Safety and Feasibility of a Protocolized Daily Assessment of Readiness for Liberation From Venovenous Extracorporeal Membrane Oxygenation.

Background: Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO.

Research Question: Is a protocolized daily assessment of readiness to liberate from venovenous ECMO safe and feasible?

Study Design And Methods: We conducted a prospective, single-arm safety and feasibility study of a protocol for daily assessment of readiness to liberate from venovenous ECMO among consecutive adult patients receiving venovenous ECMO across four ICUs at a single center between June 20, 2020, and November 24, 2020.

Randomized Clinical Trial of an ICU Recovery Pilot Program for Survivors of Critical Illness.

Objectives: To examine the effect of an interdisciplinary ICU recovery program on process measures and clinical outcomes.

Design: A prospective, single-center, randomized pilot trial.

Setting: Academic, tertiary-care medical center.

Language preference and reinforcing efficacy of praise in bilingual children with disabilities.

We conducted a stimulus preference assessment to identify preference for praise delivered in English versus Spanish for bilingual students. Next, a concurrent-operant reinforcer assessment was used to evaluate the reinforcer efficacy of praise in each language. Participants showed limited to no preference for one language over another.

Implementation of interventions informed by precursor functional analyses with young children: A replication.

Individuals who engage in problem behavior may also engage in precursor behavior maintained by the same functional reinforcers as the more severe target problem behavior. This study replicates and extends previous research by examining precursor assessments and interventions with three preschool-aged children. We conducted assessments to identify precursor behavior, and conducted subsequent functional analyses targeting the precursor behavior.

Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center.

Purpose: To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States.

Materials And Methods: A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care.

Behavioral Interventions for Inappropriate Sexual Behavior in Individuals With Developmental Disabilities and Acquired Brain Injury: A Review.

Inappropriate sexual behavior (ISB) is a common, but understudied, issue for individuals diagnosed with developmental disabilities (DD), intellectual disability (ID), and/or acquired brain injuries (ABI). We conducted a systematic review to identify, analyze, and synthesize published behavior-analytic approaches to intervention for ISB in DD, ID, or ABI populations. Twenty-three studies employing single-subject research methodology were identified and evaluated using quality indicators described by Horner et al.

Manipulating parameters of reinforcement to reduce problem behavior without extinction.

Differential reinforcement of alternative behavior (DRA) most often includes extinction as a treatment component. However, extinction is not always feasible and it can be counter-therapeutic if implemented without optimal treatment integrity. Researchers have successfully implemented DRA without extinction by manipulating various parameters of reinforcement such that alternative behavior is favored.

Critical Care Pharmacists and Medication Management in an ICU Recovery Center.

Background: Many patients experience complications following critical illness; these are now widely referred to as post-intensive care syndrome (PICS). An interprofessional intensive care unit (ICU) recovery center (ICU-RC), also known as a PICS clinic, is one potential approach to promoting patient and family recovery following critical illness.

Objectives: To describe the role of an ICU-RC critical care pharmacist in identifying and treating medication-related problems among ICU survivors.

Preference and reinforcer efficacy of high- and low-tech items: A comparison of item type and duration of access.

This study examined the interactions of stimulus type (high- vs. low-tech) and magnitude (duration of access) on preference and reinforcer efficacy. Two preference assessments were conducted to identify highly preferred high-tech and low-tech items for each participant.

A Clinic Model: Post-Intensive Care Syndrome and Post-Intensive Care Syndrome-Family.

The number of patients surviving critical illness in the United States has increased with advancements in medicine. Post-intensive care syndrome and post-intensive care syndrome-family are terms developed by the Society of Critical Care Medicine in order to address the cognitive, psychological, and physical sequelae emerging in patients and their families after discharge from the intensive care unit. In the United Kingdom and Europe, intensive care unit follow-up clinics have been used to address the complications of post-intensive care syndrome for some time.

Implications for practice: Resurgence and differential reinforcement of alternative responding.

During the maintenance stages of differential reinforcement of alternative responding (DRA), failure to reinforce alternative responses could result in a resurgence of problem behavior. However, translational work done with arbitrary human responses suggests that teaching individuals to emit multiple alternative responses in sequential order may facilitate the resurgence of appropriate, rather than problem, behavior. This paper discusses the practical implications of serial DRA training on problem and appropriate behavior resurgence, as presented in the preceding article, "Serial Alternative Response Training As Intervention for Target Response Resurgence.

