, and to examine for whom self-weighing impacts mood based on weighing frequency and other eating and weight-related characteristics. Methods Survey data were collected from a large population-based sample of young adults (31.1 ± 1.6y) participating in Project EAT-IV (n = 1719). Cross-sectional data were stratified across sex and analyzed with chi-square, t-tests, and linear and logistic regressions controlling for age, ethnicity/race, education level, and income. Results Self-weighing frequency was higher among male and female young adults with a current eating disorder, those trying to lose weight or who endorsed any disordered eating behaviors or cognition, and females with higher BMI. Young adult females were significantly more likely than males to report that self-weighing impacted their mood (53% vs 27%, p Conclusion Findings suggest that for many young adults, particularly females and those with weight-related concerns, self-weighing is a behavior that comes with emotional valence. The emotional consequences of self-weighing should be considered when making public health and clinical recommendations regarding the usefulness of self-weighing.

Purpose This randomized cross-over group pilot trial assessed feasibility of recruiting survivors from a long-term follow-up clinic to an exercise group and measured whether outdoor or indoor exercise sessions better supported exercise motivation and behaviors in survivors of cancer. Methods Sixteen adolescent and young adult survivors of any cancer completed indoor and outdoor exercise sessions in this randomized cross-over pilot trial. Measures of physical activity, motivation, and fatigue were taken 2 weeks before and 2 weeks after indoor sessions and 2 weeks before and 2 weeks after outdoor sessions. Measures of physical activity and fatigue were also taken during each exercise session. Results Initial recruiting of 19 participants met recruiting goals. Survivors who attended the most sessions lived an average of 8.7 km closer to the clinic. Objectively measured physical activity intensity was 0.63 metabolic equivalents of a task (METs) per minute greater during outdoor exercise sessions as compared to indoor exercise sessions. There were no meaningful differences in long term, habitual physical activity behavior, motivation, or fatigue in the weeks following the outdoor exercise sessions as compared to the indoor exercise sessions. Conclusions This study shows the feasibility of recruiting survivors from a long-term follow-up clinic to community-based exercise groups. Although this brief pilot intervention did not show significant effects on habitual physical activity behavior or motivation in adolescent and young adult survivors of cancer, the greater exercise intensity during the outdoor exercise sessions indicate that holding group exercise sessions for survivors outdoors may promote greater intensity during exercise.

Parents in the United States have a legal right to refuse vaccination for their children. There are, however, special circumstances under which the state may compel vaccination against parental wishes. In this Ethics Rounds article, we present the case of a young boy with sickle cell disease who was partially vaccinated against encapsulated bacteria and the ethics of whether to compel complete vaccination before splenectomy.

A rapid method for the analysis of polyethylene glycol (PEG 400) in perfusate samples is presented. Because PEG 400 lacks a strong chromophore in the UV range, detection was accomplished using evaporative light scattering detection (ELSD). In order to optimize the ELSD signal performance for a volatile mobile phase, the chromatographic separation was optimized using aqueous normal phase conditions on a Cogent® Diamond Hydride column.

This study measured changes in post-traumatic stress symptoms and collective-efficacy in African Americans participating in cohorts of "Choosing Life in the Black Community: Achieving the Dream", an Afrocentricity-based Cognitive Behavioral Therapy curriculum for trauma. Participants were recruited by key leaders in the black community of the Twin Cities, Minnesota Metropolitan Area and completed a 6-week group counselling curriculum led by lay health workers and supervised by professional psychologists. Twenty-six participants provided pre- and post-curriculum responses to validated measures of post-traumatic stress symptoms, collective-efficacy and adverse childhood experiences. Thirteen participants provided semi-structured interviews. Pre- to post-curriculum change score were calculated for post-traumatic stress symptoms and collective-efficacy. Interviews were analyzed using thematic analysis. Post-traumatic stress symptoms decreased and collective-efficacy increased, though neither change achieved statistical significance. Participants with more adverse childhood experiences showed significantly greater decreases in post-traumatic stress symptoms. There is evidence that this program may be particularly effective in participants that have greater past experiences of trauma.

