bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional Experiences of Caregivers of Patients with a Ventricular Assist Device
Authors: Kaan Annemarie , Young Quincy-Robyn , Cockell Sarah , Mackay Martha
Published: July 2017

Context

Little is known about the stresses experienced by caregivers of patients discharged home with a ventricular assist device.

Objective

To describe the lived experience of caregivers of patients who were discharged home with a ventricular assist device.

Design

The study used a phenomenological framework to conduct semistructured interviews guided by 2 psychologists using a focus group setting.

Participants

Interviews of 13 caregivers of 9 patients discharged to home with a ventricular assist device between March 2004 and June 2007 were recorded, transcribed, and analyzed.

Results

Four themes emerged during the interviews: anxiety, initially exhibited as profound shock; loss of a loved one, of their lives, of freedom and independence; burden, both the physical burden and the burden of responsibility; and finally coping through faith, acceptance, empathy, and social support.

Conclusion

Caregivers of patients discharged home with a ventricular assist device experienced significant pressures that changed over the duration of support with the ventricular assist device. Caregivers described their coping mechanisms in dealing with shock, loss, and burden. Understanding the fluctuating needs of caregivers will enable teams to provide interventions based on the situation. Future care guidelines should address the significant stresses placed on caregivers of recipients of a ventricular assist device.
The Joint Commission's Disease-Specific Care Certification for Destination Therapy Ventricular Assist Devices
Authors: Lockard Kathleen L. , Weimer Ashley , O'Shea Genevieve , Driggers Erin , Conroy Linda , Teuteberg Jeffrey J. , Winowich Stephen , Lohmann Douglas , Schaub Richard D. , Severyn Donald A. , Kormos Robert L.
Published: July 2017

The Centers for Medicare and Medicaid Services announced that all hospitals implanting ventricular assist devices are required to have certification from the The Joint Commission for disease-specific care destination therapy with a ventricular assist device effective March 27, 2009, in order to receive Medicare reimbursement for services rendered to patients who have devices implanted for destination therapy. On February 23, 2007, The Joint Commission released the certification requirements for ventricular assist devices implanted for destination therapy in an 8-page document so that hospitals could prepare to meet the 2009 certification deadline. The Artificial Heart Program of the University of Pittsburgh Medical Center undertook a multidisciplinary project, under the guidance of the nurse coordinator, to prepare the hospital and program for a precertification survey by The Joint Commission for disease-specific destination therapy ventricular assist device certification. The Presbyterian Hospital Artificial Heart Program was awarded The Joint Commission's device-specific certification for destination therapy with ventricular assist devices in June 2008.
Hypotension after Reperfusion in Liver Transplantation: Histidine-Tryptophan-Ketoglutarate versus University of Wisconsin Solution
Authors: Ghafaripour S. , Sahmeddini M. A. , Lahsaee S. M. , Khosravi M. B. , Sattari H. , Nikeghbalian S. , Shokrizadeh S. , Malekhosseine S. A.
Published: July 2017

Background

The greatest hemodynamic instability during orthotopic liver transplantation occurs at graft reperfusion. Many factors have been implicated.

Purpose

To compare hemodynamic changes after reperfusion in grafted livers preserved with histidine-tryptophan-ketoglutarate (HTK) solution versus grafted livers preserved with University of Wisconsin (UW) solution.

Methods

In this prospective study, we randomly divided 89 patients who underwent deceased donor liver transplantation into 2 groups: the UW group and the HTK group. The HTK group was further divided into 2 subgroups: flushed and not flushed before reperfusion. The patients were monitored with hemodynamic and metabolic parameters at 3 times: after the skin incision, 5 minutes before reperfusion, and 5 minutes after reperfusion.

Results

Hemodynamic parameters in the UW group had not changed significantly at 5 minutes before reperfusion or 5 minutes after reperfusion ( P= .45), and the incidence of hypotension after reperfusion in the UW group was 20%. In both HTK groups, the mean arterial pressure 5 minutes after reperfusion was significantly lower than at 5 minutes before reperfusion ( P = .002); the incidence of hypotension after reperfusion in the nonflushed HTK group was 83.3% and in the flushed HTK group, 65.5%.

