bluuebunny/crossref_metadata_2025 huggingface dataset:
Contiguity, Reinforcement Rate and the law of Effect
Authors: Thomas Glyn
Published: October 2014

There is an ambiguity in formulations of the Law of Effect which stress the importance of the correlation of rate of responding with frequency of reinforcement. The main problem is that such theories have not specified precisely how the correlation of response and reinforcement rates should be determined, with the result that the theories can become irrefutable. Two experiments were carried out which expose some of the problems created by this ambiguity. “Free” food reinforcers were delivered to rats in the absence of responding. Lever responses intermittently provided immediate (contiguous) reinforcement, but cancelled some of the following “free” reinforcements. Responding was established and maintained even when the overall rate of responding was negatively correlated with the overall frequency of reinforcement. Several ways in which correlational theories could attempt to accommodate these results are discussed but rejected as unsatisfactory, either because they severely limit the scope of the theories or because they lose their most important feature: that of treating behaviour at a molar rather than a molecular level.
Hoarding Behaviour and the Defence of body Weight in Adult Rats, following Undernutrition during Different Periods of Early Development
Authors: Stephens D. N.
Published: October 2014

In Experiment I, male rats, previously undernourished by underfeeding their mothers during lactation, weighed less as adults than progeny of mothers underfed during gestation, or than normally-nourished control rats. Daily 16 h food deprivation of the adults induced weight loss and elicited hoarding of food pellets. Deprivation-induced weight losses at criterion for hoarding did not differ significantly among the groups, and the critical weight at which hoarding began was thus significantly lower in the lactationally-undernourished group than in the controls. Thus adult rats, previously undernourished during their suckling period, appear to defend their body weights in a manner similar to controls, although at a lower level. Lactationally-undernourished rats also hoarded significantly fewer pellets than controls. Similar results were obtained when the rats were partially satiated before hoarding tests, suggesting that hoarding scores were unlikely to have been significantly affected by competition with feeding. Foetal undernutrition had weaker, and less consistent effects than lactational undernutrition on the ad libitum weight of the adult, and on the critical weight for hoarding. In Experiment II, severe undernutrition after weaning did not affect adult body weight, the weight loss necessary to induce hoarding, or the number of pellets hoarded. It is concluded that the pre-weaning period is specifically sensitive to the effects of undernutrition on body weight regulation and on hoarding. The data on hoarding do not support the view that a period of undernutrition at any time in early life increases the rat's responsiveness towards food.
Radio-Tracking Study of Foxes’ Movements Related to their Home Range. A Cognitive Map Hypothesis
Authors: Fabrigoule C. , Maurel D.
Published: October 2014

A radio-tracking study of foxes’ movements ( Vulpes vulpes L.) was conducted in the Chizé Forest (France). Five foxes captured as adults returned to their trapping zone during the night following their release, and very soon showed a settled occupation of their home-range. Their utilization of the home range changed in time. In the movements of adult foxes, the presence of a network of preferred ways, mainly situated along the forest roads, could be detected. The animals, however, also moved around a great deal without using this preferred network. Two foxes, captured young and sub-adult, showed first a period of erratic movements before they started coming back to the same burrow. The first movements they made from that burrow were very variable. The variability of foxes’ movements is discussed in relation to the notion of a cognitive map.
Rapidly Developed Scalar Timing in Unsignalled Shuttlebox Avoidance Learning
Authors: Cotton M. M. , Wood W P.
Published: October 2014

Three groups of rats were given brief inescapable shocks in a shuttlebox with equal shock-shock (S-S) and response-shock (R-S) intervals of 10, 15 or 20 s. Non shock-elicited responses (experimentally defined) postponed the occurrence of the next shock while shock elicited responses had no programmed consequences. Avoidance behaviour was rapidly acquired with all groups avoiding 85% or more of scheduled shocks by the end of the fifth 1 h session. Interresponse times revealed the development of excellent temporal discriminations in all groups. The data provide quantitative support for Gibbon's (1971) scalar timing hypothesis.
Blocking and Sensory Preconditioning Effects in Morphine Analgesic Tolerance: Support for a Pavlovian Conditioning Model of Drug Tolerance
Authors: Dafters Richard , Hetherington Marion , Mccartney Helen
Published: October 2014

