Convergent and Discriminant Validity of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and the Vineland Adaptive Behavior Scales (VABS).

Behavior analysts frequently use the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) to assess the language and social skills of children with autism in everyday practice and in research. Despite the widespread use of the VB-MAPP, its psychometric characteristics have not been extensively investigated. To provide information about its convergent validity, we calculated correlations between scores earned by 235 children with autism on the VB-MAPP and the Vineland Adaptive Behavior Scale (VABS), a commonly used assessment with good reliability and validity. We obtained moderate or strong positive correlations between the VB-MAPP Milestones score and VABS Communication, Socialization, and Daily Living Skills subdomains. There was also a strong positive correlation between the VB-MAPP Milestones score and VABS overall raw score. These findings suggest that the VB-MAPP Milestones Assessment measures aspects of social and communicative behavior comparable to those indexed by these VABS subdomains which, like prior findings, supports the use of the Milestones Assessment. No significant relationship was observed between the VB-MAPP Barriers score and the VABS Internalizing, Externalizing, or overall Maladaptive Behavior scores. These findings, like prior findings, question the value of the VB-MAPP's Barriers Assessment as a measure of maladaptive behavior.

The conformations and basal conformational dynamics of translocation factor SecDF vary with translocon SecYEG interaction.

The general secretory, or Sec, system is a primary protein export pathway from the cytosol of Escherichia coli and all eubacteria. Integral membrane protein complex SecDF is a translocation factor that enhances polypeptide secretion, which is driven by the Sec translocase, consisting of translocon SecYEG and ATPase SecA. SecDF is thought to utilize a proton gradient to effectively pull precursor proteins from the cytoplasm into the periplasm. Working models have been developed to describe the structure and function of SecDF, but important mechanistic questions remain unanswered. Atomic force microscopy (AFM) is a powerful technique for studying the dynamics of single-molecule systems including membrane proteins in near-native conditions. The sharp tip of the AFM provides direct access to membrane-external protein conformations. Here, we acquired AFM images and kymographs (∼100 ms resolution) to visualize SecDF protrusions in near-native supported lipid bilayers and compared the experimental data to simulated AFM images based on static structures. When studied in isolation, SecDF exhibited a stable and compact conformation close to the lipid bilayer surface, indicative of a resting state. Interestingly, upon SecYEG introduction, we observed changes in both SecDF conformation and conformational dynamics. The population of periplasmic protrusions corresponding to an intermediate form of SecDF, which is thought to be active in precursor protein handling, increased more than ninefold. In conjunction, our dynamics measurements revealed an enhancement in the transition rate between distinct SecDF conformations when the translocon was present. Together, this work provides a novel vista of basal-level SecDF conformational dynamics in near-native conditions.

Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism.

BACKGROUND: Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes. PURPOSE: The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder. METHODS: This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite. RESULTS: There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period. CONCLUSIONS: In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.

Caregiver Satisfaction with Delivery of Telehealth Autism Services.

Objective: The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. Methods: A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. Results: There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. Conclusions: The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.

Evaluation of a Reinforcement Contingency to Increase University Students' Webcam Usage During Online Classroom Instructions.

During the COVID-19 pandemic, in-person classroom instruction was placed on hold and university courses transitioned to online instruction. This transition resulted in novel challenges for instructors, including reduced professor-student interactions due to limited student webcam usage. The purpose of this study was to assess the impact of a reinforcement contingency on students' use of webcams during synchronous online instruction. An alternating treatments design was used to assess the impact of a reinforcement contingency consisting of 0.5 points contingent on daily webcam usage. We also assessed the results based on how the contingency was communicated to the students (a verbal statement on the daily quiz plus a reminder on lecture slides versus a statement on the lecture slide only). The reinforcement contingency reliably increased webcam usage, but there was not a significant difference in results as a function of how the presence of the reinforcement contingency was communicated. These findings suggest that the behavior of using webcams can change with a simple reinforcement contingency.

Resurgence increases with repetition.

