Implementation and Utilization of Mobile Technology In Adolescent Bariatric Surgery Patients

Obesity is the most prevalent chronic disease of childhood. Obese adolescents are likely to become obese adults with significant associated co-morbidities and early mortality. In Massachusetts, 30% of children ages 10-17 are overweight or obese. It is projected that 48% of Massachusetts’ adults will be obese by 2030. In March of 2015, the Good Fit Adolescent Weight and Wellness Center opened, with a goal of addressing this issue with a proven multidisciplinary approach. Mobile technology continues to develop at a rapid pace. Adolescent access to mobile technology on smart phones and tablets continues to increase. Mobile fitness tracker applications are numerous and easy to use for today’s tech savvy teens. Successful weight loss and health maintenance is variable and has been difficult to validate with this technology so far. The purpose of this study is to evaluate existing mobile applications to be used by adolescent patients in the Good Fit Center. Our aim is to determine whether adolescent patients will be compliant with diet and exercise challenges sent through a mobile application and social media platform. We will work closely with dietitians, physicians and surgeons to evaluate feasibility and compliance within the first year of this project. In the second year, we will then test the functionality of this mobile application as it relates to patient success in the Good Fit program. The proposed research is a novel multimodal study combining behavioral sciences research, clinical outcomes research, and mobile technology to help to better understand the fitness management of adolescents struggling with morbid obesity. The findings of our research may have a number of important implications. These include the refinement of existing fitness strategies, as well as the development of a new useful piece of technology to combat obesity and improve the health and clinical outcomes of our nation’s children

Ultrasound guided drainage of an esophageal duplication cyst in a newborn in respiratory distress

AbstractNewborns with chest masses may present with respiratory distress in the perinatal period. We present the case of a term male infant with a cystic right upper chest mass born in respiratory distress at 39 4/7 weeks gestation who underwent ultrasound guided percutaneous drainage of the mass. The patient responded well to the percutaneous drainage and two days later the mass was surgically excised. Final pathology revealed an esophageal duplication cyst. This report describes a unique management of a patient with a congenital cystic chest mass presenting in respiratory distress

Teen Distracted Reality an Interactive Virtual Education (D.R.I.V.E.): Experience and Impact on Teenage Drivers

Introduction: In 2013, 2,163 teens in the United States ages 16–19 were killed and 243,243 were treated in emergency departments for injuries from motor vehicle crashes. distracted driving (i.e. texting, loud music, or phone conversations) and impaired driving (driving under the influence) play a role in these motor vehicle crashes. Prevention efforts aimed at high-risk teenager driving behavior may encourage safe driving habits. Methods: The Teen D.R.I.V.E. program is a mobile driving simulator that provides teenagers with distracted and impaired driving scenarios. We administered anonymous surveys from April 2015-April 2016 to obtain demographic data and evaluate the program’s impact on their driving behavior. We retrospectively analyzed survey responses using univariate and multivariate statistical analysis. Results: A total of 1374 participants in the survey, however, 50 did not respond to the driving experience portion of the survey. Most participants (70%) were between 16-17 years of age years old and 51% were males. A majority (76%) of respondents had driving experience (26% permit, and 46% license) or had attended a driver’s education course (67%). After experiencing the simulation respondents felt that the consequences of driving distracted (53%) and driving impaired (61%) were worse than previously expected. In addition, participants said that they would never drive distracted (70%) or drive impaired (90%). A majority of participants (72%) feel that simulation is the most effective way to teach driving related topics. Conclusion: Teen D.R.I.V.E. offers a valuable experience to teenagers, teaching them about the dangers of driving distracted and impaired. Participants are likely to never drive impaired compared or distracted. Most teenagers feel simulation teaches these driving lessons most effectively

Are Goods for Guns Good for the Community? An Update of a Community Gun Buyback Program