Two experiments on rats tested predictions of a Pavlovian conditioning model of drug tolerance which holds that tolerance is the result of compensatory conditioned responses, developed to environmental stimuli accompanying the drug administrations, which attenuate the direct effects of the drug. In Experiment I, the acquisition of tolerance-modulating properties by the tone component of a tone-light compound stimulus which accompanied morphine administrations was reduced by prior light-morphine pairings (blocking). In Experiment II, a tone stimulus acquired tolerance-modulating properties through prior pairings with a light stimulus which later accompanied morphine administrations (sensory preconditioning). These findings are uniquely predicted by the Pavlovian conditioning model of drug tolerance and are incompatible with traditional theories which assign no role to environmental stimuli present at the time of drug administration.
Flavour-Odour Compound Conditioning: Odour-Potentiation and Flavour-Attenuation
Authors: Westbrook R. F. , Homewood J. , Horn K. , Clarke J. C.
Published: October 2014

Five experiments employed a toxiphobia conditioning paradigm to examine the strengths of odour and flavour aversions when conditioned separately and in compound. When conditioned in compound, odour aversions were stronger than when conditioned separately, i.e., the flavour potentiated the odour (Experiment Ia), but flavour aversions were weaker than when conditioned separately, i.e., the odour attenuated the flavour (Experiment Ib). The duration of exposure to the reinforced compound governed the nature of the interaction between the components: at a brief exposure, the flavour overshadowed the odour; at a long exposure, the flavour potentiated the odour (Experiment II). The remaining experiments examined the mechanism subserving the potentiation effect. Experiment III demonstrated that extinction of the flavour associate of the odour attenuated the odour aversion but further conditioning of the flavour did not strengthen the odour aversion. Experiment IV confirmed this effect of extinction but also found a comparable attenuation of the odour aversion from extinction of a separately conditioned flavour. Experiment V examined the previous failure to influence the strength of the odour aversion by strengthening the flavour aversion. In this experiment, conditioning the flavour associate or a separately conditioned flavour with a more potent US augmented the strength of the odour aversion. The results did not provide support for the idea that the potentiation phenomenon reflects the formation of within-compound associations but did indicate that a potentiated odour aversion could be modulated by manipulations designed to alter the US representation.
The Role of Response-Reward Correlation in Stimulus-Response Overshadowing
Authors: Tarpy Roger M. , Lea Stephen E. G. , Midgley Marie
Published: October 2014

Rats pressed levers for food reward which was delivered, when appropriate, 0·4 s after the response. For one group, the delay interval was filled by a light cue; for the other group, the same number of lights was given but they were not correlated with food delivery. In Experiment I, all lever presses were reinforced and there were no differences in response rate between groups. In Experiments II and III, lever pressing was rewarded according to a VI and VR schedule respectively. Group differences were observed in Experiment II but they disappeared in Experiment III. The results of Experiments I and II show that a reward-related stimulus does not overshadow a lever response unless the stimulus is a better predictor of reward. Differences in salience or competition from sign-tracking behaviors were ruled out as causes of this phenomenon. Experiment III demonstrated, however, that a weak response-reward correlation is not a sufficient condition for the overshadowing effect. A fourth experiment replicated the results of Experiment III using naive animals. The results of these last two experiments are not consistent with an information theory approach unless (a) a response-units concept is adopted or (b) the cue involved in overshadowing is not the pre-food light but the end of a temporal interval, whose salience is enhanced by the light.
Organisational Effects of Neonatal and Pubertal Testosterone on Sexually Differentiated Behaviours in the Open-Field and Head-Dip Apparatus
Authors: Stevens Robin , Goldstein Ralph
Published: October 2014

