A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

Stimulus motion increases measured visual field extent in children 3.5 to 30 months of age.

PURPOSE: To examine the influence of stimulus motion on measured visual field extent of 3.5- to 30-month-old children and adults. METHODS: Each subject was tested with LED-hybrid and LED-kinetic perimetry procedures, using a black double-arc perimeter. Targets in both procedures were identical in size, color, luminance, contrast, and flicker rate. However, in the LED-hybrid procedure, peripheral targets were sequentially illuminated from more peripheral to more central locations, whereas in the LED-kinetic procedure, a peripheral target on a black wand was manually moved centrally along the perimeter arm. A subset of subjects was also tested with white sphere kinetic perimetry (WSKP). RESULTS: The LED-kinetic procedure produced larger measured visual field extent than the LED-hybrid procedure in 3.5-, 11-, 17-, and 30-month-olds, but not in 7-month-olds or adults. Data from subjects tested with WSKP indicated that both stimulus motion and discrepancies in scoring methods contributed to the difference reported previously between visual field measurements obtained with WSKP vs. LED-hybrid perimetry. CONCLUSION: In infants and toddlers, measured visual field extent is larger for moving than for nonmoving targets. Further research is needed to determine whether the effect of motion is related to the visual system or to attentional factors.

Shape recognition contributions to figure-ground reversal: which route counts?

Observers viewed upright and inverted versions of figure-ground stimuli, in which Gestalt variables specified that the center was figure. In upright versions, the surround was high in denotivity, in that most viewers agreed it depicted the same shape; in inverted versions, the surround was low in denotivity. The surround was maintained as figure longer and was more likely to be obtained as figure when the stimuli were upright rather than inverted. In four experiments, these effects reflected inputs to figure-ground computations from orientation-specific shape representations only. To account for these findings, a nonratiomorphic mechanism is proposed that enables shape recognition processes before figure-ground relationships are determined.