Background The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although recommended, schools have difficulty consistently implement evidence-based obesity programing. We report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school after-school programming. Methods Using a longitudinal pre-post study design, we evaluated program effectiveness at one year on target behaviors on students recruited during three consecutive school years (2016–2018). We used generalized linear (or logistic) mixed-effects modeling to determine: 1) impact on healthy weight and target healthy behavior attainment, and 2) whether target behavior improvement and weight change were associated with after-school program attendance. The seven target behaviors relate to eating healthy, physical activity, and sleep. Results Over the three years, a total of 76 students enrolled and completed one year of programming (62% Hispanic, 46% girls, 72% with BMI > 85th %ile, 49% with BMI > 95th %ile). Of students with BMI > 85th %ile, 44% maintained or decreased BMI Z-score. There were improvements (non-significant) in BMI Z-score and the adoption of four healthy eating behaviors: fruit, vegetables, sugar-free beverages, and unhealthy snack food. Students with higher after-school attendance (> 75%) had greater improvements (non-significant) in composite behavior scores, BMI Z-score, and in most target behaviors (5/7) than students with lower after-school attendance (< 75%). Sleep improvements were significantly associated with BMI Z-score decrease (Beta = − 0.05, 95% CI (− 0.1,-0.003), p = 0.038.) Conclusions Enhancement of existing after-school programming with structured nutrition education and minimum physical activity requirements demonstrates positive improvements in several health behaviors and weight outcomes. Adopting enhanced after-school programming increases access to health activities and may bring us closer to solving obesity in at-risk youth in impoverished communities. Trial registration ClinicalTrials.govidentifier (NCT number):NCT03565744. Registered 21 June 2018 – Retrospectively registered.

Objectives/Hypothesis Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. Study Design Prospective observational (quality improvement). Methods A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was “timely discharges,” defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven‐day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record‐based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. Results Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7‐day readmission rates were unchanged. Conclusions By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. Level of Evidence 3 Laryngoscope, 132:225–233, 2022

Background: The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although interventions targeting schools are recommended, schools rarely implement evidence-based obesity programing.Methods: Using a pragmatic quasi-experimental design, we report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school onsite afterschool programming. Programming was evaluated over three school years (2016- 2018) to determine: 1) impact on healthy weight and target healthy behavior attainment; and 2) whether target behavior improvement was associated with afterschool program attendance and weight change.Results: In response to 601 recruitment letters 13% (76 students) enrolled (62% Hispanic, 46% girls, 72% with BMI > 85 th %ile, 49% with BMI > 95 th %ile). With low baseline attainment of 7 target behaviors including:1) daily breakfast and lunch (32%); 2) 2-3 servings fruit/day (53%); 3) > 3 servings vegetables/day (29%); 4) 8 cups sugar-free beverages (SFB)/day and <1 cup sugary beverage/day (9%); 5) > 8 hours sleep/night (75%); 6) > 7 hours PA/week (21%); and 7) < 1 unhealthy snack (US) and <1 fast food meal/week (25%), the calculated composite score was 2.5 out of 7. Of students with BMI > 85 th %ile, 44% maintained or decreased BMI Z-score. There were non-significant trends in improvements in BMI Z-score and target consumption of: fruit, vegetables, SFB, and US food. Students with higher afterschool attendance ( > 75%) had greater non-significant improvements in composite score, BMI Z-score, and in most target behaviors (5/7) compared to students with lower afterschool attendance (<75%). Although not significant, improvements in composite score attainment and most target behaviors (5/7) were associated with decreases in BMI Z-score. Sleep improvements were significantly associated with BMI Z-score decrease (Beta=-0.05, 95% CI (-0.1,-0.003), p=0.038.) Conclusions : Enhancement of existing afterschool programming with health oriented elements and minimum physical activity requirements demonstrates trends toward improvement in several health behaviors and weight outcomes. Addition of enhanced programming increases access to health activities and may bring us closer to solving issue of obesity in at-risk youth in impoverished communities.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT03565744. Registered 21 June 2018 – Retrospectively registerd, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.