On days 1 and 4 after birth rats were injected with 100 μg of testosterone propionate (TP) or vehicle, and at 35 days of age they were injected intramuscularly with 400 μg of testosterone oenanthate (TO), a long acting androgen, or the vehicle. There were four groups (oil-oil, TP-oil, oil-TO, TP-TO), each group subdivided by sex. Females treated with testosterone neonatally or at puberty were masculinised or defeminised on adult open-field behaviours, being less active and rearing less than oil-oil females; the oil-TO group also defaecated significantly more than controls. The TP-TO female group was indistinguishable from the oil-TO group. In a second experiment, sex differences were found in head-dipping behaviour as well as in activity and rearing. Females treated with TP or TO reared less and defaecated more than controls, and TP also decreased activity, but neither hormone treatment affected head-dipping behaviour. There is thus a peripubertal as well as a neonatal period when testosterone can act organisationally to masculinise or defeminise female rats. Potentiation between effects of neonatal and pubertal androgens was found on female body weights. TO alone had no effect, but TP-TO females were significantly heavier than controls at 90 days of age and by 130 days of age the TP-oil group was also heavier than controls.
Effects of Fornix Transection on Spontaneous and Trained Non-Matching by Monkeys
Authors: Gaffan David , Gaffan E. A. , Harrison Susan
Published: October 2014

Three monkeys with fornix transection and three normal control monkeys performed a series of tasks which were variations of delayed non-matching. Experiment 1 showed that even at short retention intervals fornix transection impaired the spontaneous tendency to explore novel objects. Experiment 2 provided differential reward for non-matching and showed that the fornix-transected monkeys learned and performed non-matching normally even though the sample-match retention intervals were long throughout the experiment. Experiment 3 showed that non-matching performance was transiently more disrupted in fornix-transected than in normal monkeys when the testing procedure was changed, in a variety of ways, while maintaining the basic non-match rule. Experiment 4 required the monkeys to discriminate objects they had displaced from objects they had seen but not displaced; fornix transection produced in this task a substantial and stable impairment. These four experiments require a revised interpretation of the effects of fornix transection upon recognition memory and exploration. Particularly they contradict the hypothesis, suggested by previous experiments, that fornix transection produces a defect in discrimination of stimulus familiarity in long-term but not in short-term memory. They suggest rather that fornix transection impairs memory of instrumental responses.
The Influence of Generalization Decrement on the Outcome of a Feature-Positive Discrimination
Authors: Young Douglas B. , Pearce John M.
Published: October 2014

In a feature-positive discrimination subjects receive training in which reinforced presentations of a compound, AB+, are intermixed among non-reinforced presentations of one element, Ao. The three reported experiments compared the results of this procedure when using a light or a tone as the feature-positive stimulus, B. In all three experiments, the tone elicited a stronger conditioned response than the light when it was presented alone. The main concern of Experiments 2 and 3 was to examine whether this effect was due to training being incomplete for subjects receiving the light as the B element. In Experiment 2 it was found that extended discrimination training did not diminish the difference between the properties of the light and the tone. Experiment 3 revealed that this effect was not due to differences in the asymptotic associative strength of either A or the compound. It is argued that these results are not readily compatible with contemporary theories of learning, and an alternative account is presented.
The Effect of Intertrial Conditioned Stimuli in Autoshaping
Authors: Durlach Paula J.
Published: October 2014

Three autoshaping experiments, using pigeon subjects, examined the effect of presenting an S+ or an S− on acquisition to a different conditioned stimulus (CS). Experiment 1 found that signalling intertrial food with an S+ or an S− allowed acquisition of responding to the target-CS; however, that acquisition was slower when the signal was the S+. Experiment 2 found that even when the S+ or S− were presented without food in the intertrial interval, acquisition was slower in the group receiving the S+. Experiment 3 found that a similar, but weaker effect occurred when the S+ or S− stimuli were presented in the session prior to target-CS training, rather than intermixed. These results have implications for the interpretation of experiments that use a signalling manipulation to assess the interaction of CS and context in Pavlovian conditioning; they suggest that signalling unconditioned stimuli (USs) may have consequences other than that of modulating context-US learning.
Retroactive Interference in Rats: Independent Effects of Time and Similarity of the Intervening Event with Respect to Acquisition
Authors: Miller Ralph R. , Greco Carolyn , Marlin Nancy A. , Balaz Mary Ann
Published: October 2014

