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Context Pediatric obesity is a serious health problem in the United States. While lifestyle modification therapy with dietary changes and increased physical activity are integral for the prevention and treatment of mild to moderate obesity in youth, only a modest effect on sustained weight reduction is observed in children and young adults with severe obesity. This underscores the need for additional evidence-based interventions for children and adolescents with severe obesity, including pharmacotherapy, before considering invasive procedures such as bariatric surgery. Evidence Acquisition This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity. Evidence Synthesis We review medications currently available in the United States, both those approved for weight reduction in children and “off-label” medications that have a broad safety margin. Conclusion It is intended that this review will provide guidance for practicing clinicians and will encourage future exploration for successful pharmacotherapy and other interventions for obesity in youth.

Objectives The aim of the study was to evaluate the impact of a resident-led patient safety council. This study measured change in resident perceptions and knowledge of safety issues for 3 years, as well as behavioral choices to participate in patient safety activities during and after residency. Methods Pediatric residents formed a resident-led safety council to engage their peers in patient safety activities. Surveys were distributed annually from 2013 to 2015 to measure residents' perception and knowledge surrounding patient safety. The number of patient safety reports submitted by residents was tracked for the same period. In addition, recent graduates were surveyed to assess the influence of the council on postresidency involvement in patient safety. Results Resident perception of the institutional culture of safety improved and knowledge of basic patient safety concepts increased. The number of resident-submitted safety reports increased from 6.2 to 15.2 reports per month in the 2013 and 2015 academic years, respectively. Surveys of recent graduates suggest that involvement with the safety council during residency fostered future engagement in patient safety. Conclusions This resident-led council models successful involvement of trainees in system-based patient safety. Such involvement can help shape the safety culture within a training program and encourages continued participation in patient safety after residency completion.

Topic It is recognized that facilitating change in workplace culture is a significant challenge in healthcare service delivery. Practice development strategies and principles provide a framework for initiating and sustaining programs focused on enhancing patient-centered care by concentrating on the therapeutic attributes of nursing. However, little literature exists on explicating “what worked” in practice development programs. Purpose This paper details the processes, people, resources, and relationships that enabled the successful implementation, and led to the sustainability, of a practice development program employed in an acute adolescent mental health unit in Sydney, Australia. Sources Used Following an external review of the unit, a meeting of key stakeholders was convened and subsequently an advisory panel formed to address specific issues facing nursing staff. This process resulted in the development of an educational package and adoption of the tidal model as the framework for mental health nursing practice in the unit. Clinical reasoning sessions and journal article presentations were incorporated to consolidate and maintain the change in nursing care. Conclusions A planned, structured, and inclusive practice development program has transformed the nursing culture and vastly improved the care provided to adolescents presenting in acute states of distress to this mental health unit.

Purpose – The purpose of this paper is to provide a comprehensive narrative review of the literature on migrant farm worker child and adolescent health. It highlights current health issues and suggests methods to improve research and clinical practices with this underserved and vulnerable population. Design/methodology/approach – The methodology for this narrative review included a search of articles published between 2000 and 2012. From the primary search, 76 articles met the search criteria. A secondary search revealed three additional articles. Findings – The various methodologies used in the current literature have limited rigorous analysis of the health of pediatric migrant populations. The findings highlight the complex factors that influence migrant pediatric health. Despite the many challenges migrant farm worker children and their families face, they exhibit enormous resilience and strengths that may help counterbalance these challenges. Study categories that emerged from the analysis include health perspectives and behaviors, occupational health, access to care, utilization and satisfaction with health services, health outcomes and health disparities, and oral health. This review provides a strong foundation from which to work toward improving migrant pediatric health. Originality/value – This paper provides an original review of the unique health needs and the complex factors influencing the health of migrant farm worker children and adolescents. This will be of value to clinicians and researchers since migrant farm worker families are part of communities across the country. It offers public health professionals insight into services and programs that can improve the health and well-being of children, families, and communities.

This article highlights the Farm Worker Family Health Program’s (FWFHP) strategies for providing care to migrant farm workers residing within a unique social and cultural context. The care provided by health professions students from a variety of disciplines extends and augments the work of the local migrant farm worker clinic that is pushed beyond capacity during peak growing and harvest times. Nursing’s social responsibility to care for underserved populations is a guiding principle of the FWFHP and shapes how the work is translated into action. The FWFHP is a community—academic partnership that began in the rural southeastern United States in 1993. Challenges facing migrant farm worker families include access to health care, language, health literacy, housing and sanitation, family and community integrity, and workplace safety. The nursing practice strategies used to address these health challenges may be adapted to strengthen health programs serving other populations who live in poverty or reside in low-resource settings.

