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Function and the independent performance of daily activities are of critical importance to older adults. Although function was once a domain of interest primarily limited to geriatricians, transdisciplinary research has demonstrated its value across the spectrum of medical and surgical care. Nonetheless, integrating a functional perspective into medical and surgical therapeutics has yet to be implemented consistently into clinical practice. This article summarizes the presentations and discussions from a workshop, "Embedding/Sustaining a Focus on Function in Specialty Research and Care," held on January 31 to February 1, 2019. The third in a series supported by the National Institute on Aging and the John A. Hartford Foundation, the workshop aimed to identify scientific gaps and recommend research strategies to advance the implementation of function in care of older adults. Transdisciplinary leaders discussed implementation of mobility programs and functional assessments, including comprehensive geriatric assessment; integrating cognitive and sensory functional assessments; the role of culture, environment, and community in incorporating function into research; innovative methods to better identify functional limitations, techniques, and interventions to facilitate functional gains; and the role of the health system in fostering integration of function. Workshop participants emphasized the importance of aligning goals and assessments and adopting a team science approach that includes clinicians and frontline staff in the planning, development, testing, and implementation of tools and initiatives. This article summarizes those discussions., (© 2020 The American Geriatrics Society.)

Purpose: This article reports on the presentations and discussion from the working group on "Influences on Sedentary Behavior and Interventions To Reduce Sedentary Behavior" as part of the Sedentary Behavior: Identifying Research Priorities workshop., Methods: Interventions were discussed in the context of targeting sedentary behavior (SB) as a concept distinct from physical activity. It was recommended that interventions targeting SB should consider a life course perspective, a position predicated on the assumption that SB is age and life stage dependent. In addition, targeting environments where individuals have high exposure to SB--such as workplace sitting--could benefit from new technology (e.g., computer-based prompting to stand or move), environmental changes (e.g., active workstations), policies targeting reduced sedentary time (e.g., allowing employees regular desk breaks), or by changing norms surrounding prolonged sitting (e.g., standing meetings)., Results and Conclusions: There are limited data about the minimal amount of SB change required to produce meaningful health benefits. In addition to developing relevant scientific and public health definitions of SB, it is important to further delineate the scope of health and quality-of-life outcomes associated with reduced SB across the life course and to clarify what behavioral alternatives to SB can be used to optimize health gains. SB interventions will benefit from having more clarity about the potential physiological and behavioral synergies with current physical activity recommendations, developing multilevel interventions aimed at reducing SB across all life phases and contexts, harnessing relevant and effective strategies to extend the reach of interventions to all sectors of society, as well as applying state-of-the-science adaptive designs and methods to accelerate advances in the science of SB interventions.

Social media has become an integral part of modern society. Many people now turn to social media platforms to share or gain knowledge about best practices for personal health. This new form of health information dissemination has greatly increased in popularity especially among young adults. Currently, more research is needed to identify why so many individuals choose to turn to social media for health information. Using Q methodology, this study aimed to uncover the attitudes, opinions, and beliefs of young adults who engage with social media as a means of obtaining health and fitness information. Results revealed four primary factors: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders. Each group possessed different motivations for accessing health-related content on social media. The insights gained from this study can benefit public health institutions, advertisers, and social media content creators as they disseminate health information on social media platforms. [ABSTRACT FROM AUTHOR]

Introduction: Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS).Methods: An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5 s, open air activation of the monopolar scissors was done on 30 W and 60 W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180 W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer.Results: Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3 °C vs. 8.4 ± 1.6 °C, p = 0.013). Reducing power from 60 to 30 W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4 °C vs. 11.6 ± 3.3 °C, p = 0.023), but not significantly for TRS (9.4 ± 2.5 °C vs. 8.4 ± 1.6 °C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4 °C, p < 0.001) and TRS (0.7 ± 0.4 °C, p < 0.001).Conclusions: More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy. [ABSTRACT FROM AUTHOR]

Introduction: Stray energy transfer from monopolar radiofrequency energy during laparoscopy can be potentially catastrophic. Robotic surgery is increasing in popularity; however, the risk of stray energy transfer during robotic surgery is unknown. The purpose of this study was to (1) quantify stray energy transfer using robotic instrumentation, (2) determine strategies to minimize the transfer of energy, and (3) compare robotic stray energy transfer to laparoscopy.Methods: In a laparoscopic trainer, a monopolar instrument (L-hook) was activated with DaVinci Si (Intuitive, Sunnyvale, CA) robotic instruments. A camera and assistant grasper were inserted to mimic a minimally invasive cholecystectomy. During activation of the L-hook, the non-electric tips of the camera and grasper were placed adjacent to simulated tissue (saline-soaked sponge). The primary outcome was change in temperature from baseline (°C) measured nearest the tip of the non-electric instrument.Results: Simulated tissue nearest the robotic grasper increased an average of 18.3 ± 5.8 °C; p < 0.001 from baseline. Tissue nearest the robotic camera tip increased (9.0 ± 2.1 °C; p < 0.001). Decreasing the power from 30 to 15 W (18.3 ± 5.8 vs. 2.6 ± 2.7 °C, p < 0.001) or using low-voltage cut mode (18.3 ± 5.8 vs. 3.1 ± 2.1 °C, p < 0.001) reduced stray energy transfer to the robotic grasper. Desiccating tissue, in contrast to open air activation, also significantly reduced stray energy transfer for the grasper (18.3 ± 5.8 vs. 0.15 ± 0.21 °C, p < 0.001) and camera (9.0 ± 2.1 vs. 0.24 ± 0.34 °C, p < 0.001).Conclusions: Stray energy transfer occurs during robotic surgery. The assistant grasper carries the highest risk for thermal injury. Similar to laparoscopy, stray energy transfer can be reduced by lowering the power setting, utilizing a low-voltage cut mode instead of coagulation mode and avoiding open air activation. These practical findings can aid surgeons performing robotic surgery to reduce injuries from stray energy. [ABSTRACT FROM AUTHOR]

