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Meadows T.,University of Nebraska Medical Center | Meadows T.,Munroe Meyer Institute | Valleley R.,University of Nebraska Medical Center | Thorson R.,University of Nebraska Medical Center | Evans J.,University of Nebraska Medical Center
Clinical Pediatrics | Year: 2011

Objective: To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. Methods: Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%. Results: Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. Conclusion: Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement. © The Author(s) 2011.

Rodriguez N.M.,Munroe Meyer Institute | Thompson R.H.,Western New England University | Stocco C.S.,Western New England University | Schlichenmeyer K.,Western New England University
Journal of Intellectual and Developmental Disability | Year: 2013

Background There is a need for a more accurate characterisation of higher level restricted and repetitive behaviour (RRB) in autism spectrum disorder (ASD), including why it might be considered problematic and events associated with its occurrence. Method We selected one form of higher level RRB-Arranging and ordering-that was rated as severe for a large percentage of the population sampled. We interviewed 20 students' teachers and conducted naturalistic observations for 15 of those students. Results The characteristics of arranging and ordering varied across, and sometimes within, individuals. Problems associated with compulsive-like behaviour also varied, with several unanticipated reported problems. With the exception of attention, social consequences were relatively infrequent. Conclusions These data highlight the need for research on the assessment and treatment of arranging and ordering and clinical attention to compulsive-like behaviour in ASD. Interviews and naturalistic observations are useful for structuring additional observations and analyses. © 2013 Australasian Society for Intellectual Disability, Inc.

Zhao Z.,Munroe Meyer Institute | Verma V.,University of Nebraska Medical Center | Zhang M.,University of Nebraska Medical Center
Cancer Biology and Therapy | Year: 2015

Anaplastic lymphoma kinase (ALK) is correlated with oncogenesis in different types of cancers, such as anaplastic large cell lymphoma, lung cancer, neuroblastoma, and even breast cancer, by abnormal fusion of ALK or non-fusion ALK activation. ALK is a receptor tyrosine kinase, with a single transmembrane domain, that plays an important role in development. Upon ligand binding to the extracellular domain, the receptor undergoes dimerization and subsequent autophosphorylation of the intracellular kinase domain. In recent years, ALK inhibitors have been developed for cancer treatment. These inhibitors target ALK activity and show effectiveness in ALK-positive non-small cell lung cancer. However, acquired treatment resistance makes the future of this therapy unclear; new strategies are underway to overcome the limitations of current ALK inhibitors. © 2015 Taylor & Francis Group, LLC.

Mathews T.L.,Munroe Meyer Institute | King M.L.,University of Nebraska Medical Center | Kupzyk K.A.,Munroe Meyer Institute | Lake C.M.,Wedgwood Christian Services
Journal of Pediatric Health Care | Year: 2014

Introduction: The primary goal of this article is to describe an intake process and results of screening for developmental and autism spectrum disorders in children referred to a tertiary center. A secondary analysis of abnormal screening results, demographic variables, and parental concerns of autism was conducted, along with a correlation analysis between developmental and autism-specific screening tools. Methods: A total of 379 children younger than 6 years were "prescreened" with the Ages and Stages Questionnaire-3 and the Modified Checklist for Autism in Toddlers or the Social Communication Questionnaire. Medical records were reviewed to identify demographic variables and parental primary concerns. Results: In approximately 11% of participants who screened positive for autism, no parental concerns of autism were present. Medium effect size correlations were found between the failed autism screening tools and delays in two domains on the Ages and Stages Questionnaire-3. Discussion: Clinical implications are addressed concerning diligent use of developmental and autism-specific rating scales to identify children at risk. © 2014 National Association of Pediatric Nurse Practitioners.

Lomas J.E.,Marcus Institute | Fisher W.W.,Munroe Meyer Institute | Kelley M.E.,Munroe Meyer Institute
Journal of Applied Behavior Analysis | Year: 2010

Prior research indicates that reinforcement of an appropriate response (e.g., compliance) can produce concomitant reductions in problem behavior reinforced by escape when problem behavior continues to produce negative reinforcement (e.g., Lalli et al., 1999). These effects may be due to a preference for positive over negative reinforcement or to positive reinforcement acting as an abolishing operation, rendering demands less aversive and escape from demands less effective as negative reinforcement. In the current investigation, we delivered a preferred food item and praise on a variable-time 15-s schedule while providing escape for problem behavior on a fixed-ratio 1 schedule in a demand condition for 3 participants with problem behavior maintained by negative reinforcement. Results for all 3 participants showed that variable-time delivery of preferred edible items reduced problem behavior even though escape continued to be available for these responses. These findings are discussed in the context of motivating operations.

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