This study prospectively examined the relationship of home yard-size to objectively measured physical activity over three years among a cohort of 531 low-income pre-school-aged children. An adjusted total-effect association of 12.72 additional minutes per week of moderate/vigorous physical activity (MVPA) was observed for each additional hectare of yard-size. The direct-effect association, adjusting for previous year MVPA, was not statistically significant. This study provides evidence that the private or semi-private space around the house may impact children's' physical activity. Public health and urban planning practitioners should consider these results to identify built environment solutions for improving MVPA among low-income minority children.

Background Over the past decade, consumer demand for gluten-free products has increased, but little is known about the public health impact of and factors correlated with valuing gluten-free food. Objective Describe the sociodemographic and behavioral characteristics of young adults valuing gluten-free as an important food attribute, and compare their dietary intake with other young adults. Design Cross-sectional analysis of survey data collected in 2015 to 2016 as part of the fourth wave of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Participants/setting Population-based sample of 1,819 young adults (25 to 36 years) (57% women, 69% white), initially recruited in Minneapolis-St Paul, MN, public middle and senior high schools. Measures Valuing gluten-free food, weight goals and weight control behaviors, food production values, eating behaviors, physical activity, and dietary intake. Statistical analyses performed Logistic regression models were used to investigate associations with potential correlates of valuing gluten-free food. For dietary intake, adjusted mean estimates were calculated for those who did and those who did not value gluten-free foods. Results Approximately 13% of young adults valued gluten-free food, a characteristic most strongly related to valuing food production practices (eg, organic, locally grown); factors such as Nutrition Facts use and having a weight goal were also related to gluten-free food values. Valuing gluten-free food was related to engagement in both healthy behaviors (eg, eating breakfast daily, eating more fruits and vegetables) and unhealthy behaviors (eg, using diet pills to control weight). Conclusions and relevance Young adults valuing gluten-free food generally engaged in healthier behaviors and had better dietary intake; of concern, they were also more likely to engage in unhealthy weight control behaviors. Valuing gluten-free food may be part of a cluster of behaviors representing an interest in making healthier food choices but may also be a marker for unhealthy weight preoccupation and behaviors.

Loss of freshwater mollusk populations nationally has prompted the use of these species in establishing USEPA water quality criteria (WQC). The objectives of this study were to determine the sensitivity (EC50) of 5 at-risk mollusk species endemic to the Mobile River Basin to chloride, potassium, nickel, and zinc. Villosa nebulosa (Alabama Rainbow) was the only species evaluated in the study with an EC50 value included under current WQC for chloride and nickel. All species in the current study were more sensitive to potassium than other mollusk species previously tested, although there is currently no established WQC for that contaminant. For zinc, all species but Leptoxis ampla (Round Rocksnail) had EC50 values included under existing criteria. Results suggest current WQC may be insufficient for basins containing localized endemic species in a relatively small geographical space, such as the Mobile River Basin. We urge broader testing of highly regionalized aquatic species to aid in establishing national WQC.

Kinorhynch assemblages along the northern continental shelf of the Gulf of Mexico were examined to better understand the distributional trends of this understudied group of meiofauna. Samples were collected with a multicorer from 37 stations at 36–187 m depths in the years 2013 and 2014. Sediment was collected and the animals were isolated from the mud using Ludox® centrifugation. Kinorhynchs were isolated with a stereomicroscope and the adult animals were identified to species level either by light microscopy or scanning electron microscopy. A total of 1328 animals were recovered, including juveniles and adults. After processing, 812 adults were identified and classified to 6 families, 12 genera and 32 species. The identifications were used to explore relationships among the species, and to determine if the animal assemblages at each site revealed relationships to each other. Sediment characteristics were determined at each site, to reveal if abiotic factors correlated with animal densities. Cluster analysis revealed distinct assemblages in Louisiana versus Florida sediment. The highest abundance of kinorhynchs was found in western sediments in Louisiana, which are characterized by higher levels of silt and clay, and aluminum-associated trace metals. These sediment characteristics indicated a strong influence from the outflow of the Mississippi River. The most abundant species were Echinoderes bookhouti , E . skipperae , E . augustae , and E . spinifurca , which comprised 79% of the identified animals. This was the first kinorhynch survey to cover a geographic area as large as the northern Gulf of Mexico, over multiple years, and to statistically analyze the animals in relation to their sediment type.

