Deconstructing the time-out: What do mothers understand about a common disciplinary procedure?

Problem behavior is extremely common throughout childhood, and time-out (TO) is one of the most common disciplinary tactics used by parents to address problem behavior. However, despite the prevalence of use and five decades of research demonstrating the efficacy of time-out, parents rate time-out as one of the least useful behavior modification techniques. This discrepancy between parental opinion and empirical data may be due to the fact that all research conducted thus far has used adults highly trained in empirically-supported time-out procedures. No research has examined the degree of similarity between time-out conducted by untrained parents to empirically-supported time-out procedures. Fifty-five mothers were asked to define time-out and to provide information on how they conduct time-out. In addition, videotaped vignettes were used to determine the extent to which mothers could identify errors in time-out procedures and whether that ability was related to child problem behavior. Results indicate that participants’ conceptualizations of TO differed considerably from the empirical rationale for TO. Relatively few participants reported adhering to or could identify the majority of parameters that have been shown to make TO effective. No significant relationships between TO accuracy and levels of child problem behavior were found. However, mothers who use TO procedures that are closer to the empirical ideal and who find TO to be more effective report using TO to punish a greater number of child problem behaviors

SPIRE - combining SGI-110 with cisplatin and gemcitabine chemotherapy for solid malignancies including bladder cancer: study protocol for a phase Ib/randomised IIa open label clinical trial

Background Urothelial bladder cancer (UBC) accounts for 10,000 new diagnoses and 5000 deaths annually in the UK (Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bladder-cancer, Cancer Research UK, Accessed 26 Mar 2018). Cisplatin-based chemotherapy is standard of care therapy for UBC for both palliative first-line treatment of advanced/metastatic disease and radical neoadjuvant treatment of localised muscle invasive bladder cancer. However, cisplatin resistance remains a critical cause of treatment failure and a barrier to therapeutic advance in UBC. Based on supportive pre-clinical data, we hypothesised that DNA methyltransferase inhibition would circumvent cisplatin resistance in UBC and potentially other cancers. Methods The addition of SGI-110 (guadecitabine, a DNA methyltransferase inhibitor) to conventional doublet therapy of gemcitabine and cisplatin (GC) is being tested within the phase Ib/IIa SPIRE clinical trial. SPIRE incorporates an initial, modified rolling six-dose escalation phase Ib design of up to 36 patients with advanced solid tumours followed by a 20-patient open-label randomised controlled dose expansion phase IIa component as neoadjuvant treatment for UBC. Patients are being recruited from UK secondary care sites. The dose escalation phase will determine a recommended phase II dose (RP2D, primary endpoint) of SGI-110, by subcutaneous injection, on days 1–5 for combination with GC at conventional doses (cisplatin 70 mg/m2, IV infusion, day 8; gemcitabine 1000 mg/m2, IV infusion, days 8 and 15) in every 21-day cycle. In the dose expansion phase, patients will be randomised 1:1 to GC with or without SGI-110 at the proposed RP2D. Secondary endpoints will include toxicity profiles, SGI-110 pharmacokinetics and pharmacodynamic biomarkers, and pathological complete response rates in the dose expansion phase. Analyses will not be powered for formal statistical comparisons and descriptive statistics will be used to describe rates of toxicity, efficacy and translational endpoints by treatment arm. Discussion SPIRE will provide evidence for whether SGI-110 in combination with GC chemotherapy is safe and biologically effective prior to future phase II/III trials as a neoadjuvant therapy for UBC and potentially in other cancers treated with GC

Functional Outcomes for a Patient with West Nile Virus Encephalitis Receiving Physical Therapy in the Long Term Acute Care Hospital: A Case Report

Background and Purpose: West Nile virus (WNV) was first introduced into the United States in 1999 and continues to be an annual epidemic, particularly in the Midwest region. Approximately 1% of WNV cases are neuroinvasive. The subtypes of neuroinvasive WNV include encephalitis, meningitis and poliomyelitis. The purpose of this case report is to describe the physical therapy plan of care and functional outcomes for a 54 year old female patient with West Nile virus encephalitis in the long term acute care hospital (LTACH). Case Description: The patient was a 54 year old Caucasian woman in good health who became acutely ill. The patient was diagnosed with West Nile virus encephalitis with respiratory failure and presented with debility, weakness and flaccid paralysis in her left upper extremity. She was admitted to the long term acute care hospital for ventilator weaning and physical therapy was introduced to address the patient’s functional limitations. Outcomes: After receiving care for 19 days and participating in 9 physical therapy treatment sessions, the patient’s functional status improved from being dependent for standing and non-ambulatory to ambulating 24 feet with a rolling walker. There was a clinically significant improvement in the patient’s AM-PAC “6-Clicks” Basic Mobility score and an improvement in her FIM score, although not clinically significant. Following care in the LTACH, the patient advanced to an acute inpatient rehabilitation facility. Discussion: The patient’s improvements in bed mobility and transfers are promising indicators that functional mobilization helped increase endurance and strength necessary for these activities. Further research may help determine preferred treatment options for patients with West Nile encephalitis (WNE) and the possibility of post-West Nile virus poliomyelitis syndrome

Deconstructing the time-out: What do mothers understand about a common disciplinary procedure?

Time-out (TO) is one of the most common and effective disciplinary tactics used to address problem behavior; however, parents rate TO as one of the least useful behavior modification techniques. This may be due to a discrepancy between empirically supported TO procedures and how mothers are actually conducting TO. Fifty-five mothers were asked to define TO, provide information on how they conduct TO, and identify errors in TO procedures. Results indicate that maternal knowledge and implementation of TO differs considerably from the empirical ideal, potentially impacting the utility and frequency of TO usage in the home to address child problem behaviors