Beyond the Task List: A Proposed Integration of Naturalistic Developmental Behavioral Interventions to BCBA Training.

Naturalistic developmental behavioral intervention (NDBI) is firmly rooted in both the science of ABA as well as developmental science. Research indicates that many practicing board certified behavior analysts (BCBAs) are unfamiliar with NDBI models and do not implement these approaches when working with young autistic children (Hampton and Sandbank Autism, 26(4), 875-888, 2022). In this article we align NDBI to the seven dimensions of ABA, describe their compatibility with the ABA service system, and urge community agencies and insurance funders to support NDBI use. Finally, we provide a roadmap for BCBAs who provide behavior analytic intervention to young autistic children and for Verified Course Sequence faculty to effectively align the 6th edition BCBA Test Content Outline with the principles and application of NDBI.

The taming of the weed: Developmental plasticity facilitated plant domestication.

Our experiments with crop progenitors have demonstrated that these species exhibit dramatic plasticity in key traits that are affected by domestication, including seed and fruit morphology. These traits can be altered by cultivating crop progenitors for a single season, in the absence of any selection for domesticated phenotypes. We hypothesize that cultivation caused environmental shifts that led to immediate phenotypic changes in crop progenitors via developmental plasticity, similar to tameness in animals. Here we focus on the loss or reduction of germination inhibitors in an annual seed crop because seeds with high dormancy are undesirable in crops, and also present a serious barrier to selective pressures that arise from seed-saving and planting by humans. Data from four seasons of observation of the crop progenitor Polygonum erectum L. suggest that the low plant density conditions of an agroecosystem trigger a phenotypic response that reduces germination inhibitors, eliminating a key barrier to further selection. The timing of the harvest can also be used to manipulate the germinability of seed stock. These observations suggest that genetic assimilation may have played a role in the domestication of this plant. More experimental work with crop progenitors is needed to understand whether or not this phenomenon played a part in the domestication of other plants, and to accurately interpret the significance of ancient plant phenotypes in the archaeological record.

Hypoxia during maintenance hemodialysis-the critical role of pH.

Background: The impact and management of subclinical hypoxia during hemodialysis is a significant medical challenge. As key determinants of O2 availability and delivery, proposed mechanisms contributing to hypoxia include ischemia, alkalemia and pulmonary leukocyte sequestration. However, no study has comprehensively investigated and compared these interrelated mechanisms throughout a typical hemodialysis treatment week. This study aimed to comprehensively assess the physiological mechanisms that contribute to hypoxia during hemodialysis. Methods: In 76 patients, we measured arterial blood gases and pH at four time-points during hemodialysis (start, 15 min, 60 min, end) over the course of a standard treatment week. For the mid-week hemodialysis session, we additionally measured central hemodynamics (non-invasive cardiac output monitoring) and white blood cell count. Results: Linear regression modelling identified changes in pH, but not central hemodynamics or white blood cell count, to be predictive of changes in PaO2 throughout hemodialysis (e.g. at 60 min, ß standardized coefficient pH = 0.45, model R2 = 0.25, P < .001). Alkalemia, hypokalemia, decreased calcium and increased hemoglobin-O2 affinity (leftward shift in the oxyhemoglobin dissociation curve) were evident at the end of hemodialysis. pH and hemoglobin-O2 affinity at the start of hemodialysis increased incrementally over the course of a standard treatment week. Conclusion: These data highlight the important role of pH in regulating O2 availability and delivery during hemodialysis. Findings support routine pH monitoring and personalized dialysate bicarbonate prescription to mitigate the significant risk of alkalemia and subclinical hypoxia.

Comparative analysis of reported physical activity from leisure centres' members versus the general population in Spain.

OBJECTIVES: (1) To describe the physical activity (PA) levels of the members of a Spanish leisure centre operator according to age and gender; (2) to describe the differences in the three PA levels between the members of a Spanish leisure centre operator and the general Spanish population considering the PA Eurobarometer data according to their gender and age and (3) to explore the intensity origin of the PA either in Spanish members of leisure centres or the Spanish population considering their gender. DESIGN: Descriptive epidemiology study. PARTICIPANTS: Data from 16 Spanish leisure centres (n=3627) and from the 2017 Eurobarometer 472 for Spain (n=1002) were used for this research. PRIMARY AND SECONDARY OUTCOMES MEASURES: The PA levels were analysed with the International Physical Activity Questionnaire short version, and respondents were grouped into physical inactivity (PIA), moderate-PA and high-PA. Moreover, gender (men or women) and age (18-29 years; 30-44 years; 45-59 years; 60-69 years; ≥70 years) were considered. Total metabolic equivalent (MET)-min/week, as well as total MET-min/week for walking intensity, moderate intensity and vigorous intensity were recorded. RESULTS: Leisure centres showed a lower prevalence of PIA and a higher prevalence of high-PA than the general population (p<0.05). Women displayed a higher prevalence of PIA and lower prevalence of high-PA than men (p<0.05). The prevalence of PIA increases with age while the prevalence of high-PA decreases. CONCLUSION: Leisure centres engage most of their members in regular PA, including women and older adults, and these members also perform a higher number of MET in vigorous PA, than the general population.

Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise.

BACKGROUND: Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in 'cardiac stunning', evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning. METHODS: This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty exercise-naïve participants on maintenance HD (mean ± SD, 59 ± 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed. RESULTS: Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 ± 4, mean 7 ± 4 segments versus total 77 ± 3, mean 5 ± 3, respectively; P = 0.008). Global cardiac function, intra-dialytic haemodynamics and LV volumetric parameters were not significantly altered with exercise. CONCLUSIONS: Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT was sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic exercise.

Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England.

BACKGROUND: Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics. OBJECTIVE: To understand what key delivery approaches are currently used within exercise referral schemes in England. METHODS: Across England, a total of 30 schemes with a combined total of 85,259 exercise referral scheme participants completed a Consensus on Exercise Reporting Template-guided questionnaire. The questionnaire explored program delivery, nonexercise components, and program management. RESULTS: Results found that program delivery varied, though many schemes were typically 12 weeks in length, offering participants 2 exercise sessions in a fitness gym or studio per week, using a combination of exercises. Adherence was typically measured through attendance, with nonexercise components and program management varying by scheme. CONCLUSION: This research provides a snapshot of current delivery approaches and supports the development of a large-scale mapping exercise to review further schemes across the whole of the United Kingdom in order to provide evidence of best practice and delivery approaches nationwide.

A Comparison of Physical Activity Between Home-Based and Centre-Based Pulmonary Rehabilitation: A Randomised Controlled Secondary Analysis.

Background: Pulmonary rehabilitation (PR) is a highly effective intervention for individuals with chronic obstructive pulmonary disease (COPD). Physical activity (PA) has been shown to increase after a centre-based programme, yet it is not clear if a home-based programme can offer the same benefit. This study aimed to evaluate the effect of home-based PR compared with the centre-based PR on the PA levels post 7 weeks of PR and 6 months follow-up. Method: In this study, 51 participants with COPD, of them, 36 (71%) men completed physical activity monitoring with a SenseWear Armband, at three time points (baseline, 7 weeks, and 6 months). The participants were randomly assigned to either centre-based supervised PR (n = 25; 69 ± 6 years; FEV1 55 ± 20% predicted) or home-based PR (n = 26; 68 ± 7 years; FEV1 42 ± 19% predicted) programmes lasting 7 weeks. The home-based programme includes one hospital visit, a self-management manual, and two telephone calls. The PA was measured as step count, time in moderate PA (3-6 metabolic equivalent of tasks [METs]) in bouts of more than 10 min and sedentary time (<2 METs). Results: Home-based PR increased step count significantly more than the centre-based PR after 7 weeks (mean difference 1,463 steps: 95% CI 280-2,645, p = 0.02). There was no difference in time spent in moderate PA was observed (mean difference 62 min: 95% CI -56 to 248, p = 0.24). Sedentary behaviour was also significantly different between the centre and home-based groups. The home group spent 52 min less time sedentary compared with the centre-based (CI -106 to 2, p = 0.039). However, after 6 months, the step count and time spent in moderate PA returned to baseline in both the groups. Conclusion: This study provides an important insight into the role of home-based PR which has the potential to be offered as an alternative to the centre-based PR. Understanding who may best respond from the centre or home-based PR warrants further exploration and how to maintain these initial benefits for the long-term. Trial Registry: ISRCTN: No.: ISRCTN81189044; URL: isrctn.com.

Effectiveness of Structured Physical Activity Interventions Through the Evaluation of Physical Activity Levels, Adoption, Retention, Maintenance, and Adherence Rates: A Systematic Review and Meta-Analysis.

BACKGROUND: Structured physical activity (PA) interventions (ie, intentionally planned) can be implemented in a variety of facilities, and therefore can reach a large proportion of the population. The aim of the authors was to summarize the effectiveness of structured interventions upon PA outcomes, in addition to proportions of individuals adopting and maintaining PA, and adherence and retention rates. METHODS: Systematic review with narrative synthesis and exploratory meta-analyses. Twelve studies were included. RESULTS: Effectiveness on PA levels during adoption (pre- to first time point) showed a trivial standardized effect (0.15 [-0.06 to 0.36]); during maintenance (any time point after the first and >6 mo since initiation) the standardized effect was also trivial with a wide interval estimate (0.19 [-0.68 to 1.07]). Few studies reported adoption (k = 3) or maintenance rates (k = 2). Retention at follow-up did not differ between structured PA or controls (75.1% [65.0%-83.0%] vs 75.4% [67.0%-82.3%]), nor did intervention adherence (63.0% [55.6%-69.6%] vs 77.8% [19.4%-98.1%]). CONCLUSION: Structured PA interventions lack evidence for effectiveness in improving PA levels. Furthermore, though retention is often reported and is similar between interventions and controls, adoption, maintenance, and adherence rates were rarely reported rendering difficulty in interpreting results of effectiveness of structured PA interventions.

Are Exercise Referral Schemes Associated With an Increase in Physical Activity? Observational Findings Using Individual Patient Data Meta-Analysis From the National Referral Database.

