Changes in Physical Activity Associated With a Multicomponent Weight-Loss Randomized Controlled Trial for Youth With Intellectual Disabilities.

Youth with intellectual disabilities engage in low levels of physical activity (PA). An aim of this family-based weight-loss behavioral intervention (FBBI) trial was to increase and sustain PA in these youth. Accelerometry data were available from 21 individuals with intellectual disabilities, age 14-22 years. Each completed the 6-month FBBI, after which 10 completed a 6-month maintenance intervention (FBBI-M), and 11 received no further intervention (FBBI-C). Twenty participated in a further 6-month follow-up. Accelerometry data were analyzed using linear mixed models. During FBBI, mean (SE) moderate to vigorous PA increased by 4.1 (2.5) min/day and light PA by 24.2 (13.5) min/day. Mean (SE) difference in moderate to vigorous PA between participants in FBBI-M and FBBI-C at 18 months was 14.0 (5.1) min/day (p = .005); mean (SE) difference in light PA was 47.4 (27.4) min/day (p = .08). Increasing PA through behavioral intervention is possible in youth with intellectual disabilities.

Gonadotropin releasing hormone analogs as part of controlled ovarian stimulation.

I describe how we identified the need to block the luteinizing hormone (LH) surge when trying to control the processes of luteinization and ovulation within the clinic. The first step, in fact, was using ovarian ultrasound evaluation of follicular development in the natural cycle (published in 1979) and then when the ovary was stimulated with exogenous follicle stimulating hormone. We observed that induced multiple follicular development often led to "premature" LH surges-which occurred before the leading follicle had achieved normal preovulatory dimensions. The work required both ovarian ultrasound and reliable radioimmunoassays, which were not always available. When early work with gonadotropin releasing hormone agonists showed that they could suppress LH activity, it was the logical step to try to use them to perform that task during the induction of multiple follicular development. High frequency administration of the gonadotropin releasing hormone-agonist successfully achieved sustained LH suppression through the follicular phase allowing clinical control of luteinization and ovulation.

FSH administration at 12-hour intervals for the first 2 days, combined with mandatory GnRH-agonist trigger and blastocyst vitrification in women (<80Kg) with high AMH levels, results in higher cumulative live birth rates and is safer.

We aimed to determine if a programme change to 12 hourly injections of FSH (150 IU per injection) for the first 2 days of stimulation in women with high ovarian reserve (AMH ≥ 30 pmol/L), followed by 24 hourly injections, would elicit increased earlier follicular recruitment, higher egg yields and blastocyst embryos for cryopreservation, leading to potential higher cumulative pregnancy rates, than conventional daily injections throughout. For safety reasons, the approach required mandatory cryopreservation of all blastocysts (mFET group; n = 74), after ovulation trigger with GnRH-agonist, in GnRH-antagonist controlled cycles. The 'Comparator group' (n = 91) comprised women with the same high AMH levels treated with the same base dose of FSH, with the aim of fresh blastocyst transfer and cryopreservation of supernumerary embryos, treated over the preceding 2 years. There was no difference in age, AMH, weight or BMI between the groups. The mFET group achieved higher egg (17.7 versus 11.7; p < 0.001) and embryo (10.9 versus 7.2; p < 0.001) yields and fewer cases with sub-optimal embryo yields (7% versus 22%; p = 0.018). The cumulative live birth rate was superior in the mFET group (73% versus 43%), as was the safety profile, and negligible rate of treatment plan modification.

Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record.

OBJECTIVE: After a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders. MATERIALS AND METHODS: A reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants. To evaluate outcomes of the reBoot camp, we used survey data to study baseline, immediate, and long-term perceptions of program satisfaction and self-assessed skills with the EHR. The study was conducted among practitioners at a large ambulatory practice network based in several states. Data were collected from April 2018 through January 2021. We analyzed automatically collected metadata and scores that evaluated the amount of personalization and proficiency of use. RESULTS: Confidence in skills increased by 13.5 points for general EHR use and was significant in 5 subdomains of use (13-18 point improvement). This degree of user confidence was maintained at the 6-month reassessment. The outcomes of configuration and proficiency scores also improved significantly. DISCUSSION: Ongoing education regarding EHR tools is necessary to support continued use of technology. This study was novel because of the amount and breadth of data collected, diversity of user participation, and validation that improvements were maintained over time. CONCLUSIONS: Participating in a reBoot camp significantly improved user confidence in each domain of the EHR and demonstrated use of best-practice tools. Users maintained gains at the 6-month evaluation phase.