BACKGROUND: Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms and household mental illness of buyback participants in hopes of improving the program\u27s effectiveness. METHODS: A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. RESULTS: A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between $25 and$75 in gift cards dependent on what type of gun was turned in, with an average cost of $41/gun. A total of 109 participants (59%) completed the survey. Respondents were mostly white (99%), male (90%) and first-time participants in the program (85.2%). Among survey respondents, 54% turned in firearms for safety reasons . Respondents reported no longer needing/wanting their weapons (47%) and approximately one in eight participants were concerned the firearm(s) were accessible to children. Most respondents (87%) felt the program encouraged neighborhood awareness of firearm safety. Three out of every five participants reported that guns still remained in their homes, additionally; 21% where children could potentially access them and 14% with a history of mental illness/suicide/domestic violence in the home. CONCLUSIONS: Gun buybacks can provide a low-cost means of removing unwanted firearms from the community. Most participants felt their homes were safer after turning in the firearm(s). In homes still possessing guns, emphasis on secure gun storage should continue increasing the safety of children and families. The results of this survey also provided new insights into the association between mental illness/suicide and gun ownership. LEVEL OF EVIDENCE: Level III, Prognostic and Epidemiological

Application of Mitomycin C after dilation of an anastomotic stricture in a newborn with necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a common life-threatening condition in premature infants. Bacterial translocation, localized inflammation and subsequent perforation often require surgery for source control and definitive treatment. Small and large intestinal strictures may result from either creation of a surgical anastomosis or the disease process itself. Current methods to treat strictures include, balloon dilation and surgical resection with or without anastomosis. We report the diagnosis and surgical management of a premature infant treated for NEC, who developed an anastomotic stricture and was successfully treated with topical Mitomycin C after balloon stricturoplasty

Individualized Image Display Improves Performance in Laparoscopic Surgery

Background: Laparoscopic surgery has made great advances over the years, but it is still dependent on a single viewpoint. This single-lens system impedes multitasking and may provide suboptimal views of the operative field. We have previously developed a prototype of interactive laparoscopic image display to enable individualized manipulation of the displayed image by each member of the operating team. The current study examines whether the concept of individualized image display improves performance during laparoscopic surgery. Materials and Methods: Individualized display of the endoscopic image was implemented in vitro using two cameras, independently manipulated by each operator, in a Fundamental of Laparoscopic Surgery (Society of American Gastrointestinal and Endoscopic Surgeons) endotrainer model. The standardized bead transfer and endoloop tasks were adapted to a two-operator exercise. Each team of two was paired by experience level (novice or expert) and was timed twice: once while using a single camera (control) and once using two cameras (individualized image). Results: In total, 20 medical students, residents, and attending surgeons were paired in various combinations. Bead transfer times for the individualized image experiment were significantly shorter in the expert group (61.8 +/- 14.8% of control, P = .002). Endoloop task performance time was significantly decreased in both novices (80.3 +/- 44.4%, P = .04) and experts (69.5 +/- 12.9%, P = .001) using the two-camera set-up. Conclusions: Many advances in laparoscopic image display have led to an incremental improvement in performance. They have been most beneficial to novices, as experts have learned to overcome the shortcomings of laparoscopy. Using a validated tool of laparoscopic training, we have shown that efficiency is improved with the use of an individualized image display and that this effect is more pronounced in experts. The concept of individual image manipulation and display will be further developed into a hands-free, intuitive system and must be validated in a clinical setting

And the survey said.... evaluating rationale for participation in gun buybacks as a tool to encourage higher yields

BACKGROUND: Gun buyback programs represent one arm of a multipronged approach to raise awareness and education about gun safety. METHODS: The city of Worcester, MA has conducted an annual gun buyback at the Police Department Headquarters since 2002. We analyzed survey responses from a voluntary, 18-question, face-to-face structured interview from December 2009 to June 2015 using descriptive statistics to determine participant demographics and motivations for participation. RESULTS: A total of 943 guns were collected, and 273 individuals completed surveys. The majority of participants were white males older than 55years (42.4%). Participants represented 61 zip codes across Worcester County, with 68% having prior gun safety training and 61% with weapons remaining in the home (27% of which children could potentially access). The top reasons for turning in guns were no longer needed (48%) and fear of children accessing the gun (14%). About 1 in 3 respondents knew someone injured/killed by gun violence. Almost all (96%) respondents claimed the program raised community awareness of firearm risk. CONCLUSION: The Worcester Goods for Guns Buyback has collected more than 900 guns between 2009 and 2015. The buyback removes unwanted guns from homes and raises community awareness about firearm safety