Conclusions

The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.
Differential Lung Ventilation during Adult Donor Care
Authors: Powner David J.
Published: July 2017

Differential lung ventilation may be required when one lung is injured or affected more than the other lung following, for example, aspiration, crush injury, or selective pneumonia, or if lung rupture results in formation of a bronchopleural fistula. Unilateral lung failure causes increased ventilation-perfusion mismatching that often leads to severe hypoxemia. Treatment may include careful attention to ventilator parameters to avoid overdistention of the less-affected lung or lateral decubitus positioning of the donor with the less-affected lung down (gravitationally dependent position). Under extreme conditions, use of a specialized double-lumen endotracheal tube and separate ventilators with individualized parameters for each lung is required to provide adequate oxygenation and ventilation for organ preservation.
Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites
Authors: Robinson June K. , Alam Murad , Ashourian Neda , Khan Misbah , Kundu Roopal , Laumann Anne E. , Schlosser Bethanee J. , Yoo Simon , Gordon Elisa J.
Published: July 2017

Context

Repeated patient education about skin cancer prevention is important to self-care after transplant.

Objective

Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma.

Design

Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists.

Participants

An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist.

Main Outcome Measures

Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination.

Results

Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination

Conclusion

Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
Stranger Donors: A Key Link in Transplant Chains
Authors: Veys Christopher G. , Bramstedt Katrina A.
Published: July 2017

Living donation to strangers is a complex issue that has caused some transplant centers to ban the practice altogether. Most prominent of the troublesome issues is the common source of these donors; namely, the Internet. These “stranger donors,” however, are critical to both paired kidney transplants and chain kidney transplants. This article presents the ethical complexities of donors in these transplant arrangements and offers 2 case examples from our facility. Rigorous donor screening and informed consent processes are crucial, and together they help make transplant pairs and chains ethically feasible.
Recommendations for the Proper Use of Nonprescription Cough Suppressants and Expectorants in Solid-Organ Transplant Recipients
Authors: Gabardi Steven , Carter Danielle , Martin Spencer , Roberts Keri
Published: July 2017

Objective

To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions.

Data Sources and Extraction

Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed.

Data Synthesis

Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined.

Conclusion

Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.
A Systematic Approach to Postoperative Management of Deceased Donor Kidney Transplant Patients with a Clinical Pathway
Authors: Seawright Ashley Heath , Taylor Laura
Published: July 2017

Context

Clinical pathways have been used in many acute hospital settings.

Objectives

To develop a systematic approach to postoperative care of adult recipients of deceased donor kidney transplants at the University of Mississippi Medical Center.

Design and Setting

A pilot quality improvement project that uses implementation of a clinical pathway 24 hours after surgery for adult recipients of a deceased donor kidney transplant for 7 months. Charts from the same 7 months of the preceding year were retrospectively reviewed for comparison. The project occurred on the transplant floor in an acute care hospital and did not include any patients admitted to the intensive care unit.

Main Outcome Measures

To demonstrate that clinical pathways can (1) promote a method for standardizing postoperative care, (2) decrease postoperative length of stay, and (3) contain costs by minimizing hospital charges related to laboratory and room fees and promote efficient medication use in adult recipients of a deceased donor kidney transplant.

Results

All 24 patients in the clinical pathway group met daily goals of the implemented clinical pathway. The clinical pathway group had statistically significant decreases in postoperative length of stay, use of laboratory tests, and use of intravenous medications compared with the comparison group. The 2 groups were similar in race, sex, age, and body mass index. Surgical readmissions did not differ significantly between the 2 groups.
Identifying and Addressing Barriers to African American and Non—African American Families' Discussions about Preemptive Living Related Kidney Transplantation
Authors: Boulware L. Ebony , Hill-Briggs Felicia , Kraus Edward S. , Melancon J. Keith , Senga Mikiko , Evans Kira E. , Troll Misty U. , Ephraim Patti , Jaar Bernard G. , Myers Donna I. , McGuire Raquel , Falcone Brenda , Bonhage Bobbie , Powe Neil R.
Published: July 2017

Context

Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown.

Objective, Setting, and Participants

To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non—African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored.

Results

Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of family members, (4) uncertainty about when to initiate discussions, and (5) inducing guilt or coercing family members. Family members' barriers included (1) feeling overwhelmed by patients' illness, (2) patients' denial about their illness, (3) caregiver stress, and (4) uncertainty about their own health or the health of other family members who might donate or need a kidney in the future. Participants reported that social workers could facilitate difficult or awkward discussions and help families understand the LRKT process, address financial concerns, and cope emotionally. Themes were similar between African Americans and non—African Americans.

