The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to ...lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.
Abstract
Obstructive sleep apnea (OSA) involves intermittent cessations of breathing during sleep. People with OSA can experience memory deficits and have reduced hippocampal volume; these features ...are also characteristic of Alzheimer’s disease (AD), where they are accompanied by neurofibrillary tangles (NFTs) and amyloid beta (Aβ) plaques in the hippocampus and brainstem. We have recently shown reduced hippocampal volume to be related to OSA severity, and although OSA may be a risk factor for AD, the hippocampus and brainstems of clinically verified OSA cases have not yet been examined for NFTs and Aβ plaques. The present study used quantitative immunohistochemistry to investigate postmortem hippocampi of 34 people with OSA (18 females, 16 males; mean age 67 years) and brainstems of 24 people with OSA for the presence of NFTs and Aβ plaques. OSA severity was a significant predictor of Aβ plaque burden in the hippocampus after controlling for age, sex, body mass index (BMI), and continuous positive airway pressure (CPAP) use. OSA severity also predicted NFT burden in the hippocampus, but not after controlling for age. Although 71% of brainstems contained NFTs and 21% contained Aβ plaques, their burdens were not correlated with OSA severity. These results indicate that OSA accounts for some of the “cognitively normal” individuals who have been found to have substantial Aβ burdens, and are currently considered to be at a prodromal stage of AD.
•Alkaline sulphide is highly selective for the extraction of antimony and arsenic.•Hypochlorite leaching suffers from high reagent requirements and poor selectivity.•Possible to leach fluorine in ...dilute sulphuric acid both with and without addition of aluminium sulphate.•Pressure oxidative/copper precipitation leaching increases copper grade while simultaneously removing penalty elements.
Custom copper smelters impose substantial financial penalties for the presence of deleterious impurity elements in copper concentrates and can outright reject concentrates which contain impurity elements in concentrations that exceed specified values. Hence, there is strong motivation to remove penalised impurity elements from copper concentrates at the mine site before shipping to custom smelters. A number of leach systems have been developed for the selective extraction of penalty elements from copper concentrates, including: alkaline sulphide leaching (ASL); hypochlorite leaching; dilute sulphuric acid leaching with aluminium sulphate; and combined pressure oxidation (POX) leaching with copper precipitation leaching. This paper reviews these four systems with emphasis on the leaching behaviour of penalty elements. ASL has previously been employed in industry for the selective extraction of As and Sb from tetrahedrite-rich copper concentrates. Sodium sulphide solution leaches As, Sb, and Hg from a large range of minerals, however, does not leach arsenopyrite, a mineral which often contains a significant portion of the total As in copper concentrates. Hypochlorite leaching extracts As associated with enargite minerals. This leach system benefits from superior rates of As extraction when compared with ASL, and for this reason, has gained recent interest within the research community. Two major issues have been identified with hypochlorite leaching of copper concentrates. These are poor reagent selectivity towards As-bearing minerals and high levels of hypochlorite consumption. Unless these two issues are resolved it is unlikely that hypochlorite leaching will be employed in commercial processes. Dilute sulphuric acid leaching with aluminium sulphate is used to extract F associated with fluorite. This leach system also extracts F associated with apatite and chlorite. Laboratory-scale experiments and extensive operating experience have indicated that fluorite can be substantially leached from copper concentrates without addition of aluminium sulphate provided that the concentration of sulphuric acid in the leach solution is sufficiently high (at least 40gL−1). POX/copper precipitation leach systems have potential to extract a large number of penalty elements from copper sulphide concentrates while simultaneously upgrading the concentration of copper in the concentrate. Two patented POX/copper precipitation leach processes have been specifically developed for the deportment of penalty elements. These two processes are reviewed in detail.
Objective:Two antidepressant medication combinations were compared with selective serotonin reuptake inhibitor monotherapy to determine whether either combination produced a higher remission rate in ...first-step acute-phase (12 weeks) and long-term (7 months) treatment.