Events occurring during the retention intervals for a 5-min delayed alternation task were used to investigate the factors that influence retroactive interference. Appetitive reinforcement in an E-maze was employed to train rats on the delayed alternation task consisting of a forced-choice (target event) trial followed by a free-choice (test) trial. Occasional probe trials added a potentially interfering event either at the beginning, middle, or end of the retention period. These events also varied in similarity to the target events, ranging from low similarity to the converse of the target event. Interference increased both with the interval between the target and intervening events and with the similarity between the converse of the target event and the intervening event; however, there was no tendency, significant or otherwise, towards an interaction between stimulus similarity and the interval between the target and intervening events. Control groups demonstrated that the interference was of an associative nature and that the interval between the intervening event and the test trial was little consequence. These results are discussed in terms of two separate types of interference: similarity interference which depends on stimulus similarity of the intervening event to the converse of the target event but not on the temporal location of the intervening event, and processing interference which depends on the temporal location of the intervening event but not on its similarity to the converse of the target event.
Effects of Associatively Significant Posttrial Stimuli on Learning and Memory
Authors: Colwill Ruth M.
Published: October 2014

Pigeons were trained on a delayed conditional discrimination in which the choice between two simultaneously presented stimuli depended on how the trial started. Choice of one of the stimuli was reinforced if the trial had been initiated by presentation of a food sample and choice of the other was reinforced if no sample had been presented. Subsequently, test trials were administered on which an associatively significant stimulus was presented during the retention interval. This manipulation was intended to modulate the short-term retention of information about the food sample. It was found that performance on food sample test trials was enhanced by presentation of an excitor for food, disrupted by presentation of an inhibitor for food and unaffected by presentation of an associatively neutral stimulus. The impact of these posttrial stimuli was also assessed on the ability of the food sample to serve as a reinforcer. This was done by recording the development of responding to a keylight that signalled the food sample on these test trials. Compared to the associatively neutral stimulus, both the excitor and the inhibitor interfered with the development of keypecking. These results are discussed with regard to the issue of how posttrial events modulate associative learning.
Prevention of the degraded-contingency effect by signalling training trials
Authors: Gunther Lisa M. , Miller Ralph R.
Published: October 2014

Presentation of unsignalled unconditioned stimuli (USs) interspersed among Pavlovian excitatory conditioning trials weakens conditioned responding to a target conditioned stimulus (CS; Rescorla, 1968). However, signalling these intertrial USs with another cue (a cover stimulus) has been shown to alleviate this degraded-contingency effect (e.g. Durlach, 1982, 1983). In contrast to signalling the inter-trial USs, the present experiments examined the effect on the degraded-contingency effect of signalling the target CS-US pairings. Experiment 1, using parameters selected to avoid overshadowing, found that consistently presenting a cover stimulus immediately prior to the target CS-US pairings during degraded-contingency training alleviated the degraded-contingency effect. Experiment 2 examined the underlying mechanism responsible for this cover-stimulus effect through posttraining associative inflation of the cover stimulus or the context, and found that inflation of the cover stimulus attenuated responding to the target CS (i.e. empirical retrospective revaluation). The results are discussed in terms of various acquisition- and expression-focused models of acquired responding.
Effects of varying the amount of preexposure to spatial cues on a subsequent navigation task
Authors: Prados José
Published: October 2014

In each of two experiments rats were preexposed to four compound landmarks (AX, BX, CX, and DX) one at a time; they were then trained to find a submerged platform located in a fixed position in a swimming pool using these same landmarks. When the preexposure was SHORT (4 sessions) it facilitated subsequent learning (a perceptual learning effect), whereas when rats were given a LONG preexposure phase (8 sessions) this facilitatory effect disappeared. EXTRA-LONG preexposure (16 sessions) reversed the facilitatory effect—that is to say, we observed retarded learning. The results show that rats’ ability to navigate towards an invisible goal is affected by the length of their preexposure to the spatial cues that signal the location of the goal. These data are consistent with an associative analysis of the swimming pool navigation task.
Stimulus exposure effects in human associative learning
Authors: Myers Catherine E. , Oliver Lindsay M. , Warren Stacey G. , Gluck Mark A.
Published: October 2014

