Increasing Student On-Task Behavior in a Juvenile Detention Day School Through the Use of a Token Procedure Implemented by Juvenile Correctional Officers

Abstract Education is important for all children. This is especially true for students in detention facilities where they may receive less than optimal learning opportunities. Among many barriers to students in detention facilities receiving a quality education is the students’ lack of on-task behavior or engaging in frequent classroom disruptions (Houchins, Puckett-Patterson, Crosby, Shippen, & Jolivette, 2009). Researchers have used differential reinforcement procedures in classroom settings to increase student on-task behaviors (Heering & Wilder, 2006; Kelly & Bushell, 1987; Lo & Cartledge, 2006). Additionally, token economies have been used to improve delinquent youths’ behaviors such as academic performance and appropriate classroom behaviors (Bednar, Zelhart, Greathouse, & Weinberg, 1970; Seymour & Sanson-Fisher, 1975; Tyler, 1967; Tyler & Brown, 1968). Although token economies have often been used with delinquent youth in detention facilities, minimal research exists on teaching juvenile correctional officers (JCOs) to implement token procedures to increase appropriate youth behaviors in a detention day school. Therefore, the purpose of the current study was to evaluate the effects of a differential reinforcement of alternative behavior (DRA) token procedure, implemented by juvenile correctional officers (JCOs), on the on-task behavior of detention day school student participants. JCO participants were taught how to implement the DRA token procedure using behavioral skills training (BST). Results demonstrated that BST was effective in teaching the JCO participants how to implement the DRA token procedure and the DRA token procedure was effective in increasing the on-task behavior of detention day school student participants attending a detention day school

Effect of rosuvastatin on outcomes in chronic haemodialysis patients – design and rationale of the AURORA study

BACKGROUND: Patients with end-stage renal disease (ESRD) are at high risk of cardiovascular events. Multiple risk factors for atherosclerosis are present in ESRD and may contribute to the increased risk of cardiovascular mortality in this population. In contrast to patients with normal renal function, the benefits of modifying lipid levels on cardiovascular outcomes in patients with ESRD on haemodialysis have yet to be confirmed in large prospective randomised trials. A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events (AURORA) will be the first large-scale international trial to assess the effects of statin therapy on cardiovascular morbidity and mortality in ESRD patients on chronic haemodialysis. METHODS: More than 2,750 ESRD patients who have been receiving chronic haemodialysis treatment for at least 3 months have been randomised (1:1), irrespective of baseline lipid levels, to treatment with rosuvastatin 10 mg or placebo. The primary study endpoint is the time to a major cardiovascular event (first occurrence of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke). Secondary endpoints include all-cause mortality, major cardiovascular event-free survival time, time to cardiovascular death, time to non-cardiovascular death, cardiovascular interventions, tolerability of treatment and health economic costs per life-year saved. Study medication will be given until 620 subjects have experienced a major cardiovascular event. CONCLUSION: Our hypothesis is that results from AURORA will establish the clinical efficacy and tolerability of rosuvastatin in patients with ESRD receiving chronic haemodialysis and guide the optimal management of this expanding population

Does Instructor Type Matter? Undergraduate Student Perception of Graduate Teaching Assistants and Professors

Graduate teaching assistants (GTAs) are used extensively as instructors in higher education, yet their status and authority as teachers may be unclear to undergraduates, to administrators, and even to the GTAs themselves. This study explored undergraduate perception of classroom instruction by GTAs and professors to identify factors unique to each type of instructor versus the type of classes they teach. Data collection was via an online survey composed of subscales from two validated instruments, as well as one open-ended question asking students to compare the same class taught by a professor versus a GTA. Quantitative and qualitative results indicated that some student instructional perceptions are specific to instructor type, and not class type. For example, regardless of type of class, professors are perceived as being confident, in control, organized, experienced, knowledgeable, distant, formal, strict, hard, boring, and respected. Conversely, GTAs are perceived as uncertain, hesitant, nervous, relaxed, laid-back, engaging, interactive, relatable, understanding, and able to personalize teaching. Overall, undergraduates seem to perceive professors as having more knowledge and authority over the curriculum, but enjoy the instructional style of GTAs. The results of this study will be used to make recommendations for GTA professional development programs

Decision Making during International Crises

This study investigated the hypothesis that high-quality decision-making procedures during crises are associated with better crisis outcomes than are defective decision-making procedures. Presidential decision making during 19 international crises since World War II was examined for seven symptoms of defective decision making proposed by Janis and Mann (1977). Crisis outcomes were rated by outside experts in terms of their effect on U.S. vital interests and on international conflict. Results indicated that crisis outcomes tended to have more adverse effects on U.S. interests and were more likely to increase international conflict when the decision-making process was characterized by a large number of symptoms. Alternative explanations are considered and the implications of these results for improving decision makers' procedures are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66832/2/10.1177_0022002787031002001.pd

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged 6518 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40\ub70 (30\ub70 to 53\ub70). 1397 (66\ub79%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87\ub75%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64\ub70%) of 2088 patients were given benzodiazepines for a median of 7\ub70 days (4\ub70 to 12\ub70) and 1481 (70\ub79%) were given propofol for a median of 7\ub70 days (4\ub70 to 11\ub70). Median Richmond Agitation\u2013Sedation Scale score while on invasive mechanical ventilation was \u20134 (\u20135 to \u20133). 1704 (81\ub76%) of 2088 patients were comatose for a median of 10\ub70 days (6\ub70 to 15\ub70) and 1147 (54\ub79%) were delirious for a median of 3\ub70 days (2\ub70 to 6\ub70). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p 640\ub704), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p<0\ub70001). During the 21-day study period, patients were alive without delirium or coma for a median of 5\ub70 days (0\ub70 to 14\ub70). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p<0\ub701). 601 (28\ub78%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. Interpretation: Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. Funding: None. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section