ABSTRACT. Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is >50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.Conclusions.

Research Summary: This study analyzed data on 3,237 offenders placed in 1 of 38 community‐based residential programs as part of their parole or other post‐release control. Offenders terminated from these programs were matched to, and compared with, a group of offenders (N = 3,237) under parole or other post‐release control who were not placed in residential programming. Data on program characteristics and treatment integrity were obtained through staff surveys and interviews with program directors. This information on program characteristics was then related to the treatment effects associated with each program. Policy Implications: Significant and substantial relationships between program characteristics and program effectiveness were noted. This research provides information that is relevant to the development of correctional programs, and it can be used by funding agencies when awarding contracts for services.

ADAMTS13 limits platelet-rich thrombosis by cleaving von Willebrand factor at the Tyr1605 -Met 1606 bond. Previous studies showed that ADAMTS13 truncated after spacer domain remains proteolytically active or hyperactive. However, the relative contribution of each domain within the proximal carboxyl terminus of AD-AMTS13 in substrate recognition and specificity is not known. We showed that a metalloprotease domain alone was unable to cleave the Tyr-Met bond of glutathione S-transferase (GST)-VWF73-H substrate in 3 h, but it did cleave the substrate at a site other than the Tyr-Met bond after 16 -24 h of incubation. Remarkably, the addition of even one or several proximal carboxyl-terminal domains of ADAMTS13 restored substrate specificity. Full proteolytic activity, however, was not achieved until all of the proximal carboxyl-terminal domains were added. The addition of TSP1 2-8 repeats and two CUB domains did not further increase proteolytic activity. ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeat) (1-6) cleaves von Willebrand factor (VWF) 1 at the Tyr 1605 -Met 1606 bond of the central A2 subunit (7,8). Inability to cleave newly synthesized and released "unusually large" VWF multimers from endothelial cells or platelets due to deficiency of ADAMTS13 proteolytic activity may result in an accumulation of the unusually large VWF multimers (9), leading to formation of disseminated platelet-rich microthrombi in small arteries, a characteristic pathologic feature of thrombotic thrombocytopenic purpura. For purposes of discussion, ADAMTS13 may be divided arbitrarily into four functionally distinct regions: the metalloprotease, the proximal, the middle, and the distal carboxyl-terminal regions. The metalloprotease domain is the catalytic center, containing a characteristic HEXXHXXGXXHD sequence that coordinates Zn 2ϩ or Ca 2ϩ binding (1-6, 10). The proximal carboxyl-terminal region consists of a disintegrin domain, a first thrombospondin type 1 (TSP1) repeat, a Cys-rich domain, and a spacer domain. The middle and distal carboxyl-terminal regions of ADAMTS13 have seven additional TSP1 repeats and two CUB (C1r/C1s, urinary epidermal growth factor, bone morphogenetic protein) domains (3, 6, 10, 11).Studies have shown that ADAMTS13 truncated after the spacer domain remains proteolytically active toward plasma VWF in the presence of 1.5 M urea and low ionic strength (12, 13) and appears to be hyperactive toward unusually large VWF that are newly released from cultured endothelial cells under flow conditions (14). In addition, the autoantibodies identified in patients with idiopathic thrombotic thrombocytopenic purpura all react with the Cys-rich domain and spacer domain (15,16). These data suggest a critical role of the proximal C terminus of ADAMTS13 in substrate recognition in vivo. However, the relative contribution of each domain within the proximal carboxyl-terminal region of ADAMTS13 to substrate recognition and enzymatic activity remains unclear, as the assays using plasma VWF in the pr...

Research Summary Over the past two decades, researchers have been increasingly interested in measuring the risk of offender recidivism as a means of advancing public safety and of directing treatment interventions. In this context, one instrument widely used in assessing offenders is the Level of Service Inventory‐Revised (LSI‐R). Recently, however, the LSI‐R has been criticized for being a male‐specific assessment instrument that is a weak predictor of criminal behavior in females. Through the use of meta‐analytic techniques, we assessed this assertion. A total of 27 effect sizes yielded an average r value of .35 ([confidence interval] CI = .34 to .36) for the relationship of the LSI‐R with recidivism for female offenders (N= 14,737). When available, we also made within‐sample comparisons based on gender. These comparisons produced effect sizes for males and females that were statistically similar. Policy Implications These results are consistent with those generated in previous research on the LSI‐R. They call into question prevailing critiques that the LSI‐R has predictive validity for male but not for female offenders. At this stage, it seems that corrections officials should be advised that the LSI‐R remains an important instrument for assessing all offenders as a prelude to the delivery of treatment services, especially those based on the principles of effective intervention. Critics should be encouraged, however, to construct and validate through research additional gender‐specific instruments that revise, if not rival, the LSI‐R.

Because of the substantial impact of families on the developmental trajectories of children, family interventions should be a critical ingredient in comprehensive prevention programs. Very few family interventions have been adapted to be culturally sensitive for different ethnic groups. This paper examines the research literature on whether culturally adapting family interventions improves retention and outcome effectiveness. Because of limited research on the topic, the prevention research field is divided on the issue. Factors to consider for cultural adaptations of family-focused prevention are presented. Five research studies testing the effectiveness of the generic version of the Strengthening Families Program (SFP) compared to culturally-adapted versions for African Americans, Hispanic, Asian/Pacific Islander, and American Indian families suggest that cultural adaptations made by practitioners that reduce dosage or eliminate critical core content can increase retention by up to 40%, but reduce positive outcomes. Recommendations include the need for additional research on culturally-sensitive family interventions.

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Research addressing genetic screening for hereditary hemochromatosis remains insufficient to confidently project the impact of, or estimate the benefit from, widespread or high-risk genetic screening for hereditary hemochromatosis.

Imprisonment provides opportunities for the diagnosis and successful treatment of HIV, however, the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services. In response, some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees. We conducted a randomized controlled trial of a motivational Strengths Model bridging case management intervention (BCM) beginning approximately 3 months prior to and continuing 6 months after release versus a standard of care prison-administered discharge planning program (SOC) for HIV-infected state prison inmates. The primary outcome variable was self-reported access to post-release medical care. Of the 104 inmates enrolled, 89 had at least 1 post-release study visit. Of these, 65.1% of BCM and 54.4% of SOC assigned participants attended a routine medical appointment within 4 weeks of release (P >0.3). By week 12 post-release, 88.4% of the BCM arm and 78.3% of the SOC arm had at attended at least one medical appointment (P = 0.2), increasing in both arms at week 24–90.7% with BCM and 89.1% with SOC (P >0.5). No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48. The mean number of clinic visits during the 48 weeks post release was 5.23 (SD = 3.14) for BCM and 4.07 (SD = 3.20) for SOC (P >0.5). There were no significant differences between arms in social service utilization and re-incarceration rates were also similar. We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison.