Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008–2011

OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010–2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length \u3e/=95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age \u3e/=95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of earlylife obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs

Low serum sodium level during cardiopulmonary bypass predicts increased risk of postoperative stroke after coronary artery bypass graft surgery

ObjectiveRapid decreases in serum sodium levels are associated with altered mental status, seizures, and coma. During cardiac surgery, serum sodium levels decrease rapidly when cardiopulmonary bypass is initiated because cardiopulmonary bypass causes hemodilution. However, whether this decrease influences neurologic outcome after cardiac surgery remains unclear. We investigated whether the average serum sodium level during cardiopulmonary bypass is independently predictive of postoperative stroke or 30-day all-cause mortality in patients who undergo primary coronary artery bypass grafting.MethodsIn a single-institution, retrospective cohort of 2348 consecutive patients who underwent primary, isolated coronary artery bypass grafting, sequential multivariate logistic regression was performed to determine the threshold below which the average serum sodium level during cardiopulmonary bypass independently predicts postoperative stroke or early death. To further test the validity of this threshold and to control for selection bias, stepwise multivariate logistic regression was also performed on propensity score–matched patients (n = 924).ResultsAn average serum sodium level less than 130 mEq/L during cardiopulmonary bypass was independently predictive of stroke, both in the entire study cohort (1.44% vs 2.92%; odds ratio, 2.09; 95% confidence interval, 1.1-4.1; P = .03) and in the propensity-matched patients (0.9% vs 3.0%; odds ratio, 4.1; 95% confidence interval, 1.3-13.0; P = .02). The average serum sodium level during cardiopulmonary bypass was not independently associated with early death, regardless of what threshold value was used.ConclusionsAn average serum sodium level of less than 130 mEq/L during cardiopulmonary bypass is independently associated with an increased risk of postoperative stroke in patients who undergo primary coronary artery bypass grafting

Flexible hydrogen fuel cell fabricated on paper with embedded aluminium foil

Direct hydrogen fuel cells are generally heavy and rigid systems based on metal or plastic materials, which are not suitable for various miniwatt and flexible devices. In this study, we have developed a lightweight and flexible fuel cell based on paper substrate embedded with an Al foil inside, which is used as an in-situ hydrogen source by reaction with an electrolyte solution during operation. Benefited from the inhibited hydroxyl transportation by the porous cellulose network, the vigorous Al corrosion reaction is well controlled even though strong alkaline electrolyte is adopted, so that the fuel cell can be discharged for more than 5 hours at 1 mA cm-2 (0.83 V) with only 3.5 mg Al foil. The corresponding faradaic and energy efficiencies are as high as 72% and 18.3%, respectively. The fuel cell flexibility is also quite good when facing different bending angles. Considering its moderate power output, this flexible paper-based hydrogen fuel cell is especially suitable for powering various miniwatt and flexible devices, such as wearable electronics, biosensors, RFID tags, etc. However, higher power can be obtained by suitable stacking of the fuel cell

Antimicrobial resistance with Streptococcus pneumoniae in the United States, 1997 98.

From November 1997 to April 1998, 1,601 clinical isolates of Streptococcus pneumoniae were obtained from 34 U.S. medical centers. The overall rate of strains showing resistance to penicillin was 29. 5%, with 17.4% having intermediate resistance. Multidrug resistance, defined as lack of susceptibility to penicillin and at least two other non-ss-lactam classes of antimicrobial drugs, was observed in 16.0% of isolates. Resistance to all 10 ss-lactam drugs examined in this study was directly related to the level of penicillin resistance. Penicillin resistance rates were highest in isolates from middle ear fluid and sinus aspirates of children ambulatory-care settings. Twenty-four of the 34 medical centers in this study had participated in a similar study 3 years before. In 19 of these 24 centers, penicillin resistance rates increased 2.9% to 39.2%. Similar increases were observed with rates of resistance to other antimicrobial drugs

Justice derailed : the uncertain fate of Haitian migrants and Dominicans of Haitian descent in the Dominican Republic

Over time, the Dominican Republic formalized a more restrictive definition of citizenship by birth. By expanding the interpretation of what it means to be “in transit,” the Dominican Republic began to chip away at its jus soli (right of soil) regime. Given the long history of migration from Haiti to the Dominican Republic and demographic realities, this shift has had a disproportionate impact on individuals of Haitian descent. The redefinition of the jus soli basis for citizenship reached its peak in the now infamous sentence of the Constitutional Tribunal of the Dominican Republic, 168-13. In September 2013, the Constitutional Tribunal issued Sentence 168-13, which retroactively denationalized and effectively rendered stateless many Dominicans of Haitian descent by establishing that children born in the Dominican Republic to those illegally residing in the country were not entitled to citizenship by birth, as their parents were considered to be “in transit.” The Sentence further called for a national regularization plan. In an effort to implement Sentence 168-13, the Dominican government established the National Plan for the Regularization of Foreigners (PNRE). The PNRE is a plan to regularize the status of undocumented migrants in the Dominican Republic, which most notably impacts Haitian migrants. Following international backlash over Sentence 168-13, Dominican Republic President Danilo Medina issued Law 169-14 (Naturalization Law), which provides a pathway to naturalization for those effectively left stateless by the Sentence. This report will detail the problems in the implementation of the PNRE and the Naturalization Law, how various actors were involved in or impacted by the regularization and naturalization processes, and finally, will outline the constraints that may inhibit the work of policy makers and human rights defenders in addressing immigration and citizenship issues going forward

Challenges and recommendations to improve institutional review boards’ review of community-engaged research proposals: A scoping review

Academic and community investigators conducting community-engaged research (CEnR) are often met with challenges when seeking Institutional Review Board (IRB) approval. This scoping review aims to identify challenges and recommendations for CEnR investigators and community partners working with IRBs. Peer-reviewed articles that reported on CEnR, specified study-related challenges, and lessons learned for working with IRBs and conducted in the United States were included for review. Fifteen studies met the criteria and were extracted for this review. Four challenges identified (1) Community partners not being recognized as research partners (2) Cultural competence, language of consent forms, and literacy level of partners; (3) IRBs apply formulaic approaches to CEnR; & (4) Extensive delays in IRB preparation and approval potentially stifle the relationships with community partners. Recommendations included (1) Training IRBs to understand CEnR principles to streamline and increase the flexibility of the IRB review process; (2) Identifying influential community stakeholders who can provide support for the study; and (3) Disseminating human subjects research training that is accessible to all community investigator to satisfy IRB concerns. Findings from our study suggest that IRBs can benefit from more training in CEnR requirements and methodologie

Assessing patients’ preferences for gender, age, and experience of their urogynecologic provider

Introduction and hypothesis Understanding patient preferences regarding provider characteristics is an under-explored area in urogynecology. This study aims to describe patient preferences for urogynecologic care, including provider gender, age, experience, and presence of medical trainees. Methods This was a multicenter, cross-sectional, survey-based study assessing patient preferences with a voluntary, self-administered, anonymous questionnaire prior to their first urogynecology consult. A 5-point Likert scale addressing provider gender, age, experience, and presence of trainees was used. Descriptive statistics summarized patient characteristics and provider preferences. Chi-squared (or Fisher’s exact) test was used to test for associations. Results Six hundred fifteen women participated from eight sites including all geographic regions across the US; 70.8% identified as white with mean age of 58.5 ± 14.2 years. Urinary incontinence was the most commonly reported symptom (45.9%); 51.4% saw a female provider. The majority of patients saw a provider 45–60 years old (42.8%) with > 15 years’ experience (60.9%). Sixty-five percent of patients preferred a female provider; 10% preferred a male provider. Sixteen percent preferred a provider 60 years old. Most patients preferred a provider with 5–15 or > 15 years’ experience (49% and 46%, respectively). Eleven percent preferred the presence of trainees while 24% preferred trainee absence. Conclusion Patient preferences regarding urogynecologic providers included female gender and provider age 45–60 years old with > 5 years’ experience. Further study is needed to identify qualitative components associated with these preferences

