The Many Uses of the Humble Alcohol Swab.

Readily available and comparatively inexpensive, the common alcohol swab can aid dermatologists in everything from diagnosis to preoperative and postoperative care. The 70% isopropyl alcohol swab can aid in the accurate diagnosis of lesions and skin conditions, identification of biopsy sites, and disinfection.

Consistent Visual Analysis of Multielement Data: A Preliminary Evaluation.

Experimenters provided 33 graphical displays of hypothetical data depicted in a multielement experimental design to editorial board members of prominent, applied, behavior-analytic journals via an online survey. For each display, participants indicated (a) the presence or absence of experimental control and (b) the degree of experimental control (rated on a 1-100 scale). Each depiction varied systematically in (a) the number of data paths, (b) the number of data paths elevated above the control, (c) the mean difference between affected data paths and control conditions, and (d) the degree of variability within conditions. Correspondence among experts' ratings of experimental control was high across all presented graphical displays, supporting the reliability of visual analysis as an evaluative tool for these designs.

Comparing paired-stimulus and multiple-stimulus concurrent-chains preference assessments: Consistency, correspondence, and efficiency.

Concurrent-chains preference assessments have been used to assess preferences for leisure activities, teaching strategies, behavioral interventions, and other protracted events. This assessment model involves presenting an array of representative stimuli (e.g., pictures or colored cards), providing participants with an opportunity to select a representative stimulus from the array, arranging access to the associated activity, and then rank-ordering activities based upon their accumulated selection frequency across trials. The predominant model for presenting stimuli has been one in which all stimuli are presented in arrays simultaneously (i.e., a multiple-stimulus model). Activities selected repeatedly are identified as highly preferred and are then sequentially removed from the array to determine a preference hierarchy. The current study compared this approach with an alternative in which representative stimuli were presented to participants in paired arrays. Assessments conducted in the paired-array format were completed more rapidly than the multiple-stimulus format with a high degree of correspondence between preference rankings generated by both approaches.

On the validity of data produced by isolated and synthesized contingencies during the functional analysis of problem behavior.

Functional analyses are intended to identify the reinforcers maintaining problem behavior in order to inform clinicians' selection of interventions. Traditionally, these analyses have exposed problem behavior to multiple, isolated reinforcement contingencies and in doing so, have ruled in and ruled out potential sources of reinforcement. Recently, some functional analysis models have forgone testing individual reinforcement contingencies and instead exposed problem behavior to 2 or more reinforcers simultaneously in a single, synthesized reinforcement contingency. The current review applies assessment analytics to these approaches to consider their relative sensitivity, specificity, discriminant validity, and predictive validity to yield practice recommendations and to nominate areas of future research.

DRA contingencies promote improved tolerance to delayed reinforcement during FCT compared to DRO and fixed-time schedules.

Following Functional Communication Training (FCT), clinicians often gradually expose newly taught communicative responses to delayed reinforcement contingencies to prepare clients for the normative environment in which requests are frequently reinforced after a delay. The introduction of delays may result in the resurgence and maintenance of problem behavior and the weakening of the newly trained communicative response. The current study compared delay tolerance with three individuals diagnosed with intellectual and developmental disabilities when reinforcement for the functional communication response (FCR) was delivered following (a) the passage of time, (b) the omission of problem behavior, or (c) the occurrence of an alternative behavior. We measured delay tolerance in terms of minimizing problem behavior and maintaining efficient FCRs. Outcomes support requiring alternative responding during delays to attain optimal treatment results.

Providing noncontingent, alternative, functional reinforcers during delays following functional communication training.

Functional Communication Training (FCT) involves arranging extinction for problem behavior and reinforcement for a more desirable, functionally equivalent, communicative response (FCR). Although effective under ideal arrangements, the introduction of delays to reinforcement following the FCR can result in increased problem behavior. Austin and Tiger (2015) showed that for individuals whose problem behavior was sensitive to multiple sources of reinforcement, providing access to alternative, functional reinforcers during delays mitigated this increase in problem behavior during delay fading. The current study replicated the procedures of Austin and Tiger with 2 individuals displaying multiply controlled problem behavior. Providing alternative functional reinforcers reduced problem behavior during 10-min delays for both participants without requiring delay fading.

A comparison of accumulated and distributed reinforcement periods with children exhibiting escape-maintained problem behavior.

