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The current experiment assessed whether relating abstract stimuli with familiar pictures by exclusion would produce the formation of a meaningful equivalence class. Ten participants learned conditional discrimination relations with abstract stimuli and established equivalence classes (ABC classes). They then learned DA (D1A1, D2A2, and D3A3) conditional discriminations with written words as D stimuli; two words (D1 and D2) were meaningful stimuli in the participants verbal community ("Dentist" and "Baker"), whereas the third (D3) was a pseudoword ("Tabilu"). In testing trials, participants evidenced derived relations between pictures related preexperimentally to D1 and D2 with the experimental equivalence classes related to D1 and D2. For some participants, the decontextualized stimuli were a set of boat pictures (Condition 1), whereas for others they were a set of miscellaneous pictures (Condition 2). Participants in both conditions successfully matched decontextualized pictures (unrelated to dentist and baker contexts) to all abstract stimuli in the class related to D3 (exclusion responding). In Condition 1 the meaning reported to the word Tabilu was similar across participants, but in Condition 2 participants showed more variations to answer to the meaning of Tabilu. These results suggest that exclusion learning can occur under different stimulus control topographies., (© 2024 Society for the Experimental Analysis of Behavior.)

Relational frame theory (RFT) as a behavior-analytic approach to understanding human language and cognition is now over 40 years old. However, the last 8 years have seen a relatively intense period of empirical and conceptual developments within the theory. Some of this work has begun to draw on early and much underplayed features of RFT, including field-theoretical analyses and concepts. These analyses are relatively nascent and thus the current article aims to provide a relatively detailed example of a field-theoretical analysis of a specific RFT research program. We begin with a brief overview of the "traditional" RFT approach to human language and cognition, followed by a summary of recent research involving the implicit relational assessment procedure (IRAP) and the differential arbitrarily applicable relational responding effects (DAARRE) model. We then go on to consider the DAARRE model in the context of J. R. Kantor's interbehavioral formula for the psychological event. Having done so, we conclude that the challenge involved in analyzing increasingly complex forms of human language and cognition appears to call for more field-based theorizing in some form or another., Competing Interests: Conflicts of InterestsThe authors declare that they have no known conflicts of interest/competing interests., (© The Author(s) 2024.)

The current study explored the influence of different levels of speaker coherence on rule following and speaker preference. In Experiment 1, rules provided by three different speakers were either 100% accurate, 0% accurate, or 50% accurate/inaccurate. Experiment 2 was similar to Experiment 1 except that the speaker's coherence was adjusted to 80% accurate, 20% accurate, and 50% accurate/inaccurate, respectively. Overall, participants tended to follow coherent speaker rules and avoid following incoherent speaker rules during training and testing phases. The results also indicated that following and not following rules provided by speakers may be generalizable to novel stimuli and maintained in the absence of differential reinforcement (i.e., in experimental test phases). Additionally, in a preference test, participants tended to prefer coherent over incoherent and partially coherent speakers. Furthermore, participants tended to prefer the relatively more incoherent speaker (i.e., 0% or 20% accurate) over the 50% accurate coherent speaker in both experiments. Finally, a comparison of the results of both experiments indicated that different levels of relational coherence affected the variability of rule-following and speaker preference behaviors. These findings are discussed in the context of the complexities that appear to be involved in rule-following behaviors and speaker preference., (© 2024 The Authors. Journal of the Experimental Analysis of Behavior published by Wiley Periodicals LLC on behalf of Society for the Experimental Analysis of Behavior.)

