IVF outcomes in obese donor oocyte recipients: a systematic review and meta-analysis.

STUDY QUESTION: Does obesity influence the chance of pregnancy after IVF in donor oocyte recipients? SUMMARY ANSWER: The chance of pregnancy after IVF is no different in obese donor oocyte recipients versus those in the normal BMI range. WHAT IS KNOWN ALREADY: Obesity is associated with decreased chances of pregnancy in women undergoing IVF with autologous oocytes. Prior studies have investigated the impact of obesity on IVF outcomes in donor oocyte recipients, with disparate results. This is the first systematic review and meta-analysis to address this topic. STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis of published literature identified in Medline, EMBASE and Scopus through December of 2011 were performed to address the association between BMI and outcomes for donor oocyte recipients. The primary outcome of this study was implantation. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two authors conducted the searches independently, selected the studies and abstracted the data. Studies in English of first donor oocyte cycles with reported recipient BMI were included. Primary data collected from the IVF program at Washington University were also included as one study (n = 123 donor oocyte recipients). Studies limited to frozen embryo transfer were excluded. Data were synthesized using DerSimonian-Laird random effects models for implantation, clinical pregnancy, miscarriage and live birth. MAIN RESULTS AND THE ROLE OF CHANCE: Of 475 screened articles, 7 were reviewed and 5 were included together with primary data from Washington University, giving a total of 4758 women who were included for the assessment of the primary outcome. No associations between obesity (BMI ≥ 30 kg/m(2)) and chance of pregnancy after IVF were noted in women using donor oocytes [risk ratio (RR): 0.98, 95% confidence intervals (CI): 0.83-1.15, I(2): 61.6%]. Additional analyses assessing associations between recipient obesity and embryo implantation (RR: 0.93, 95% CI: 0.80-1.07, I(2): 0%), miscarriage (RR: 1.12, 95% CI: 0.83-1.50, I(2): 0%) and live birth (RR: 0.91, 95% CI: 0.65-1.27, I(2) 47.9%) also failed to show a negative effect. LIMITATIONS, REASONS FOR CAUTION: Included studies were small and they were performed in a variety of locations and practice settings where stimulation and laboratory protocols may differ, and extremes of BMI may also differ. Furthermore, included studies had different inclusion and exclusion criteria. These factors could not be controlled for in this meta-analysis and statistical heterogeneity was noted for some outcomes. WIDER IMPLICATIONS OF THE FINDINGS: These data suggest obesity does not affect IVF outcomes in women using donor oocytes. Oocyte quality rather than endometrial receptivity may be the overriding factor influencing IVF outcomes in obese women using autologous oocytes. STUDY FUNDING/COMPETING INTEREST(S): E.S.J. and M.G.T receive support from the Women's Reproductive Health Research Program sponsored by the National Institutes of Health (K12 HD063086). The authors do not have any competing interests. TRIAL REGISTRATION NUMBER: N/A.

Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.

Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

Evolution of soft contact lens coatings.

To investigate further the reported possibility that surface deposits on soft contact lenses contribute to giant papillary conjunctivitis, we performed scanning electron microscopy on 22 lenses worn for varying durations by a group including persons who had never worn contact lenses and asymptomatic persons who had, and on five never-worn lenses. Thirty minutes' wear resulted in covering of about 50% of the anterior surface with scattered cell-membrane-like and mucus-like material, with mucus-like material on top of cells in places. Eight hours' wear produced about 90% covering with more complex coatings. Routinely worn and cleaned lenses had still more complex coatings on more than 90% of the surface. Deposits were found on routinely worn lenses even after professional cleaning. We conclude that all worn soft contact lenses have coatings that become more complex with time and may never be removed completely.

The surface of the continuously worn contact lens.

The anterior surfaces of continuously worn therapeutic contact lenses and routinely cleaned cosmetic lenses were compared by scanning electron microscopy. The continuously worn lenses were uniformly and completely coated with material thicker and smoother that that on the incompletely coated cosmetic lenses. It is concluded that continuously worn lenses build up coatings steadily, whereas routinely cleaned lenses have at least part of the coating removed with each cleaning.

The effect of cleaning soft contact lenses. A scanning electron microscopic study.