Learning that one cue (CS) predicts a second, salient cue (US) can often be slowed by prior exposure to one or both stimuli. In animals, CS-US learning is more strongly retarded following uncorrelated exposure to both CS and US than following exposure to the US alone. In this paper we present several studies showing a similar effect in humans, using a computer-based task. Experiments 1 and 2 used a between-groups design and demonstrated a strong CS/US exposure effect, whether or not the US was signalled by a neutral cue during exposure. Experiment 3 demonstrated similar effects using a within-subjects design. Overall, these results are consistent with several theoretical interpretations and suggest that uncorrelated CS/US exposure leads to a robust retardation of subsequent CS-US learning in humans.
Positive and negative patterning in human causal learning
Authors: Young Michael E. , Wasserman Edward A. , Johnson Janelle L. , Jones Farrasha L.
Published: October 2014

Investigations of patterning discriminations by nonhuman animals have generally found that positive patterning is easier to learn than negative patterning. Studies of patterning discriminations in human causal learning tasks have failed to document any differences between positive and negative patterning. In the present study, human participants predicted an outcome on trials involving either a compound cue or its elements. Positive and negative patterning problems were successfully solved in a within-subjects design; negative patterning problems proved to be more difficult when an additional, 50% contingent cue was included (Experiment 2), but not when it was excluded (Experiment 1). Possible reasons for these results are discussed. The discussion concludes with an analysis of exemplar models (e.g., Pearce, 1994) of human causal learning and considers the conditions under which these models do and do not anticipate our results.
Overshadowing of subsequent events and recovery thereafter
Authors: Burger Daniel C. , Mallemat Haney , Miller Ralph R.
Published: October 2014

Four experiments using a conditioned lick suppression preparation with rats were conducted to examine whether overshadowing of subsequent events could be obtained in Pavlovian backward conditioning (i.e. unconditioned stimulus [US] before conditioned stimulus [CS]), and to determine whether such overshadowing could be reversed without further training with the overshadowed CS, as has been reported in overshadowing of antecedent events. In Experiment 1, a backward-conditioned CS overshadowed a second backward-conditioned CS. Two posttraining manipulations, extinction of the overshadowing CS (Experiment 2) and shifting of the temporal relationship of the overshadowing CS to the US (Experiment 3), increased responding to the overshadowed CS. These results constitute the first unambiguous demonstration of stimulus competition between subsequent events using first-order conditioning, and they show that, like overshadowing with forward conditioning, such overshadowing is due, at least in part if not completely, to a failure to express information that had been acquired.
Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial
Authors: Huang Susan S. , Septimus Edward , Avery Taliser R. , Lee Grace M. , Hickok Jason , Weinstein Robert A. , Moody Julia , Hayden Mary K. , Perlin Jonathan B. , Platt Richard , Ray G. Thomas
Published: October 2014

Objective.

To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).

Design.

Cost analysis using decision modeling.

Methods.

We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.

Results.

In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.

Conclusions.

A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.
Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement
Authors: Sloane Philip D. , Zimmerman Sheryl , Reed David , Beeber Anna Song , Chisholm Latarsha , Kistler Christine , Khandelwal Christine , Weber David J. , Mitchell C. Madeline
Published: October 2014

Objective.

To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.

Design.

Pre-post study, with a 13-month intervention period.

Setting.

Four AL communities.

Participants.

All prescribers, all AL staff who communicate with prescribers, and all patients who had an infection during the baseline and intervention periods.

Intervention.

A standardized form for AL staff, an online education course and 5 practice briefs for prescribers, and monthly quality improvement meetings with AL staff.

Measurements.

Monthly inventory of all systemic antibiotic prescriptions; interviews with the prescriber, AL staff member, closest family member, and patient (when capable) regarding 85 antibiotic prescribing episodes (30 baseline, 55 intervention), with data review by an expert panel to determine prescribing appropriateness.

Results.

The mean number of systemic antibiotic prescriptions was 3.44 per 1,000 resident-days at baseline and 3.37 during the intervention, a nonsignificant change (P = .30). Few prescribers participated in online training. AL staff use of the standardized form gradually increased during the program. The proportion of prescriptions rated as probably inappropriate was 26% at baseline and 15% during the intervention, a nonsignificant trend (P = .25). Drug selection was largely appropriate during both time periods.

Conclusions.