Background:Interventions to raise population physical activity generally show modest effects; one possible reason is that trends and determinants of moderate to vigorous physical activity (MVPA) differ between population subgroups. This study examined differences in trends and determinants of reported MVPA by ethnicity/race and sex in a 15-year longitudinal study.Methods:Participants (n = 2092) in the Project Eating and Activity in Teens and Young Adults study were surveyed on MVPA behavior and potential determinants from adolescence to young adulthood. Generalized estimating equations were used to model age trends in MVPA and associations with determinants.Results:Mean MVPA declined by 2.1 hours per week over 15 years of follow-up from adolescence to young adulthood. Asian males reported the lowest levels of MVPA at each age. Nonwhite females reported less MVPA than white females at each age. The association of body mass index (BMI) with MVPA differed by sex and ethnicity/race. Asian males and females showed lower levels of MVPA at both low and high BMI.Conclusions:Interventions to increase MVPA may need to begin earlier among Asian men and nonwhite women than among other groups. Asian adolescents with lower BMI show lower MVPA and may benefit from additional intervention efforts compared with Asian adolescents with normal BMI.

Vitamin E TPGS (TPGS) has both surfactant and P-glycoprotein (P-gp) inhibitory effects. While surfactants were previously found to cause solubility-permeability tradeoff, TPGS P-gp inhibitory effects may change this unfavorable interplay. The purpose of this research was to investigate the solubility-permeability interplay when using TPGS vs. amorphous solid dispersions (ASD) as oral drug delivery systems for the anticancer, P-gp substrate, lipophilic drug etoposide. The concentration-dependent effects of TPGS (0-100mg/mL) vs. ASD on the solubility of etoposide, as well as the in-vitro (PAMPA) vs. in-vivo (intestinal rat perfusion) permeability of the drug were studied, and the resulting solubility-permeability interplay was analyzed. TPGS above CMC (0.3mg/mL) increased etoposide solubility linearly, and ASD allowed significant supersaturation. Etoposide in-vitro PAMPA permeability decreased markedly with increasing TPGS levels, similarly to the solubility-permeability tradeoff previously defined for surfactants. In contrast, the presence of TPGS significantly increased etoposide in-vivo rat permeability, attributable to P-gp inhibition, similarly to the effect of the potent P-gp inhibitor GF120918 (10µg/mL). High supersaturation achieved via ASD increased the drug's in-vivo permeability to the level obtained by TPGS or GF120918, supporting P-gp saturation. In conclusion, unique pattern of solubility-permeability interplay was found, involving concomitant increase of both the solubility and the permeability, as opposed to the previously reported tradeoff for solubilization methods and the unchanged permeability for supersaturation; P-gp inhibition/saturation by TPGS or by supersaturation allows simultaneous increase of both solubility and permeability, representing a significant advantage of such drug delivery approaches when suitable.