Physical environmental designs in residential care to improve quality of life of older people.

BACKGROUND: The demand for residential aged care is increasing due to the ageing population. Optimising the design or adapting the physical environment of residential aged care facilities has the potential to influence quality of life, mood and function. OBJECTIVES: To assess the effects of changes to the physical environment, which include alternative models of residential aged care such as a 'home-like' model of care (where residents live in small living units) on quality of life, behaviour, mood and depression and function in older people living in residential aged care. SEARCH METHODS: CENTRAL, MEDLINE, Embase, six other databases and two trial registries were searched on 11 February 2021. Reference lists and grey literature sources were also searched. SELECTION CRITERIA: Non-randomised trials, repeated measures or interrupted time series studies and controlled before-after studies with a comparison group were included. Interventions which had modified the physical design of a care home or built a care home with an alternative model of residential aged care (including design alterations) in order to enhance the environment to promote independence and well-being were included. Studies which examined quality of life or outcomes related to quality of life were included. Two reviewers independently assessed the abstracts identified in the search and the full texts of all retrieved studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data, assessed the risk of bias in each included study and evaluated the certainty of evidence according to GRADE criteria. Where possible, data were represented in forest plots and pooled. MAIN RESULTS: Twenty studies were included with 77,265 participants, although one large study included the majority of participants (n = 74,449). The main comparison was home-like models of care incorporating changes to the scale of the building which limit the capacity of the living units to smaller numbers of residents and encourage the participation of residents with domestic activities and a person-centred care approach, compared to traditional designs which may include larger-scale buildings with a larger number of residents, hospital-like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety. Six controlled before-after studies compared the home-like model and the traditional environment (75,074 participants), but one controlled before-after study included 74,449 of the participants (estimated on weighting). It is uncertain whether home-like models improve health-related quality of life, behaviour, mood and depression, function or serious adverse effects compared to traditional designs because the certainty of the evidence is very low. The certainty of the evidence was downgraded from low-certainty to very low-certainty for all outcomes due to very serious concerns due to risk of bias, and also serious concerns due to imprecision for outcomes with more than 400 participants. One controlled before-after study examined the effect of home-like models on quality of life. The author stated "No statistically significant differences were observed between the intervention and control groups." Three studies reported on global behaviour (N = 257). One study found little or no difference in global behaviour change at six months using the Neuropsychiatric Inventory where lower scores indicate fewer behavioural symptoms (mean difference (MD) -0.04 (95% confidence interval (CI) -0.13 to 0.04, n = 164)), and two additional studies (N = 93) examined global behaviour, but these were unsuitable for determining a summary effect estimate. Two controlled before-after studies examined the effect of home-like models of care compared to traditional design on depression. After 18 months, one study (n = 242) reported an increase in the rate of depressive symptoms (rate ratio 1.15 (95% CI 1.02 to 1.29)), but the effect of home-like models of care on the probability of no depressive symptoms was uncertain (odds ratio 0.36 (95% CI 0.12 to 1.07)). One study (n = 164) reported little or no difference in depressive symptoms at six months using the Revised Memory and Behaviour Problems Checklist where lower scores indicate fewer depressive symptoms (MD 0.01 (95% CI -0.12 to 0.14)). Four controlled before-after studies examined function. One study (n = 242) reported little or no difference in function over 18 months using the Activities of Daily Living long-form scale where lower scores indicate better function (MD -0.09 (95% CI -0.46 to 0.28)), and one study (n = 164) reported better function scores at six months using the Interview for the Deterioration of Daily Living activities in Dementia where lower scores indicate better function (MD -4.37 (95% CI -7.06 to -1.69)). Two additional studies measured function but could not be included in the quantitative analysis. One study examined serious adverse effects (physical restraints), and reported a slight reduction in the important outcome of physical restraint use in a home-like model of care compared to a traditional design (MD between the home-like model of care and traditional design -0.3% (95% CI -0.5% to -0.1%), estimate weighted n = 74,449 participants at enrolment).  The remaining studies examined smaller design interventions including refurbishment without changes to the scale of the building, special care units for people with dementia, group living corridors compared to a non-corridor design, lighting interventions, dining area redesign and a garden vignette. AUTHORS' CONCLUSIONS: There is currently insufficient evidence on which to draw conclusions about the impact of physical environment design changes for older people living in residential aged care. Outcomes directly associated with the design of the built environment in a supported setting are difficult to isolate from other influences such as health changes of the residents, changes to care practices over time or different staff providing care across shifts. Cluster-randomised trials may be feasible for studies of refurbishment or specific design components within residential aged care. Studies which use a non-randomised design or cluster-randomised trials should consider approaches to reduce risk of bias to improve the certainty of evidence.