Scanning electron microscopy was used to investigate the effectiveness of surfactant and enzyme cleaners in removing coatings from soft contact lenses. We examined ten continuously worn lenses and 15 lenses worn and cleaned regularly for at six months. About 30% of the surface of continuously worn lenses cleaned with surfactant or enzyme was uncoated; smooth, matted coating covered the remainder. Continuously worn lenses cleaned with the combination surfactant and enzyme cleaner had similar deposits covering 50% of the surface. Lenses worn and cleaned regularly had more deposits after cleaning with surfactant or enzyme cleaner than after cleaning with combination cleaner. Approximately 25% of the surface of lenses cleaned with the combination was coated with deposits. The deposits on both types of lenses were about 30% less thick after use of the combination cleaner than with either single cleaner. The coating on worn contact lenses is not completely removed by any method we tested.

Attachment of bacteria to soft contact lenses.

A total of 25 soft contact lenses from 17 asymptomatic contact lens wearers and eight patients with contact lens-associated giant papillary conjunctivitis were examined by scanning electron microscopy. Structures that resembled bacteria were present on the anterior surface of seven lenses. All lenses showed a coating of granular mucus-like deposits. Some bacteria were seen scattered randomly over the surface, with no apparent attachment to the lens, whereas others were attached to the coated surface by thin, flagella-like foot processes, the distal ends of which were unattached. These attached bacteria were cylindrical in shape. Several bacteria showed a constriction centrally. Some bacteria were covered by the surface coating, while others, which were round to ovoid in shape, appeared partially embedded in the coating itself. Aggregations of bacteria were seen around clumps of mucus-like debris.

Identification of proteins in contact lens surface deposits by immunofluorescence microscopy.

Worn soft contact lenses from five asymptomatic subjects were examined by immunofluorescence microscopy for type of protein on the lens surface. Lysozyme was the predominant protein component identified by this technique. IgA was also identified in deposits on all five lenses, but the staining was less intense than that for lysozyme. Lactoferrin was identified on the surface of four lenses, one of which stained intensely for this protein and three less intensely. IgG was identified on two contact lenses; the staining was less intense than that for lysozyme. New, never-worn soft contact lenses did not stain for any of the proteins examined in this study. We conclude that several normal tear proteins are capable of contributing to surface deposits on soft contact lenses, and all worn soft contact lenses have protein adherent to their surface as a result of normal wear.

Surface deposits on worn hard contact lenses.

Giant papillary conjunctivitis (GPC) is associated with deposits on contact lenses. We used scanning electron microscopy to study the anterior surface of 30 hard contact lenses, both cleaned and not cleaned, worn by patients with GPC and with keratoconus and by asymptomatic subjects. Uncleaned lenses worn by asymptomatic subjects for one day had deposits on about 5% of the surface. In most cases, the deposits were removed completely by one cleaning. Uncleaned lenses worn by patients with GPC or keratoconus had deposits on about 90% of the surface. Most of these deposits were removed by one cleaning. However, residual deposits after cleaning were greater on lenses from patients with keratoconus than on those from patients with GPC. Lenses from asymptomatic subjects rarely had residual deposits after cleaning. We found that the types of deposits on worn soft and hard contact lenses are similar, that there are fewer deposits on hard lenses than on soft lenses, and that deposits on hard lenses, unlike those on soft lenses, generally can be removed by one cleaning.

Soft contact lenses from patients with giant papillary conjunctivitis.

We used scanning electron microscopy to study the surfaces of five coated soft contact lenses from subjects with giant papillary conjunctivitis. Findings were compared to the surfaces of five coated lenses from normal, asymptomatic wearers and five new, nerver-worn lenses. Lenses were from various manufacturers. All worn contact lenses differed strikingly from new, never-worn lenses. The anterior surface of worn lenses was covered with apparently adherent deposits. In only a few areas was the surface similar to new, never-worn lenses. Thick coatings on lenses from patients with giant papillary conjunctivitis and asymptomatic wearers were similar. High magnification of the coatings revealed a trabeculated morphology. Also seen was debris that resembled mucus-like material in both strand and particulate forms. On some lenses bacterial-shaped structures were scattered randomly over the surface. Smooth structures resembling cells were also seen. The posterior lens surface of all worn lenses was smoother than the anterior lens surface. The findings support our idea that the capacity to develop giant papillary conjunctivitis is influenced by individual differences more than by differences in lens deposits.

Color-matching technique to train children in the correct use of stairs.

