Multidrug-Resistant Shigella sonnei Bacteremia among Persons Experiencing Homelessness, Vancouver, British Columbia, Canada.

Increased invasive bloodstream infections caused by multidrug resistant Shigella sonnei were noted in Vancouver, British Columbia, Canada, during 2021-2023. Whole-genome sequencing revealed clonal transmission of genotype 3.6.1.1.2 (CipR.MSM5) among persons experiencing homelessness. Improvements in identifying Shigella species, expanding treatment options for multidrug resistant infections, and developing public health partnerships are needed.

Targeted management of influenza A/B outbreaks incorporating the cobas® Influenza A/B & RSV into the virology laboratory.

During the 2017/18 influenza season, the authors' virology laboratory implemented the cobas® Influenza A/B & RSV (Roche Molecular Diagnostics, Pleasanton, CA, USA) for influenza outbreak management in two scenarios: initial outbreak investigation or at outbreak conclusion to avoid prolonged measures. Twenty-seven investigations were conducted, including declaration of 11 influenza A/B outbreaks. Thirty percent of investigations would have missed the standard batched daily laboratory-developed respiratory polymerase chain reaction (PCR), and delayed outbreak confirmation until the following day. The average reduction in turnaround time for influenza A/B testing was 10.2 h. A rapid molecular PCR in specific outbreak scenarios improved timely management of influenza outbreaks.

Automated coaching to help parents increase their children's brushing frequency: an exploratory trial.

UNLABELLED: Advances in digital communication, such as the internet, now provide a cost effective channel to reach and help families struggling to establish good oral hygiene in their homes. This paper describes a novel internet based oral hygiene intervention whose design draws from advances in social cognitive models of behaviour change. Intervention components included role-modelling cartoons for children, a guide for parents on using rewards, a personalised plan with clear steps, tips to follow and a weekly 10-minute review of progress. OBJECTIVE: To evaluate the efficacy of the online coaching programme; specifically we expected that those in the intervention group would brush their teeth more frequently during the intervention period than those in the control group. BASIC RESEARCH DESIGN: An exploratory trial using a randomised controlled parallel approach. PARTICIPANTS: Children aged 5 to 9 years from 44 families (23 control and 21 intervention). MAIN OUTCOME MEASURE: An objective monitoring of tooth brushing. RESULTS: In the 3-week intervention period, children from families assigned to the coaching programme brushed their teeth 38% more often than those in the control group. CONCLUSIONS: The programme was effective in a number of respects. Opportunities for further research are discussed, including the need to create a more engaging system and so increase compliance.

Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia, Canada: a 10-year review.

Between 1998 and 2007, records from 33 patients with cutaneous diphtheria from Vancouver's inner city were reviewed. Cases were associated with injection drug use and poverty. Coinfections with Staphylococcus aureus, Streptococcus pyogenes, and Arcanobacterium haemolyticum occurred. Corynebacterium diphtheriae is endemic in Vancouver's urban core, with strains of multilocus sequence type (MLST) 76 predominating.

Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention.

BACKGROUND/OBJECTIVES: Previous research in the United Kingdom, where there is a school canteen system, has shown that the Food Dudes intervention substantially increases children's fruit and vegetable consumption. The current study evaluated its effectiveness in Ireland where school meals are not provided and children bring food to school in lunchboxes. SUBJECTS/METHODS: Participants were 4- to 11-year-old children attending two primary schools; the schools were randomly assigned to experimental or control conditions (n=228 and 207, respectively). During the 16-day intervention in the experimental school, children watched video adventures featuring the heroic Food Dudes, and received small rewards for eating fruit and vegetables provided. In both schools, parental provision and children's consumption of fruit and vegetables in the lunchboxes were assessed at baseline and 12-month follow-up (Lunchbox measures). Fruit and vegetables were provided in both schools over an 8-day baseline phase and the 16-day intervention, and children's consumption was measured (school-provided food measures). RESULTS: Relative to baseline, consumption of the school-provided foods increased during the intervention in the experimental school (P<0.001), whereas in the control school it showed a significant decline. At 12-month follow-up, parents in the experimental school provided and their children consumed significantly more lunchbox fruit, vegetables and juice relative to baseline and to the control school (P<0.001 in all instances). CONCLUSIONS: The Food Dudes intervention was effective in changing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland.

Increasing children's physical activity: a peer modelling, rewards and pedometer-based intervention.