German Translation, Linguistic Validation, and Cultural Adaptation of the Environmental Audit Tool-High Care.

BACKGROUND: In dementia-specific care, the design of the environment is regarded as an influential element in the support and maintenance of skills and can improve the quality of life of residents. To date, there is no valid instrument in the German-speaking countries with which the quality of the physical environment in residential long-term care facilities can be systematically assessed. OBJECTIVE: To report the translation, linguistic validation, cultural adaptation, and content validity evaluation of the Australian Environmental Audit Tool-High Care in preparation for use in German nursing homes. METHOD: The procedure was guided by an adapted multistep process of the World Health Organization (1998) and included focus groups involving potential users of the new tool such as scientific experts and healthcare professionals (n = 40). Content validity indices were calculated following a two-step expert survey. RESULTS: The final draft versions of the German Environmental Audit Tool (G-EAT) included 74 and 77 items, for non-secured units and secure units, respectively, divided into 10 key design principles according to the Australian original. The evaluation of content validity showed that cultural differences existed in several items. CONCLUSIONS: The G-EAT provides the means for conducting a valid assessment of the environmental quality of people with dementia in German nursing homes. However, its usability in healthcare research must be preceded by testing its interrater reliability.

A family-based weight loss randomized controlled trial for youth with intellectual disabilities.

BACKGROUND: Scant data exist on weight loss interventions for youth with intellectual disabilities (ID). OBJECTIVE: To compare weight loss among youth with ID randomized to a 6-month, family-based behavioural intervention (FBBI) or a waitlist and to compare weight loss among youth who completed a 6-month maintenance (FBBI-M) intervention to a control group (FBBI-C). METHODS: Youth with ID and overweight/obesity, aged 14-22 years, were randomized to the FBBI or to a waitlist and subsequently randomized to a maintenance intervention or a control group. Sessions were held weekly during the FBBI and biweekly during the FBBI-M. Using an intention-to-treat approach, we used linear mixed models to test differences in the change in weight and in BMI from the start of FBBI. RESULTS: The 24 participants who received the FBBI lost, on average (SE), 5.1 (1.1) kg (P < .001) over 6 months. The 13 participants who were waitlisted gained, on average (SE), 1.2 (1.6) kg over the 6-month waiting period. At 12 months, those who received FBBI-M lost, on average (SE), 4.4 (1.7) kg more than those who received FBBI-C (-7.6 vs -3.2 kg, P-value = .008). CONCLUSION: Participation in an intensive FBBI for weight loss with ID was efficacious, and continued participation in a maintenance intervention yielded additional weight loss.

Japanese Translation and Validation of the Environmental Assessment Tool-Higher Care.

OBJECTIVE: The purpose of this study was to translate the Environmental Assessment Tool-Higher Care (EAT-HC) into Japanese and validate its use in small-scale group living facilities in Japan. BACKGROUND: Environment of a facility is shown to improve its residents' quality of life (QOL). Japan's "welfare-based nursing homes for the elderly" are gradually shifting to a small-scale group living concept called group care units (GCUs). However, there is no appropriate environmental tool available for evaluating GCUs. The application of valid environmental assessment tools brings about a better understanding of the nature of good environments and the relationship between environments and outcomes for residents living with dementia. METHODS: The study had a mixed method design conducted in several steps, covering translation and adaptation. The translation phase involved (1) forward translation and (2) backward translation. The adaptation phase involved (3) content validity and homogeneity reliability and (4) concurrent validity and interrater reliability. RESULTS: 71 Items (92%) met the acceptable level of content validity (item-content validity index [CVI] > .79) and had good scale-CVI of .88. Concurrent validity was confirmed between .65 and .78 (p < .001). For reliability test, the internal consistency of six subscales was between .88 and .98. Overall interobserver agreement was 90.3%. Intraclass correlation coefficients were .80-.98 (p < .001), and homogeneity reliability coefficient for all items was >.76 (p < .01). CONCLUSIONS: Validation of the EAT-HC-Japanese Version (EAT-HC-JV) was confirmed as an appropriate tool for environmental assessment to enhance the QOL in Japan's GCUs. For future study, we plan to modify the EAT-HC-JV to adapt to Japanese cultural aspects in order to increase its usability in Japan.

