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IMPORTANCE: Because major surgery carries significant risks for older adults with comorbid conditions, shared decision-making is recommended to ensure patients receive care consistent with their goals. However, it is unknown how often shared decision-making is used for these patients. OBJECTIVE: To describe the use of shared decision-making during discussions about major surgery with older adults. DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of conversations audio recorded during a randomized clinical trial of a question prompt list. Data were collected from June 1, 2016, to November 31, 2018, from 43 surgeons and 446 patients 60 years or older with at least 1 comorbidity at outpatient surgical clinics at 5 academic centers. INTERVENTIONS: Patients received a question prompt list brochure that contained questions they could ask a surgeon. MAIN OUTCOMES AND MEASURES: The 5-domain Observing Patient Involvement in Decision-making (OPTION5) score (range, 0-100, with higher scores indicating greater shared decision-making) was used to measure shared decision-making. RESULTS: A total of 378 surgical consultations were analyzed (mean [SD] patient age, 71.9 [7.2] years; 206 [55%] male; 312 [83%] White). The mean (SD) OPTION5 score was 34.7 (20.6) and was not affected by the intervention. The mean (SD) score in the group receiving the question prompt list was 36.7 (21.2); in the control group, the mean (SD) score was 32.9 (19.9) (effect estimate, 3.80; 95% CI, −0.30 to 8.00; P = .07). Individual surgeon use of shared decision-making varied greatly, with a lowest median score of 10 (IQR, 10-20) to a high of 65 (IQR, 55-80). Lower-performing surgeons had little variation in OPTION5 scores, whereas high-performing surgeons had wide variation. Use of shared decision-making increased when surgeons appeared reluctant to operate (effect estimate, 7.40; 95% CI, 2.60-12.20; P = .003). Although longer conversations were associated with slightly higher OPTION5 scores (effect estimate, 0.69; 95% CI, 0.52-0.88; P < .001), 57% of high-scoring transcripts were 26 minutes long or less. On multivariable analysis, patient age and gender, patient education, surgeon age, and surgeon gender were not significantly associated with OPTION5 scores. CONCLUSIONS AND RELEVANCE: These findings suggest that although shared decision-making is important to support the preferences of older adults considering major surgery, surgeon use of shared decision-making is highly variable. Skillful shared decision-making can be done in less than 30 minutes; however, surgeons who engage in high-scoring shared decision-making are more likely to do so when surgical intervention is less obviously beneficial for the patient. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02623335

The article presents authors views on deceptive art criticism. Topics discussed include importance of self-assessment for young critics and mentions that Criticism is not for pursuing social prestige in the art world; mentions use of emotional and legal sense in criticism; and information related to several American artist and critics such as Rosalind E. Krauss and David Hammons.

The article presents an personal narrative which explores the author's experience of working as editor and staff writer for an art magazine.

The article offers step-by-step instructions for making a bamboo clock.

A personal narrative is presented which explores the author's experience of bowhunting a bear.

The article analyzes third base coaching in American baseball. It attempts to determine whether the job of directing traffic on the bases is quantifiable. If it is measurable, the article asks whether some coaches can be said to be more skilled at this half of their job than their peers. The article discusses the publication of articles on the Baseball Prospectus Web site which endeavored to more formally quantify base running by developing a series of metrics measured in terms of runs.

The article discusses the foundations of architecting and building smart client applications in Visual Basic .NET. Leveraging the Windows user interface is the most obvious of the pillars and entails creating applications that take advantage of the Windows Forms application program interface in the .NET Framework and installing them locally on the client machine. The need to create a responsive and appealing user interface is not particular to smart clients. Primary among these techniques is designing your user interface to be adaptive. This will be useful if you want your smart client to be able to add new features over time through the auto-deployment of additional assemblies. The second pillar of smart client applications is the need to work seamlessly in both connected and disconnected scenarios. To support this kind of functionality, an application with offline usage in mind must be designed. The third pillar is the ability for smart client applications to be auto-deployed and updated. To many,this is the quintessential feature of smart clients and addresses the second of the two driving factors that led architects and developers to move away from Windows-based applications installed on the desktop in the first place. The infrastructure of the .NET framework supports both auto-deployment and auto-updating by providing automatic application isolation through the use of private assemblies and removing the need to register code on the machine, as was the case in the unmanaged world. The final pillar in building smart client applications is to provide secure access to data and services.

This article discusses the changes made to ADO.NET in Visual Studio .NET, code-named Whidbey. These changes include an extended object model, enhanced support for objects and Extensible Markup Language, and features that take advantage of the SQL Server, code-named Yukon. Microsoft Corp. implements all of the .NET data providers such as SqlClient, OLE DB, ODBC, and OracleClient using a common pattern that involves extending a set of interfaces that include IDbCommand, IDbConnection, IDataReader, IDbDataAdapter, and IDbDataParameter, among others. A DbProviderFactories class includes a shared GetFactory method that returns the appropriate factory class based on an invariant string passed to the method. One of the most interesting aspects of the DbTable object is that if a table name to the object is provided, it can generate the update, delete, and insert Structured Query Language statements, the way a commander builder does, when the Update method is called. Whidbey implements the asynchronous methods using the familiar async pattern used elsewhere in the .NET Framework. ObjectSpaces is an object-relational mapping layer that lets developers work with true .NET objects as data suppliers, rather than being limited to DataTables and DataSets.

Focuses on the implementation of data access functionality as core activity of most developers working with the .NET Framework. Ideas to consider when building a data access layer with Visual Studio .NET and the .NET Framework; Advantage of object-oriented techniques and the .NET Framework infrastructure by using base classes; Creation of an abstract base class using implementation inheritance.

Explains the implementation of Web Services Development Kit (WSDK). Information on the Web Services Interoperability Organization; Requirements of WSDK; Samples of WSDK; Programming model of WSDK.

A correction to the article "Young at Heart" that was published in the February 2011 issue is presented.

The article features Dan Fox, executive chef for The Madison Club in Wisconsin. Cox is a native of Chicago, Illinois and studied in a culinary school at Kendall College. After graduation, he cooked in restaurants in Austria and France. It notes that cooking is a way of life for him, and he states that he does everything from fine dining to kids' cooking classes. His duties at the Madison Club include training and supervising other chefs and creating menus and plate designs for different banquets and meetings.