We present a data-based perspective concerning recent (e.g., 2008) Maclean’s magazine rankings of Canadian universities, including cluster analysis of the 2008 data. Canadian universities empirically resemble and relate to each other in a manner different from their formal classification and final rank ordering in the Maclean’s system. Several pitfalls in ranking procedures, related to invalid and unreliable relationships among indices underlying the final ranks, are outlined, along with relevant findings from previous studies. In their present format, although they have become increasingly publicized and promoted, data based on the Maclean’s system can seemingly be of only limited practical use to students. Perhaps more important, in our opinion, ranking exercises have unintended though potentially serious consequences for the intellectual and personal well-being of students.

Though a great deal of research focuses on the range expansion and presence of adult zebra mussels, there is still a need to understand the processes of larval settlement and how that relates to adult populations. There is evidence that marine bivalves preferentially settle on filamentous substrates such as hydroid colonies and algae; however, similar studies are rare in freshwater systems. We examined the importance of filamentous substrate for the settlement of the zebra mussel (Dreissena polymorpha) larvae by deploying PVC settlement plates with and without polypropylene filaments in the Bark River for a 6-week period. Larval supply was monitored weekly. Our results suggest that artificial filaments facilitated recruitment, primarily by increasing surface area available for attachment. Mussels on artificial filaments were significantly smaller in size than mussels attached to filamentous or control plate surfaces, providing some evidence that mussels may detach from filamentous substrate after initial settlement. This study adds to our general understanding about the role of filamentous substrates in the process of larval settlement and suggests that substrates colonized by filamentous epibionts may face increased risk of fouling by zebra mussels.

It is recognized that facilitating change in workplace culture is a significant challenge in healthcare service delivery. Practice development strategies and principles provide a framework for initiating and sustaining programs focused on enhancing patient-centered care by concentrating on the therapeutic attributes of nursing. However, little literature exists on explicating "what worked" in practice development programs.This paper details the processes, people, resources, and relationships that enabled the successful implementation, and led to the sustainability, of a practice development program employed in an acute adolescent mental health unit in Sydney, Australia.Following an external review of the unit, a meeting of key stakeholders was convened and subsequently an advisory panel formed to address specific issues facing nursing staff. This process resulted in the development of an educational package and adoption of the tidal model as the framework for mental health nursing practice in the unit. Clinical reasoning sessions and journal article presentations were incorporated to consolidate and maintain the change in nursing care.A planned, structured, and inclusive practice development program has transformed the nursing culture and vastly improved the care provided to adolescents presenting in acute states of distress to this mental health unit.

We present a data-based perspective concerning the recent Maclean’s magazine rankings of Canadian universities, including cluster and other analyses of the 2007 and 2008 data. Canadian universities empirically resemble and relate to each other in a manner different from their formal classification and final rank ordering in the Maclean’s system. Several pitfalls in ranking procedures, related to invalid and unreliable relationships among indices underlying the final ranks, are outlined, along with relevant findings from previous studies. In their present format, although they have become increasingly publicized and promoted, data based on the Maclean’s system are of limited practical use to students. Perhaps more important, ranking exercises have unintended though potentially serious consequences in terms of the intellectual and personal well-being of students.

Sea urchin embryo micromeres form the primary mesenchyme, the skeleton-producing cells of the embryo. Almost nothing is known about nature and timing of the embryonic cues which induce or initiate spicule formation by these cells. A related question concerns the competence of the micromeres to respond to the cues. To examine competence in this system we have exposed cultured sea urchin micromeres to an inducing medium containing horse serum for various periods of time and have identified a period when micromeres are competent to respond to serum and form spicules. This window, between 30 and 50 h after fertilization, corresponds to the time when mesenchyme cells in vivo are aggregating and beginning to form the syncytium in which the spicule will be deposited. The loss of competence after 50 h is not due to impaired cell health since protein synthesis at this time is not significantly different from controls. Likewise the accumulation of a spicule matrix mRNA (SM 50) and a cell surface glycoprotein (msp 130), both indices of micromere/mesenchyme differentiation, still occurs in cells that have lost competence to respond to serum by forming spicules. These experiments demonstrate that the acquisition and loss of competence in these cells are regulated developmental events and establish an in vitro system for the identification of the molecular basis for inductive signal recognition and signal transduction.