Color cues were used to train four severely retarded children and two learning disabled children to move in a left foot-right foot alteration pattern when using stairs. The occurrence of left-right alterations and marking time behavior was recorded throughout baseline and training conditions. The color-cue procedure effectively produced a consistent pattern of alteration of four of the children and eliminated marking time in three of the children. Physical prompts were used to train alteration in two children for whom color-cue training was not sufficient. At the termination of training, observations of the children's performances in new settings and to new adults were conducted. Results indicated that the children continued to alternate correctly. In addition, follow-up investigations conducted between two weeks to 16 months after training indicated that the children were maintaining the stair alteration pattern. Future research should determine whether a visual-cue procedure could be used in training other forms of locomotion or motor behavior.

Perspectives on the transition from preschool to kindergarten for children with disabilities and their families.

This article addresses the transition of young children from preschool programs that provide special education services to kindergarten or alternative elementary school placements. The roles of the child, family, and service providers in transition preparation, planning, implementation, and evaluation are described. Successful transitions include assessments of children's skills in meeting the demands of kindergarten programs, teaching these skills to children, and actively encouraging parent participation in plans and programs. Barriers to successful transitions include lack of time and funding to coordinate both parent activities and between-school arrangements. A critical area for future research is the long-term evaluation of the procedures described as "best practice," as well as the definition of what constitutes a successful transition.

Training prosocial behaviors to young children: an analysis of reciprocity with untrained peers.

We examined the effects of a social skills training package on the play behaviors of three young girls. Two children were taught to invite their peers to play and to use social amenities during their conversations with other children. A combined reversal and multiple baseline across responses design demonstrated that both children directed more social behaviors to their classroom peers after training and that these two children's play invitations were maintained in the later absence of experimental contingencies. In addition, both target children received a greater number of play invitations from their peers during the free play periods. In contrast, a third child's play invitations were not reciprocated by peers; her invitations subsequently decreased in rate after training was discontinued. An interdependent group contingency produced a reciprocal exchange of invitations between this child and her classroom peers. A reversal design demonstrated partial maintenance of subject-peer exchanges after the group intervention was discontinued. The results obtained with the three target children suggest that peer reciprocity may facilitate the maintenance of children's play invitations over time.

"Do I have to be good all day? The timing of delayed reinforcement as a factor in generalization.

Delayed reinforcement, sometimes delivered just after the setting in which the critical behavior had occurred (Early), and sometimes delivered only after several further settings had been encountered (Late), was used to improve a variety of behaviors in seven preschool children, and to control their generalization. Performance of those behaviors was measured in two classroom settings: the Contingent setting, within which performance of the specified behavior determined the latter (Early or Late) reinforcement, and the Generalization setting, in which there were no experimental contingencies, immediate or delayed, for the performance of the same behavior. Performances by all children in the Contingent setting were controlled by delayed reinforcement, whether Early or late. All children showed consistent generalization from the Contingent setting to the Generalization setting during the Late condition, when reinforcement was delivered at the end of the school day. Generalization did not occur during the Early condition, when reinforcement was provided immediately after the Contingent setting (prior to the Generalization setting), unless that condition had been preceded by a Late condition (as it was for S6 and S7). The results suggest that the Late timing of delayed reinforcement was an effective and efficient generalization-promotion technique for performances that did not generalize spontaneously.

Positive peer pressure: the effects of peer monitoring on children's disruptive behavior.

Classroom peers can serve as powerful sources of reinforcement in increasing or maintaining both the positive and negative behaviors of their classmates. In two experiments, we examined the effectiveness of a peer-monitored token system on reducing disruption and nonparticipation during a transition period of a kindergarten class for behaviorally impaired children. Additionally, the effect of providing and subsequently withholding corrective feedback to peer mediators on the accuracy of their point awards was evaluated. Results in Experiment 1 suggest that both teacher- and peer-monitored interventions were successful in decreasing disruption and increasing participation of monitored peers. Experiment 2 further demonstrated that peer monitors could successfully initiate the token system without prior adult implementation. Analysis of the point awards in both experiments indicates that peer monitors consistently awarded points that were earned. However, when corrective feedback was withdrawn the peer monitors frequently awarded points that were not earned, i.e., they rarely withheld points for undesirable behavior. Even so, the monitored peers' disruptive behavior was maintained at low rates.

Reactivity in self-recording: obtrusiveness of recording procedure and peer comments.

