Further evidence of renewal in automatically maintained behavior.

Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self-injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self-injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization.

Repetitive Speech and Problem Behavior: Functional Analysis of Precurrent Contingencies.

When mands and problem behavior co-occur within an individual's repertoire, a functional analysis of precurrent contingencies helps to identify any relation between the two responses, as well as the function of problem behavior. Repetitive behaviors may function similarly to mands and also co-occur with problem behavior; particularly when repetitive behavior is blocked, or when caregivers refrain from participating in repetitive behavior episodes (e.g., the repetitive behavior involves a verbal or physical interaction with a caregiver). The current study presents assessment and treatment results for two participants diagnosed with autism, who demonstrated repetitive speech and problem behavior. Informal observations suggested that problem behavior occurred when an adult failed to emit a specific response to the participant's repetitive speech. Functional analysis results confirmed the informal observations and suggested that problem behavior functioned as a precurrent response to increase the probability of reinforcement for repetitive speech. We report treatment results and discuss the application of precurrent contingency analyses for problem behavior and repetitive behavior.

A replication and extension of the augmented competing stimulus assessment.

Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.

Percutaneous Cystolitholapaxy Is Safe and Effective in Adult Patients With Lower Urinary Tract Reconstruction Utilizing Bowel.

OBJECTIVE: To investigate the safety, efficacy, and surgical approach of percutaneous bladder calculi removal in adult patients with prior lower urinary tract reconstruction utilizing bowel using a single-institution database. METHODS: Twenty patients with prior history of lower urinary tract reconstruction (continent cutaneous urinary reservoir, augmentation enterocystoplasty with catheterizable channel, or ileal neobladder) who underwent percutaneous cystolitholapaxy from 2014 to 2020 were identified from an IRB-approved database. Analysis of patient demographics, operative details, stone composition, stone-free rates, recurrence, and associated complications was performed. RESULTS: Percutaneous access and either ultrasonic lithotripter or laser lithotripsy were utilized to remove bladder stones. Over half of the patients also underwent concomitant renal stone removal via percutaneous removal or retrograde ureteroscopy. Postoperative computed tomography imaging revealed complete bladder stone clearance in 90% of patients. There were no notable complications from percutaneous bladder stone removal and most patients were discharged either the same day or within 24hours. Urine and stone analysis revealed infection was present in the majority of patients. Bladder stones recurred in 45% of patients after more than 2years of follow-up, on average. CONCLUSION: Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution.

Efficiency of lagoon-based municipal wastewater treatment in removing microplastics.

Municipal wastewater treatment plants act as a sink, but also are a source of microplastics in the environment. A conventional wastewater lagoon system and an activated sludge (AS)-lagoon system in Victoria (Australia) were investigated through a two-year sampling program to understand the fate and transport of MP in such treatment processes. The abundance (>25 µm) and characteristics (size, shape, and colour) of the microplastics present in the various wastewater streams were determined. The mean values of MP in the influent of the two plants were 55.3 ± 38.4 and 42.5 ± 20.1 MP/L, respectively. The dominant MP size of influent and final effluent was <500 µm, with 25-200 µm accounting for >65 % of the total MP; synthetic fibres were the dominant MP in all wastewater streams. Influent MP concentration was significantly higher in summer than in other seasons for both systems, which was related to the lower plant inflow due to less stormwater entering the sewer during summer. The promising MP removal capability of the lagoon system (97 %) was attributed to its lengthy wastewater detention time (total HRT >250 days, including the storage lagoons) that would allow effective separation of MP from the water column via various physical and biological pathways. For the AS-lagoon system, the high MP reduction efficiency (98.4 %) was attributed to the post-secondary treatment of the wastewater with the lagoon system, in which MP was further removed during the month-long detention in the lagoons. The results indicated the potential of such low-energy and low-cost wastewater treatment systems for MP control.

Machine-Learning-Assisted Determination of the Global Zero-Temperature Phase Diagram of Materials.