Objectives: To explore (1) differences in validity and feasibility ratings for geriatric surgical standards across a diverse stakeholder group (surgeons vs. nonsurgeons, health care providers vs. nonproviders, including patient-family, advocacy, and regulatory agencies); (2) whether three multidisciplinary discussion subgroups would reach similar conclusions.Data Source/study Setting: Primary data (ratings) were reported from 58 stakeholder organizations.Study Design: An adaptation of the RAND-UCLA Appropriateness Methodology (RAM) process was conducted in May 2016.Data Collection/extraction Methods: Stakeholders self-administered ratings on paper, returned via mail (Round 1) and in-person (Round 2).Principal Findings: In Round 1, surgeons rated standards more critically (91.2 percent valid; 64.9 percent feasible) than nonsurgeons (100 percent valid; 87.0 percent feasible) but increased ratings in Round 2 (98.7 percent valid; 90.6 percent feasible), aligning with nonsurgeons (99.7 percent valid; 96.1 percent feasible). Three parallel subgroups rated validity at 96.8 percent (group 1), 100 percent (group 2), and 97.4 percent (group 3). Feasibility ratings were 76.9 percent (group 1), 96.1 percent (group 2), and 92.2 percent (group 3).Conclusions: There are differences in validity and feasibility ratings by health professions, with surgeons rating standards more critically than nonsurgeons. However, three separate discussion subgroups rated a high proportion (96-100 percent) of standards as valid, indicating the RAM can be successfully applied to a large stakeholder group. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To examine whether televised food commercials influence preschool children's food preferences. Design In this randomized, controlled trial, preschool children viewed a videotape of a popular children's cartoon either [...]

Introduction: The Fundamental Use of Surgical Energy (FUSE) program includes a Web-based didactic curriculum and a high-stakes multiple-choice question examination with the goal to provide certification of knowledge on the safe use of surgical energy-based devices. The purpose of this study was (1) to set a passing score through a psychometrically sound process and (2) to determine what pretest factors predicted passing the FUSE examination.Methods: Beta-testing of multiple-choice questions on 62 topics of importance to the safe use of surgical energy-based devices was performed. Eligible test takers were physicians with a minimum of 1 year of surgical training who were recruited by FUSE task force members. A pretest survey collected baseline information.Results: A total of 227 individuals completed the FUSE beta-test, and 208 completed the pretest survey. The passing/cut score for the first test form of the FUSE multiple-choice examination was determined using the modified Angoff methodology and for the second test form was determined using a linear equating methodology. The overall passing rate across the two examination forms was 81.5%. Self-reported time studying the FUSE Web-based curriculum for a minimum of >2 h was associated with a passing examination score (p < 0.001). Performance was not different based on increased years of surgical practice (p = 0.363), self-reported expertise on one or more types of energy-based devices (p = 0.683), participation in the FUSE postgraduate course (p = 0.426), or having reviewed the FUSE manual (p = 0.428). Logistic regression found that studying the FUSE didactics for >2 h predicted a passing score (OR 3.61; 95% CI 1.44-9.05; p = 0.006) independent of the other baseline characteristics recorded.Conclusion(s): The development of the FUSE examination, including the passing score, followed a psychometrically sound process. Self-reported time studying the FUSE curriculum predicted a passing score independent of other pretest characteristics such as years in practice and self-reported expertise. [ABSTRACT FROM AUTHOR]

