No abstract

The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. This is due to an increased risk of venous stasis secondary to paralysis as well as an increased prevalence of underlying pathologies that cause endothelial activation and create an increased risk of embolus formation. In many of these diseases, there is an associated risk from bleeding because of standard VTE prophylaxis. There is a paucity of prospective studies examining different VTE prophylaxis strategies in the neurologically ill. The lack of a solid evidentiary base has posed challenges for the establishment of consistent and evidence-based clinical practice standards. In response to this need for guidance, the Neurocritical Care Society set out to develop and evidence-based guideline using GRADE to safely reduce VTE and its associated complications.

We studied the relation between the presence versus the absence of sleep deprivation or allergy symptoms and the rate and function of problem behavior. Three students whose problem behavior was negatively reinforced by escape from instruction were studied across several weeks using analogue functional analyses. Our results indicated that the extraexperimental events were associated with (a) termination of instruction functioning as a negative reinforcer, (b) METHOD Participants and SettingMarcello was 15 years old, ambulatory, and diagnosed as profoundly retarded, and had a 12-year history of head banging and hitting others or objects. Mimi was 18 years old, ambulatory, and diagnosed with moderate retardation, and hit others and threw objects. Rudolfo was 13 years old, nonambulatory, and diagnosed as profoundly retarded, and bit his arms and hands. No participant was taking prescription medication.Sessions were conducted in classrooms with similar dimensions (9 m square) and arrangements (several tables and chairs were present). Allergy Symptoms and Sleep DeprivationUsing descriptive analyses and interviews, allergy symptoms (Rudolfo) and sleep deprivation (Marcello and Mimi) were identified as events correlated with elevated rates of problem behavior. For Rudolfo, allergy symptoms included the presence of swollen, reddened, and irritated eyes and excess nasal mucous. For Marcello, sleep deprivation occurred when he stayed awake past his typical bedtime (i.e., until 2:00 a.m. to 3:00 a.m.), and often proceeded to attack his mother from the time he awakened until he depart-133

We studied behavioral functions associated with stereotypical responses for students with autism. In Study 1, analogue functional analyses (attention, demand, no-attention, and recreation conditions) were conducted for 5 students. Results suggested that stereotypy was multiply determined or occurred across all assessment conditions. For 2 students, stereotypy was associated with positive and negative reinforcement and the absence of environmental stimulation. For 2 other students, stereotypy occurred at high levels across all experimental conditions. For the 5th student, stereotypy was associated with negative reinforcement and the absence of environmental stimulation. In Study 2, the stereotypy of 1 student was further analyzed on a function-by-function basis. Within a concurrent-schedules procedure, alternative responses were taught to the student using functional communication training. The results of Study 2 showed that similar topographies of stereotypy, based on qualitatively different reinforcers, were reduced only when differential reinforcement contingencies for alternative forms of communication were implemented for specific response-reinforcer relations. Our results suggest that the causes of stereotypy for students with autism are complex and that the presumed association between response topography and behavioral function may be less important than previously realized.

A functional analysis involving antecedent events was conducted with 4 students who had been identified as having behavior problems. Off-task behavior was measured while task difficulty and level of adult attention were manipulated during analogue sessions. Results revealed two patterns: Three students displayed higher rates of off-task behavior during difficult tasks, and 1 displayed higher rates of off-task behavior during sessions with low attention. Improved behavior was observed when students were taught an alternative behavior that matched the assessment results.