People with late-stage Parkinson's disease (PD) often suffer from debilitating locomotor deficits that are resistant to currently available therapies. To alleviate these deficits, we developed a neuroprosthesis operating in closed loop that targets the dorsal root entry zones innervating lumbosacral segments to reproduce the natural spatiotemporal activation of the lumbosacral spinal cord during walking. We first developed this neuroprosthesis in a non-human primate model that replicates locomotor deficits due to PD. This neuroprosthesis not only alleviated locomotor deficits but also restored skilled walking in this model. We then implanted the neuroprosthesis in a 62-year-old male with a 30-year history of PD who presented with severe gait impairments and frequent falls that were medically refractory to currently available therapies. We found that the neuroprosthesis interacted synergistically with deep brain stimulation of the subthalamic nucleus and dopaminergic replacement therapies to alleviate asymmetry and promote longer steps, improve balance and reduce freezing of gait. This neuroprosthesis opens new perspectives to reduce the severity of locomotor deficits in people with PD., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Studying relating of relational networks is a complex and challenging task. The main objective of the present study was to demonstrate relating within and across relational networks based on same/opposite and bigger/smaller contextual cues and establish antecedent control. After nonarbitrary pretraining of the contextual cues, two nonsense stimulus classes were established based on comparative relations. Participants were trained to select stimuli from an array of options based on a symbolic rule that established a relation between two stimuli: one of Network 1 and one of Network 2. Training involved relating Network 1 to Network 2, and testing assessed relating Network 2 to Network 1. Seven of eight participants reached the mastery criterion in training and responded accordingly in test. In a final stage, reinforcing and punishing consequences were varied systematically in the presence of two novel stimuli and antecedent control was observed for all 7 participants. Experiment 2 replicated the results of Experiment 1 but using contextual cues taken from natural language, and Experiment 3 sought to understand the effects of pretraining relational responding using natural language. The mastery criteria were reached by four of seven participants in Experiment 2 and by all eight participants in Experiment 3. Future studies could develop and refine the methods employed here in analyzing the relating of relational networks, thus allowing for an increasingly sophisticated behavior-analytic account of human language and cognition., (© 2023 Society for the Experimental Analysis of Behavior.)

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis 1,2 . Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals 3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking 4-6 . A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis., (© 2023. The Author(s).)

Two experiments with human adults investigated the extent to which the transfer of function in accordance with nonarbitrary versus arbitrary stimulus relations may be brought under contextual control. Experiment 1 comprised four phases. Phase 1 consisted of multiple-exemplar training to establish discriminative functions for solid, dashed, or dotted lines. Phase 2 trained and tested two equivalence classes, each containing a 3D picture, a solid, a dashed, and a dotted form. During Phase 3, a discriminative function was established for each 3D picture. Phase 4 presented the solid, dashed, and dotted stimuli in two different frames, black or gray. The black frame cued function transfer based on nonarbitrary stimulus relations (Frame Physical); the gray frame cued function transfer based on equivalence relations (Frame Arbitrary). Testing and training with the frames was continued until contextual control was established; subsequently contextual control was demonstrated with novel equivalence classes with stimuli composed of the same forms. Experiment 2 replicated and extended Experiment 1 by demonstrating that such contextual control generalized to novel equivalence classes comprising novel forms and responses. The potential implications of the findings for developing increasingly precise experimental analyses of clinically relevant phenomena are considered (e.g., defusion)., (© 2023 Society for the Experimental Analysis of Behavior.)

Purpose: Venous thromboembolism (VTE) is a significant complication following lower limb arthroplasty (LLA). There is a paucity of evidence with regard to air travel following LLA. Orthopaedic surgeons are often asked by patients regarding air travel following LLA, and there is a need for evidence to guide these patients., Methods: This was a retrospective cohort study. We identified two cohorts, one travelling to and from the hospital by air and another, by land. All patients received routine preoperative and post-operative care, and thromboprophylaxis, as per our hospital guidelines. We collected baseline demographics, ASA score and incidence of VTE at 90 days using local patient records and a national joint registry. We also recorded data on flight time and overland distance of travel., Results: Two hundred and forty-three patients travelled by air; mean flight time was 74 min. In total, 5498 patients travelled a mean 25.3 miles over land to the hospital. No differences in baseline demographics or ASA score were observed. Four patients developed a VTE in the flight group, with 32 patients suffering a VTE in the control group. There was a significant difference in the VTE rate between the flight and control groups (p < 0.05); the relative risk of developing a VTE in the flight group was 2.85., Conclusions: In our cohort, perioperative short haul air travel is associated with an increased risk of VTE at 90 days following LLA. Orthopaedic surgeons must ensure that their patients are cognizant of the risks associated with perioperative air travel and take measures to minimise these risks., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Relational frame theory (RFT) has historically been considered the basic explanatory science behind acceptance and commitment therapy (ACT). However, some have argued that there has been an increasing separation between the two in recent years. The primary aim of the current article is to explore the extent to which RFT concepts, particularly those that have been proposed recently in the context of "up-dating" the theory, may be used to build stronger links between basic and applied behavior analyses in which there is a shared language of relatively precise technical terms. As an example of this strategy, we outline RFT process-based experimental and conceptual analyses of the impact of one of the most widely used sets of interventions employed in the ACT literature, defusion. In addition, we suggest a potential experimental methodology for analyzing the basic behavioral processes involved. Overall, the current article should be seen as part of a broader research agenda that aims to explore how RFT may be used to provide a functional-analytic abstractive treatment of the behavioral processes involved in human psychological suffering., Competing Interests: Conflicts of InterestThe authors declare that they have no conflicts of interest., (© Association for Behavior Analysis International 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Prosthetic service development and delivery rely on data describing population needs. These needs are context-specific, but most existing data come from high-income countries or small geographic areas, which are often not comparable. This study analysed routinely collected digital patient record data at multiple time points to provide insights into characteristics of people accessing Cambodian prosthetic services., Methods: We investigated trends in birth year, sex, year and reason for limb absence, and prosthesis type, over three decades. Then, we observed data from 2005 and 2019 indicating how the population actively accessing prosthetics services has changed., Results: Temporal trends in prosthetics service user demographics corresponded with events in Cambodia's socio-political history. The predominant historical reason for limb absence prior to 2000 was weapon trauma during and following conflict. Since 2000, this was replaced by non-communicable disease and road accidents. Transtibial remained the most prevalent amputation level but transfemoral amputation had higher incidence for people with limb loss from road accidents, and people with limb loss due to disease were older. These observations are important as both transfemoral and older-aged groups experience particular rehabilitation challenges compared to the young, transtibial group., Conclusions: The study shows how standardised, routinely collected data across multiple clinics within a country can be used to characterise prosthetics service user populations and shows significant changes over time. This indicates the need to track client characteristics and provides evidence for adapting services according to population dynamics and changes in patient need., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