OBJECTIVES: To examine if exercise referral schemes (ERSs) are associated with meaningful changes in physical activity in a large cohort of individuals throughout England, Scotland, and Wales from The National Referral Database. METHODS: Data were obtained from 5246 participants from 12 different ERSs, lasting 6-12 weeks. The preexercise referral scheme and changes from the preexercise to the postexercise referral scheme in self-reported International Physical Activity Questionnaire scores were examined. A 2-stage individual patient data meta-analysis was used to generate the effect estimates. RESULTS: For the pre-ERS metabolic equivalent (MET) minutes per week, the estimate (95% confidence interval [CI]) was 676 MET minutes per week (539 to 812). For the change in MET minutes per week, the estimate (95% CI) was an increase of 540 MET minutes per week (396 to 684). Changes in the total PA levels occurred as a result of increases in vigorous activity of 17 minutes (95% CI, 9 to 24), increases in moderate activity of 29 minutes (95% CI, 22 to 36), and reductions in sitting of -61 minutes (95% CI, -78 to -43), though little change in walking (-5 min; 95% CI, -14 to 5) was found. CONCLUSIONS: Most participants undergoing ERSs are already "moderately active." Changes in PA behavior associated with participation are through increased moderate to vigorous PA and reduced sitting. However, this was insufficient to change the International Physical Activity Questionnaire category, and the participants were still "moderately active."

Augmented reality-based dance intervention for individuals with Parkinson's disease: A pilot study.

BACKGROUND: The effects of dance on improving the symptoms of individuals with Parkinson's disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance. OBJECTIVE: To evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol. METHODS: Seven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention. RESULTS: Recruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants' balance scores, quality of life or mood. CONCLUSIONS: The outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.

Inclusive Preschool Practitioners' Implementation of Naturalistic Developmental Behavioral Intervention Using Telehealth Training.

This single-case investigation was designed to evaluate the effects of telehealth training on practitioner implementation of a naturalistic developmental behavioral intervention (NDBI). Six general education preschool practitioners engaged in an intervention with six children with varying disabilities in inclusive classroom settings. The telehealth training package included a collaborative approach to intervention planning, online training module, video self-evaluation, and performance feedback via videoconferencing. Following telehealth training, practitioners reached criteria for implementation fidelity and increased communication opportunities. Additionally, child participants increased communication behaviors above baseline levels. All behaviors generalized to a different activity context and maintained over time. Social validity was measured and results suggest high levels of acceptability for the telehealth training package.

The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review.

BACKGROUND: Exercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines. METHOD: Data was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only. RESULTS: In the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8-12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders. CONCLUSION: Longer length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual's health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise.

Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20-30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD.

Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial.

BACKGROUND: Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD. METHODS: A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units. RESULTS: There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: -0.24, 95% CI -0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks. CONCLUSIONS: The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation. TRIAL REGISTRATION NUMBER: ISRCTN81189044.

Growing the lost crops of eastern North America's original agricultural system.

Thousands of years before the maize-based agriculture practiced by many Native American societies in eastern North America at the time of contact with Europeans, there existed a unique crop system only known through archaeological evidence. There are no written or oral records of how these lost crops were cultivated, but several domesticated subspecies have been identified in the archaeological record. Growth experiments and observations of living progenitors of these crops can provide insights into the ancient agricultural system of eastern North America, the role of developmental plasticity in the process of domestication, and the creation and maintenance of diverse landraces under cultivation. In addition, experimental gardens are potent tools for public education, and can also be used to conserve remaining populations of lost crop progenitors and explore the possibility of re-domesticating these species.

Medial Malleolar Osteotomy and Osteochondral Autograft Transfer for Osteochondritis Dissecans of the Distal Tibial Plafond.

UNLABELLED: The literature on the surgical treatment of osteochondritis dissecans of the distal tibial plafond is significantly limited. The purpose of this case study is to present a novel surgical technique to repair osteochondritis dissecans of the distal medial tibial plafond. A retrospective chart and radiographic review of a 15-year-old male was performed with a 24-month follow-up along with a review of the literature. A right angled medial malleolar osteotomy provides adequate exposure, width, and depth of the medial distal tibial plafond allowing for the successful transfer of osteochondral autograft plugs. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case report.

Physical activity monitoring: addressing the difficulties of accurately detecting slow walking speeds.

OBJECTIVE: To test the accuracy of a multi-sensor activity monitor (SWM) in detecting slow walking speeds in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Concerns have been expressed regarding the use of pedometers in patient populations. Although activity monitors are more sophisticated devices, their accuracy at detecting slow walking speeds common in patients with COPD has yet to be proven. METHODS: A prospective observational study design was employed. An incremental shuttle walk test (ISWT) was completed by 57 patients with COPD wearing an SWM. The ISWT was repeated by 20 patients wearing the same SWM. RESULTS: Differences were identified between metabolic equivalents (METS) and between step-count across five levels of the ISWT (p < 0.001). Good within monitor reproducibility between two ISWT was identified for total energy expenditure and step-count (p < 0.001). CONCLUSIONS: The SWM is able to detect slow (standardized) speeds of walking and is an acceptable method for measuring physical activity in individuals disabled by COPD.