Background: Energy devices can result in devastating complications to patients. Yet, they remain poorly understood by trainees and surgeons. A single-institution pilot study suggested that structured simulation improves knowledge of the safe use of electrosurgery (ES) among trainees (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). The purpose of this study was to estimate the extent to which the addition of this structured bench-top simulation improves ES knowledge across multiple surgical training programs.Methods: Trainees from 11 residency programs in Canada, the USA and UK participated in a 1-h didactic ES course, based on SAGES' Fundamental Use of Surgical Energy™ (FUSE) curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Pre- and post-curriculum (immediately and 3 months after) knowledge of the safe use of ES was assessed using separate examinations. Data are expressed as mean (SD) and N (%), *p < 0.05.Results: A total of 289 (145 control; 144 Sim) trainees participated, with 186 (96 control; 90 Sim) completing the 3-month assessment. Baseline characteristics were similar between the two groups. Total score on the examination improved from 46% (10) to 84% (10)* for the entire cohort, with higher post-curriculum scores in the Sim group compared with controls [86% (9) vs. 83% (10)*]. All scores declined after 3 months, but remained higher in the Sim group [72% (18) vs. 64% (15)*]. Independent predictors of 3-month score included pre-curriculum score and participation in a goal-directed simulation.Conclusions: This multi-institutional study confirms that a 2-h curriculum based on the FUSE program improves surgical trainees' knowledge in the safe use of ES devices across training programs with various geographic locations and resident volumes. The addition of a structured interactive bench-top simulation component further improved learning. [ABSTRACT FROM AUTHOR]

On 21 May 2003, we discovered a completed Blue Grosbeak (Passerina caerulea) nest in an Eastern Bluebird (Sialia sialis) nest box. On 28 May, the nest contained four whitish-tan eggs with light-brown, streaky and spotty markings, an unusual color pattern for Blue Grosbeak eggs. Species' identification was confirmed by capturing the breeding female in the nest box, and confirmed again later with identification of the chicks as Blue Grosbeaks. To our knowledge, this is the first published account of cavity nesting, artificial or otherwise, for this species., The Blue Grosbeak (Passerina caerulea) is a large bunting in the family Cardinalidae and is relatively common in the southeastern United States. However, little is known of the breeding ecology [...]

Objective. A randomized controlled pilot study to test the hypothesis that increasing preschool children's outdoor free play time increases their daily physical activity levels. Methods. Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children (3.6±0.5 years) attending a preschool for low-income families. After two days of baseline physical activity assessment, participants were randomly assigned to an intervention (RECESS; n =17) or control (CON; n =15) group. The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days. The CON group followed their normal classroom schedule. Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test. Results. There were no statistically significant differences between groups in changes from baseline in average total daily (CON, 48.2±114.5; RECESS, 58.2±74.6) and during school day (CON, 64.6±181.9; RECESS, 59.7±79.1) counts per minute, or total daily (CON, 0.4±1.3; RECESS, 0.3±0.8) and during school day (CON, 0.6±2.1; RECESS, 0.5±0.8) percent of time spent in moderate to vigorous physical activity. Conclusions. Substantially increasing preschoolers' outdoor free play time did not increase their physical activity levels. Trial registration name: clinicaltrials.gov Registration number: NCT00285792 [ABSTRACT FROM AUTHOR]

Abstract: Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. The implications of this problem-oriented approach are responsible for leaving many of the most important applied research questions unanswered, and for slowing efforts to prevent obesity and improve individual and population health. An alternative, and complementary, solution-oriented research paradigm is proposed, emphasizing experimental research to identify the causes of improved health. This subtle conceptual shift has significant implications for phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice. The solution-oriented research paradigm encourages research with more immediate relevance to human health and a shortened cycle of discovery from the laboratory to the patient and population. Finally, a “litmus test” for evaluating research studies is proposed, to maximize the efficiency of the research enterprise and contributions to the promotion of health and the prevention and treatment of disease. A research study should only be performed if (1) you know what you will conclude from each possible result (whether positive, negative, or null); and (2) the result may change how you would intervene to address a clinical, policy, or public health problem. [Copyright &y& Elsevier]

Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, "Bovie"), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed. [ABSTRACT FROM AUTHOR]

Background: Data are lacking on primary care interventions to reduce children’s television viewing. Low-income African-American children watch greater amounts of television than their peers.Design Methods: A randomized controlled pilot and feasibility trial was conducted. Twenty-eight families with 7- to 12-year-old African-American children receiving primary care at an urban community clinic serving a low-income population were randomized to receive counseling alone or counseling plus a behavioral intervention that included an electronic television time manager. The main outcome was hours of children’s television, videotape, and video game use. Parents/guardians and children completed baseline and 4-week follow-up self-report surveys. Additional outcomes included overall household television use, time spent in organized physical activity and playing outside, and meals eaten by the child while watching television.Results: Both intervention groups reported similar decreases in children’s television, videotape, and video game use (mean changes of −13.7, SD=26.1 and −14.1, SD=16.8 hours per week). The behavioral intervention group reported significantly greater increases in organized physical activity (changes of +2.5, SD=5.9 and −3.6, SD=4.7 hours per week; p =0.004) and nearly significant greater increases in playing outside (changes of 1.0, SD=5.9 and −4.7, SD=9.4 hours per week; p <0.06). Changes in overall household television use and meals eaten while watching television also appeared to favor the behavioral intervention, with small to medium effect sizes, but differences were not statistically significant.Conclusions: This small pilot and feasibility study evaluated two promising primary care-based interventions to reduce television, videotape, and video game use among low-income African-American children. The effects on physical activity suggest that the behavioral intervention may be more effective. [Copyright &y& Elsevier]