Conclusions

Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
The Role of Clinical Nurse Educators in Organ Procurement Organizations
Authors: Swain Sharon
Published: July 2017

Clinical nurse educators are advanced practice nurses with preparation at the master's level or higher. Such nurses play an important role in organ procurement organizations. As leaders and members of the team, they provide structure and design to the training process. These educators oversee orientation of new employees, serve as mentors to preceptors, assess the learning needs of the organization, and provide ongoing training to veteran staff. Clinical nurse educators also contribute to continuous quality improvement for the organization and help to comply with regulatory standards.
The Role of Advanced Practice Nurses in Transplant Center Staffing
Authors: Hoy Haley , Alexander Susan , Payne Jerita , Zavala Edward
Published: July 2017

Context

Despite increased rates of solid organ transplantation and frequent use of advanced practice nurses (APNs) to manage patients, no established staffing model including APNs and their roles exists.

Objective

To characterize the role and integration of APNs in the staffing models of existing transplant centers.

Design

Descriptive research using a researcher-designed survey of transplant APN professionals.

Participants

53 attendees of a national APN transplant clinical management symposium.

Main Outcome Measure

Investigator-designed survey tool consisting of 21 questions delivered in a paper format with 1 open-ended question about adequacy of current staffing and ideas for improvement.

Results

53 responses from staff members of 21 different transplant centers were collected. In addition to APNs, members of existing transplant staffing models were identified as licensed practical nurses, registered nurses, social workers, administrative assistants, and data managers. The primary responsibilities of APNs were both inpatient and outpatient, before and after transplant, and consisted primarily of collecting patients' medical histories, doing physical examinations, handling clinic visits, and education. Licensed practical and registered nurses handled pretransplant referral management and phone triage duties. Social workers, administrative assistants, and data managers were responsible for social support, medical record management, and regulatory documentation, respectively. Most respondents (57%) found current staffing to be inadequate in their centers and suggested areas for improvement.

Conclusion

APNs play a vital role in management of transplant patients. Transplant centers use APNs in different capacities, depending on the individual needs of the institution. Across institutions, support staff is crucial in the perception of adequate staffing. Additional research is needed to determine the most efficient use of APNs in transplant centers.
Low-dose Gabapentin for Intractable Hiccups in a Heart Transplant Recipient
Authors: Page Robert L. , Luna Megan , Brieke Andreas , Lindenfeld JoAnn
Published: July 2017

Intractable hiccups can be a serious complication in transplant recipients. Unfortunately, many of the pharmacotherapies used to stop hiccups are associated with severe side effects as well as drug-drug interactions with immunosuppressants. We report a case of a heart transplant recipient who had had intractable hiccups for 2 months, resulting in severe insomnia, diminished appetite, and weight loss. To treat the hiccups, treatment with oral baclofen (5–10 mg 3 times daily) was started. After 6 weeks of therapy, the baclofen was titrated down and discontinued because it had not stopped the hiccups and was causing severe central nervous system side effects. Gabapentin (100 mg twice daily) was then prescribed and within 24 hours of the start of that treatment, the hiccups had resolved completely. After 3 weeks of therapy, the patient had no side effects and the gabapentin was subsequently discontinued. One year after stopping the gabapentin, the patient remains free of hiccups. Gabapentin appears to be a promising medication for the treatment of intractable hiccups in thoracic transplant recipients because of its lack of serious side effects at low doses, rapid onset of action, and lack of drug-drug interactions with transplant medications.
Polylactic Acid Polymers from Com. Applications in the Textiles Industry
Authors: Lunt James , Shafer Andrew L.
Published: July 2017

Tables 10 and 11 summarize the key takeaways.

Looking at the world of “Technical Textiles” (Table 12) it is clear that this unique spectrum of properties will allow PLA polymers to participate in a wider range of markets.

In particular, in this segment, the unique combination of outstanding resistance to sunlight, resiliency, and elastic recovery offers potential for use in tents, patio umbrellas, and awnings. In addition, automotive applications requiring high moisture wicking and UV stability, such as seating will benefit from these materials. The high loft and resiliency offers promise in sleeping bags and other applications requiring good insulation properties.

A brief glimpse of a new polymer platform has been provided. These materials provide a rare example of a competitive polymer whose primary building block comes from a natural renewable carbohydrate source.

One billion pounds of PLA is equivalent to 0.5% of the annual US corn crop. Only 75% of the available acreage is presently used and corn is the cheapest source of dextrose; therefore, monomer supply is more than adequate to meet the foreseeable future. The minimal impact on corn utilization and existing uses leads to no negative impact for either society, or disposal. In addition, because potentially any carbohydrate feedstock can be used, this technology offers the future potential to use other natural feedstocks, such as wheat, sugar beets, rice and ultimately biomass.

