Five students classified as profoundly/multiply handicapped were trained to use microswitches to indicate reinforcer preferences. The students were trained to emit a designated motoric response (raise arm or raise head) which in turn activated a microswitch. The microswitches were connected to battery-operated toys and devices, and served to provide immediate, contingent consequences to the students for their motoric responding. The results of the investigation were evaluated within a multiple baseline (across students) with alternating treatments (potential reinforcers) design. During baseline, the students were provided with the switches and devices, but the switches were not connected to the devices. During the training conditions, the switches activated the devices. Evaluation of the devices was conducted by recording the cumulative frequency and duration of the students' responses. When the microswitches activated the devices during training, a substantial increase in the duration of motoric responding occurred for all students. In addition, some students performed differentially across devices, suggesting that they had reinforcer preferences.

For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information. A survey of family members indicated that receiving the card reduced anxiety in a significant proportion of the respondents.

Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact. By involving and educating staff, the investigators raised awareness and improved the process of identifying and helping depressed patients. The lessons in study design and execution gained from this experience will help ensure success in future studies of this condition.

Many land-grant universities are examining approaches to community engagement to better align with the US land-grant mission of knowledge democratization. With a growing majority of the United States’ population living in urbanized spaces, it is a societal imperative for university engagement initiatives to devise strategies for engaging people on the complexity of urban issues central to individual and community wellbeing. Effective urban engagement demands collaboration and strong relationships with urban organizations and residents to co-create approaches to urban concerns. Through narrative-based inquiry, we explore urban engagements within Penn State Extension (PSE) across the Commonwealth of Pennsylvania (USA). PSE, located administratively in the College of Agricultural Sciences, is charged with carrying out Penn State’s land-grant commitment to serve Pennsylvania’s citizens through community engagement and nonformal education in the agricultural and food, human, and social sciences. We examine extension educator and faculty practices, program development, community engagements, and experiences, and those of community stakeholders. This work draws upon democratic methods to uncover the undergirding philosophies of engagement within PSE and how communities experience those engagements. This project offers an entry-point to longer-term applied research to develop a broadly applicable theory and praxis of translational research, engagement, and change privileging urban community resilience.

We initiated a study at Baylor Jack and Jane Hamilton Heart and Vascular Hospital to compare the sliding scale insulin (SSI) protocol used in 2006 with the SSI protocol currently used to treat diabetic patients admitted for procedures or surgery. An audit of patients' records revealed greater variation in staff compliance with the current protocol than with the previous one. In addition, it seemed that more patients were refusing insulin coverage under the current protocol than under the prior version. Although the study was aborted, the initial findings motivated us to identify obstacles to glucose control and to launch a health care improvement initiative to increase compliance with the SSI protocol. As a result of this process, the hospital has made several changes, including re-educating staff nurses, initiating competency checks of protocol interpretation, promoting patient education, and implementing early identification of inconsistent glucose control.