human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Constipation and body weight loss are prevalent among old people . Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders . Objective , participants and interventionThis pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A , and to evaluate the influence on bowel movements and body weight in 15 people with dementia , aged 65–95 years in residential care facility . Design A drinkable yoghurt ( Verum Drickyoghurt © ) with added bacteria was served daily for 6 months in conjunction with ordinary food intake .  Body weight , bowel movement frequency and consistency , food and fluid intake and time spent in various activities were recorded for two weeks preintervention , and 3 times during the follow-up period . Result This study showed that the yoghurt was easy to serve , with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete . The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements . The overnight fast was almost 15 hours per day . Body weight decreased by 0.65 kg/month ( 95 % confidence interval . 0.27–0.97 ) . Conclusions The present study design was feasible in this group of old people with dementia . The absence of any detectable effect of the supplement on constipation , but rather a considerable loss in body weight , indicate that further research is needed in a large r and omised controlled trial , if associations between dementia , constipation and energy balance are to be understood Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation , the most commonly utilized instrumental method for dysphagia diagnosis and treatment . Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians . The majority of extant studies compared judgments among clinicians . No studies included judgments made during the use of a postural compensatory strategy . The purpose of this study was to examine the accuracy of judgments made by speech- language pathologists ( SLPs ) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale .  Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale . Videofluoroscopic data were collected from 669 patients as part of a large , r and omized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states . Judgments were made on swallows during use of dysphagia compensatory strategies : chin-down posture with thin liquids and head-neutral posture with thickened liquids ( nectar-thick and honey-thick consistencies ) . The subject population included patients with Parkinson ’s disease and /or dementia .  Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration ( all κ > 0.86 ) and variable accuracy ( range = 69–76 % ) using the Penetration/Aspiration Scale when compared to expert judges . It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent , more extensive training and /or image enhancement is recommended for precise use of the Penetration/Aspiration Scale Background Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Souvenaid aims to improve synapse formation and function . An earlier study in patients with Alzheimer 's disease ( AD ) showed that Souvenaid increased memory performance after 12 weeks in drug-naïve patients with mild AD . The Souvenir II study was a 24-week , r and omized , controlled , double-blind , parallel-group , multi-country trial to confirm and extend previous findings in drug-naïve patients with mild AD . Patients were r and omized 1:1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks . The primary outcome was the memory function domain Z-score of the Neuropsychological Test Battery ( NTB ) over 24 weeks . Electroencephalography ( EEG ) measures served as secondary outcomes as marker for synaptic connectivity . Assessment s were done at baseline , 12 , and 24 weeks . The NTB memory domain Z-score was significantly increased in the active versus the control group over the 24-week intervention period ( p = 0.023 ; Cohen 's d = 0.21 ; 95 % confidence interval [-0.06]-[0.49 ] ) . A trend for an effect was observed on the NTB total composite z-score ( p = 0.053 ) . EEG measures of functional connectivity in the delta b and were significantly different between study groups during 24 weeks in favor of the active group . Compliance was very high ( 96.6 % [ control ] and 97.1 % [ active ] ) . No difference between study groups in the occurrence of ( serious ) adverse events . This study demonstrates that Souvenaid is well tolerated and improves memory performance in drug-naïve patients with mild AD . EEG outcomes suggest that Souvenaid has an effect on brain functional connectivity , supporting the underlying hypothesis of changed synaptic activity Concord grape juice contains polyphenol compounds , which have antioxidant and anti-inflammatory properties and influence neuronal signalling . Concord grape juice supplementation has been shown to reduce inflammation , blood pressure and vascular pathology in individuals with CVD , and consumption of such flavonoid-containing foods is associated with a reduced risk for dementia . In addition , preliminary animal data have indicated improvement in memory and motor function with grape juice supplementation , suggesting potential for cognitive benefit in ageing humans . In this initial investigation of neurocognitive effects , we enrolled twelve older adults with memory decline but not dementia in a r and omised , placebo-controlled , double-blind trial with Concord grape juice supplementation  for 12 weeks . We observed significant improvement in a measure of verbal learning and non-significant enhancement of verbal and spatial recall . There was no appreciable effect of the intervention on depressive symptoms and no effect on weight or waist circumference . A small increase in fasting insulin was observed for those consuming grape juice . These preliminary findings suggest that supplementation with Concord grape juice may enhance cognitive function for older adults with early memory decline and establish a basis for more comprehensive investigations to evaluate potential benefit and assess mechanisms of action Short-term nutritional supplements enable an improvement in Alzheimer patients ’ nutritional status , but it remains to be seen whether they will be sufficient to improve