The unique properties of these polymers have attracted considerable attention across the spectrum of plastics' applications. In particular, polylactic acid polymers show significant promise to the textiles and non-wovens industry.
A Study of Seam Leakage in Coated Fabrics
Authors: Frederick Edward B. , Henry Malcolm C.
Published: July 2017

Extensive investigations of sewn seams in coated fabrics have been conducted. The relative roles of thread, sewing machine components, stitch and seam types and properties of fabrics have been evaluated as parameters involved in seam leakage. Utilization of various experimental seam constructions, gasketing, application of heat during seam sewing and other techniques were attempted as poten tially useful approaches in combating seam leakage. Results indicate the main source of leakage, under experimentally generated hydro static pressure conditions, to be in the folds of the fabric and the needle holes generated in the sewing operation. Post sealing, accord ingly, must be considered to be a necessary requirement for all coated fabrics to assure moisture-proof seams under field use conditions.
Design and Analysis of Crosshead Annular Die for Braided Medical Tubing Extrusion
Authors: Guo Xiaoping , Stehr Richard E.
Published: July 2017

A theoretical method is proposed for optimum design of a crosshead annular die used for medical tubing. According to this method, the geometric variables are determined to minimize the change in gapwisely-averaged flow velocities due to the variation in flow patterns inside the transitional region of the flow channel of the die, namely the gum space. To achieve this, a numerical approach to flow analysis is put forward based upon the simplified motion and energy equations as well as the approximation of the flow channel using a series of varying annular slits, each having constant geometric parameters. Accordingly, the numerical schemes for flow analysis and design optimization are established, and the computer program is developed using Microsoft Visual C ++ 6.0. For an optimum die design, the heat adhesion between the cold-fed inner tube and the hot melt during the over-extrusion is evaluated based upon the temperature rise and pressure profile of the melt in the die land. Based upon the optimum die design obtained from the method, the flow is well balanced with enhancement of extrusion quality. Also, it is found that the optimum die designs are less sensitive to extrusion conditions within a certain range.
“In Music Nothing Is Worse Than Playing Wrong Notes”
Authors: Laor Lia
Published: July 2017

The literature of pedagogical music for the piano was the center of unparalleled critical dialogue and scholarly discourse in nineteenth-century Europe. Focusing on the theory of piano pedagogy and the merit of pedagogical music, this discourse was unique not only because of its subject matter but also because it was shared, shaped, and constructed by a wide diversity of contributors, including renowned composers, performers, pedagogues, and music critics of the period. Despite contemporary musicologists’ explicit interest in music within the fabric of sociocultural life, their research has mostly overlooked the important educational processes and practices for training the musician-performer, as well as the existing repertoire dedicated to initiating young children into the world of music.

Looking back at pedagogical traditions developed in the first half of the 1800s, I contend that piano pedagogy was governed by a conceptual framework consisting of two paradigms—mechanistic and holistic—which emerged, respectively, from the Enlightenment and Romantic philosophies. In this study I reviewed mechanistic piano pedagogy and its critique, as it evolved in the first half of nineteenth-century Europe, and offered a conceptual framework (based on the mechanistic paradigm and the contrasting principles underlying the holistic paradigm) that may be used to map current theories and practices, thereby enabling a continuous, unfragmented perspective of piano pedagogy from its inception.
Application of Piagetian Sensorimotor Concepts to Assessment and Curriculum for Severely Handicapped Children
Authors: Robinson Cordelia C.
Published: July 2017

People who work with very young handicapped children encounter problems in infant cognitive functioning. Standardized intelligence tests are inadequate tools for the assessment of these children's developmental capacities and the design of appropriate intervention strategies. This paper describes the adaptation of Piagetian sensorimotor concepts to the assessment of severely handicapped infants and toddlers. The objective of this procedure is to develop and validate a curriculum that will aid these children in the acquisition of sensorimotor skills.
Definitions of Severely Handicapped: A Survey of State Departments of Education
Authors: Justen Joseph E. , Brown Gregory E.
Published: July 2017

State departments of education were surveyed to determine the definitions of severely handicapped currently in use and also to determine whether the provision of education services to this population was mandatory or permissive. It was found that while the majority of states required that education services be provided to all children, fewer than half had a definition of the severely handicapped. Of the states surveyed which had definitions, the majority referred to either the mentally retarded or the multiply handicapped.
Some Current Directions in Education of the Severely/Multiply Handicapped
Authors: Sailor Wayne , Haring Norris G.
Published: July 2017