Crystal-graph attention neural networks have emerged recently as remarkable tools for the prediction of thermodynamic stability. The efficacy of their learning capabilities and their reliability is however subject to the quantity and quality of the data they are fed. Previous networks exhibit strong biases due to the inhomogeneity of the training data. Here a high-quality dataset is engineered to provide a better balance across chemical and crystal-symmetry space. Crystal-graph neural networks trained with this dataset show unprecedented generalization accuracy. Such networks are applied to perform machine-learning-assisted high-throughput searches of stable materials, spanning 1 billion candidates. In this way, the number of vertices of the global T = 0 K phase diagram is increased by 30% and find more than ≈150 000 compounds with a distance to the convex hull of stability of less than 50 meV atom-1 . The discovered materials are then accessed for applications, identifying compounds with extreme values of a few properties, such as superconductivity, superhardness, and giant gap-deformation potentials.

Investigating the fate and transport of microplastics in a lagoon wastewater treatment system using a multimedia model approach.

Effluents of municipal wastewater treatment plants (WWTPs) are a major source of microplastics (MP) in the terrestrial and aquatic environment; there is growing concern over the environmental and health impacts of MP pollution. In this study, the MP removal (MP cut-off size= 25 µm) in a lagoon-based wastewater treatment system was predicted by developing a model based on the multimedia modelling approach and utilising MP-specific properties for improving the understanding of the fate and transport of MP in such treatment processes. The high MP removal efficiency of the lagoon treatment system as predicted by the model (99.3%) and determined with the site wastewater samples (97%) could be attributed to its high HRT (>200 days, including that for the storage lagoons) that would allow effective MP removal with the system. Evaluation of the model predictions of MP concentration demonstrated reasonable alignment with measured concentrations in the facultative, maturation and winter storage lagoons of the system. Further evaluation of model predictions for various MP size classes (25-100, 100-200, 200-500 and >500 µm) obtained reasonable predictions for MP within the size range of 25-500 µm, indicating that the model is better used for predicting MP within that size range. The sensitivity analysis revealed the model predictions to be sensitive towards the operating/water quality parameters in the order of influent wastewater flowrate, MP concentration in influent wastewater, and MP settling rate in the water column of the lagoon. The study showed the potential of the developed model as a quantitative assessment tool for better management of MP in lagoon-based WWTPs.

Early and Midterm Complications of the Continent Catheterizable Indiana Pouch Urinary Diversion: A 7-year Experience.

OBJECTIVES: To describe the most recent 7 year experience with 137 Indiana pouch patients at a single institution and provide data on complications with this type of urinary diversion during the first postoperative year. METHODS: We queried our bladder cancer database to identify all patients who underwent cystectomy with continent catheterizable urinary reservoir between 2012 and 2018. Pre-, intra-, and postoperative data were collected. Complications were stratified into early (within 90 days) and midterm (90-365 days). The primary outcomes were postoperative complications, and overall and cancer-specific mortality. RESULTS: A total of 137 patients underwent open cystectomy with Indiana pouch creation. Of these, 93% were radical cystectomies. On average, the operation took 422 minutes. There were 53 (39%) patients who experienced any type of complication during the first postoperative year (Clavien II-V). Twenty-five patients (18.2%) readmitted in the early postoperative period vs 18 (13.1%) patients midterm. There were 10 (7.3%) patients that required early reoperation and 11 (8%) in the midterm period. The overall mortality rate was 1.5% early and 3.7% midterm, with the majority of the mortality rate attributed to cancer progression (85.7%). CONCLUSION: Patients undergoing continent catheterizable reservoir urinary diversion appear to have comparable complication rates to other urinary diversions published in the literature. At high-volume urologic institutions, Indiana Pouch creation is a suitable option for select patients desiring a continent diversion.

A dataset of 175k stable and metastable materials calculated with the PBEsol and SCAN functionals.

In the past decade we have witnessed the appearance of large databases of calculated material properties. These are most often obtained with the Perdew-Burke-Ernzerhof (PBE) functional of density-functional theory, a well established and reliable technique that is by now the standard in materials science. However, there have been recent theoretical developments that allow for increased accuracy in the calculations. Here, we present a dataset of calculations for 175k crystalline materials obtained with two functionals: geometry optimizations are performed with PBE for solids (PBEsol) that yields consistently better geometries than the PBE functional, and energies are obtained from PBEsol and from SCAN single-point calculations at the PBEsol geometry. Our results provide an accurate overview of the landscape of stable (and nearly stable) materials, and as such can be used for reliable predictions of novel compounds. They can also be used for training machine learning models, or even for the comparison and benchmark of PBE, PBEsol, and SCAN.

Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate.