Creating a dementia enabling university using a Knowledge Translation approach: Innovative practice.

Universities can promote social impact by developing a dementia literate workforce. The Dementia Enabling University Strategy utilised a knowledge translation framework in an Australian university to inspire and support academics to engage students and consider how their skills and knowledge could contribute to the creation of more supportive environments for people with dementia. Dementia Enabling University Strategy ran across eight disciplines: law, media, social sciences, public health, engineering, business, marketing and psychology and was successful in engaging university academics and students. However, a longer term strategy is needed to embed 'dementia' as core business to the university impact agenda.

The Development and Reliability of the Singaporean Environmental Assessment Tool (SEAT) for Facilities Providing High Levels of Care for People Living With Dementia.

BACKGROUND: This article describes the development of the Singapore Environmental Assessment Tool (SEAT), a culturally appropriate, usable, reliable, and valid assessment tool designed to evaluate the extent to which the built environment in Singaporean aged care facilities is able to support the provision of high levels of care to people living with dementia. METHODS: A multistage sequential mixed methods approach was carried out involving 16 raters in Stage 1 and six raters in Stage 2 using a culturally adapted English version of the Environmental Audit Tool-High Care (EAT-HC) in eight nursing homes. The first stage captured qualitative data on cultural sensitivities and usability of the tool. The SEAT was improved based on the findings, and in the second stage, the usability and psychometric properties of the modified tool were again assessed. Usability was determined by data collected via the System Usability Scale and the Questions to Assess Barriers and Facilitators survey. Psychometric properties were examined by the calculation of percentage agreement, item-level interrater agreement was measured using Fleiss's κ, and Cronbach's α was used to measure the internal consistency of the subscale scores. RESULTS: The culturally adapted SEAT was found to have an acceptable level of usability and moderate level of reliability among subscales. CONCLUSION: The study indicated that the tool is reliable and valid when completed by users with knowledge of dementia-enabling environments. For the tool to be used with confidence education in the application of principles of design to the design of environments for people living with dementia is recommended prior to its use.

Human Rights and the Confinement of People Living with Dementia in Care Homes.

This paper responds to growing concerns in human rights practice and scholarship about the confinement of people living with dementia in care homes. Moving beyond the existing focus in human rights scholarship on the role of restrictive practices in confinement, the paper broadens and nuances our understanding of confinement by exploring the daily facilitators of confinement in the lives of people with dementia. The paper draws on data from focus groups and interviews with people living with dementia, care partners, aged care workers, and lawyers and advocates about Australian care homes. It argues that microlevel interrelated and compounding factors contribute to human rights abuses of people living with dementia related to limits on freedom of movement and community access of people living with dementia, at times irrespective of the use of restrictive practices. These factors include immobilization and neglect of residents, limited and segregated recreational activities, concerns about duty of care and liability, apprehension of community exclusion, and pathologization and subversion of resistance. It is necessary to challenge the organizational, cultural, economic, and social dynamics that shape day-to-day, microlevel, routine, and compounding factors that remove the agency of people living with dementia and in turn facilitate entrenched and systematic human rights breaches in care homes.

Weight Management in Primary Care for Children With Autism: Expert Recommendations.

Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.

Anti-Müllerian Hormone: A Personal View of the Empowering Analyte.

Circulating Anti Mullerian hormone (AMH) represents the total number of granulosa cells in the ovaries and is therefore a direct measure of the number of growing follicles within the ovaries. The close agreement of the main commercial assays for circulating AMH is allowing improved validation of the test in numerous circumstances. Consequently, it can be explored in all circumstances where ovarian activity may be relevant, and thereby bring improved guidance to the choices doctors and patients need to make in their reproductive lives. Apart from numerous aspects of ovarian stimulation, the main areas of impact are in endometriosis and the menopause. The best advice approach requires use of this evidence in many circumstances, and the future will see its measurement on a widespread basis.

Effects of Exergaming on Cognition and Gait in Older Adults at Risk for Falling.