The current phase in our national education program for handicapped people began in November, 1975, with passage by Congress and signature by President Ford of the National Education for All Handicapped Children Act (P.L. 94–142). Before this legislation was passed, no specific agency assumed responsibility for the education of severely handicapped children and youth. In a few instances, school districts carried out experimental programs. Other programs were conducted by special facilities operated by county and local Association for Retarded Citizens programs. For the most part, “education” fell to large, understaffed, ill-equipped state institutions for retarded children, where most of the children and young adults were maintained. As a result of the often very primitive assessment, diagnosis, and classification systems available, many severely and multiply handicapped children–who are functionally retarded–were diagnosed as mentally retarded and placed in these institutions. So the primary milestone in the impetus for educating the severely/multiply handicapped was a legislative one, sponsored by a relatively small group of professionals.

Milestones in the educational process for this population are coming thick and fast. As a rapidly growing cadre of highly competent professionals gains experience with these children in 6-hour-per-day classes, new and creative developments in their educational strategies become legion.
The Relationship between Training Activities and Job Placement in Vocational Education of the Severely and Profoundly Handicapped
Authors: Mithaug Dennis E. , Hagmeier Lee D. , Haring Norris G.
Published: July 2017

This paper discusses problems associated with vocational training and job placement by focusing upon the functional relationship between the two. Developing a successful prevocational training program for the severely and profoundly handicapped is contingent upon a precise specification of the long-term objective, job placement. Rather than providing a flexible and general training program that could potentially lead anywhere (and, as a consequence, would probably lead nowhere), this approach specifies the client's next most probable placement as the basis for arranging training. This means that an assessment of the requirements for entry into the next job placement or training program is necessary. The information obtained from this assessment provides a basis for evaluating individual clients' strengths and weaknesses for that particular job. The client assessment, in turn, determines the appropriate prevocational training objectives, which in turn suggest the range of training activities that most probably relate to the targeted job. The paper also describes a procedure employed In a pilot study to assess entry-level requirements of sheltered workshops in the Seattle area. The instrument developed from that study is attached for possible use in other prevocational training programs serving the severely and profoundly handicapped.
A Replication Survey of Sheltered Workshop Entry Requirements
Authors: Johnson Janis L. , Mithaug Dennis E.
Published: July 2017

Replication of a survey to identify sheltered workshop entry requirements (Mithaug & Hagmeier, 1978) was completed in Kansas. The original survey involved 56 respondents representing sheltered workshops, developmental centers, and activity centers in five northwestern states. Replication in Kansas involved 15 respondents. Spearman's rank order correlations and Pearson's product moment correlations for Kansas-vs.-Northwest sample, Kansas-vs.-combined sample, and Northwest-vs.-combined sample were all significant from zero beyond the .001 level. This lends support to the notion that there are agreed-upon entry requirements for sheltered employment that are reliable across states and regions.
Developing a Leisure Skill Repertoire in Severely and Profoundly Handicapped Persons
Authors: Wehman Paul , Renzaglia Adelle , Berry Geraldine , Schutz Richard , Karan Orv
Published: July 2017

The present paper describes the development of a repertoire of leisure time skills in severely and profoundly handicapped adolescents and adults. Specific instructional direction and appropriate task analyses were provided in data-based programs involving the training of three exercises and four table games. The results of each program were evaluated in a multiple baseline design. Results were discussed in terms of the importance of helping the severely and profoundly handicapped develop a repertoire of leisure time skills. The ability to use leisure time is viewed as a potentially critical component in the move toward community reintegration.
An Analysis of the Effectiveness of a Preservice Workshop for Educators of Severely Handicapped Young Students
Authors: Filler John , Hecimovic Anton , Blue Sima
Published: July 2017

The pretest and posttest scores of eight professional and four paraprofessional staff were examined to determine the effectiveness of a preservice workshop. The results indicated that the didactic Instructional method employed was effective for building informational competency but only partially successful for performance competency.
Behavioral Training by Paraprofessionals for Families of Developmentally Disabled Persons
Authors: Mendelsohn Mark B.
Published: July 2017