Resurgence refers to a behavioral process in which a recent response is extinguished (or reinforcement conditions worsen) and a previously extinguished response recurs. In previous research, resurgence has been reliably produced when the resurgence procedure is repeated. Changes in the degree of increase of the resurging response across iterations of the procedure have been inconsistent, however, with some studies showing increases and some showing no changes or decreases in resurgence magnitude. The present study examined the nature of resurgence across repeated iterations of the conventional resurgence procedure by exposing four pigeons to the resurgence procedure six times in succession. In the first condition of the resurgence procedure, pecks on one key (e.g., the left) were reinforced under a variable-interval (VI) 30-s schedule. In the second condition pecks on that key were extinguished, and pecks on another key (e.g., the right) were reinforced under the same schedule. In the final condition there were no programmed consequences for either response. Resurgence was observed in 21 of 24 opportunities (87.5%). Iteration-over-iteration increases in resurgence were observed in 15 of 20 opportunities (75.0%), and this increase was found to be statistically significant. These findings demonstrate that, under certain conditions, resurgence generally increases in magnitude with repeated exposure to the procedures that generate it.

Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables.

Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.

Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery?

The oropharyngeal throat pack is commonly used in oral and maxillofacial surgery despite debated evidence regarding its barrier function. The study objectives were to investigate whether the oropharyngeal pack reduces blood ingestion and to evaluate its relationship with postoperative nausea and vomiting (PONV) and throat pain. This was a single-center, parallel group, single-blind randomized controlled trial. Participants undergoing orthognathic surgery, age ≥16 years, were included in the study. After intubation and prior to surgery start, the treatment group received oropharyngeal packing; the control group received no packing. Outcome variables were the quality of gastric contents aspirated by nasogastric tube (bloody or not bloody), PONV, and throat pain (visual analog scale). Thirty patients (treatment n = 15; control n = 15) were randomized and analyzed. There was no difference between the groups in quality of gastric contents (P = 1.00) or incidence of PONV at 2 hours and 24 hours (P = 1.00). Throat pain incidence and severity at 2 hours were both higher in the treatment group, but this was not statistically significant (P = 0.128, P = 0.223). The results indicate that the oropharyngeal pack is not an effective barrier against blood ingestion. Oropharyngeal packs do not improve or worsen PONV, but may increase throat pain.

Motivating Operations and Discriminative Stimuli: Distinguishable but Interactive Variables.

The motivating operations concept has been of considerable interest and practical value to behavior analysts, including practitioners. Nonetheless, the concept has generated substantial controversy and has significant limitations. To address some of these limitations, we suggest that it would be wise to redefine motivating operations, to deemphasize the importance that has historically been placed on subtypes of conditioned motivating operations, to emphasize how motivating operations and discriminative stimuli interact, and to further examine the kinds of environmental changes that alter the reinforcing value of particular kinds of stimuli. These suggestions are detailed elsewhere and summarized in this article.

Moderate Effects of Low-Intensity Behavioral Intervention.

We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose-response relationship between ABA intervention hours and outcomes.

New Findings Confirm Regional Internal Disc Strain Changes During Simulation of Repetitive Lifting Motions.

To understand the mechanisms of disc injuries that result from repetitive loading, it is important to measure disc deformations and use MRI to quantify disc damage. The aim of this study was to measure internal disc strains during simulated repetitive lifting and their relation to disc injury. Eight cadaveric lumbar segments underwent a pre-test MRI and 20,000 cycles of loading under combined compression (1.0 MPa), hyperflexion, and right axial rotation (2°), which simulated bending and twisting while lifting a 20 kg box. The remaining eight segments had a grid of tantalum wires inserted and used stereoradiography to calculate maximum shear strain (MSS) at increasing cycles. Post-test MRI revealed that 73% of specimens were injured after repetitive loading (annular protrusion, endplate failure, or lumbar disc herniation). MSS at cycle 20,000 was significantly larger than all earlier cycles (p < 0.003). MSS in the anterior, left posterolateral, and left lateral regions was significantly greater than the nucleus region (p < 0.006). Large strains, annular protrusion and herniation in the posterolateral regions were found in this study, which is consistent with clinical observations. In vitro strains can be used to develop more-robust computational models for understanding of the specimen-specific effects of repetitive lifting on disc tissue.

Motivating operations and stimulus control.