PURPOSE: To test whether an 8-wk exergaming (EG) program would improve cognition and gait characteristics compared with a traditional physical exercise (TPE) program in older adults at risk for falling. METHODS: A pilot quasi-experimental study was conducted in adults age ≥65 yr at risk for falls, living in senior communities. Participants enrolled (n = 35) in either exercise program offered twice weekly for 8 wk. Cognition and single-task and dual-task gait characteristics were measured before and after the 8-wk exercise intervention. For each outcome, a repeated-measures ANCOVA adjusted for age, gender, and exercise intensity (ratings of perceived exertion, RPE) was used to examine the group-time interaction. RESULTS: Twenty-nine participants (age, 77 ± 7 yr) completed either the EG program (n = 15) or the TPE program (n = 14). Statistically significant group-time interactions were observed in Trail Making Test Part A (P < 0.05) and single-task gait speed, stride length, swing time percentage, and double support percentage (all P < 0.05), and marginal group differences were observed in Mini-Mental State Examination (P = 0.07), all favoring the EG program. There were no statistically significant group differences in dual-task gait measurements except for swing time percentage and double support percentage, favoring the EG program. CONCLUSIONS: An 8-wk EG program for older adults at risk for falls contributed to modest improvements in a number of cognitive measures and single-task but limited improvements in dual-task gait measures, compared with TPE. These findings support the need for larger trials to determine cognitive and mobility benefits related to EG.

Correction to: FMTVDM-TFM©â„—: True quantification requires standardization of the tool being used to measure, with a known, unchanging standard to produce accurate, consistent and reproducible quantified measurements.

The Editor wishes to clarify that the authors of the above named Letter provided ICMJE Conflict of Interest forms at the time of submission, and that the Journal omitted to include the resulting statement in the published Letter.

Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis.

BACKGROUND: Ovarian endometrioma is a frequent manifestation of endometriosis in women of reproductive age. Several issues related to its space occupying effects, local reactions and surgical removal continue to be actively debated today. The impact of ovarian endometrioma per se on ovarian reserve is still controversial and the effect of ovarian surgery is still actively discussed. Furthermore, the optimal biomarker of ovarian reserve estimation in women with ovarian endometrioma is still under examination. Additionally, there is no consistent agreement on the effect of endometrioma bilaterality on ovarian reserve. OBJECTIVE AND RATIONALE: The objective of this systematic review and meta-analysis was to study the impact of unilateral versus bilateral ovarian endometrioma on ovarian reserve biomarkers before and after endometrioma cystectomy. SEARCH METHODS: We performed an extensive electronic database search employing PubMed, EBSCO, Web of Science, ClinicalTrials.gov and the Cochrane Library, to identify published research articles published between January 2000 and October 2018. Search terms included endometriotic cyst OR endometrioma OR endometriomata, cystectomy OR resection OR stripping OR removal OR excision and infertility OR subfertility. Only prospective controlled studies that compared the impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve tests in the same setting were included. Studies which included cases with PCOS, ovarian failure, early menopause, oral contraception treatment, or prior chemotherapy and/or radiotherapy or ovarian surgery, were excluded from evaluation. We used the Newcastle-Ottawa Scale for assessing the quality of studies found eligible for meta-analysis. We registered the systematic review on PROSPERO and its number is CRD42018117170. OUTCOMES: Twelve studies were eligible for meta-analysis including collectively 783 women: 489 and 294 in the unilateral and bilateral groups, respectively. The included studies had a low risk of bias. The pre-operative weighted mean difference (WMD) showed that serum AMH levels did not differ significantly between the groups. Conversely, AMH levels were significantly (P < 0.05) lower in bilateral groups than in unilateral groups at the early, intermediate and late post-operative periods, corresponding WMDs of 0.78 ng/ml (95% CI: 0.41-1.15), 0.59 ng/ml (95% CI: 0.14-1.04) and 1.08 ng/ml (95% CI: 0.63 to 1.52), respectively. Heterogeneity among eligible studies reporting on before the operation and at the early and intermediate post-operative periods was high. Pre-operative and post-operative AFC values were not significantly different between the groups. The heterogeneity among the studies reporting on AFC was high. Analysis of each of the unilateral and bilateral groups separately showed a significant and sustained serum AMH drop by 39.5% and 57.0%, respectively from baseline to after the operation. WIDER IMPLICATIONS: Our results challenge the concept that endometrioma per se adversely affects ovarian reserve, whereas endometrioma cystectomy, especially as bilateral operation, has a deleterious and sustained effect on ovarian reserve. AMH seems to be a more appropriate biomarker of ovarian reserve than AFC in cases with endometrioma. Since low AMH implies a shorter reproductive lifespan, excision of endometrioma should be cautiously considered, especially in bilateral cases.