BACKGROUND/OBJECTIVES There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction. METHODS Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated. RESULTS A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r = .77, P =

ObjectiveThe present study examined longitudinal associations between four family meal patterns (i.e. never had regular family meals, started having regular family meals, stopped having regular family meals, maintained having regular family meals) and young adult parents’ dietary intake, weight-related behaviours and psychosocial well-being. In addition, family meal patterns of parents were compared with those of non-parents.DesignAnalysis of data from the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study. Linear and logistic regressions were used to examine the associations between family meal patterns and parents’ dietary intake, weight-related behaviours and psychosocial well-being.SettingSchool and in-home settings.SubjectsAt baseline (1998; EAT-I), adolescents (n 4746) from socio-economically and racially/ethnically diverse households completed a survey and anthropometric measurements at school. At follow-up (2015; EAT-IV), participants who were parents (n 726) and who were non-parents with significant others (n 618) completed an online survey.ResultsYoung adult parents who reported having regular family meals as an adolescent and as a parent (‘maintainers’), or who started having regular family meals with their own families (‘starters’), reported more healthful dietary, weight-related and psychosocial outcomes compared with young adults who never reported having regular family meals (‘nevers’; PConclusionsResults suggest that mental and physical health benefits of having regular family meals may be realized as a parent whether the routine of regular family meals is carried forward from adolescence into parenthood, or if the routine is started in parenthood.

The purpose of this work was to investigate key factors dictating the success/failure of cyclodextrin-based solubility-enabling formulations for oral delivery of low-solubility drugs. We have studied the solubility, the permeability, and the solubility–permeability interplay, of the highly lipophilic drug danazol, formulated with different levels (8.5, 10, 20, and 30%) of the commonly used hydroxypropyl-β-cyclodextrin (HPβCD), accounting for the biorelevant solubilization of the drug along the gastrointestinal tract (GIT), the unstirred water layer (UWL) adjacent to the GI membrane, and the overall absorption. HPβCD significantly increased danazol solubility, and decreased the drugs’ permeability, in a concentration-dependent manner. These Peff results were in good correlation (R2 = 0.977) to literature rat AUC data of the same formulations. Unlike vehicle without HPβCD, formulations containing 8.5% HPβCD and above were shown to successfully dissolve the drug dose during the entire biorelevant dissolution...

Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved.

The current study examined differences in sediment stability preferences for two federally threatened and a locally common mussel species’ habitats in the Choctawhatchee River watershed located in southeastern Alabama and northwestern Florida. Relative shear stress (RSS), the ratio of shear stress to critical shear stress, was calculated for individuals of two threatened mussel species, Fusconaia burkei (N = 94), and Pleurobema strodeanum (N = 201), and a common mussel species, Elliptio pullata (N = 94). Relative shear stress is related to sediment movement and deposition as sediment movement takes place when RSS > 1. Mussels were collected and RSS measured at each individual mussel location (N = 389). The Kruskal–Wallis H-test and/or Mann–Whitney U-test found that RSS for the target-threatened species’ habitats were significantly higher than that for E. pullata at all sites (p < 0.05). Spearman's rank correlation found significant negative correlations between shear stress and total mussel abundance at all sites (p < 0.05). Streams selected in our study were typical representatives of high-quality southeastern Coastal Plain streams. Therefore, we suggest that our findings of differences in hydraulic instability of mussel habitats among species may represent similar conditions for other rare and endangered species. Sediment movement and deposition may be linked to the decline and consequent federal listing of the target-threatened species under our study.

INTRODUCTION: Common life events such as getting married or gaining employment may be opportunities to intervene on health behaviors like physical activity. The purpose of this study was to determine the changes in moderate-to-vigorous physical activity (MVPA) associated with several common life events from adolescence to young adulthood. METHODS: Participants in Project EAT (ages 11 to 18 at baseline and 25 to 36 at wave 4) were surveyed at four time points from 1998 to 2016. Questions included marital status, employment status, post-secondary education completion and enrollment, and living situation between each wave. Linear regression was used to model the effect of each life event on change in self-reported MVPA. Post-hoc mediation analysis was conducted to examine whether having a child mediated the effect of getting married on the change in MVPA. RESULTS: Average MVPA declined from 6.5 hours per week at baseline to 4.3 hours per week at wave 4. Having a child was associated with a significant decrease in MVPA between waves 2 and 3 and between waves 3 and 4. Getting married and leaving parents’ home were associated with significant decreases in MVPA between waves 3 and 4. Having a child both mediated and moderated the effect of getting married on MVPA. CONCLUSION: This study provides evidence that MVPA declines both after getting married and after having a child and that these effects are not independent. Interventions to maintain or increase MVPA could profitably target couples planning to get married or have a child.

