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Background: Laparoscopic sleeve gastrectomy (LSG) in patients with BMI ≥ 60 presents technical challenges, that might be overcome by robotic surgery, but its effectiveness has not been rigorously evaluated. We compared the 30-day outcomes of LSG and robotic sleeve gastrectomy (RSG) in patients with BMI < 60 versus ≥ 60 and between LSG and RSG in patients with BMI ≥ 60. Methods: Patients aged 18–65 years who underwent sleeve gastrectomy were included using the 2019–2022 MBSAQIP database. We performed a Propensity Score Matching analysis, with 21 preoperative characteristics. We compared 30-day postoperative outcomes for patients with BMI < 60 versus ≥ 60 using either a laparoscopic (Analysis 1) or robotic approach (Analysis 2) and compared LSG versus RSG in patients with BMI ≥ 60 (Analysis 3). Results: 297,250 patients underwent LSG and 81,008 RSG. Propensity-matched¸ outcomes in analysis 1 (13,503 matched cases), showed that patients with BMI ≥ 60 had higher rates of mortality (0.1% vs. 0.0%, p = 0.014), staple line leak (0.3% vs. 0.2%, p = 0.035), postoperative bleeding (0.2% vs 0.1%, p = 0.028), readmissions (3.5% vs. 2.4%, p < 0.001), and interventions (0.7% vs. 0.5%, p = 0.028) when compared to patients with BMI < 60. In analysis 2 (4350 matched cases), patients with BMI ≥ 60 demonstrated longer operative times, length of stay, and higher rates of unplanned ICU when compared to patients with BMI < 60. In analysis 3 (4370 matched cases), patients who underwent RSG had fewer readmissions (2.9% vs. 3.7%, p = 0.037), staple line leaks (0.1% vs. 0.3%, p = 0.029), and postoperative bleeding (0.1% vs. 0.3%, p = 0.045), compared to LSG. Conversely, a longer operative time (92.74 ± 38.65 vs. 71.69 ± 37.45 min, p < 0.001) was reported. Conclusion: LSG patients with BMI ≥ 60 have higher rates of complications compared to patients with a BMI < 60. Moreover, some outcomes may be improved with the robotic approach in patients with BMI ≥ 60. These results underscore the importance of considering a robotic approach in this super super obese population. [ABSTRACT FROM AUTHOR]

Learning to descend stairs requires motor and cognitive capacities on the part of infants and opportunities for practice and assurance of safety offered by caregivers. The American Academy of Pediatrics prescribes the age strategy to teach toddlers to safely descend stairs but without much consideration for individual differences in infants' skills or caregivers' techniques. The purpose of this study was to observe the natural ways in which caregivers teach infants to descend stairs at home and the extent to which infants abide. Of particular interest was to examine the dynamic nature of caregivers' teaching and infants' learning over the session with attention to individual differences. Dyads (N = 59) were videorecorded on Zoom for 10 min interacting on stairs at home in the United States, Brazil, Canada, Italy, and Spain. Infants (n = 30 girls, 29 boys; 13-month-olds ± 1 week) were novice walkers (M = 2.04 months walking experience). Caregivers used a variety of teaching strategies and focused on "backing" and "scooting." Infants were more likely to heed caregivers' guidance when caregivers provided hands-on support and verbal encouragement suggesting infants were engaged and responsive to caregivers' overtures. Infants' walking experience predicted change in descent strategy over the session. Although infants did not show evidence of learning over the session, consistent caregiver instruction suggested caregivers were persistent, if not effective, teachers. Teaching and learning motor skills in a potentially risky task creates a unique opportunity for interaction, allowing infants and caregivers to learn from one another. Public Significance Statement: This work contributes to the general body of knowledge regarding infant motor development and problem solving in specific contexts. This study is one of the first to explore the nature of caregiver-infant interaction on stairs and identifies caregiver teaching strategies and infant motor characteristics that are associated with safe infant stair descent. By doing so, we hope to encourage further investigation of infant behavior in this context, upon which recommendations to caregivers for safe infant descent may be based. [ABSTRACT FROM AUTHOR]

This study aimed to compare characteristics of nurse educators, factors related to teaching global nursing, contents of global education and support and the level of burden of global education and factors related to the burden between nurse educators among top nursing universities in Japan and four English-speaking countries. Intercultural sensitivity is the active desire to motivate oneself to understand, appreciate and accept different cultures. Nurse educators need to be culturally sensitive to teach cultural care to nursing students. This is a cross-sectional exploratory international comparative study using an online survey. Participants were nurse educators with a nurse license in the top 20 in Japan and the top 10 universitiesin the United States, Canada, United Kingdom and Australia (hereafter "English-speaking countries"), respectively. The questions in Google form selected participants by the inclusion criteria. Intercultural sensitivity was measured by the Intercultural Sensitivity Scale. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and Spearman's correlation coefficients were used for the analyses. Data were collected from October 2023 to January 2024. A total of 144 in Japan (response rate=29.0 %) and 106 educators in English-speaking countries (response rate=2.4 %) were included in the analysis. Nurse educators in Japan had less work experience in foreign countries, had fewer opportunities to take part in cross-cultural interactions and had significantly lower intercultural sensitivity. In both groups, those who had more experience in foreign countries with higher intercultural sensitivity taught global nursing. While in Japan nurse educators who had higher proficiency in non-native languages and those who had more frequently taken part in cross-cultural interactions taught global nursing, in English-speaking countries full-time workers who had attended international academic conferences taught. In Japan, global nursing was a more optional course and the number of contents taught was lower. While participants in Japan had international seminars at universities as support for global nursing education, those in English-speaking countries had faculty members with different cultural backgrounds. Participants in Japan felt more burden for global nursing education. In Japan, more proficient non-native language, more frequent cross-cultural interaction and higher intercultural sensitivities were associated with a lower burden, while teaching other than in their native language, contents taught and performance evaluation were associated with a higher burden in English-speaking countries. Higher intercultural sensitivity, performance evaluation and proficiency in non-native language may be important for nurse educators to teach global nursing and support is necessary to enhance them. [ABSTRACT FROM AUTHOR]