long-term nutritional status . The aim of this study was to evaluate the long-term impact of a 3-week nutritional supplementation on the nutritional status of undernourished patients with probable mild Alzheimer disease . A 21-day prospect i ve r and omized nonblinded controlled trial was conducted . Patients were followed-up for an additional period until the 90th day after the beginning of the intervention . Intervention result ed in significant improvements in Mini Nutritional Assessment ( MNA ) score [ Mean=1.4 , st and ard deviation (SD)=0.8 vs. 0.0 ( 0.1 ) in the control group , P<0.001 ] and also in anthropometrical and serum biomarkers of Alzheimer disease ( AD ) patients ’ nutritional status . Further improvements in the AD patients ’ MNA mean score=1.4 ( SD=2.3 ) versus —0.5 ( SD=0.6 ) in the control group ( P=0.003 ) were seen at 90 days follow-up . Data show that a 3-week nutritional supplementation has a positive long-term impact on the nutritional status of undernourished patients with mild probable AD Background : Serum osmolality is an accurate indicator of hydration status in older adults . Glucose , urea , and electrolyte concentrations are used to calculate serum osmolarity , which is an indirect estimate of serum osmolality , but which serum osmolarity equations best predict serum osmolality in the elderly is unclear . Objective : We assessed the agreement of measured serum osmolality with calculated serum osmolarity equations in older people . Design : Serum osmolality was measured by using freezing point depression in a cross-sectional study .  Plasma glucose , urea , and electrolytes were analyzed and entered into 38 serum osmolarity-prediction equations . The Bl and -Altman method was used to evaluate the agreement and differential bias between measured osmolality and calculated osmolarity . The sensitivity and specificity of the most-promising equations were examined against serum osmolality ( reference st and ard ) . Results : A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study ( 66 % women ; mean ± SD age : 85.8 ± 7.9 y ; with a range of cognitive and physical impairments ) and were included in analyses . Forty-six percent of participants had impending or current dehydration ( serum osmolality ≥295 mmol/kg ) . Participants with diabetes ( n = 33 ; 18 % ) had higher glucose ( P < 0.001 ) and serum osmolality ( P < 0.01 ) . Of 38 predictive equations used to calculate osmolarity , 4 equations showed reasonable agreement with measured osmolality . One [ calculated osmolarity = 1.86 × ( Na+ + K+ ) + 1.15 × glucose + urea + 14 ; all in mmol/L ] was characterized by narrower limits of agreement and the capacity to predict serum osmolality within 2 % in > 80 % of participants , regardless of diabetes or hydration status . The equation 's sensitivity ( 79 % ) and specificity ( 89 % ) for impending dehydration ( ≥295 mmol/kg ) and current dehydration ( > 300 mmol/kg ) ( 69 % and 93 % , respectively ) were reasonable . Conclusions : The assessment of a panel of equations for the prediction of serum osmolarity led to identification of one formula 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Constipation and body weight loss are prevalent among old people . Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders . Objective , participants and interventionThis pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A , and to evaluate the influence on bowel movements and body weight in 15 people with dementia , aged 65–95 years in residential care facility . Design A drinkable yoghurt ( Verum Drickyoghurt © ) with added bacteria was served daily for 6 months in conjunction with ordinary food intake .  Body weight , bowel movement frequency and consistency , food and fluid intake and time spent in various activities were recorded for two weeks preintervention , and 3 times during the follow-up period . Result This study showed that the yoghurt was easy to serve , with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete . The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements . The overnight fast was almost 15 hours per day . Body weight decreased by 0.65 kg/month ( 95 % confidence interval . 0.27–0.97 ) . Conclusions The present study design was feasible in this group of old people with dementia . The absence of any detectable effect of the supplement on constipation , but rather a considerable loss in body weight , indicate that further research is needed in a large r and omised controlled trial , if associations between dementia , constipation and energy balance are to be understood Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation , the most commonly utilized instrumental method for dysphagia diagnosis and treatment . Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians . The majority of extant studies compared judgments among clinicians . No studies included judgments made during the use of a postural compensatory strategy . The purpose of this study was to examine the accuracy of judgments made by speech- language pathologists ( SLPs ) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale .  Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale . Videofluoroscopic data were collected from 669 patients as part of a large , r and omized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states . Judgments were made on swallows during use of dysphagia compensatory strategies : chin-down posture with thin liquids and head-neutral posture with thickened liquids ( nectar-thick and honey-thick consistencies ) . The subject population included patients with Parkinson ’s disease and /or dementia .  Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration ( all κ > 0.86 ) and variable accuracy ( range = 69–76 % ) using the Penetration/Aspiration Scale when compared to expert judges . It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent , more extensive training and /or image enhancement is recommended for precise use of the Penetration/Aspiration Scale Background Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Souvenaid aims to improve synapse formation and function . An earlier study in patients with Alzheimer 's disease ( AD ) showed that Souvenaid increased memory performance after 12 weeks in drug-naïve patients with mild AD . The Souvenir II study was a 24-week , r and omized , controlled , double-blind , parallel-group , multi-country trial to confirm and extend previous findings in drug-naïve patients with mild AD . Patients were r and omized 1:1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks . The primary outcome was the memory function domain Z-score of the Neuropsychological Test Battery ( NTB ) over 24 weeks . Electroencephalography ( EEG ) measures served as secondary outcomes as marker for synaptic connectivity . Assessment s were done at baseline , 12 , and 24 weeks . The NTB memory domain Z-score was significantly increased in the active versus the control group over the 24-week intervention period ( p = 0.023 ; Cohen 's d = 0.21 ; 95 % confidence interval [-0.06]-[0.49 ] ) . A trend for an effect was observed on the NTB total composite z-score ( p = 0.053 ) . EEG measures of functional connectivity in the delta b and were significantly different between study groups during 24 weeks in favor of the active group . Compliance was very high ( 96.6 % [ control ] and 97.1 % [ active ] ) . No difference between study groups in the occurrence of ( serious ) adverse events . This study demonstrates that Souvenaid is well tolerated and improves memory performance in drug-naïve patients with mild AD . EEG outcomes suggest that Souvenaid has an effect on brain functional connectivity , supporting the underlying hypothesis of changed synaptic activity Concord grape juice contains polyphenol compounds , which have antioxidant and anti-inflammatory properties and influence neuronal signalling . Concord grape juice supplementation has been shown to reduce inflammation , blood pressure and vascular pathology in individuals with CVD , and consumption of such flavonoid-containing foods is associated with a reduced risk for dementia . In addition , preliminary animal data have indicated improvement in memory and motor function with grape juice supplementation , suggesting potential for cognitive benefit in ageing humans . In this initial investigation of neurocognitive effects , we enrolled twelve older adults with memory decline but not dementia in a r and omised , placebo-controlled , double-blind trial with Concord grape juice supplementation  for 12 weeks . We observed significant improvement in a measure of verbal learning and non-significant enhancement of verbal and spatial recall . There was no appreciable effect of the intervention on depressive symptoms and no effect on weight or waist circumference . A small increase in fasting insulin was observed for those consuming grape juice . These preliminary findings suggest that supplementation with Concord grape juice may enhance cognitive function for older adults with early memory decline and establish a basis for more comprehensive investigations to evaluate potential benefit and assess mechanisms of action Short-term nutritional supplements enable an improvement in Alzheimer patients ’ nutritional status , but it remains to be seen whether they will be sufficient to improve long-term nutritional status . The aim of this study was to evaluate the long-term impact of a 3-week nutritional supplementation on the nutritional status of undernourished patients with probable mild Alzheimer disease . A 21-day prospect i ve r and omized nonblinded controlled trial was conducted . Patients were followed-up for an additional period until the 90th day after the beginning of the intervention . Intervention result ed in significant improvements in Mini Nutritional Assessment ( MNA ) score [ Mean=1.4 , st and ard deviation (SD)=0.8 vs. 0.0 ( 0.1 ) in the control group , P<0.001 ] and also in anthropometrical and serum biomarkers of Alzheimer disease ( AD ) patients ’ nutritional status . Further improvements in the AD patients ’ MNA mean score=1.4 ( SD=2.3 ) versus —0.5 ( SD=0.6 ) in the control group ( P=0.003 ) were seen at 90 days follow-up . Data show that a 3-week nutritional supplementation has a positive long-term impact on the nutritional status of undernourished patients with mild probable AD Background : Serum osmolality is an accurate indicator of hydration status in older adults . Glucose , urea , and electrolyte concentrations are used to calculate serum osmolarity , which is an indirect estimate of serum osmolality , but which serum osmolarity equations best predict serum osmolality in the elderly is unclear . Objective : We assessed the agreement of measured serum osmolality with calculated serum osmolarity equations in older people . Design : Serum osmolality was measured by using freezing point depression in a cross-sectional study .  Plasma glucose , urea , and electrolytes were analyzed and entered into 38 serum osmolarity-prediction equations . The Bl and -Altman method was used to evaluate the agreement and differential bias between measured osmolality and calculated osmolarity . The sensitivity and specificity of the most-promising equations were examined against serum osmolality ( reference st and ard ) . Results : A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study ( 66 % women ; mean ± SD age : 85.8 ± 7.9 y ; with a range of cognitive and physical impairments ) and were included in analyses . Forty-six percent of participants had impending or current dehydration ( serum osmolality ≥295 mmol/kg ) . Participants with diabetes ( n = 33 ; 18 % ) had higher glucose ( P < 0.001 ) and serum osmolality ( P < 0.01 ) . Of 38 predictive equations used to calculate osmolarity , 4 equations showed reasonable agreement with measured osmolality . One [ calculated osmolarity = 1.86 × ( Na+ + K+ ) + 1.15 × glucose + urea + 14 ; all in mmol/L ] was characterized by narrower limits of agreement and the capacity to predict serum osmolality within 2 % in > 80 % of participants , regardless of diabetes or hydration status . The equation 's sensitivity ( 79 % ) and specificity ( 89 % ) for impending dehydration ( ≥295 mmol/kg ) and current dehydration ( > 300 mmol/kg ) ( 69 % and 93 % , respectively ) were reasonable . Conclusions : The assessment of a panel of equations for the prediction of serum osmolarity led to identification of one formula 
    Output:
    