OBJECTIVE. To evaluate the effect of a pediatric primary care-based intervention, on improved clinical decision support and family management of risk behaviors for childhood overweight.METHODS. An experimental field trial was conducted with 12 intervention sites in urban and rural areas of Maine and nonrandomized control sites. Change was assessed by using clinical and parent measures from 9 intervention and 10 control sites before and during the Maine Youth Overweight Collaborative intervention. Longitudinal information was collected from chart audits of patients aged 5-18 years (n ϭ 600), systematic samples of parents collected before (n ϭ 346) and during (n ϭ 386) the intervention in 12 sites, and systematic samples of parents in 9 intervention (n ϭ 235) and 10 control (n ϭ 304) sites collected during the intervention. Surveys of health care providers (n ϭ 14 and 17) before and during the intervention were also collected. Teams worked over 18 months to implement improvements in clinical decision support, including tracking BMI percentiles, identification of overweight patients, appropriate laboratory tests, counseling of families and patients use of a behavioral screening tool, and other improvements following the chronic-care model targeting patients aged 5 to 18 and their families.RESULTS. Large changes occurred in clinical practice from before to during the Maine Youth Overweight Collaborative: increases in assessment of BMI (38%-94%), BMI percentile for age and gender (25%-89%), use of the 5-2-1-0 behavioral screening tool (0%-82%), and weight classification (19%-75%). Parent surveys indicated improvements in providers' behavior and rates of counseling. Intervention providers reported improvements in knowledge, attitudes, self-efficacy, and practice.CONCLUSIONS. The Maine Youth Overweight Collaborative intervention improved clinical decision support and family management of risk behaviors, indicating a promising primary care-based approach to address overweight risk among children and youth. Pediatrics 2009;123:S258-S266 T HE PREVALENCE OF childhood overweight* is increasing rapidly in the United States and now affects at least 16% of children and adolescents, 1 with even higher rates among subpopulations of minority, economically disadvantaged 2,3 and rural children. 4 Overweight is associated with significant health problems in this age group and is an important early risk factor for much of adult morbidity and mortality. The rapid increase in the prevalence of childhood and adolescent overweight portends an increase in associated chronic disease. An estimated 60% of overweight 5-to 10-year-olds already have 1 associated cardiovascular disease risk factor, or hyperinsulinemia, and more than 20% have 2 or more associated cardiovascular disease risk factors. 5 The incidence of type 2 diabetes, until recently thought to have an almost exclusively adult onset, has increased dramatically among youth. 6 Overweight and sedentary children and adolescents are also more likely than their peers to have adv...

Mobile manipulator systems hold promise in many industrial and service applications including assembly, inspection, and work in hazardous environments. The integration of a manipulator and a mobile robot base places special demands on the vehicle's drive system. For smooth accurate motion and coordination with an on-board manipulator, a holonomic vibration-free wheel system that can be dynamically controlled is needed. In this paper, we present the design and development of a Powered Caster Vehicle (PCV) which is shown to possess the desired mechanical properties. To dynamically control the PCV, an new approach for modeling and controlling the dynamics of this parallel redundant system is proposed. The experimental results presented in the paper illustrate the performance of this platform and demonstrate the significance of dynamic control and its effectiveness in mobile manipulation tasks.

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Mobile manipulation capabilities are key to many new applications of robotics in space, underwater, construction, and service environments. This article discusses the ongoing effort at Stanford University for the development of multiple mobile manipulation systems and presents the basic models and methodologies for their analysis and control. This work builds on four methodologies we have previously developed for fixed-base manipulation: the Operational Space Formulation for task-oriented robot motion and force control; the Dextrous Dynamic Coordination of Macro/Mini structures for increased mechanical bandwidth of robot systems; the Augmented Object Model for the manipulation of objects in a robot system with multiple arms; and the Virtual Linkage Model for the characterization and control of internal forces in a multi-arm system. We present the extension of these methodologies to mobile manipulation systems and propose a new decentralized control structure for cooperative tasks. The article also discusses experimental results obtained with two holonomic mobile manipulation platforms we have designed and constructed at Stanford University. 0 2996 ]ohti Wiley 6 Sons, Inc.

We design, optimize and demonstrate the behavior of a tendon-driven robotic gripper performing parallel, enveloping and fingertip grasps. The gripper consists of two fingers, each with two links, and is actuated using a single active tendon. During unobstructed closing, the distal links remain parallel, for parallel grasps. If the proximal links are stopped by contact with an object, the distal links start flexing, creating a stable enveloping grasp. We optimize the route of the active flexor tendon and the route and stiffness of a passive extensor tendon in order to achieve this behavior. We show how the resulting gripper can also execute fingertip grasps for picking up small objects off a flat surface, using contact with the surface to its advantage through passive adaptation. Finally, we introduce a method for optimizing the dimensions of the links in order to achieve enveloping grasps of a large range of objects, and apply it to a set of common household objects.