Method:The single-blind, prospective, randomized trial enrolled 665 outpatients at six primary and nine psychiatric care sites. Participants had at least moderately severe nonpsychotic chronic and/or recurrent major depressive disorder. Escitalopram (up to 20 mg/day) plus placebo, sustained-release bupropion (up to 400 mg/day) plus escitalopram (up to 20 mg/day), or extended-release venlafaxine (up to 300 mg/day) plus mirtazapine (up to 45 mg/day) was delivered (1:1:1 ratio) by using measurement-based care. The primary outcome was remission, defined as ratings of less than 8 and less than 6 on the last two consecutive applications of the 16-item Quick Inventory of Depressive Symptomatology—Self-Report. Secondary outcomes included side effect burden, adverse events, quality of life, functioning, and attrition.
Results:Remission and response rates and most secondary outcomes were not different among treatment groups at 12 weeks. The remission rates were 38.8% for escitalopram-placebo, 38.9% for bupropion-escitalopram, and 37.7% for venlafaxine-mirtazapine, and the response rates were 51.6%–52.4%. The mean number of worsening adverse events was higher for venlafaxine-mirtazapine (5.7) than for escitalopram-placebo (4.7). At 7 months, remission rates (41.8%–46.6%), response rates (57.4%–59.4%), and most secondary outcomes were not significantly different.
Conclusions:Neither medication combination outperformed monotherapy. The combination of extended-release venlafaxine plus mirtazapine may have a greater risk of adverse events.
Insect‐specific viruses (ISVs) can affect insect health and fitness, but can also interact with other insect‐associated microorganisms. Despite this, ISVs are often studied in isolation from each ...other, in laboratory populations. Consequently, their diversity, prevalence and associations with other viruses in field populations are less known, yet these parameters are important to understanding virus epidemiology. To help address this knowledge gap, we assessed the diversity, prevalence and coinfections of three ISVs (horizontally transmitted cripavirus, biparentally transmitted sigmavirus and maternally transmitted iflavirus) in 29 field populations of Queensland fruit fly, Australia's most significant horticultural pest, in the context of their different transmission modes. We detected new virus variant diversity. In contrast to the very high virus prevalence in laboratory populations, 46.8% of 293 field flies carried one virus and 4.8% had two viruses. Cripavirus and sigmavirus occurred in all regions, while iflavirus was restricted to subtropical and tropical regions. Cripavirus was most prevalent (37.5%), followed by sigmavirus (13.7%) and iflavirus (4.4%). Cripavirus coinfected some flies with either one of the two vertically transmitted viruses. However, sigmavirus did not coinfect individuals with iflavirus. Three different modelling approaches detected negative association patterns between sigmavirus and iflavirus, consistent with the absence of such coinfections in laboratory populations. This may be linked with their maternal transmission and the ineffective paternal transmission of sigmavirus. Furthermore, we found that, unlike sigmavirus and iflavirus, cripavirus load was higher in laboratory than field flies. Laboratory and mass‐rearing conditions may increase ISV prevalence and load due to increased transmission opportunities. We conclude that a combination of field and laboratory studies is needed to uncover ISV interactions and further our understanding of ISV epidemiology.
OBJECTIVES: To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a ...recent history of falls and to ascertain the effect of the OEP on falls during a 1‐year follow‐up period.
DESIGN: Randomized controlled trial.
SETTING: Dedicated falls clinics.
PARTICIPANTS: Seventy‐four adults aged 70 and older who presented to a healthcare professional after a fall.
INTERVENTION: The OEP, a home‐based program that consists of resistance training and balance training exercises.
MEASUREMENTS: Physiological falls risk was assessed using the Physiological Profile Assessment. Functional mobility was assessed using the Timed Up and Go Test. Three central executive functions were assessed: set shifting, using the Trail Making Test Part B; updating, using the verbal digits backward test; and response inhibition, using the Stroop Color‐Word Test. Falls were prospectively monitored using daily calendars.