Abstract Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial. We now present an expanded update after widespread adoption at our facility. Methods: We reviewed patients who underwent same day catheter removal after HoLEP between January 1, 2020 and March 21, 2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. Results: The success rate of same day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 ± 8.6 years and prostate volume was 109.2 ± 61.5 cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with American Society of Anesthesiology score (ASA) 3 or 4 failed catheter removal compared with 3.9% of patients with ASA 1 or 2 (likelihood ratio 9.32, p = 0.002), ASA status lost significance on multivariate analysis (p = 0.076). Effective catheter removal was not significantly associated with age, body mass index, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, American Urologic Association symptom score, prior BPH surgery, or prostate cancer in final pathology report. Conclusion: Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.

Crystal graph attention networks for the prediction of stable materials.

Graph neural networks for crystal structures typically use the atomic positions and the atomic species as input. Unfortunately, this information is not available when predicting new materials, for which the precise geometrical information is unknown. We circumvent this problem by replacing the precise bond distances with embeddings of graph distances. This allows our networks to be applied directly in high-throughput studies based on both composition and crystal structure prototype without using relaxed structures as input. To train these networks, we curate a dataset of over 2 million density functional calculations of crystals with consistent calculation parameters. We apply the resulting model to the high-throughput search of 15 million tetragonal perovskites of composition ABCD2. As a result, we identify several thousand potentially stable compounds and demonstrate that transfer learning from the newly curated dataset reduces the required training data by 50%.

Unhappy Triad: Infection with Leptospira spp. Escherichia coli and Bacteroides uniformis Associated with an Unusual Manifestation of Portal Vein Thrombosis.

Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. We report on a 76-year-old German male who was admitted with a history of recurrent fever and acute renal failure. Blood cultures taken on admission showed Escherichia coli, as well as Bacteroides uniformis after an extended incubation period of 90 h. In addition, infection with Leptospira spp. was diagnosed serologically. Computerized tomography of the abdomen revealed an extensive PVT along with signs of colonic diverticulitis. Symptoms resolved under prolonged antimicrobial therapy with beta-lactams and adequate heparinization. A myeloproliferative disorder could be excluded. There was no evidence of an underlying coagulation disorder. Imaging controls showed an almost complete resolution of the PVT after 6 months of anticoagulation therapy. To the best of our knowledge, this is the first report of such an "unhappy triad," which includes atypical manifestations of leptospirosis and involvement of other intestinal bacteria.

Passive Sampling of SARS-CoV-2 for Wastewater Surveillance.

The shedding of pathogens by infected humans enables the use of sewage monitoring to conduct wastewater-based epidemiology (WBE). Although most WBE studies use data from large sewage treatment plants, timely data from smaller catchments are needed for targeted public health action. Traditional sampling methods, like autosamplers or grab sampling, are not conducive to quick ad hoc deployments and high-resolution monitoring at these smaller scales. This study develops and validates a cheap and easily deployable passive sampler unit, made from readily available consumables, with relevance to the COVID-19 pandemic but with broader use for WBE. We provide the first evidence that passive samplers can be used to detect SARS-CoV-2 in wastewater from populations with low prevalence of active COVID-19 infections (0.034 to 0.34 per 10,000), demonstrating their ability for early detection of infections at three different scales (lot, suburb, and city). A side by side evaluation of passive samplers (n = 245) and traditionally collected wastewater samples (n = 183) verified that the passive samplers were sensitive at detecting SARS-CoV-2 in wastewater. On all 33 days where we directly compared traditional and passive sampling techniques, at least one passive sampler was positive when the average SARS-CoV-2 concentration in the wastewater equaled or exceeded the quantification limit of 1.8 gene copies per mL (n = 7). Moreover, on 13 occasions where wastewater SARS-CoV-2 concentrations were less than 1.8 gene copies per mL, one or more passive samplers were positive. Finally, there was a statistically significant (p < 0.001) positive relationship between the concentrations of SARS-CoV-2 in wastewater and the levels found on the passive samplers, indicating that with further evaluation, these devices could yield semi-quantitative results in the future. Passive samplers have the potential for wide use in WBE with attractive feasibility attributes of cost, ease of deployment at small-scale locations, and continuous sampling of the wastewater. Further research will focus on the optimization of laboratory methods including elution and extraction and continued parallel deployment and evaluations in a variety of settings to inform optimal use in wastewater surveillance.