BACKGROUND/OBJECTIVES: To evaluate a peer modelling, rewards and pedometer-feedback intervention designed to increase children's physical activity and which uses the same behaviour-change principles underlying the Food Dude Healthy Eating Programme. SUBJECTS/METHODS: The study was conducted in two primary schools in Wales. Participants were 47 children (21 boys, 26 girls) from the experimental school and 53 children (29 boys, 24 girls) from a matched control school, aged 9-11 years. Children in the experimental school took part in the intervention; over 8 days they were introduced to fictional role models (the Fit n' Fun Dudes) via visual and audio intervention materials and received small rewards when their daily pedometer step counts increased by 1500 steps per day relative to their baselines. Pedometer measures were taken from children in both schools at baseline, intervention (baseline 2 for the control school) and 12-week follow-up. RESULTS: Among experimental girls, steps per day were significantly higher during the intervention (14 686+/-2540) and at follow-up (13 737+/-3288) compared to baseline (10 864+/-2481, P<0.001) and control girls (P<0.005). Experimental boys showed significantly higher daily steps during the intervention compared to baseline (16 237+/-4204 cf. 13 452+/-3258, P<0.001) and control boys (P<0.005). There were no significant differences between activity levels of experimental and control boys at follow-up. CONCLUSIONS: The intervention resulted in substantial increases in children's physical activity, which was well maintained over a 12-week period in girls.

When to respond? And how much? Temporal control and response output on mixed-fixed-interval schedules with unequally probable components.

Rats were trained on mixed-fixed-interval (FI) schedules, with component FIs of 30 and 60s. The probability of reinforcement according to FI 30s varied between conditions, across values of 0.1, 0.3, 0.5, 0.7 and 0.9. When response rate in the 60s intervals was measured, separate response peaks, one close to 30s, the other at 60s, could be identified when the probability of reinforcement at 30s was 0.3 or greater. Nonlinear regression found that the location of the earlier peak was always close to 30s, that the coefficient of variation of the response functions at 30 and 60s were unaffected by reinforcement probability, but that the 30s component appeared to be timed slightly more precisely than the 60s one. Response rate at around 30s increased with increasing probability of reinforcement according to FI 30s, but responding at 60s was unaffected by reinforcement probability. The data are discussed with respect to a number of contemporary models of animal timing (scalar expectancy theory, the Behavioural Theory of Timing and the Learning to Time model), and a recent account of response output on FI-like schedules.

Increasing children's fruit and vegetable consumption: a peer-modelling and rewards-based intervention.

OBJECTIVE: To evaluate a peer-modelling and rewards-based intervention designed to increase children's fruit and vegetable consumption. DESIGN: Over a 5-month period, children in an experimental and a control school were presented with fruit and vegetables at lunchtime. Children aged 5-7 y also received fruit at snacktime (mid-morning). The intervention was implemented in the experimental school and levels of fruit and vegetable consumption were measured at baseline, intervention and at 4-month follow-up. SETTING: Two inner-city London primary schools. SUBJECTS: In total, 749 children aged 5-11 y. INTERVENTION: Over 16 days children watched video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. After 16 days there were no videos and the rewards became more intermittent. MAIN OUTCOME MEASURES: Consumption was measured (i) at lunchtime using a five-point observation scale; (ii) at snacktime using a weighed measure; (iii) at home using parental recall. RESULTS: Compared to the control school, lunchtime consumption in the experimental school was substantially higher at intervention and follow-up than baseline (P<0.001), while snacktime consumption was higher at intervention than baseline (P<0.001). The lunchtime data showed particularly large increases among those who initially ate very little. There were also significant increases in fruit and vegetable consumption at home (P<0.05). CONCLUSIONS: The intervention was effective in bringing about substantial increases in children's consumption of fruit and vegetables.

Reinforcer concentration effects on a fixed-interval schedule.

Four rats received training on a mixed FI 30-s FI 150-s schedule, where the different FI values were associated with different levers. During baseline, the reinforcer was a 30% concentration of condensed milk. During subsequent testing sessions, the reinforcer concentration was varied within sessions over values of 10, 30, 50, and 70%. Measures of behaviour were taken from the FI 30-s lever during trials where the reinforcer was delivered for responses on the other lever. Increasing the reinforcer concentration which began the interval (a) increased the time to start responding in the interval, and (b) increased the location of the response peak on the FI 30-s lever (often to values well above 30s). Response rate at the peak, and spread of the response rate versus time function, changed much less with reinforcer concentration. The data are discussed relative to predictions derived from Scalar Expectancy Theory, the Behavioural Theory of Timing, and the Tuned-trace model.

Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children.

OBJECTIVE: To measure children's consumption of, and liking for, fruit and vegetables and how these are altered by a peer modelling and rewards-based intervention. DESIGN: In this initial evaluation of the programme, children's consumption of fruit and vegetables were compared within and across baseline and intervention phases. SETTING: Three primary schools in England and Wales. SUBJECTS: In total, 402 children, aged from 4 to 11 y. INTERVENTION: Over 16 days, children watched six video adventures featuring heroic peers (the Food Dudes) who enjoy eating fruit and vegetables, and received small rewards for eating these foods themselves. MAIN OUTCOME MEASURES: Fruit and vegetable consumption was measured (i) in school at lunchtime and snacktime using a five-point observation scale, with inter-rated reliability and weighed validation tests; and (ii) at home using parental recall. A questionnaire measured children's liking for fruit and vegetables before and after the intervention. RESULTS: Consumption during the intervention was significantly higher than during baseline at lunchtime and at snacktime (P<0.001 in all instances). Consumption outside school was significantly higher during the intervention on weekdays (P<0.05) but not weekend days. Following the intervention, children's liking for fruit and vegetables also showed a significant increase (P<0.001). CONCLUSIONS: The peer modelling and rewards-based intervention was shown to be effective in bringing about substantial increases in children's consumption of, and expressed liking for, fruit and vegetables. SPONSORSHIP: : Horticultural Development Council, Fresh Produce Consortium, ASDA, Co-operative Group, Safeway, Sainsbury, Somerfield, Tesco and Birds Eye Wall's.

Multiple-interval timing in rats: Performance on two-valued mixed fixed-interval schedules.

Three experiments studied timing in rats on 2-valued mixed-fixed-interval schedules, with equally probable components, Fixed-Interval S and Fixed-Interval L (FI S and FI L, respectively). When the L:S ratio was greater than 4, 2 distinct response peaks appeared close to FI S and FI L, and data could be well fitted by the sum of 2 Gaussian curves. When the L:S ratio was less than 4, only 1 response peak was usually visible, but nonlinear regression often identified separate sources of behavioral control, by FI S and FI L, although control by FI L dominated. Data were used to test ideas derived from scalar expectancy theory, the behavioral theory of timing, and learning to time.

Testing for symmetry in the conditional discriminations of language-trained chimpanzees.

If subjects are taught to match Stimulus A to B and then, without further training, match B to A, they have passed a test of symmetry. It has been suggested that non-humans' lack of success on symmetry tests might be overcome by giving them a history of symmetry exemplar training, that is, by directly teaching a large number of conditional relations (e.g., AB, CD, EF,...) and also directly training the "reverse" of these relations (e.g., BA, DC, FE,...). The chimpanzee subjects of the present study, Sherman, Austin, and Lana, had already received extensive symmetry exemplar training as a result of attempts to teach a selection-based language system of lexigrams. The present study systematically subjected 2 of these chimps (Sherman and Lana), for the first time, to standard symmetry tests in controlled conditions. Both chimps failed the tests, even when their correct responses on test trials were reinforced. The findings do not support the exemplar training hypothesis, and cast doubt upon whether the chimps can pass tests of stimulus equivalence.

Delusional phenomenology--dimensions of change.

Although the application of cognitive techniques to both the measurement and modification of delusional beliefs has recently been developed in more theoretical detail (e.g. Chadwick & Lowe, 1994, Behaviour Research and Therapy, 32, 355-367) there has not been an effort to examine the variability of delusional phenomenology across time. In the present study we report on the treatment of 6 individuals who fulfilled DSM-III-R (American Psychiatric Association, 1987) criteria for Delusional Disorder and who received cognitive therapy targeted specifically on the single symptom of their delusional belief(s). Single-case time-series methodology was used to examine the associations between different aspects of delusional phenomenology through baseline and intervention study phases. Belief maintenance factors were found to be significantly associated with conviction in all 3 individuals who responded to the intervention. Negative behaviours, affect associated with the belief, preparedness to talk to others about the belief and insight were associated with conviction in some individuals but not others. Preoccupation and acting on the belief were aspects of delusional phenomenology that were found to systematically vary independent of belief conviction. The results support a multidimensional view of delusional phenomenology and the process of change during cognitive intervention.

On the origins of naming and other symbolic behavior.

