Epidural Abscess in the Lumbar Spine: A Single Institution's Experience With Nonsurgical and Surgical Management.

The purpose of this study was to compare patient factors and outcomes in conservatively and surgically treated patients with spinal epidural abscess (SEA). This was a single-center retrospective review of adult patients treated for SEA of the lumbar spine. Primary treatment outcome was readmission for recurrent abscess. Sixty-one patients met inclusion criteria: 59% male, mean age 56.9 years, and body mass index 30.8 kg/m2. Initially 47.5% of patients were treated with conservative measures and 52.5% were treated with surgery. In the conservative group, 31.0% failed treatment and underwent delayed surgery; 26.2% of the overall cohort was readmitted for SEA. Readmitted patients had a greater incidence of history of methicillin-resistant Staphylococcus aureus (p = .048), recurrent infections (p = .008), and recent sepsis and bacteremia (p = .005). Nearly one-third of patients failed initial conservative treatment and needed delayed surgery; however, no significant differences were found between the two treatment groups. Patients with a past history of infections may require more aggressive treatment and closer follow-up, because they are at higher risk for recurrence and readmission. (Journal of Surgical Orthopaedic Advances 28(3):224-231, 2019).

Some effects of detection dogs on passenger behavior at border control ports.

Detection dogs are used at border controls as an antecedent intervention to deter the smuggling of contraband. However, there is little research that has explored how the presence of dogs might affect passenger behavior. We observed passengers' behavior at a port when there was an officer alone, an officer with a dog, and an officer with a dog wearing a florescent yellow jacket with "police" written on it for increased salience. We measured eye contact, vocal-verbal interactions, facial expressions, and nonvocal verbal gestures toward the officer and dog, and changes in passenger direction. Passengers looked, talked, and had the highest frequencies of positive facial expressions when the dog was not wearing a jacket. However, passengers looked toward the dog the quickest and had the highest frequency of negative facial expressions and gestures when the dog was wearing a jacket. We discuss how these findings might inform antecedent interventions to address undesirable behavior such as smuggling.

An Assessment Method for Identifying Acceptable and Effective Ways to Present Demands to an Adult With Dementia.

Simple instructions are often recommended for presenting demands to people with dementia; however, simple instructions may be perceived as authoritative and may not be appropriate for all individuals. We conducted a demand assessment with a woman with dementia who engaged in problem behaviors in response to direct instructions. We measured latency to compliance and verbal behavior when demands were presented as questions, rules, simple instructions, or demands embedded in social chatter. In contrast to the other conditions, simple instructions resulted in the most undesirable behavior and were least likely to evoke compliance. We conducted an intervention in which demands were phrased as requests for assistance.

Preference for leisure items over edible items in individuals with dementia: A replication.

We replicated previous research in which adults with dementia tended to show a preference for leisure items over edible items when presented in the same array. Additionally, we conducted engagement analyses with the highest, middle, and lowest preference leisure items to determine whether relative preference corresponded to engagement in the natural environment. The most highly preferred stimulus for 6 out of 7 participants was a leisure item, and for each of those six the top 3 preferred stimuli were leisure stimuli. For 4 participants, the most preferred stimulus also produced the longest duration of engagement. We discuss the issues we encountered when conducting preference assessments with adults with intact vocal verbal repertoires, and suggest potential explanations for the displacement of edibles by leisure stimuli in older adults with dementia.

Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature.

Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley's (Journal of Applied Behavior Analysis, 1, 91-97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.

Lounge Layout to Facilitate Communication and Engagement in People with Dementia.

The design of care settings for people with dementia is often guided by expert opinion rather than empirical data. We evaluated the effect of arranging lounge furniture in different configurations on communication, engagement with activities, and indices of happiness in people with dementia. We found that the common configuration of chairs placed around the outside of the room resulted in the least of all 3 behaviors. Communication occurred most when the furniture was arranged in groups, and engagement occurred most when the furniture layout maximized the salience of available activities.

Representativeness of direct observations selected using a work-sampling equation.

Deciding on appropriate sampling to obtain representative samples of behavior is important but not straightforward, because the relative duration of the target behavior may affect its observation in a given sampling interval. Work-sampling methods, which offer a way to adjust the frequency of sampling according to a priori or ongoing estimates of the behavior to achieve a preselected level of representativeness, may provide a solution. Full-week observations of 7 behaviors were conducted for 3 students with autism spectrum disorder and intellectual disabilities. Work-sampling methods were used to select momentary time samples from the full time-of-interest, which produced representative samples. However, work sampling required impractically high numbers of time samples to obtain representative samples. More practical momentary time samples produced less representative samples, particularly for low-duration behaviors. The utility and limits of work-sampling methods for applied behavior analysis are discussed.