Correction to: Assessment and Treatment of Challenging Behavior Maintained by a Nonvocal Mands Function.

[This corrects the article DOI: 10.1007/s40617-020-00486-z.].

Decreasing motor stereotypy with competing stimuli and tasks: Analysis of prompted engagement and response blocking.

Competing stimulus assessments (CSAs) are used to empirically identify stimuli associated with low levels of problem behavior. For some individuals with automatically maintained behavior, it can be difficult to identify effective competing stimuli. Recent research shows that prompting engagement and response blocking can be employed during the CSA to obtain significant reductions in problem behavior. The purpose of the present study was to replicate and extend prior research on the use of these tactics not only with competing stimuli, but also competing tasks, which require the active completion of a discrete response or response sequence. In addition, the current study validated the results of these pretreatment assessments in an extended treatment analysis, and examined the isolated and combined effects of prompting and response blocking within a component analysis. Future research directions and implications for clinical practice are discussed.

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting.

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

Assessment and Treatment of Noise Hypersensitivity in a Teenager with Autism Spectrum Disorder: A Case Study.

Noise hypersensitivity is a poorly understood symptom of Autism Spectrum Disorder (ASD). For some, problem behaviors co-occur with the aversive noise. Limited literature exists on treating noise hypersensitivity; however, noise hypersensitivity may be related to a specific phobia. This case study utilizes modified Cognitive Behavioral Therapy (CBT) to address anxiety, avoidance, and problem behaviors evoked by noise in a teen with ASD and mild Intellectual Disability (ID). Using multi-method assessment and individualized treatment, problem behaviors reduced, and independent coping strategies use occurred. Successful desensitization supports the efficacy of modified CBT as a treatment for noise-related anxiety and problem behaviors in individuals with ASD and ID. Outcomes are discussed considering intervention difficulties for noise hypersensitivity in a complex and diverse population.

A Clinical Demonstration of Correlational and Experimental Analyses of Precursor Behavior.

Individuals with intellectual and developmental disabilities are at an increased risk for engaging in severe problem behavior, which is often preceded by less intense precursor behaviors. These precursor behaviors may be a viable option as target behaviors for functional analyses in situations where evoking severe problem behavior is not ideal. We identified precursor behaviors through a correlational analysis and confirmed their membership in the same response class as more severe problem behavior through an experimental analysis.

Assessment and Treatment of Challenging Behavior Maintained by a Nonvocal Mands Function.

Standard functional analysis procedures may require modifications to assess idiosyncratic variables, such as adult compliance with mands. In the literature, the mands function is largely represented by individuals who vocally communicate idiosyncratic requests. Although effective treatment procedures have been published, schedule thinning has rarely been conducted. Using a reversal design, a mands functional analysis was completed with a 12-year-old nonvocal male. Results showed differentiated rates of challenging behavior. Treatment consisted of differential reinforcement via a chained schedule with signaled availability. During schedule thinning, low rates of challenging behavior were maintained.

Characterization of an unbalanced translocation causing 3q28qter duplication and 10q26.2qter deletion in a patient with global developmental delay and self-injury.

Chromosomal structural variation can cause severe neurodevelopmental and neuropsychiatric phenotypes. Here we present a nonverbal female adolescent with severe stereotypic movement disorder with severe problem behavior (e.g., self-injurious behavior, aggression, and disruptive and destructive behaviors), autism spectrum disorder, severe intellectual disability, attention deficit hyperactivity disorder, and global developmental delay. Previous cytogenetic analysis revealed balanced translocations present in the patient's apparently normal mother. We hypothesized the presence of unbalanced translocations in the patient due to maternal history of spontaneous abortions. Whole-genome sequencing and whole-genome optical mapping, complementary next-generation genomic technologies capable of the accurate and robust detection of structural variants, identified t(3;10), t(10;14), and t(3;14) three-way balanced translocations in the mother and der(10)t(3;14;10) and der(14)t(3;14;10) translocations in the patient. Instead of a t(3;10), she inherited a normal maternal copy of Chromosome 3, resulting in an unbalanced state of a 3q28qter duplication and 10q26.2qter deletion. Copy-imbalanced genes in one or both of these regions, such as DLG1, DOCK1, and EBF3, may contribute to the patient's phenotype that spans neurodevelopmental, musculoskeletal, and psychiatric domains, with the possible contribution of a maternally inherited 15q13.2q13.3 deletion.