An innovative system to deliver behavioral services was developed to extend a residential facility's community outreach and provide an alternative to institutionalization. The successful implementation of this program suggests a way to combine clinical service and staff training at the bachelor-technician career ladder step in psychology and related disciplines. Specifically, a team of behavior technicians delivered the skills of a mental retardation center to families of disabled children and adults formerly beyond the center's range. Parents were taught specific modification procedures to lessen the likelihood of disruptive behavior and to hasten the acquisition of new developmental skills by their children.
Case Study in Training Generalized Instruction-Following Responses to Preposition-Noun Combinations in a Severely Retarded Young Adult
Authors: Mithaug Dennis E.
Published: July 2017

In this study a 16-year-old severely retarded male was trained to respond to instructional requests that included the prepositions “in,” “on,” and “beside.” The training consisted of presenting untrained nouns and prepositions in isolation to develop appropriate discriminations before combining them into multiple-word phrases. Once discrimination was established between four direct-object nouns, four prepositions, and four prepositional-object nouns, the subject was trained briefly to respond to two-word combinations that included a direct object and a prepositional object. Following this training, there were increases in the subject's correct responses to untrained two-word requests and to expanded, untrained phrases containing random combinations of four direct objects, four prepositions, and four prepositional objects. The accuracy of the instruction-following response was evaluated in a second experiment in which the experimenter altered the structure and delivery of the instructional request. When the experimenter added irrelevant cues to the three-word request, “put the ___ ___ the ___,” the subject's accuracy decreased; and when the experimenter paused between the third and fourth words, e.g., “put the ___ (pause) ___ the ___,” accuracy increased. These results indicated that generalization to new instructional forms may depend upon training in the appropriate responses to relevant and irrelevant verbal cues as well as to different styles of delivering the request.
A Comparison of Procedures to Increase Responding in Three Severely Retarded, Noncompliant Young Adults
Authors: Mithaug Dennis E.
Published: July 2017

This study compared the relative effectiveness of different procedures for decreasing response durations in three severely retarded 14 to 20-year-old women who were severely disruptive and noncompliant. The conditions included two potentially positively reinforcing procedures and two potentially negatively reinforcing procedures. The two positive procedures consisted of contingent deliveries of verbal praise, back pats, and squirts of juice. One of the negative procedures consisted of tapping the subjects' hands, arms, back, and back of the neck until the correct response was evoked. The other negative procedure consisted of finger and thumb pressure to the sides of the subject's neck until a correct response was evoked. During both of these negative procedures, cessation of tapping or finger pressure was contingent upon emission of an appropriate response. For two of the subjects, the two positive procedures were compared with the negative tapping procedure and with each other; for the third subject, the positive praise plus juice procedure was compared with the two negative procedures, which were also compared with each other. The results consistently indicated that for the first two subjects, the negative tapping procedure was more effective than either praise or praise plus juice, with the latter two being equally effective. For the third subject, the negative finger pressure procedure was more effective than the negative tapping procedure, which in turn was more effective than the positive praise plus juice procedure.
Identifying Competency Indicators of Teachers of the Severely Handicapped
Authors: Fredericks H. D. Bud , Anderson Roy , Baldwin Victor
Published: July 2017

This article describes a research effort designed to identify indicators of competencies of teachers of the severely handicapped. Two indicators of competency (amount of instruction time, percentage of curriculum materials task analyzed) were identified as contributing to 78% of the variance for all variables. A training model was described for teaching these competencies to teachers, and subsequent student performance data were reported which demonstrate that the students of teachers trained under this model perform significantly better than students of teachers not trained. The implications of this study for teacher-training institutions are also addressed.
The Transdisciplinary Model: Implications for Service Delivery and Personnel Preparation for the Severely and Profoundly Handicapped
Authors: McCormick Linda , Goldman Ronald
Published: July 2017

This article describes three models of service delivery to the severely and profoundly handicapped and advocates a transdisciplinary model, in which team members serve as consultants to one primary service implementor. Data are given to demonstrate the inefficiency of one traditional program of service delivery. The authors suggest that professional responsibilities be more equally shared among team members, and that team members for all disciplines have a functional understanding of applied behavior analysis to use as a common set of techniques.
Effectiveness and Generalization of Overcorrection Procedures with the Stereotyped Behavior of a Severely Retarded Adult
Authors: Rose Heidi
Published: July 2017