AL antibiotic prescribing rates appear to be approximately one-half those seen in nursing homes, with up to a quarter being potentially inappropriate. Interventions to improve prescribing must reach all physicians and staff and most likely will require long time periods to have the optimal effect.
Pediatrician Perceptions of an Outpatient Antimicrobial Stewardship Intervention
Authors: Szymczak Julia E. , Feemster Kristen A. , Zaoutis Theoklis E. , Gerber Jeffrey S.
Published: October 2014

Objective.

Inappropriate antibiotic prescribing commonly occurs in pediatric outpatients with acute respiratory tract infections. Antimicrobial stewardship programs are recommended for use in the hospital, but less is known about whether and how they will work in the ambulatory setting. Following a successful cluster-randomized trial to improve prescribing for common acute respiratory tract infections using education plus audit and feedback in a large, pediatric primary care network, we sought to explore the perceptions of the intervention and antibiotic overuse among participating clinicians.

Methods.

We conducted a qualitative study using semistructured interviews with 24 pediatricians from 6 primary care practices who participated in an outpatient antimicrobial stewardship intervention. All interviews were transcribed and analyzed using a modified grounded theory approach.

Results.

Deep skepticism of the audit and feedback reports emerged. Respondents ignored reports or expressed distrust about them. One respondent admitted to gaming behavior. When asked about antibiotic overuse, respondents recognized it as a problem, but they believed it was driven by the behaviors of nonpediatric physicians. Parent pressure for antibiotics was identified by all respondents as a major barrier to the more judicious use of antibiotics. Respondents reported that they sometimes “caved” to parent pressure for social reasons.

Conclusions.

To improve the effectiveness and sustainability of outpatient antimicrobial stewardship, it is critical to boost the credibility of audit data, engage primary care pediatricians in recognizing that their behavior contributes to antibiotic overuse, and address parent pressure to prescribe antibiotics.
Can Additional Information Be Obtained from Claims Data to Support Surgical Site Infection Diagnosis Codes?
Authors: Warren David K. , Nickel Katelin B. , Wallace Anna E. , Mines Daniel , Fraser Victoria J. , Olsen Margaret A.
Published: October 2014

Objective.

International Classification of Diseases, Ninth Revision, Clinical Modification(ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.

Methods.

We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old withICD-9-CMprocedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified byICD-9-CMdiagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.

Results.

Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.

Conclusions.

More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.
Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia
Authors: Ali Kisha Jezel , Farley Donna O. , Speck Kathleen , Catanzaro Mary , Wicker Karol G. , Berenholtz Sean M.
Published: October 2014

Objective.

To develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention of ventilator-associated pneumonia (VAP) in a two-state collaborative, including data on actions implemented by participating teams and contextual factors that may influence their efforts. Using the data collected, learn how implementation actions can be improved and analyze effects of implementation progress on outcome measures.

Design.

We developed the tool as an interview protocol that included quantitative and qualitative items addressing actions on the Comprehensive Unit-based Safety Program (CUSP) and clinical interventions for use in guiding data collection via telephone interviews.

Setting.

We conducted interviews with leaders of improvement teams from units participating in the two-state VAP prevention initiative.

Methods.

We collected data from 43 hospital units as they implemented actions for the VAP initiative and performed descriptive analyzes of the data with comparisons across the 2 states.

Results.

Early in the VAP prevention initiative, most units had made only moderate progress overall in using many of the CUSP actions known to support their improvement processes. For contextual factors, a relatively small number of barriers were found to have important negative effects on implementation progress (in particular, barriers related to workload and time issues). We modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified.

Conclusion.

These assessments provided important new knowledge regarding the implementation science of quality improvement projects, including feedback during implementation, and give a better understanding of which factors most affect implementation.
Nascent Regional System for Alerting Infection Preventionists about Patients with Multidrug-Resistant Gram-Negative Bacteria: Implementation and Initial Results
Authors: Rosenman Marc B. , Szucs Kinga A. , Finnell S. Maria E. , Khokhar Shahid , Egg James , Lemmon Larry , Shepherd David C. , Friedlin Jeff , Li Xiaochun , Kho Abel N.
Published: October 2014

Objective.

To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.

Design.

Observational, retrospective study.

