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.

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.

Prolongation of the intravascular retention of hemoglobin modified with a long-chain fatty acid derivative.

To develop hemoglobin (Hb) derivatives with an increased circulatory half-life, Hb was chemically modified with long chain fatty acid analogs. One compound, sodium 1-hexadecyl 6-(2-iodoacetamido)hexyl phosphate, specifically modified the Cys-93 beta residues of human hemoglobin (HbA) as determined by sulfhydryl titration analysis. The resulting modified Hb derivative, FAHbA, was isolated and was shown to have a two-fold longer circulatory half-life than native HbA in a rat low-dose acute transfusion model.

Allosteric kinetics and equilibria of triligated, cross-linked hemoglobin.

Using modulated excitation, we have measured the forward and reverse rates of the allosteric transition between relaxed (R) and tense (T) quaternary structures for triply ligated hemoglobin (Hb), cross-linked between the alpha chains at Lys 99. Oxygen, carbon monoxide, and water were used as ligands and were studied in phosphate and low Cl- bis-Tris buffers at neutral pH. Since the cross-link prohibits disproportionation, triply ligated aquomet Hb species with ferrous beta chains were specifically isolated by isoelectric focusing. Modulated excitation provides rate pairs and therefore gives equilibrium constants between quaternary structures. To coordinate with that information, oxygen binding curves of fully ferrous and tri-aquomet Hb were also measured. L3, the equilibrium constant between three liganded R and T structures, is determined by modulated excitation to be of order unity for O2 or CO (1.1 to 1.5 for 3O2 and 0.7 for 3CO bound), while with three aquomet subunits it is much greater (> or = 23). R-->T conversion rates are similar to those found for HbA, with weak sensitivity to changes in L3. The L3 values from HbXL O2 were used to obtain a unique allosteric decomposition of the ferrous O2 binding curve in terms of KT, KR, and L3. From these values and the O2 binding curve of tri-aquomet HbXL, L3 was calculated to be 2.7 for the tri-aquomet derivative. Consistency in L3 values between equilibrium and modulated excitation data for tri-aquomet-HbXL can be achieved if the equilibrium constant for O2 binding to the alpha chains is six times lower than that for binding to the beta chains in the R state, while the cooperative properties remain homogeneous. The results are in quantitative agreement with other studies, and suggest that the principal effect of the cross-link is to decrease the R state and T state affinity of the alpha subunits with almost no change in the affinity of the beta subunits, leaving the allosteric parameters L and c unchanged.

Isolation and characterization of the triply oxidized derivative of a cross-linked hemoglobin.

Hemoglobin A, cross-linked between Lys 99 alpha 1 and Lys 99 alpha 2, was used to obtain a partially oxidized tetramer in which only one of the four hemes remains reduced. Because of the absence of dimerization, asymmetric, partially oxidized derivatives are stable. This is evidenced by the fact that eight of the ten possible oxidation states could be resolved by analytical isoelectric focusing. A triply oxidized hemoglobin population HbXL+3 was isolated whose predominant component was (alpha + alpha +, beta + beta 0). This triferric preparation was examined as a possible model for the triliganded state of ferrous HbA. The aquomet and cyanomet derivatives were characterized by their CD spectra and their kinetic reactions with carbon monoxide. CD spectra in the region of 287 nm showed no apparent change in quaternary structure upon binding ligand to the fourth, ferrous heme. The spectra of the oxy and deoxy forms of the cyanomet and aquomet derivatives of HbXL+3 differed insignificantly and were characteristic of the normal liganded state. Upon addition of inositol hexaphosphate (IHP), both the oxy and deoxy derivatives of the high-spin triaquomet species converted to the native deoxy conformation. In contrast, IHP had no such effect on the conformation of the low-spin cyanomet derivatives of HbXL+3. The kinetics of CO combination as measured by stopped-flow and flash photolysis techniques present a more complex picture. In the presence of IHP the triaquomet derivative does bind CO with rate constants indicative of the T state whether these are measured by the stopped-flow technique or by flash photolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

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.

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.

Scanning electron microscopy of deposits remaining in soft contact lens polishing marks after cleaning.

Deposits are a complication of contact lens wear that have been associated with ocular diseases, including keratitis and giant papillary conjunctivitis. The purpose of this morphologic study was to describe the deposits on soft contact lenses fabricated by different surface manufacturing methods and to evaluate the ease of removal of deposits by surfactant cleaning. We studied the anterior surfaces of 30 soft contact lenses (10 lathe cut [polished]; 10 spin cast [unpolished], and 10 cast molded [unpolished]) of the same polymer and water content. All lenses were worn for 8 hours by two asymptomatic persons who did not routinely wear contact lenses. Lenses from one eye were immersed in glutaraldehyde, while lenses from the other eye were cleaned before immersion in glutaraldehyde. All lenses were then dehydrated in graded alcohols, critical-point-dried, and observed by scanning electron microscopy. The amount of deposit on the lens surface was judged by an individual who did not know the identity of the lens. All lenses showed similar types of deposits. At the end of 8 hours wear, all types of lens surfaces were covered with deposits. Cleaning removed some but not all deposits. The lens surfaces manufactured in such a way as to leave polishing or lathe marks showed deposits "heaped-up" on the marks before cleaning and remaining in the mark after cleaning. Polishing marks from lens fabrication may represent an increased risk for conjunctival insult from deposits remaining in the marks after cleaning.

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.

Language training for generalization.

This paper presents a classroom-based language intervention program for preschool children with language delays or deficits. A major goal of the program is to ensure that children acquire missing skills through daily speech therapy and that they actively generalize these skills from therapy times to other classroom activities. This paper presents data collected with two children during daily speech therapy sessions and daily play activities. Instances in which the children generalized new language acquired in therapy to play activities will be discussed as well as instances in which the children failed to generalize new language. In addition, the influence of peer and teacher language usage on children's language production will be discussed. Finally, recommendations to enhance generalization of language skills within and across school settings will be presented.

Binding of iron by factor IX. Possible role for beta-hydroxyaspartic acid.

In concentrations exceeding 1 mg/ml, bovine factor IX exhibits a pink color that arises from a broad absorption band with a lambda max = 500 nm. Analysis by x-ray fluorescence reveals the presence of iron but no other transition metals in the factor IX preparation. Quantitative analysis by atomic absorption spectroscopy indicates that 1 g atom of iron is bound tightly to 1 mol of factor IX. The iron is removed slowly (t1/2 = 3 h) by EDTA. In contrast, prothrombin binds no detectable iron, and factor X binds less than 0.2 g atom/mol. alpha-Hydroxybutyrate chelates Fe3+ with sufficient stability to preclude formation of [Fe(OH)3]n. It is proposed that factor IX binds iron with physiologically significant affinity and that the beta-hydroxyaspartate residue in factor IX is a chelator for the bound metal.

Role reversals: an analysis of therapeutic effects achieved with disruptive boys during their appointments as peer monitors.

Three 7-year-old boys with histories of negative interactions were appointed to monitor individual classmates during daily noon recess. As monitors, the boys awarded points to their classmates for playing appropriately and, on rare occasions, withdrew a point for negative interactions. The three boys immediately decreased their own rates of negative interactions during the sessions in which they were appointed as monitors. Two of the boys concomitantly increased their rates of positive interactions. Their reductions in negative interactions were not maintained during reversals and did not clearly generalize to the morning or afternoon recess periods. Subsequent appointment of the boys as peer monitors during the morning recess produced similar improvements in their behavior. Results suggest that appointment to the role of peer monitor may itself function as an intervention.

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.

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 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.