Differential reinforcement is a common treatment for escape-maintained problem behavior in which compliance is reinforced on a fixed-ratio (FR) 1 schedule with brief access to positive and/or negative reinforcement. Recent research suggests some individuals prefer to complete longer work requirements culminating in prolonged (i.e. accumulated) reinforcement periods relative to brief (i.e. distributed) periods, but prolonged work exposure may evoke problem behavior and prevent compliance from contacting reinforcement when treating escape-maintained problem behavior. We exposed 3 children with escape-maintained problem behavior to both distributed (FR 1 resulting in 30 s of reinforcement) and accumulated (FR 15 resulting in 7.5 min of reinforcement) arrangements to compare their efficacy in maintaining low levels of problem behavior. We then assessed participants' preferences for these conditions in a concurrent-chains arrangement. Accumulated-reinforcement arrangements did not occasion additional problem behavior, but rather resulted in consistently lower levels of problem behavior for 2 of 3 participants. Participants demonstrated idiosyncratic preferences.

A single-institution retrospective evaluation of Mohs incision angles and histopathologic specimen quality.

BACKGROUND: Traditionally, Mohs layers are excised using a beveled incision to facilitate tissue flattening for tangential sectioning. Some surgeons perform non-beveled incisions; however, these specimens may be harder for the histotechnician to process. Limited data exist comparing slide quality between these techniques. METHODS: Retrospective review of cases performed by two Mohs surgeons (surgeon 1 = non-beveled incision; surgeon 2 =  beveled incision) using different incision angles between June 2014 and December 2016. Daily histopathologic slide quality assessment scores (maximum score = 5, minimum score = 1) of the day's first case were compared. RESULTS: About 536 slides (surgeon 1 = 277, surgeon 2 = 259) were evaluated from 2,825 cases. Mean quality assessment scores were similar between surgeons (4.89 and 4.86; P = 0.31) with missing or folded epidermis being the most commonly reported issue for both surgeons. CONCLUSION: Similar slide quality can be achieved via both beveled and non-beveled Mohs cutting angles. While more relaxing incisions may be necessary to optimize tissue flattening with non-beveled incisions, there is no associated increased loss of epidermal margins. The potential benefits of non-beveled incisions, such as minimizing tangentially cut adnexal structures and creating vertical wound edges optimized for repair, may offer an alternative technique with positive clinical implications.

A video-based, flipped classroom, simulation curriculum for dermatologic surgery: A prospective, multi-institution study.

BACKGROUND: Medical education is evolving to emphasize trainee engagement. The impact of a flipped classroom curriculum and surgical simulation on dermatology resident education has not been evaluated. OBJECTIVE: To assess the impact of video education and surgical simulation on dermatology resident procedural skills. METHODS: We created a curriculum on foundational surgical skills for 31 first- and second-year dermatology residents at 3 institutions. The flipped classroom approach replaces traditional in-person lectures with at-home viewing of instructional videos. After this self-directed learning, trainees had 3 hands-on sessions using simulated skin models. The Objective Structured Assessment of Technical Skills (OSATS) instrument was used to assess residents performing a simulated elliptical excision with intermediate repair before and after the curriculum. Residents completed precurriculum and postcurriculum surveys evaluating operative confidence and perceived value of the curriculum. RESULTS: Residents' total OSATS score increased from a median of 27 (interquartile range, 22-38.5) before the curriculum to 46 (interquartile range, 39.5-51.5) after the curriculum (P < .001). Self-reported confidence in surgical performance significantly improved, and residents were highly satisfied. LIMITATIONS: Limitations include the small sample size and potential influence from concurrent learning on surgical rotations. CONCLUSIONS: Video education and simulation are effective for improving dermatology residents' procedural skills. We hope to serve as a template for other institutions and nondermatology trainees hoping to improve procedural skills.

Acquisition and generative responding following print-to-braille construction response training with sighted learners.

Previous researchers have taught sighted adults to match braille sample stimuli to print comparisons in a matching-to-sample (MTS) format and assessed the emergence of other braille repertoires, such as transcribing and reading braille following this training. Although participants learned to match to sample with braille, they displayed limited emergence of other braille repertoires. Lack of generative responding may have resulted from participants' over-selective attending to components of compound braille characters during instruction. We taught undergraduates to construct braille characters given a print sample, which required attending to each individual braille symbol, and assessed generative braille responding. Participants met mastery of 378 braille construction responses and demonstrated modestly improved responding compared with previous research.

Shifting preferences for choice-making opportunities through histories of differential reinforcer quality.