Setting.

Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).

Patients.

During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO.

Methods/Intervention.

A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).

Results.

The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn).

Conclusions.

It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
Multidrug-Resistant Organism Infections in US Nursing Homes: A National Study of Prevalence, Onset, and Transmission across Care Settings, October 1, 2010-December 31, 2011
Authors: Kahvecioglu Daver , Ramiah Kalpana , McMaughan Darcy , Garfinkel Steven , McSorley Veronica E. , Nguyen Quy Nhi , Yang Manshu , Pugliese Christopher , Mehr David , Phillips Charles D.
Published: October 2014

Objective.

To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).

Methods.

Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.

Results.

Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Among residents who acquired an MDRO infection during the study period, 57% became positive in the NH, 41% in the ACH, and 2% in other settings (eg, at a private home or apartment).

Conclusion.

Even though NHs are the most likely setting where residents would acquire MDROs after admission to an NH (accounting for 57% of cases), a significant fraction of NH residents acquire MDRO infection at ACHs (41%). Thus, effective MDRO infection control for NH residents requires simultaneous, cooperative interventions among NHs and ACHs in the same community.
American Environmental Diplomacy
Authors: Dorsey Kurk
Published: October 2014

From its inception as a nation in 1789, the United States has engaged in an environmental diplomacy that has included attempts to gain control of resources, as well as formal diplomatic efforts to regulate the use of resources shared with other nations and peoples. American environmental diplomacy has sought to gain control of natural resources, to conserve those resources for the future, and to protect environmental amenities from destruction. As an acquirer of natural resources, the United States has focused on arable land as well as on ocean fisheries, although around 1900, the focus on ocean fisheries turned into a desire to conserve marine resources from unregulated harvesting.

The main 20th-century U.S. goal was to extend beyond its borders its Progressive-era desire to utilize resources efficiently, meaning the greatest good for the greatest number for the longest time. For most of the 20th century, the United States was the leader in promoting global environmental protection through the best science, especially emphasizing wildlife. Near the end of the century, U.S. government science policy was increasingly out of step with global environmental thinking, and the United States often found itself on the outside. Most notably, the attempts to address climate change moved ahead with almost every country in the world except the United States.

While a few monographs focus squarely on environmental diplomacy, it is safe to say that historians have not come close to tapping the potential of the intersection of the environmental and diplomatic history of the United States.
US Indian Policy, 1783–1830
Authors: Nichols David A.
Published: October 2014

From 1783 to 1830, American Indian policy reflected the new American nation-state’s desire to establish its own legitimacy and authority, by controlling Native American peoples and establishing orderly and prosperous white settlements in the continental interior. The Federalists focused on securing against Native American claims and attacks several protected enclaves of white settlement (Ohio, Kentucky, Tennessee), established—often violently—during the Revolutionary War. They used treaties to draw a legal boundary between these enclaves and Indian communities, and annuities and military force to keep Indians on their side of the line. The Jeffersonian Republicans adopted a more expansive plan of development, coupled with the promotion of Native American dependency. Treaty commissioners persuaded chiefs to cede road easements and riverfront acreage that the government used to link and develop dispersed white settlements. Meanwhile, the War Department built trading factories whose cheap merchandise would lure Indians into commercial dependency, and agents offered Indian families agricultural equipment and training, hoping that Native American farmers would no longer need “extensive forests” to support themselves. These pressures helped engender nativist movements in the Old Northwest and southeast, and Indian men from both regions fought the United States in the War of 1812, reinforcing frontier settlers’ view that Indians were a security threat. After this war’s end, the United States adopted a strategy of containment, pressuring Indian leaders to cede most of their peoples’ lands, confining Indians to enclaves, financing vocational schooling for Indian children, and encouraging Native peoples voluntarily to move west of the Mississippi. This policy, however, proved too respectful of Indian autonomy for the frontier settlers and politicians steadily gaining influence in the national government. After these settlers elected one of their own, Andrew Jackson, to the presidency, American Indian policy would enter a much more coercive and violent phase, as white Americans redefined the nation-state as a domain of white supremacy ethnically cleansed of indigenous peoples.
Sexuality and American Religion
Authors: Lofton Kathryn
Published: October 2014