The motivating operations concept has generated substantial conceptual analysis and research interest. Following an analysis of how motivating operations affect behavior, one which emphasizes the interactive role of motivating operations and discriminative stimuli, we propose: a) redefining motivating operations as operations that modulate the reinforcing or punishing effectiveness of particular kinds of events and the control of behavior by discriminative stimuli historically relevant to those events, b) dropping the distinction between behavior-altering and function-altering effects of motivating operations, and c) reducing or eliminating emphasis on conditioned motivating operations. This reconceptualization of the motivating operations concept is intended to increase its value in predicting and gainfully changing behavior.

Inter-Rater Agreement for the Milestones and Barriers Assessments of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP).

We determined inter-rater agreement for the VB-MAPP, an instrument sometimes used in planning educational goals and evaluating intervention effects for young people with autism. A pair of raters independently rated each of 32 children diagnosed with autism. Intraclass correlation coefficients for the total Milestones and Barrier scores were 0.876 and 0.629, respectively, indicating good and moderate reliability. There was variability in reliability in the different domains of the Milestones Assessment, with most indicating moderate reliability, and most of the individual Barriers Assessment domains indicating poor reliability. These are the first data relevant to the reliability of the VB-MAPP, they suggest that further evaluation of its reliability is merited and that a high reliability for individual domains should not be assumed.

Hyponatremia and activation of vasopressin secretion are both independently associated with 30-day mortality: results of a multicenter, observational study.

BACKGROUND: Hyponatremia is a common feature of acute illness and associated with increased mortality. This may be explained by a stress-mediated activation of the vasopressin system with an increase in free-water reabsorption. OBJECTIVES: To investigate whether the association between hyponatremia and mortality could be explained by activation of the vasopressin system. METHODS: We prospectively enrolled adult, medical patients seeking emergency care in three centres in Switzerland, France and the United States. We investigated associations between admission plasma sodium and copeptin, a stable portion of the vasopressin-precursor peptide, with 30-day mortality. We performed uni- and multivariate regression analysis. RESULTS: Of 6962 included patients, 18% had hyponatremia (sodium ≤135 mmol L-1 ), which doubled their risk for mortality compared to patients with normonatremia (8.3% vs. 3.8%). This association was confirmed in a multivariate-adjusted logistic regression analysis [adjusted odds ratio (OR) 1.47, 95% CI 1.12-1.93, P = 0.005]. Vasopressin levels, mirrored by copeptin, were also increased in nonsurvivors and strongly associated with mortality (adjusted OR 3.42, 95% CI 2.76-4.25, P < 0.001). The association between hyponatremia and mortality remained unchanged when adding copeptin levels to the regression model (fully adjusted OR 1.53, 95% CI 1.16-2.00, P = 0.002). CONCLUSION: This prospective study including medical patients upon emergency room admission found hyponatremia as well as an activation of the vasopressin system to be independently associated with mortality. This suggests that stress- and vasopressin-independent mechanisms are responsible for the association of low sodium levels with mortality.

The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study.

AIMS: The clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort. METHODS: We prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA. We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30-day mortality, as well as adverse clinical course stratified by pre-existing diabetes and principal medical diagnoses. RESULTS: In 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30-day mortality [adjusted odds ratio (OR) 1.9; 95% confidence interval (95% CI), 1.1 to 3.3; P = 0.018] and a three-fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI, 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes (n = 1088), no association with 30-day mortality was found (adjusted OR 1.0; 95% CI, 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI, 1.5 to 4.1; P for interaction = 0.011). Overall 30-day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015). CONCLUSIONS: In this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494).

The effect of six degree of freedom loading sequence on the in-vitro compressive properties of human lumbar spine segments.