The implicit relational assessment procedure (IRAP) was initially developed as a way to assess the strength and probability of natural verbal relations, as defined within relational frame theory (RFT), and was conceptually rooted within the behavior-analytic tradition. However, the IRAP quickly became employed primarily as a measure of implicit cognition, more in line with mainstream psychology than behavior analysis. In doing so, research using the IRAP increasingly employed ill-defined mainstream psychological terms, focused on correlational analyses with traditional psychometry, and thus emphasized prediction over the prediction-and-influence of behavior. Although perhaps beneficial to the study of implicit cognition, this approach could be argued to have limited the IRAP's utility in behavior analyses of human language and cognition. In the current article we will reflect on this suggestion, on the IRAPs place and current use in the field of behavior analysis, and on its potential future within behavioral psychology in light of recent conceptual and empirical advances in RFT. In doing so, it is hoped that the measure may be refined into a better understood, more precise, functional-analytic tool., Competing Interests: Conflicts of InterestThe authors declare that they have no conflicts of interest., (© Association for Behavior Analysis International 2022.)

The seminal text on relational frame theory (RFT) was published 20 years ago and purported to offer a single overarching behavior-analytic account of human language and cognition. In the years thereafter, an increasing number of empirical and conceptual articles, book chapters in edited volumes, and whole volumes devoted to the account emerged. In recent years, RFT has experienced a period of intense empirical and conceptual development, facilitated in part by a research grant awarded by the Flanders Science Foundation, under its Odysseus program. This research program aimed to advance and extend the RFT account beyond the rendition presented in the seminal Hayes et al. (2001) volume. The current article aims to provide an overview of this research program, the empirical work and concepts it gave rise to, and their implications for an RFT account of human symbolic language and cognition. Overall, therefore, the article provides an account of relatively recent developments in RFT that extend beyond the 2001 volume and thus will, we hope, inform future research and critiques of the theory going forward., (© 2022 Society for the Experimental Analysis of Behavior.)

Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection., Methods: This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Société Internationale d'Oncologie Pédiatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board., Results: Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6-13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms' tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2-4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms' tumor) presented with pleural recurrence. One girl with Wilms' tumor died of central nervous system metastasis., Conclusions: Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application., (© 2021. Society of Surgical Oncology.)