Bone outcomes following sleeve gastrectomy in adolescents and young adults with obesity versus non-surgical controls

BACKGROUND: Sleeve gastrectomy is the most commonly performed weight loss surgery in adolescents with moderate-to-severe obesity. While studies in adults have reported on the deleterious effects of gastric bypass surgery on bone structure and strength estimates, data are lacking for the impact of sleeve gastrectomy on these measures in adolescents. OBJECTIVE: To evaluate the impact of sleeve gastrectomy on bone outcomes in adolescents and young adults over 12 months using dual energy X-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HRpQCT). PARTICIPANTS AND METHODS: We enrolled 44 youth 14-22 years old with moderate to severe obesity; 22 underwent sleeve gastrectomy and 22 were followed without surgery (16 females and 6 males in each group). At baseline and 12 months, DXA was used to assess areal bone mineral density (aBMD), HRpQCT of the distal radius and tibia was performed to assess bone geometry, microarchitecture and volumetric BMD (vBMD), and finite element analysis to assess strength estimates (stiffness and failure load). These analyses were adjusted for age, sex, race and the bone measure at baseline. Fasting blood samples were assessed for calcium, phosphorus, and 25(OH) vitamin D (25OHD) levels. RESULTS: Over 12-months, the surgical group lost 27.2% of body weight compared to 0.1% in the non-surgical (control) group. Groups did not differ for changes in 25OHD levels (p = 0.186). Compared to controls, the surgical group had reductions in femoral neck and total hip aBMD Z-scores (p \u3c /= 0.0006). At the distal tibia, compared to controls, the surgical group had reductions in cortical area and thickness and trabecular number, and increases in trabecular area and separation (p \u3c /= 0.026). At the distal radius, the surgical group had greater reductions in trabecular vBMD, than controls (p = 0.010). The surgical group had an increase in cortical vBMD at both sites (p \u3c /= 0.040), possibly from a decrease in cortical porosity (p \u3c /= 0.024). Most, but not all, differences were attenuated after adjusting for 12-month change in BMI. Groups did not differ for changes in strength estimates over time, except that increases in tibial stiffness were lower in the surgical group (p = 0.044) after adjusting for 12-month change in BMI. CONCLUSIONS: Over 12 months, weight loss associated with sleeve gastrectomy in adolescents had negative effects on areal BMD and certain HRpQCT parameters. However, bone strength estimates remained stable, possibly because of a simultaneous decrease in cortical porosity and increase in cortical volumetric BMD. Additional research is necessary to determine the relative contribution(s) of weight loss and the metabolic effects of surgery on bone outcomes, and whether the observed effects on bone stabilize or progress over time

Unintentional Window Falls in Children and Adolescents.

OBJECTIVE: Unintentional window falls represent a preventable source of injury and death in children. Despite major campaigns in some larger cities, there continue to be unintentional falls from windows throughout the United States. We aimed to identify risk factors and trends in unintentional window falls in the pediatric population in a national and regional sample. METHODS: A retrospective analysis of annual ED visits from the National Electronic Injury Surveillance System (NEISS) using product codes specific to windows, as well as patient encounters for unintentional window falls from January 2007 - August 2017 using site-specific trauma registries from 10 tertiary care children\u27s hospitals in New England. National and state-specific census population estimates were used to compute rates per 100,000 population. RESULTS: There were 38,840 ED visits and 496 regional patients who unintentionally fell from a window across the study period between 0-17 years old. The majority of falls occurred in children under the age of 6, and were related to falls from a second story or below. A decreased trend in national ED visits was seen, but no change in rates over time for regional trauma center encounters. A high number of falls were found to occur in smaller cities surrounding metropolitan areas and from single family residences. CONCLUSIONS: Falls from windows represent a low proportion of overall types of unintentional sources of injury in children, but are a high-risk for severe disability. These results provide updated epidemiologic data for targeted intervention programs, as well as raise awareness for continued education and advocacy