BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Featured Article Review: Effectiveness of Time-out with andwithout Contingent Delay

We evaluated a commonly used component of brief time-out, in which release from time-out is delayed contingent on the occurrence of disruption. Data were collected for one normal and two mentally retarded children on time-out-producing behaviors (aggression and disruption) as well as delay-producing behaviors during time-out (loud vocalizations, out-of-chair, aggression, and disruption). The results of a combination ABAC reversal and multiple-baseline design indicated that, under the conditions used in this investigation, both delay and no delay variations were effective in reducing the frequency of the target behaviors. Implications for the use of time-out to reduce aberrant behaviors are discussed

Developing and assessing stimulus control based on establishing operations during mand training using representative objects

The acquisition of verbal behavior can be difficult for some individuals with severe developmental disabilities. For two individuals who previously did not acquire picture exchange communication despite extensive efforts, we evaluated the effectiveness of using representative objects to teach mands for preferred items. In addition, we replicated and extended the findings of our previous research manipulating motivating operations (MO) for functional discriminated mands. Two individuals with developmental disabilities participated in a training procedure designed to teach two separate mands for two separate preferred items. Participants were taught to mand (e.g., for chips) using representative objects (e.g., empty bag of chips). Following training, the MO manipulation was used to assess for discriminated manding. This manipulation involved providing free access to one of the preferred items, such that there should be no motivation to ask for it, while motivation to ask for the other item remained in place. Results showed that both participants acquired at least a degree of discriminated manding using representative objects. At a minimum, a method was established to test complex discrimina‐ tions for preferred objects. Although we previously used this procedure in teaching picture card exchange discriminations, the current research extended previous research to individuals who were previously unresponsive to training and by using representative objects. Copyright © 2010 John Wiley & Sons, Ltd

Laboratory Evaluations ofReinforcement Contingencies

For nearly a decade we ran studies in an operant (rat) laboratory. The purpose of these studies was to address phenomena that were pertinent to the application of behavioral principles and to better understand the nature of behavior. In this paper we will summarize the preliminary findings of two recent lines of research and we will discuss the implications for application. Specifically, we will discuss research on reinforcement contingencies that maintain behavior and reinforcement contingencies that suppress behavior (such as differential reinforcement of other behavior)

Evaluating Features of Behavioral Treatments in the Nonhuman Animal Laboratory

Behavioral treatments for severe problem behavior are often derived from basic behavioral principles initially evaluated in the nonhuman operant laboratory. It is less common to see laboratory experiments conducted for the specific purpose of addressing nuances of behavioral treatments. Because of functional analysis/assessment methods that are now commonly used in applied behavior analysis, integrated basic and applied research is more feasible and bidirectional. This is true because a functional analysis identifies reinforcers for problem behavior and, thus, control of those reinforcers is possible in a way that is similar to controlling access to reinforcers in basic research. Because of our enthusiasm for the possibility of conducting basic research on common behavioral treatments, we initiated a rat laboratory for that purpose. In this paper, we describe some early work from the laboratory

The Effects of Extinction, Noncontingent Reinforcement, and Differential Reinforcementof Other Behavior as Control Procedures for Contingent Reinforcement

Several techniques have been used in applied research as controls for the introduction of a reinforcement contingency, including extinction, noncontingent reinforcement (NCR), and differential reinforcement of other behavior (DRO). Little research, however, has examined the relative strengths and limitations of these reversal controls. We compared the effects of extinction with those of NCR and DRO in both multi-element and reversal designs, with respect to (a) rate and amount of response decrement, (b) rate of response recovery following reintroduction of reinforcement, and (c) any positive or negative side effects associated with transitions. Results indicated that extinction generally produced the most consistent and rapid reversal effects, with few observed negative side effects

Correspondence between functional analyses of mands and functional analyses of problem behavior

When problem behavior is dangerous, there is precedent in the literature for inferring its function by conducting a functional analysis (FA) of less severe response topographies that reliably precede it (e.g., FAs of precursor behavior). In such cases, it could be advantageous to target socially desirable responses (e.g., mands) rather than less severe problem behavior. In our study, we compared the results of FAs of problem behavior with two FAs (one with prompts and one without) of mands and found poor correspondence in both instances. Although we conclude that FAs of mands are not viable replacements for FAs of problem behavior, these analyses may possess some therapeutic utility. Potential alternative uses for this methodology are discussed