Background Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have resulted in some reported long-term survival. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies that reported outcomes in children with necrotizing enterocolitis totalis were identified. The definition of necrotizing enterocolitis totalis was captured along with length of follow-up, patient demographics, and outcomes. Results A total of 766 articles were screened, of which 166 were selected for full article review. Of these, 32 articles included data on 414 patients with necrotizing enterocolitis totalis. In the majority of studies (52%), necrotizing enterocolitis totalis was not defined. Aggressive surgical therapy (defined as bowel resection or fecal diversion) was undertaken in 32 patients (7.7%), with a mortality rate of 68.8%. In contrast, nonaggressive surgical therapy was undertaken in 382 patients (92.3%), and the mortality in these patients was 95%. Long-term outcomes for necrotizing enterocolitis totalis survivors, such as length of time on parenteral nutrition, progression to liver and/or small bowel transplant, and quality of life, were not reported. Conclusion We found that there is no accepted definition of necrotizing enterocolitis totalis. Aggressive surgical therapy is rarely pursued, which likely drives the overall high mortality rate. This study underscores the importance of standardizing the definition of necrotizing enterocolitis totalis and capturing short and long-term outcomes prospectively. With more aggressive surgical therapy, more infants are likely to survive this abdominal catastrophe, which was once thought to be uniformly fatal.

Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors’ recommendations? Which treatments are so clearly in the child’s interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.

BACKGROUND Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention. OBJECTIVE This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research. METHODS Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity. RESULTS Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01). CONCLUSIONS The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Poor aqueous solubility is a major challenge in today's biopharmaceutics. While solubility-enabling formulations can significantly increase the apparent solubility of the drug, the concomitant effect on the drug's apparent permeability has been largely overlooked. The mathematical equation to describe the membrane permeability of a drug comprises the membrane/aqueous partition coefficient, which in turn is dependent on the drug's apparent solubility in the GI milieu, suggesting that the solubility and the permeability are closely related, exhibit a certain interplay between them, and treating the one irrespectively of the other may be insufficient. In this article, an overview of this solubility-permeability interplay is provided, and the available data is analyzed in the context of the effort to maximize the overall drug exposure. Overall, depending on the type of solubility-permeability interplay, the permeability may decrease, remain unchanged, and even increase, in a way that may critically affect the formulation capability to improve the overall absorption. Therefore, an intelligent design of solubility-enabling formulation needs to consider both the solubility afforded by the formulation and the permeability in the new luminal environment resulting from the formulation.

— This study examined free-living marine nematode assemblages of the northern Gulf of Mexico (GOM) continental shelf and their relationship to sediment characteristics. Sediment cores were collected in Fall 2012 and analyzed for trace metals, organic carbon, granulometry, and nematode genera. This study reports 100 genera of nematodes from 26 families, including 18 genera previously unreported in the GOM. A listing of the nematode diversity provides a bioinventory of nematodes on the GOM shelf. Cluster analysis, non-metric multidimensional scaling (nMDS) and principal component analysis revealed a distinction between eastern and western samples based on sediment characteristics as well as nematode assemblages. Spearman correlations revealed a significant correlation between sediment characteristics and nMDS coordinates, also suggesting that nematode assemblages have an east/west distinction that is reflective of their habitat. This study adds information on the biodiversity of marine nematodes, a...