We identify naming as the basic unit of verbal behavior, describe the conditions under which it is learned, and outline its crucial role in the development of stimulus classes and, hence, of symbolic behavior. Drawing upon B. F. Skinner's functional analysis and the theoretical work of G. H. Mead and L. S. Vygotsky, we chart how a child, through learning listener behavior and then echoic responding, learns bidirectional relations between classes of objects or events and his or her own speaker-listener behavior, thus acquiring naming-a higher order behavioral relation. Once established, the bidirectionality incorporated in naming extends across behavior classes such as those identified by Skinner as the mand, tact, and intraverbal so that each becomes a variant of the name relation. We indicate how our account informs the specification of rule-governed behavior and provides the basis for an experimental analysis of symbolic behavior. Furthermore, because naming is both evoked by, and itself evokes, classes of events it brings about new or emergent behavior such as that reported in studies of stimulus equivalence. This account is supported by data from a wide range of match-to-sample studies that also provide evidence that stimulus equivalence in humans is not a unitary phenomenon but the outcome of a number of different types of naming behavior.

A cognitive approach to measuring and modifying delusions.

The present paper summarizes and integrates with the existing literature the results of three studies we have conducted on the measurement and modification of delusions. The findings of two of these studies have been presented previously; the third is briefly reported here. A total of 12 people with delusions took part. Ten participated in two investigations that used between-subject multiple-baseline designs; the remaining two, each of whom held three distinct delusions, took part in a study using an across-beliefs multiple-baseline design. A variety of dimensions of delusional experience were monitored over baseline periods of at least 4 weeks, and two distinct cognitive interventions were used: a structured verbal challenge and a planned empirical test. Our focus in the present article is on intervention and the process of change as people come to question and sometimes reject their delusions. We also address related issues, including problems of measurement (i.e. demand characteristics, independent validation), the connection between depression and delusions and the prediction of treatment response. We conclude with specific recommendations for cognitive therapy for delusions.

Determinants of human performance on concurrent schedules.

Six experiments, each with 5 human adults, were conducted to investigate the determinants of human performance on multiple concurrent variable-interval schedules. A two-key procedure was employed in which subjects' key presses produced points exchangeable for money. Variables manipulated across experiments were (a) changeover delay (Experiments 2, 4, and 6), (b) ordinal cues related to scheduled reinforcement frequencies (Experiments 3 and 4), and (c) instructions describing the ordinal relations between schedule-correlated stimuli and scheduled reinforcement frequency (Experiments 5 and 6). The performances of only 13 of the 30 subjects could be described by the generalized matching equation and were within a range of values typical of those reported in the animal literature. Eight subjects showed indifference, 9 undermatched, 7 approximated matching, 3 overmatched, and a further 3 responded exclusively to the richer component of the concurrent schedules. These differing modes of responding were closely related to the different types of performance rules reported by subjects in postexperimental questionnaires. The results are in good agreement with those from studies of human performance on single schedules, suggesting that rule-governed behavior, in interaction with contingencies, may be an important determinant of human choice.

Measurement and modification of delusional beliefs.

It has been proposed that delusional thinking may be on a continuum with normal behavior and can be assessed by taking account of factors such as the client's degree of belief conviction or the extent of preoccupation with the belief. In our research a number of measures were used to assess the delusional thinking of people diagnosed as schizophrenic. Two interventions were used: (a) a structured verbal challenge and (b) a reality test in which the belief was subject to an empirical test. We used a multiple-baseline, across-subjects design. Of the 6 clients, 2 completely rejected their beliefs, and 3 others significantly reduced their belief conviction. Maintenance was good, and there was evidence that the intervention had enabled 5 of the 6 clients to effectively regulate their delusional thinking.

Nonverbal behavior correlated with the shaped verbal behavior of children.

Children under 6 years old pressed on response windows behind which stimuli appeared (star or tree). Presses occasionally lit lamps arranged in a column; a present was delivered when all lamps were lit. A random-ratio schedule in the presence of star alternated with a random-interval schedule in the presence of tree. These contingencies usually did not produce respective high and low response rates in the presence of star and tree, but the shaping of verbal behavior (e.g., "press a lot without stopping" or "press and wait") was sometimes accompanied by corresponding changes in response rate. Verbal shaping was accomplished between schedule components during verbal interactions between the child and a hand-puppet, Garfield the Cat, and used social consequences such as enthusiastic reactions to what the child had said as well as concrete consequences such as delivery of extra presents. Variables that may constrain the shaping of verbal behavior in children seem to include the vocabulary available to the child and the functional properties of that vocabulary; the correlation between rates of pressing and what the child says about them may depend upon such variables.