The complex, direction-dependent, poro-viscoelastic properties of the intervertebral disc (disc) suggest that investigations of the six degree of freedom (6DOF) behaviour may be susceptible to inter-test variation in mechanical response if the disc does not return to initial conditions between loading directions. No studies have quantified the effects of sequential multi-directional loading on the consistency of the compressive response of the disc throughout a 6DOF testing protocol. Therefore, the objective of this study was to determine the effect of 6DOF loading on the compressive properties (stiffness and phase angle) of human discs, as evaluated by a reference compression test performed after each single DOF test. Fourteen intact human functional spinal units (FSU) were tested in each of ±6DOFs (shear directions followed by bending and compression) across four orders of magnitude loading frequencies (0.001-1Hz), followed by reference compression tests while subjected to physiological preload, hydration, and body temperature conditions in a hexapod robot. Repeated measures ANOVA revealed significant within-subjects effects between the reference compression tests for modulus (p<0.001), stiffness (p<0.001), and phase angle (p=0.008). Significant post-hoc pairwise comparisons were initially seen between the control and other reference compression tests for stiffness and modulus after the shear DOFs, however, no significant differences were present after the final reference compression test compared to control. More pronounced effects were seen for stiffness in comparison to modulus and phase angle. These effects may be due to three potentials factors, which include the sequence of testing, the cohort of degenerative specimens, and/or cumulative creep due to the constant application of a follower load. While the sequence of test directions was chosen to minimise the biphasic effect, there may be other sequences, which could result in minimal changes in compressive properties.

Bovine ischaemic teat necrosis: a further potential role for digital dermatitis treponemes.

A recent outbreak of ischaemic teat necrosis (ITN) on mainland UK has resulted in large economic losses for dairy farmers. Typical cases start as an area of dry, thickened and encrusted skin on the medial aspect of the base of the teat, where the teat joins the udder, often with a fetid odour. The erosion spreads down the teat, often causing intense irritation, which in turn leads to more severely affected animals removing the entire teat. Due to the severity of ITN and the substantial economic costs to the industry, analyses were undertaken to ascertain if an infectious agent might be involved in the pathology. The study has considered a role for digital dermatitis (DD) treponemes in the aetiopathogenesis of ITN because, as well as being the prime bacteria associated with infectious lameness, they have been associated with a number of emerging skin diseases of cattle, including udder lesions. A high association between presence of DD-associated treponemes and incidence of ITN (19/22), compared with absence in the control population is reported. Furthermore, sequencing of the 16S rRNA gene of treponeme isolates supports the hypothesis that the identified treponemes are similar or identical to those isolated from classical foot DD lesions in cattle (and sheep). Further studies are required to allow effective targeted prevention measures and/or treatments to be developed.

Elevated Intracranial Pressure Diagnosis with Emergency Department Bedside Ocular Ultrasound.

Bedside sonographic measurement of optic nerve sheath diameter can aid in the diagnosis of elevated intracranial pressure in the emergency department. This case report describes a 21-year-old female presenting with 4 months of mild headache and 2 weeks of recurrent, transient binocular vision loss. Though limited by patient discomfort, fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound (BOUS) revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. Lumbar puncture demonstrated a cerebrospinal fluid (CSF) opening pressure of 54 cm H2O supporting the suspected diagnosis of idiopathic intracranial hypertension. Accurate fundoscopy can be vital to the appropriate diagnosis and treatment of patients with suspected elevated intracranial pressure, but it is often technically difficult or poorly tolerated by the photophobic patient. BOUS is a quick and easily learned tool to supplement the emergency physician's fundoscopic examination and help identify patients with elevated intracranial pressure.

Increasing food deprivation relative to baseline influences D-amphetamine dose-response gradients.

Several studies using non-pharmacological discriminative stimuli have found that stimulus control, as evident in generalization gradients, changes when motivation for (i.e., deprivation of) the relevant reinforcer is altered. Drug-discrimination studies, however, have not consistently revealed such an effect. A procedural detail that may account for the lack of a reliable effect in drug-discrimination studies is that motivation was characteristically reduced relative to the training condition in these studies. The present experiment examined how substantially increasing motivation affects D-amphetamine discrimination. Rats initially were trained to discriminate D-amphetamine (1.0 mg/kg) from vehicle (0 mg/kg) injections under 22-h food deprivation conditions. Dose-response gradients were then obtained under 22-h and 46-h deprivation levels. The ED50 was significantly higher with greater deprivation. This finding suggests that increasing motivation relative to the training condition may reduce stimulus control by drugs, while decreasing it may sharpen stimulus control.