Rapid response teams (RRT) are an important safety strategy in the prevention of deaths in patients who are progressively failing outside of the intensive care unit. The goal is to intervene before a critical event occurs. Effective teamwork and communication skills are frequently cited as critical success factors in the implementation of these teams. However, there is very little literature that clearly provides an education strategy for the development of these skills. Training in simulation labs offers an opportunity to assess and build on current team skills; however, this approach does not address how to meet the gaps in team communication and relationship skill management. At Hamilton Health Sciences (HHS) a two-day program was developed in collaboration with the RRT Team Leads, Organizational Effectiveness and Patient Safety Leaders. Participants reflected on their conflict management styles and considered how their personality traits may contribute to team function. Communication and relationship theories were reviewed and applied in simulated sessions in the relative safety of off-site team sessions. The overwhelming positive response to this training has been demonstrated in the incredible success of these teams from the perspective of the satisfaction surveys of the care units that call the team, and in the multi-phased team evaluation of their application to practice. These sessions offer a useful approach to the development of the soft skills required for successful RRT implementation.

Autophagy is a major pathway for delivery of proteins and organelles to lysosomes where they are degraded and recycled. We have previously shown excessive autophagy in a mouse model of Pompe disease (glycogen storage disease type II), a devastating myopathy caused by a deficiency of the glycogen-degrading lysosomal enzyme acid alpha-glucosidase. The autophagic buildup constituted a major pathological component in skeletal muscle and interfered with delivery of the therapeutic enzyme. To assess the role of autophagy in the pathogenesis of the human disease, we have analyzed vesicles of the lysosomal-degradative pathway in isolated single muscle fibers from Pompe patients. Human myofibers showed abundant autophagosome formation and areas of autophagic buildup of a wide range of sizes. In patients, as in the mouse model, the enormous autophagic buildup causes greater skeletal muscle damage than the enlarged, glycogenfilled lysosomes outside the autophagic regions. Clearing or preventing autophagic buildup seems, therefore, a necessary target of Pompe disease therapy.

A counterbalanced repeated measures design.To determine the effect of a soft lumbar support on abdominal oblique muscle electromyography (EMG) during lifting.Use of a soft lumbar back support is a common preventive measure to reduce the incidence of back injuries. Because the abdominal oblique muscles stabilize the spine during lifting, wearing this support may alter the activity level of these muscles.Twenty nonimpaired subjects (14 women and 6 men, mean age 28.9 +/- 8.1 years) were tested using surface electrodes to record the EMG of the right abdominal oblique muscles during lifting with and without the support.A paired t test revealed a significant decrease in activity of the abdominal oblique muscles during lifting with the support (29.7 +/- 3.13 mV) compared to without it (33.3 +/- 3.05 mV). Of the 20 subjects, the 14 women showed decreased EMG amplitude during the lift with the lumbar support compared to without the support, while 5 of the men showed increased EMG amplitude with the support and 1 man showed no change.This finding suggests that the soft lumbar support may play some role in the stabilization of the lumbar region during lifting.

We describe the isolation and characterization of a cDNA clone encoding a region of the carboxy terminal globular domain (G domain) of the alpha-1 chain of laminin from the sea urchin, Strongylocentrotus purpuratus. Sequence analysis indicates that the 1.3 kb cDNA (spLAM-alpha) encodes the complete G2 and G3 subdomains of sea urchin a-laminin. The 11 kb spLAM-alpha mRNA is present in the egg and declines slightly in abundance during development to the pluteus larva. The spLAM-alpha gene is also expressed in a variety of adult tissues. Whole mount in situ hybridization of gastrula stage embryos indicates that ectodermal and endodermal epithelia and mesenchyme cells contain the spLAM-alpha mRNA. Immunoprecipitation experiments using an antibody made to a recombinant fusion protein indicates spLAM-alpha protein is synthesized continuously from fertilization as a 420 kDa protein which accumulates from low levels in the egg to elevated levels in the pluteus larva. Light and electron microscopy identify spLAM-alpha as a component of the basal lamina. Blastocoelic microinjection of an antibody to recombinant spLAM-alpha perturbs gastrulation and skeleton formation by primary mesenchyme cells suggesting an important role for laminin in endodermal and mesodermal morphogenesis.