Although habitat alteration and degradation in riverine systems are the major threats to overall mussel assemblages to date, no or few studies have been able to document significant differences in habitat variables between species. The purpose of this study was to evaluate microhabitat associations of three federally threatened freshwater mussel species, Fusconaia burkei (Walker, 1922) (Tapered Pigtoe), Hamiota australis (Simpson, 1900) (Southern Sandshell), and Pleurobema strodeanum (Wright, 1898) (Fuzzy Pigtoe), and a common mussel species, Elliptio pullata (Lea, 1856) (Gulf Spike), at 3 localities in the Choctawhatchee River watershed in southeast Alabama and northwest Florida. Depth, current velocity, and compaction were measured, and a sediment core sample was collected for each individual mussel encountered. The Kruskal-Wallis H-test was performed to determine differences in each variable measured and each sediment size class among the mussel species at each site, followed by the Mann-Whitn...

Life-history studies have been published for only a small proportion of crayfish species native to the southeastern United States. The Southeastern Crayfish Biologist Working Group was formed to help meet this deficit by coordinating life-history research efforts. We used a combination of field sampling and computer modeling to evaluate a basic core sampling protocol and assess sample size issues. We focused on a locally abundant species, Procambarus versutus, and followed the protocol for 5 months at two sites in Alabama. Results showed a monthly sample size of 10 juvenile males plus 10 adult males could be met consistently and provided a = 85% probability of detecting seasonal shifts in proportion of Form I males under a range of scenarios. Weaknesses of the effort included inconsistent determination of sex in juveniles and form of adult males among sampling crews. More importantly, female life-history information was rarely obtainable due to an inability to collect sufficient numbers of glaired or berried adults. We suggest several priorities to address before implementation of coordinated, large-scale sampling efforts. These include development of sampling techniques to increase captures of glaired and berried females, and assessment of non-lethal gamete extraction techniques to track reproductive state of males and females.

We report one of the earliest known U.S. cases of multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C). This adolescent male presented prior to any known association between COVID-19 and immune mediated inflammatory syndrome in children. He presented in stable condition and without significant multisystem involvement. During hospitalization, he developed severe left ventricular dysfunction and mixed hypovolemic, distributive and cardiogenic shock. Clinical features overlapped with Kawasaki disease, acute rheumatic fever, and toxic shock syndrome. After centers in Europe began reporting a multisystem inflammatory condition in children with COVID-19, the patient's clinical course and laboratory findings were revisited. He underwent newly available antibody testing and was diagnosed as one of the first known cases of MIS-C in the United States.

OBJECTIVE: To prospectively examine the bidirectional relationship between parental feeding practices (eg, instrumental feeding, encouragement to eat) and child eating behaviors (eg, food responsiveness, emotional eating) in low-income, ethnically diverse preschool children over a 3-year period. STUDY DESIGN: Parent/child (age 2–4 years at baseline) pairs (n = 222 non-Hispanics; n = 312 Hispanics) participated in NET-Works (Now Everybody Together for Amazing and Healthful Kids), a randomized controlled trial carried out in community and in-home settings in urban areas of Minnesota. Data were collected at baseline and 12, 24, and 36 months. The present study is a secondary data analysis using cross-lagged models to identify bidirectional associations between parental feeding practices and child eating behaviors. RESULTS: Three models showed significant cross-lagged effects (P < .05): model 1, parental instrumental feeding influencing later child food responsiveness; model 2, parental emotional feeding influencing later child food responsiveness; and model 3, parental emotional feeding influencing later child eating satiety. Model 1 showed significant bidirectional temporal paths, whereas models 2 and 3 showed significant unidirectional temporal paths from parental feeding practices to child eating behaviors. CONCLUSIONS: Parental instrumental and emotional feeding practices prospectively influence child food responsiveness and satiety. This study demonstrates causal temporality between parental feeding practices and child eating behaviors. Heath care providers may want to use findings regarding parent feeding practices as part of their anticipatory guidance during well-child visits with parents of preschoolers.