A 38-year-old severely retarded woman who exhibited high rates of self-stimulation was exposed to an overcorrection procedure during the morning break in a sheltered workshop. Rates of self-stimulation behaviors were monitored during these breaks and in three other settings. The treatment, implemented in an ABAB design, appeared functionally related to significant reduction in the behavior in the treatment setting. The experimental design also indicates a functional relationship between treatment conditions in one setting and changes in behavior rates in two other nontreatment settings. The results are of particular relevance to programs in which limited staff resources effectively prevent intervention in all situations. The data also emphasize the need for evaluation of program effectiveness on the basis of behavior change in nontreatment settings.
Dealing with the Low Production Rates of Severely Retarded Workers
Authors: Horner Robert H. , Lahren Brian , Schwartz Thomas P. , O'Neill Candace T. , Hunter Janis D.
Published: July 2017

Two studies designed to increase the low production rates of severely retarded workers in a sheltered workshop setting are described. In one, differential reinforcement of higher rate was used to increase the rate of assembly of a cable harness from 13% of the standard rate of normal workers to almost 50% of the norm standard. In the second, a system of self-delivery of reward was used to shorten the time required to assemble a test adapter. The subject was trained successfully to perform a quality control check. The implications of the two studies for sheltered workshop settings are explored.
Improving the Leisure-Time Behaviors of Severely/Profoundly Mentally Retarded Children through Toy Play
Authors: Wambold Clark , Bailey Roberta
Published: July 2017

The present paper describes procedures that were designed to promote the toy play of a group of severely/profoundly mentally retarded children in a classroom setting. Time sampling procedures were used to assess the students' play behavior during a 30-minute play period. Group and individual interventions were established based on the pretests and probe tests. Changes were made according to student needs, based on the data collected. The results that are presented and discussed suggest improvements in the students' toy play.
The Reduction of Hyperactive Behavior in Three Profoundly Retarded Adolescents through Increased Stimulation
Authors: Evans Ronald G.
Published: July 2017

This study was designed to determine the effects of increased stimulation on the hyperactive behavior of three profoundly retarded boys. The setting for the study was a bathroom at a residential facility for mentally retarded individuals. Hyperactive behavior was measured under baseline and increased stimulation conditions through an a-b-a-b design. Increased stimulation consisted of greatly enriching the bathroom environment with auditory and visual stimulation. The results of the study indicate that increased simulation was effective in reducing the subjects' hyperactive behavior. Two conclusions can be drawn. First, the frequency of hyperactive behavior can be decreased by using a great deal of auditory and visual stimulation in a natural setting. Second, the study implies that the subjects may be more receptive to skill training in a sensorially stimulating environment.
Effects of Pairing Manual Signs with Verbal Cues upon the Acquisition of Instruction-Following Behaviors and the Generalization to Expressive Language with Severely Handicapped Students
Authors: Kohl Frances L. , Karlan George R. , Heal Laird W.
Published: July 2017

The purposes of this study were to examine whether the acquisition of instruction-following behavior is facilitated by the presentation of manual signs with verbal instructions and whether manual and verbal expressive abilities are acquired as an indirect result of receptive training. Three training conditions were presented in which manual signs were paired with each verbal instruction in a one-to-one correspondence with each word, with only key word elements, or were not presented with the instructions. Results indicate that the number of correctly completed instructions was greater for the conditions in which signs were paired with the verbal instruction than for the control conditions (signs were not presented). The effect of receptive instruction on manual and verbal expressive abilities varied among students.
An Extended Evaluation Model for Severely Handicapped Persons
Authors: Karan Orv C. , Bernstein Gail S. , Harvey John , Bates Paul , Renzaglia Adelle , Rosenthal David
Published: July 2017

This paper presents an extended evaluation model which provides a close and interactive conceptual link between evaluation and treatment processes. For some time there has been a trend in traditional vocational (re)habilitation practices to separate evaluation and treatment as if they were somehow distinct entities. This separateness can no longer continue, particularly now that vocational (re)habilitation programming is being broadened to include those with the most severe handicaps.
Using the Characteristics of Current and Subsequent Least Restrictive Environments in the Development of Curricular Content for Severely Handicapped Students
Authors: Brown Lou , Branston-McClean Mary Beth , Baumgart Diane , Vincent Lisbeth , Falvey Mary , Schroeder Jack
Published: July 2017

This paper is designed to address several critical issues that pertain to the development of longitudinal curricular content for use with severely handicapped students. More specifically, to emphasize: (a) the importance of the principle of partial participation; (b) the need to create a wide variety of adaptations that might allow severely handicapped students at least to participate in many environments and activities from which they have been excluded; and (c) a rationale for using current and subsequent environment orientations and ecological inventory strategies in curriculum development processes. In addition, the authors present a cursory example of how ecological inventory strategies and current and subsequent environment orientations might be combined to generate chrononogical age appropriate curricular content.
Use and Research Issues of a New Computer Keyboard
Authors: Kroemer K. H. E.
Published: July 2017

