The obesity epidemic in children: Latino children are disproportionately affected at younger ages

Background and objectives National surveillance clearly illustrates that U.S. children are becoming increasingly overweight. However, the timing of the onset of childhood overweight has not been well-described. Patients and methods An accelerated failure time (AFT) model was used to describe the emergence of overweight based on a 12-year collection of height and weight data of over 40,000 children. Race, sex, insurance status and their interactions were specifically examined as predictors of earlier onset of overweight. The outcome of interest was an estimate of the age at which the model predicted that a subgroup would attain a 20% prevalence of overweight. Results The three-way interaction of race, sex, and insurance status was a significant predictor of onset of overweight. The model estimated that the publicly insured Latino male subgroup had the earliest onset of overweight, attaining a prevalence of 20% overweight by 4.3 years of age. The emergence of overweight in Latino subjects was significantly earlier than that for black or white subjects, irrespective of sex or insurance status. Conclusion Regardless of sex or insurance status, overweight emerges at significantly younger ages in Latino children when compared to black and white children. Substantial numbers of Latino male children are predicted to develop overweight at preschool ages. Obesity prevention may need to be directed toward parents or children well before children enter grade-school

When an Infected Meniscus Portends a Perforated Viscus

A 59-year-old woman with a status of post–renal transplant 7 years prior for autosomal dominant polycystic kidney disease on tacrolimus and mycophenolate mofetil presented with subacute left knee and right wrist pain. She received local steroid injections to both areas as an outpatient without improvement in her symptoms. She had recently traveled to India, her home country, to visit relatives. Aspiration of the knee revealed 4+ acid fast bacilli on smear, and she was taken for surgical debridement. She was started on empiric antibiotics for presumed infection with rapidly growing mycobacteria. Her course was complicated by acute onset abdominal pain with pneumoperitoneum and mesenteric abscess on imaging, requiring exploratory laparotomy. Surgical cultures from all sites were positive for Mycobacterium tuberculosis. Her medications were adjusted to rifabutin, isoniazid, pyrazinamide, and ethambutol. Pretransplant screening results were unknown. She was discharged in stable condition and completed 12 months of medical therapy

Pre-diabetes in overweight youth and early atherogenic risk

PURPOSE: To compare atherogenic lipoprotein particles and vascular smooth muscle biomarkers in overweight youth with pre-diabetes (PD) vs. normal glucose tolerance (NGT). METHODS: 144 adolescents (60 black, 84 white; 102 female; PD=45, NGT=99) aged 10-19 years underwent a fasting blood draw and 2-h OGTT. Lipoprotein particle size and subclass concentration and vascular smooth muscle biomarkers (ICAM-1, VCAM-1 and E-selectin) were compared between youth with PD and NGT. RESULTS: Compared with NGT, PD adolescents had smaller LDL (mean±SE: 20.5±0.1 vs. 21.0±0.1 nm; P=0.002) and HDL (8.62±0.05 vs. 8.85±0.04 nm; P=0.013) size and elevated medium small (159.2±10.3 vs. 123.8±6.4 nmol/L; P=0.037) and very small (626.3±45.4 vs. 458.5±26.4 nmol/L; P=0.032) LDL particle concentrations, after adjustment for race and BMI. Further adjusting for fasting insulin or visceral adiposity obviated these differences between the groups except for LDL size. ICAM-1 and E-selectin did not differ in youth with PD but correlated with LDL and HDL size, and small LDL particle concentrations. CONCLUSIONS: Overweight adolescents with PD have an atherogenic lipoprotein profile of small LDL and HDL size and increased concentrations of small LDL, moderated by insulin resistance and visceral adiposity, but independently driven by dysglycemia for LDL size. Associations between smooth muscle biomarkers and lipoproteins could be an early signal heralding the atherogenic process. It remains to be determined if correction of dysglycemia and associated lipoprotein abnormalities in obese youth could prove effective in halting this process

Innovation in regulated electricity distribution networks : a review of the effectiveness of Great Britain's low carbon network fund

Introduced in 2010, the Low Carbon Networks Fund (LCNF) was a major development in the regulatory regime for electricity distribution networks in Great Britain, yet evaluation of its design and implementation has been limited. This paper examines the type and quality of innovation arising from the LCNF. Novel frameworks for assessing innovation project activity and learning are presented and results from their application to the LCNF are discussed. Reduction of uncertainty through the production of high quality evidence is argued to be the primary purpose of innovation project funding support. The analysis of LCNF project activity finds a step change in Research Development & Demonstration (RD&D) spend and stakeholder engagement by network licensees in Britain; however, the innovation observed was considered to be conservative and incremental in nature. It was found that the LCNF lacked a strategic approach to targeted learning and the reduction of uncertainty for innovation priority areas. Project learning outputs were contradictory and inconclusive for several innovations. Strategic learning should be a core part of policy makers’ design of innovation funding mechanisms for energy technology, and a framework for shaping, capturing and assessing the learning outputs of funded innovation projects is essential