Both sexuality and religion are terms as vexatious to define as they can be alluring to pursue. In the contemporary period, figuring out one’s sexual feelings, identity, and preferences has become a signal aspect of self-formation. Understanding one’s religious feelings, identity, and preferences may seem less imminent, but is certainly no less complicated. Both terms cause no small amount of confusion. Clearing up some of this confusion requires speaking frankly about delicate matters, and also speaking flatly about enormously complex experiences. Popular media coverage of ecclesiastical sex scandals in America suggests that people enjoy hearing about the profanation of religious duty. Despite the observed, inferred, and accused sexuality in American religious history, or maybe because of it, eroticism suffuses narrative accounts of American religious history and descriptions of religious actors. In U.S. history, sexuality has often been a key lens through which we have understood the nature of religion, the leaders of religions, and the reason for religious commitment.
Social Work Practice with Deaf and Hard of Hearing People
Authors: Sheridan Martha A. , Mounty Judith L. , White Barbara J.
Published: October 2014

Effective social work practice with deaf and hard of hearing people requires a unique multifaceted application of knowledge, values, skills, and ethical considerations. Salient topics include language, communication, educational experiences, culture, and access to information and community resources. Required competencies include knowledge of diversity within the population, the implications of various psychosocial and developmental environments, deaf communities, cultural values and norms, and sign language fluency. In this article, related theory, research, practice competencies, and intervention approaches are discussed. An integrative strengths-based transactional paradigm is recommended.
Deinstitutionalization
Authors: Segal Steven P.
Published: October 2014

The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as transinstitutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, while it has expanded admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase/model programs illustrating what can be done, yet it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness.

Deinstitutionalization policy has motivated political, economic, legal, and social change in the care and control of six populations—older adults, children, people with mental illness, people with developmental disabilities, people under correctional system supervision, and, more recently, individuals without a home. A truer implementation of deinstitutionalization’s initial aspirations requires reconsideration of these changes.
Randomized Control Trials
Authors: Solomon Phyllis
Published: October 2014

This entry defines Randomized Control Trials (RCTs) and puts them in an historical context. It provides an understanding of the distinction between efficacy and effectiveness RCTs and explains why effectiveness trials are more relevant to social work interventions. The strengths and limitations of RCTs that use experimental designs are delineated. It discusses the reporting requirements of RCTs by the standards of the CONSORT (Consolidated Standards of Reporting Trials).. It also presents the controversies of social workers in the use of RCTs.. Current health services research emphasizes evidence-based practices, research on comparative effectiveness, and using dissemination and implementation research to understand the gaps between empirically supported interventions and the services that are offered in routine care. RCTs have emerged as a central methodology in all of these efforts. Social workers, therefore, need to be knowledgeable and engage in these efforts.
Rights-Based Framework and Social Work
Authors: Androff David
Published: October 2014

The past few years have seen a surge in efforts to incorporate rights-based approaches in social work practice. This rise has been spearheaded by a growing awareness that human rights can reduce or eradicate poverty and injustice while advancing human dignity and social welfare. Professional Codes of Ethics around the world maintain social workers’ responsibilities to uphold human rights. However, few rights-based approaches to social work practice have been developed. This encyclopedia entry introduces the concept of rights-based approaches, presents new models of rights-based social work, reviews the rights-based principles for social work practice of human dignity, nondiscrimination, participation, transparency, and accountability, and discusses how this framework can be applied to various practice settings and populations.
Roma Community, Roma Minority
Authors: Urh Špela
Published: October 2014

The prevalent discourse about Roma community mainly occurs when the media reports “Roma problems.” Homogeneity, nomadism, and assumed innate characteristics (for example, laziness, aggressiveness, and lower intellectual abilities) are the most common myths about them. However, sociology recognizes Roma, Gypsies, Tzigany, Zigeuner, or Gitanos as one of the most oppressed, hated, and discriminated minority in all countries of their residence. This article discusses the multidimensional levels of discrimination of Roma minority from the perspective of their everyday life experience on a personal, cultural, and structural level. As Dominelli, Thompson, and Jones established, those are three crucial dimensions of recognizing the dynamic and rooted nature of discrimination.