For use with computers, the traditional QWERTY keyboard has been enlarged to more than 100 keys. This has generated postural and motoric challenges for the user, including cumulative trauma disorders. Among the proposed ergonomic solutions is the Ternary Chord Keyboard (TCK) which has only eight keys. Its evaluation posed use and research issues. TCK operation requires fast and finely controlled force and displacement by the fingertips in a horizontal plane, i.e., “rocking” of keys instead of their familiar “tapping”. Associated mental tasks include memorization of the chords for each character.

Experiments were performed (a) on TCK prototypes to measure the time needed to memorize and learn its operation, and to assess keying performance; and (b) on specially designed experimental apparatus to measure finger mobility, strength, and speed. The results indicate that finger mobility, strength and tapping performance were not well correlated with keying performance. All subjects were able to learn to operate the TCK, requiring memorization of 58 chords, within two to ten hours. After additional about 10 hours of use, they were inputting averages of 70 characters per minute, or more, with an accuracy of better than 97 percent.

These results indicate that key operation such as with the TCK, which is rather different from the traditional QWERTY keyboard use, is feasible.
Description and Prediction of Long-Term Learning of a Keyboarding Task
Authors: McMulkin Mark
Published: July 2017

The goal of this study was to determine an equation (“learning function”) that describes long-term learning of a new keyboard. Five subjects learned 18 characters on a chord keyboard, then improved keying speed by inputting typical numeric keypad text for about 60 total hours. Their performance, in characters typed per minute, was recorded for every trial. Of the various functions that were considered to describe performance, the best fitting equation was a Log-Log relationship of the form CPMi = eb0Tib1, where CPMi is the performance in characters per minute on the i-th trial (Ti) and b0 and b1 are fitted coefficients.

A second goal was to investigate how many trials of performance are needed before the entire learning function can be determined. The coefficients of the Log-Log function were determined using only the first 25, 50, 75, 100, 125, 150, 175, and 200 of the initial performance points (out of about 550 total actual data points). The mean squared error (MSE) was calculated for each of these fits and compared to the MSE of the fit using all points. From the results of MSE data, it appears that at least 50 performance data points are required to reduce the prediction error to an acceptable level.
Enhanced Recognition Accuracy with the Simultaneous Use of Three Automated Speech Recognition Systems
Authors: Barry Timothy P. , Liggett Kristen K. , Williamson David T. , Reising John M.
Published: July 2017

Two studies were performed to test the efficacy of using three different automated speech recognition devices in parallel to obtain speech recognition accuracies better than those produced by each of the individual systems alone. The first experiment compared the recognition accuracy of each of the three individual systems with the accuracy obtained by combining the data from all three systems using a simple “Majority Rules” algorithm. The second experiment made the same comparison, but used a more sophisticated algorithm developed using the performance data obtained from experiment 1. Results from the first experiment revealed a modest increase in speech recognition accuracy using all three systems in concert along with the Simple Majority Rules (SMR) algorithm. Results from the second experiment showed an even greater improvement in recognition accuracy using the three systems in concert and an Enhanced Majority Rules (EMR) algorithm. The implications of using intelligent software and multiple speech recognition devices to improve speech recognition accuracy are discussed.
Increasing or Decreasing? The Menu Direction Effect on User Performance
Authors: Bishu Ram R. , Zhan Ping
Published: July 2017

Although the breadth/depth issue in menu design has been identified to have significant effects on user performance, the effects of menu direction and dimension have not been well investigated, especially as iconic menus as concerned. This study investigated the effects of menu direction and dimension on user selection performance by using two different dimensions (sizes) of iconic menu systems (16-item and 32-item). The direction of the menus consisted of “increasing” and “decreasing”, with the depth of menu ranging from 2 to 3 levels. The findings indicated that “decreasing” direction menus were significantly quicker and more accurate than “increasing” menus. However, for the smaller size menus (16 item menus), user performance accuracy was better with the “increasing” direction menus. Overall, the results showed that “decreasing” direction menus are superior to “increasing” menus. It is suggested that for small size iconic menus (e.g., up to 32 items), items should be organized in “decreasing” direction, especially when speed is of particular importance to the selection task.