Effectiveness of Computer Automation for the Diagnosis and Management of Childhood Type 2 Diabetes A Randomized Clinical Trial

Importance Type 2 diabetes (T2D) is increasingly common in young individuals. Primary prevention and screening among children and adolescents who are at substantial risk for T2D are recommended, but implementation of T2D screening practices in the pediatric primary care setting is uncommon. Objective To determine the feasibility and effectiveness of a computerized clinical decision support system to identify pediatric patients at high risk for T2D and to coordinate screening for and diagnosis of prediabetes and T2D. Design, Setting, and Participants This cluster-randomized clinical trial included patients from 4 primary care pediatric clinics. Two clinics were randomized to the computerized clinical decision support intervention, aimed at physicians, and 2 were randomized to the control condition. Patients of interest included children, adolescents, and young adults 10 years or older. Data were collected from January 1, 2013, through December 1, 2016. Interventions Comparison of physician screening and follow-up practices after adding a T2D module to an existing computer decision support system. Main Outcomes and Measures Electronic medical record (EMR) data from patients 10 years or older were reviewed to determine the rates at which pediatric patients were identified as having a body mass index (BMI) at or above the 85th percentile and 2 or more risk factors for T2D and underwent screening for T2D. Results Medical records were reviewed for 1369 eligible children (712 boys [52.0%] and 657 girls [48.0%]; median [interquartile range] age, 12.9 [11.2-15.3]), of whom 684 were randomized to the control group and 685 to the intervention group. Of these, 663 (48.4%) had a BMI at or above the 85th percentile. Five hundred sixty-five patients (41.3%) met T2D screening criteria, with no difference between control and intervention sites. The T2D module led to a significant increase in the percentage of patients undergoing screening for T2D (89 of 283 [31.4%] vs 26 of 282 [9.2%]; adjusted odds ratio, 4.6; 95% CI, 1.5-14.7) and a greater proportion attending a scheduled follow-up appointment (45 of 153 [29.4%] vs 38 of 201 [18.9%]; adjusted odds ratio, 1.8; 95% CI, 1.5-2.2). Conclusions and Relevance Use of a computerized clinical decision support system to automate the identification and screening of pediatric patients at high risk for T2D can help overcome barriers to the screening process. The support system significantly increased screening among patients who met the American Diabetes Association criteria and adherence to follow-up appointments with primary care clinicians

Modifications of the metabolic pathways of lipid and triacylglycerol production in microalgae

Microalgae have presented themselves as a strong candidate to replace diminishing oil reserves as a source of lipids for biofuels. Here we describe successful modifications of terrestrial plant lipid content which increase overall lipid production or shift the balance of lipid production towards lipid varieties more useful for biofuel production. Our discussion ranges from the biosynthetic pathways and rate limiting steps of triacylglycerol formation to enzymes required for the formation of triacylglycerol containing exotic lipids. Secondarily, we discuss techniques for genetic engineering and modification of various microalgae which can be combined with insights gained from research in higher plants to aid in the creation of production strains of microalgae

Candidate LBV stars in galaxy NGC 7793 found via HST photometry + MUSE spectroscopy

Only about 19 Galactic and 25 extragalactic bonafide luminous blue variables (LBVs) are known to date. This incomplete census prevents our understanding of this crucial phase of massive star evolution which leads to the formation of heavy binary black holes via the classical channel. With large samples of LBVs one could better determine the duration and maximum stellar luminosity which characterize this phase. We search for candidate LBVs (cLBVs) in a new galaxy, NGC 7793. For this purpose, we combine high spatial resolution images from two Hubble Space Telescope (HST) programs with optical spectroscopy from the Multi Unit Spectroscopic Explorer (MUSE). By combining PSF-fitting photometry measured on F547M, F657N, and F814W images, with restrictions on point-like appearance (at HST resolution) and H α luminosity, we find 100 potential cLBVs, 36 of which fall in the MUSE fields. Five of the latter 36 sources are promising cLBVs which have MV ≤ −7 and a combination of: H α with a P-Cygni profile; no [O I]λ6300 emission; weak or no [O III]λ5007 emission; large [N II]/H α relative to H II regions; and [S II]λ6716/[S II]λ6731∼1⁠. It is not clear if these five cLBVs are isolated from O-type stars, which would favour the binary formation scenario of LBVs. Our study, which approximately covers one fourth of the optical disc of NGC 7793, demonstrates how by combining the above HST surveys with multi-object spectroscopy from 8-m class telescopes, one can efficiently find large samples of cLBVs in nearby galaxies