Reactivity refers to behavior change that occurs during self-recording without specific programming of consequences. We analyzed the effects of obtrusiveness of recording procedure and peer comments on reactivity to self-recording. Three first-grade students in Experiment 1 completed math questions during a 5-min work period. When we gave the children recording devices and told them to try to complete more questions than the highest number they had previously completed, math performance increased, as did the number of verbalizations about it. Two children showed more reactivity when they used the more obtrusive recording device. Because the increase in math performance corresponded closely to increases in peer comments, we manipulated peer comments directly in Experiment 2. Four second-grade students completed a math task and an alphabet task. Three of the students showed increased math performance during periods when peer comments occurred compared to periods when peer comments did not occur. Although the data from the math task suggested that peer comments can enhance reactivity, we did not observe this relationship with the alphabet task. These results suggest that the conditions necessary to produce desirable results through self-recording are complex and contextually specific.

The use of peer monitors to reduce negative interaction during recess.

The negative interactions of a midly retarded child, Dennis, were reduced in three daily recess periods, with the use of a point system. Adult monitors initiated the intervention in the morning recess; reductions achieved during adult monitoring were maintained in that recess during two subsequent conditions: peer monitoring and self-monitoring. Dennis' negative interactions were reduced next in the afternoon recess by peer monitors. Again, reductions were maintained during a subsequent self-monitoring condition. Finally, during the noon recess, Dennis was trained to serve as a peer monitor for Ed, a moderately retarded classmate. Dennis' rate of negative interactions quickly decreased following his appointment as a peer monitor. The results show that a point system, originally designed for adult monitoring, can be adapted without loss of program effectiveness for peer monitoring or self-monitoring. The results also suggest that classmates who serve as peer monitors may benefit significantly from their role. The conditions under which these therapeutic effects occur and the role that treatment order effects may play in this process require further investigation.

Training preschool children to recruit natural communities of reinforcement.

Four normal and four deviant children aged four-to-six years were taught to judge the quality of their academic work in a preschool classroom, and to prompt or cue their teachers to comment about the quality of that work. When these skills did not generalize spontaneously to other teachers in concurrent natural situations, generalized responding was taught by the experimenter, in multiple-baseline design across subjects. This generalization programming enabled the children to contact a sometimes dormant, but readily available natural community of teacher praise and reinforcement, i.e., to recruit an increase in cued praise and schedules of praise for their good work. These behaviors may be important to young children who find themselves bereft of attention in classrooms.

A comparison of two intervention roles: peer monitor and point earner.

Two fifth-grade students' high levels of off-task and disruptive behavior decreased rapidly during an intervention in which they were appointed peer monitors or point earners. The children worked in dyads in which one child served as a peer monitor and the other child earned points from his or her monitor for good behavior. Points were accumulated as part of a group contingency. We introduced the two appointments in an independent math period and alternated the appointments across days. The peer monitor and point earner roles, when alternated on an every-other-day basis, were equally effective in reducing the students' inappropriate behavior. Furthermore, their behavior during intervention fell well within the range of inappropriate behavior levels exhibited by classmates. The speed with which both students completed their math problems increased during both appointments. The accuracy of their academic work, however, varied; one student improved slightly and the other student decreased slightly in accuracy.

An analysis of the effects of multiple setting events on the social behavior of preschool children with special needs.

We examined the effects of four combinations of setting events on the social interactions of 7 preschool children with social delays. In Study 1, the status of the teacher, activity materials, and peer varied across conditions. In Study 2, the status of the teacher and materials varied across conditions. Within the combinations of setting events, we also examined teacher behavior. Teacher presence and absence was varied in both studies. The type and rate of teacher prompting were varied in Study 2. The four combinations of setting events produced different rates of social behavior by the children with social delays. The optimal combination of setting events for promoting peer interaction and reducing teacher-child interaction included teacher absence from the activity, a limited number and form of materials, and children paired with a socially skilled partner.

Generalization and maintenance of preschool children's social skills: a critical review and analysis.

This paper summarizes the results of a retrospective review of generalization in the context of social skills research with preschool children. A review of studies from 22 journals (1976 to 1990) that assessed generalization as part of social interaction research provided information concerning the prevalence of studies that have assessed generalization, common practices concerning the production and assessment of generalization, and the overall success of obtaining generalization and maintenance of social behaviors. A comparison of the most and least successful studies, with respect to generalization, revealed some differences concerning the practices employed by studies within each group. Differences differentially related to the production of generalization are discussed and recommendations are provided to guide and support future research efforts.