Serial alternative response training as intervention for target response resurgence.

Failure to reinforce appropriate behavior could result in resurgence of previously extinguished problem behavior and degradation of previously effective treatments such as differential reinforcement of alternative behavior (DRA). We analyzed arbitrary responses (i.e.

Generalization of negatively reinforced mands in children with autism.

Each day, people encounter stimuli they find unpleasant. Some children with autism may require systematic instruction to acquire the communication skills necessary to request the termination of such aversive stimuli. We taught 2 school-aged boys with autism a mand (e.

Cultural and Linguistic Diversity in Recent Verbal Behavior Research on Individuals with Disabilities: a Review and Implications for Research and Practice.

The number of individuals from various culture and language backgrounds who are receiving behavior-analytic services is growing. Therefore, a behavioral understanding of the role of cultural and linguistic diversity (CLD) in language acquisition may be warranted. We searched recent editions of The Analysis of Verbal Behavior and the Journal of Applied Behavior Analysis to determine the degree to which researchers report the CLD of individuals with disabilities who participate in verbal behavior research.

Training residential staff and supervisors to conduct traditional functional analyses.

In this study we extended a training outlined by Iwata to behavioral technicians working for a residential service provider for adults with developmental disabilities. Specifically, we trained ten supervisors and four assistants to organize, conduct, collect data for, and interpret the results of traditional functional analyses (FA; Iwata et al.,1994).

Evaluation of some components of choice making.

Providing access to choice-making opportunities is a useful addition to behavioral interventions, although the critical features of choice making may differ greatly across individuals. In this study, results of an initial 3-choice concurrent-operants preference assessment with 4 subjects with autism spectrum disorder suggested that 2 subjects preferred the choice-making condition and participated in subsequent assessments to examine the potential influences of reinforcer variability and differential access to high-preference reinforcers on their preferences for choice making. Two other subjects did not prefer the choice-making condition and participated in subsequent assessments to explore conditions under which they might prefer choice-making opportunities.

Training residential staff to conduct trial-based functional analyses.

We taught 6 supervisors of a residential service provider for adults with developmental disabilities to train 9 house managers to conduct trial-based functional analyses. Effects of the training were evaluated with a nonconcurrent multiple baseline. Results suggest that house managers can be trained to conduct trial-based functional analyses with a high degree of procedural fidelity.

Teacher-conducted trial-based functional analyses as the basis for intervention.

Previous studies have focused on whether a trial-based functional analysis (FA) yields the same outcomes as more traditional FAs, and whether interventions based on trial-based FAs can reduce socially maintained problem behavior. We included a full range of behavior functions and taught 3 teachers to conduct a trial-based FA with 3 boys with developmental and intellectual disabilities who engaged in problem behavior. Based on the results of the trial-based FAs, we developed and conducted 5 function-based interventions, using differential reinforcement of an alternative behavior and extinction in all but 1 case.

Experimental analysis of precursors to severe problem behavior.

Some individuals engage in both mild and severe forms of problem behavior. Research has shown that when mild behaviors precede severe behaviors (i.e.

Effects of fixed versus random condition sequencing during multielement functional analyses.

It has been suggested that a fixed condition sequence might facilitate differential responding during multielement functional analyses (FAs) by capitalizing on or limiting sequence effects (Iwata, Pace, et al., 1994); however, the effects of condition sequence have not been examined empirically. We conducted fixed- and random-sequence FAs for 7 individuals with developmental disabilities to determine the relative effects that sequence may have on assessment outcomes.

Training teachers to conduct trial-based functional analyses.

The trial-based functional analysis (FA) is a promising approach to identification of behavioral function and is especially suited for use in educational settings. Not all studies on trial-based FA have included teachers as therapists, and those studies that have, included minimal information on teacher training. The purpose of this study was to determine whether teachers trained via an in-service training would be able to conduct trial-based FAs with high procedural integrity.

Computer-assisted measurement of wound size associated with self-injurious behavior.

We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self-injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models.

Effects of preference and reinforcer variation on within-session patterns of responding.

We examined correspondence between preference assessment outcome and within-session patterns of responding in one subject with autism. Responding maintained by a single highly preferred item resulted in a greater total number of responses, a slower decline in within-session response rates, and a greater proportion of short interresponse times compared to responding maintained by varied moderately preferred (MP) stimuli. Presenting varied MP stimuli within the same session produced greater levels and more sustained responding than presenting those same stimuli individually.