Obesity and incidence of cancer: a large cohort study of over 145 000 adults in Austria

We investigated the relation of overweight and obesity with cancer in a population-based cohort of more than 145 000 Austrian adults over an average of 9.9 years. Incident cancers (n=6241) were identified through the state cancer registry. Using Cox proportional-hazards models adjusted for smoking and occupation, increases in relative body weight in men were associated with colon cancer (hazard rate (HR) ratio 2.48; 95% confidence interval (CI): 1.15, 5.39 for body mass index (BMI) ⩾35 kg m−2) and pancreatic cancer (HR 2.34, 95% CI: 1.17, 4.66 for BMI>30 kg m−2) compared to participants with normal weight (BMI 18.5–24.9 kg m−2). In women, there was a weak positive association between increasing BMI and all cancers combined, and strong associations with non-Hodgkin's lymphomas (HR 2.86, 95% CI: 1.49, 5.49 for BMI⩾30 kg m−2) and cancers of the uterine corpus (HR 3.93, 95% CI: 2.35, 6.56 for BMI⩾35 kg m−2). Incidence of breast cancer was positively associated with high BMI only after age 65 years. These findings provide further evidence that overweight is associated with the incidence of several types of cancer

Non-Hodgkin's lymphoma, obesity and energy homeostasis polymorphisms

A population-based case–control study of lymphomas in England collected height and weight details from 699 non-Hodgkin's lymphoma (NHL) cases and 914 controls. Obesity, defined as a body mass index (BMI) over 30 kg m−2 at five years before diagnosis,, was associated with an increased risk of NHL (OR=1.5, 95% CI 1.1–2.1). The excess was most pronounced for diffuse large B-cell lymphoma (OR=1.9, 95% CI 1.3–2.8). Genetic variants in the leptin (LEP 19G>A, LEP −2548G>A) and leptin receptor genes (LEPR 223Q>R), previously shown to modulate NHL risk, as well as a polymorphism in the energy regulatory gene adiponectin (APM1 276G>T), were investigated. Findings varied with leptin genotype, the risks being decreased with LEP 19AA (OR=0.7, 95% CI 0.5–1.0) and increased with LEP −2548GA (OR=1.3, 95% CI 1.0–1.7) and −2548AA (OR=1.4, 95% CI 1.0–1.9), particularly for follicular lymphoma. These genetic findings, which were independent of BMI, were stronger for men than women

An Atlas of the Thioredoxin Fold Class Reveals the Complexity of Function-Enabling Adaptations

The group of proteins that contain a thioredoxin (Trx) fold is huge and diverse. Assessment of the variation in catalytic machinery of Trx fold proteins is essential in providing a foundation for understanding their functional diversity and predicting the function of the many uncharacterized members of the class. The proteins of the Trx fold class retain common features—including variations on a dithiol CxxC active site motif—that lead to delivery of function. We use protein similarity networks to guide an analysis of how structural and sequence motifs track with catalytic function and taxonomic categories for 4,082 representative sequences spanning the known superfamilies of the Trx fold. Domain structure in the fold class is varied and modular, with 2.8% of sequences containing more than one Trx fold domain. Most member proteins are bacterial. The fold class exhibits many modifications to the CxxC active site motif—only 56.8% of proteins have both cysteines, and no functional groupings have absolute conservation of the expected catalytic motif. Only a small fraction of Trx fold sequences have been functionally characterized. This work provides a global view of the complex distribution of domains and catalytic machinery throughout the fold class, showing that each superfamily contains remnants of the CxxC active site. The unifying context provided by this work can guide the comparison of members of different Trx fold superfamilies to gain insight about their structure-function relationships, illustrated here with the thioredoxins and peroxiredoxins