RESULTS: At 6 months, there was no significant between‐group difference in physiological falls risk or functional mobility (P≥ .33). There was a significant between‐group difference in response inhibition (P=.05). A falls histogram revealed two outliers. With these cases removed, using negative binomial regression, the unadjusted incidence rate ratio of falls in the OEP group compared with the control group was 0.56. The adjusted incidence rate ratio was 0.47.
CONCLUSION: The OEP may reduce falls by improving cognitive performance.
Objective To determine the extent to which the 2007 definitions for severe obesity (body mass index BMI ≥99th percentile for age and gender) and morbid obesity (BMI ≥40 kg/m2 ) affects different ...groups of American children and adolescents and has increased over time. Methods Analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES) II, III, and 1999–2004; 12 384 US children and adolescents ages 2 to 19 years were included in the analysis. Outcome measures were the proportion of subjects with severe and morbid obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables. Results In 1999–2004, 3.8% of children 2 to 19 years old had a BMI in the ≥99th percentile, with higher prevalence among boys than girls (4.6% vs 2.9%; P < .001). Prevalence was highest among blacks, 5.7% and Mexican Americans, 5.2%, compared with whites, 3.1% ( P < .001). The prevalence differed by the PIR category as well (4.3% for those with PIR ≤3 vs 2.5% for those with PIR > 3; P = .002). BMI ≥40 kg/m2 was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI ≥99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2 to 19 years of age. Conclusions Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender, and poverty. This places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.
Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., ...insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity.
The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested.
Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders.
These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.
The rapid increase in the prevalence and severity of obesity in children is likely to lower the age of onset and increase the incidence of cardiovascular disease worldwide. Understanding the ...pathophysiology and improving the clinical management of cardiovascular disease involve a knowledge of novel risk factors and biomarkers. The clinical and mechanistic roles of these novel biological factors during childhood are currently being investigated. The goals of this scientific statement are to present the existing knowledge and theoretical framework of nontraditional risk factors for cardiovascular disease as they relate to children and adolescents, to describe the relevance and weight of available experimental and clinical evidence and the therapeutic implications pertaining to nontraditional risk factors in the pediatric population, and to stimulate further research with a goal of developing valid and reliable approaches to identify and validate novel risk factors that will aid in the clinical evaluation and perhaps prediction of cardiovascular disease in the pediatric population. Although several biomarkers are promising, substantial research is required before nontraditional risk factors can be used to identify and reduce cardiovascular disease risk in children and adolescents.
The methylotrophic yeast, Pichiapastoris, is an important organism used for the production of therapeutic proteins. However, the presence of fungal-like glycans, either N-linked or O-linked, can ...elicit an immune response or enable the expressed protein to bind to mannose receptors, thus reducing their efficacy. Previously we have reported the elimination of β-linked glycans in this organism. In the current report we have focused on reducing the O-linked mannose content of proteins produced in P. pastoris, thereby reducing the potential to bind to mannose receptors. The initial step in the synthesis of O-linked glycans in P. pastoris is the transfer of mannose from dolichol-phosphomannose to a target protein in the yeast secretory pathway by members of the protein-O-mannosyltransferase (PMT) family. In this report we identify and characterize the members of the P. pastoris PMT family. Like Candida albicans, P. pastoris has five PMT genes. Based on sequence homology, these PMTs can be grouped into three sub-families, with both PMT1 and PMT2 sub-families possessing two members each (PMT1 and PMT5, and PMT2 and PMT6, respectively). The remaining sub-family, PMT4, has only one member (PMT4). Through gene knockouts we show that PMT1 and PMT2 each play a significant role in O-glycosylation. Both, by gene knockouts and the use of Pmt inhibitors we were able to significantly reduce not only the degree of O-mannosylation, but also the chain-length of these glycans. Taken together, this reduction of O-glycosylation represents an important step forward in developing the P. pastoris platform as a suitable system for the production of therapeutic glycoproteins.
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