Children of both typical and atypical cognitive development tend to prefer contexts in which their behavior results in a choice of reinforcers rather than a single reinforcer, even when the reinforcer accessed is identical across conditions. The origin of this preference has been attributed speculatively to behavioral histories in which choice making tends to be associated with differentially beneficial outcomes. Few studies have evaluated this claim, and those that have, have yielded mixed results. We provided five preschool-aged children experiences in which choice-making and no-choice contexts were differentially associated with higher preference and larger magnitude reinforcers, and we assessed changes in their preference for choice and no-choice contexts in which outcomes were equated. These conditioning experiences resulted in consistent and replicable shifts in child preference, indicating that preference for choice is malleable through experience.

Topical timolol may improve overall scar cosmesis in acute surgical wounds.

Acute wounds created by dermatologists following the removal of nonmelanoma skin cancers are closed either by primary or secondary intention, and the best cosmetic outcome is preferentially desired. One parameter that determines the overall cosmesis of the healed wound is its vascularity. Vascular tone results from a complex interplay of a variety of chemokines in the body and their interaction with receptors located on endothelial cell surfaces. In this study, our aim was to determine if topical timolol could improve the overall cosmesis of acute surgical wounds. We determined that patients who treated their acute surgical wounds with topical timolol had improved cosmesis compared to control.

Histological Mohs Maps Improve the Accuracy of Dermatology Residents' Interpretations of Mohs Slides: A Pilot Study.

BACKGROUND: Effective Mohs surgery depends on accurate histopathological identification and mapping of tumor burden to ensure complete removal of tumor. OBJECTIVE: The purpose of this study is to evaluate whether using a photograph of the histopathological slide as the Mohs map improves mapping accuracy. MATERIALS AND METHODS: Single-blinded pilot study. Five dermatology residents at one academic institution mapped 11 cases of basal cell carcinoma using both traditional hand-drawn maps and color photographic maps. Residents' marked maps were assessed for global diagnostic accuracy, sensitivity, and specificity compared with the Mohs map verified by the attending surgeon on the day of surgery. RESULTS: Diagnostic accuracy, sensitivity, and specificity were higher using the photographic Mohs maps compared with using the traditional hand-drawn maps (58.2% vs 29.1%, 84.5% vs 76.4%, and 87.1% vs 70.8%, respectively). These results were statistically significant for accuracy and specificity, but not for sensitivity. CONCLUSION: Using histopathological photographs as the Mohs map significantly improved accuracy and specificity within a small group of residents with limited Mohs experience. More research is warranted to evaluate whether using histopathological photographs improves accuracy of Mohs mapping for experienced Mohs surgeons in a real-world setting, and whether this translates to improved clinical outcomes.

Teaching identity matching of braille characters to beginning braille readers.

We taught three children with visual impairments to make tactile discriminations of the braille alphabet within a matching-to-sample format. That is, we presented participants with a braille character as a sample stimulus, and they selected the matching stimulus from a three-comparison array. In order to minimize participant errors, we initially arranged braille characters into training sets in which there was a maximum difference in the number of dots comprising the target and nontarget comparison stimuli. As participants mastered these discriminations, we increased the similarity between target and nontarget comparisons (i.e., an approximation of stimulus fading). All three participants' accuracy systematically increased following the introduction of this identity-matching procedure.

Assessing generative braille responding following training in a matching-to-sample format.

We evaluated the effects of teaching sighted college students to select printed text letters given a braille sample stimulus in a matching-to-sample (MTS) format on the emergence of untrained (a) construction of print characters given braille samples, (b) construction of braille characters given print samples, (c) transcription of print characters given braille sample sentences, and (d) vocal reading given braille sample passages. The results demonstrated the generative development of these repertoires given MTS instruction.

Patient Satisfaction After Mohs Surgery is not Dependent on Seeing Post-Mohs Defect Prior to Repair.

BACKGROUND: Optimizing patient satisfaction and scar outcomes is important for the practicing Mohs surgeon. OBJECTIVE: To evaluate whether showing or not showing patients their post-Mohs defect prior to repair influences scar satisfaction. MATERIALS AND METHODS: Fifty patients with a nonmelanoma skin cancer on their head or neck requiring Mohs micrographic surgery were randomized to either see or not see their post-Mohs defect in the mirror prior to repair. Patients evaluated their scar at Week 1 and Week 4 using the patient scar assessment questionnaire. RESULTS: There was no statistically significant difference in the primary (scar satisfaction) or secondary outcomes (wound care compliance and complication rates) between the two groups. CONCLUSION: There is no difference in patient scar satisfaction whether patients see or do not see their post-Mohs defect prior to repair.