Introduction: Paediatric robotic surgery is gaining popularity across multiple disciplines and offers technical advantages in complex procedures requiring delicate dissection. To date, limited publications describe its perioperative management in children., Material & Methods: We retrospectively analysed the prospectively collected anaesthetic data of the first 200 robotic-assisted surgery procedures in our paediatric university hospital as part of a multidisciplinary program from October of 2016 to February of 2019. Anaesthetic technique and monitoring were based on guidelines initially derived from adult data. We examined adverse events and particular outcomes including blood loss and analgesic requirements., Results: Fifty-one different surgical procedures were performed in patients aged 4 months to 18 years (weight 5-144 kg). Operative times averaged 4 h and conversion rate was 3%. Neither robotic arm nor positional injury occurred. Limited access to the patient did not lead to any complication. Hypothermia was frequent and mostly self-limiting. Negative physiological effects due to positioning, body cavity insufflation or surgery manifesting as significant respiratory and haemodynamic changes occurred in 14% and 11% of patients, respectively. Overt haemorrhage complicated one case. Eighty per cent of 170 patients did not require level 3 analgesics postoperatively, while thoracic and certain tumour cases had greater analgesic requirements., Conclusion: These preliminary results show that paediatric robotic surgery is well tolerated with a low bleeding risk and that major intraoperative events are uncommon. A consistent anaesthetic approach is effective across a broad range of procedures. Analgesic requirements are low excluding thoracic and some complex abdominal cases. Future studies should focus on the rehabilitative aspects of robotic surgery technique., (Copyright © 2021 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Recent developments in relational frame theory (RFT) have outlined a number of key variables of potential importance when analyzing the dynamics involved in derived relational responding. Recent research has begun to explore the impact of a number of these variables on persistent rule-following, namely, levels of derivation and coherence. However, no research to date has systematically examined the impact of coherence on persistent rule-following at varying levels of derivation. Across two experiments, the impact of coherence (manipulated through the systematic use of performance feedback) was explored on persistent rule-following when derivation was relatively low (Exp. 1) and high (Exp. 2). A training protocol based on the implicit relational assessment procedure (IRAP) was used to establish novel combinatorially entailed relations that manipulated the feedback provided on the untrained, derived relations (A-C) for five blocks of trials in Experiment 1 and one block of trials in Experiment 2. One of these relations was then inserted into the rule for responding on a subsequent contingency-switching match-to-sample task to assess rule persistence. While no significant differences were found in Experiment 1, the provision or non-provision of feedback had a significant differential impact on rule persistence in Experiment 2. These differences, and the subtle complexities that appear to be involved in persistent rule-following in the face of reversed reinforcement contingencies, are discussed.

Rule-governed behavior and derived stimulus relations have always shared strong conceptual links within behavior analysis. However, experimental analysis linking the two domains remains limited. The current study consisted of three experiments that aimed to continue to bridge this experimental gap. The first experiment sought to establish the extent to which a training version of the implicit relational assessment procedure (IRAP) could be used to establish and successfully reverse experimentally established derived relations. The results suggested that the Training IRAP could successfully produce derived reversals. Experiments 2 and 3 explored the extent to which reversed derived relations would control rule-governed behavior when the contingencies for rule-following competed with the rule. In Experiment 2, the task contingencies were immediately in opposition to the (reversed) derived rule, and participants generally responded in accordance with the task contingencies, rather than the rule. In Experiment 3, the task contingencies were initially rule-consistent before a contingency reversal that later made them rule-inconsistent. Here evidence of rule-persistence emerged. The results of the research are considered within the context of a recent framework that has emerged out of RFT for analyzing the dynamics involved in derived relational responding., (© 2021 Society for the Experimental Analysis of Behavior.)

There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.

Rule-governed behavior and derived relational responding have both been identified as important variables in human learning. Recent developments in the relational frame theory (RFT) have outlined a number of key variables of potential importance when analyzing the dynamics involved in derived relational responding. Recent research has explored the impact of one of these variables, level of derivation, on persistent rule-following and implicated another, coherence, as possibly important. However, no research to date has examined the impact of coherence on persistent rule-following directly. Across two experiments, coherence was manipulated through the systematic use of performance feedback, and its impact was examined on persistent rule-following. A training procedure based on the implicit relational assessment procedure (IRAP) was used to establish novel combinatorially entailed relations that manipulated the feedback provided on the trained relations (A-B and B-C) in Experiment 1, and on the untrained, derived relations (A-C) in Experiment 2. One of these relations was then inserted into the rule for responding on a subsequent contingency-switching match-to-sample (MTS) task to assess rule persistence. While no significant differences were found in Experiment 1, the provision or non-provision of feedback had a significant differential impact on rule-persistence in Experiment 2. Specifically, participants in the Feedback group resurged back to the original rule for significantly more responses after demonstrating contingency-sensitive responding than did the No-Feedback group, after the contingency reversal. The results highlight the subtle complexities that appear to be involved in persistent rule-following in the face of reversed reinforcement contingencies.

Background: Adherence to inaccurate rules has been viewed as a characteristic of human rule-following (i.e., the rule-based insensitivity effect; RBIE) and has been thought to be exacerbated in individuals suffering from clinical conditions. This review intended to systematically examine these claims in adult populations., Methodology: We screened 1464 records which resulted in 21 studies that were deemed eligible for inclusion. Each of these studies was examined to determine: (1) if there is evidence for the RBIE in adults and (2) if this effect is larger in those suffering from psychological problems compared to their non-suffering counterparts. In addition, we investigated how (3) different operationalizations of the RBIE, and (4) the external validity and risks of bias of the experimental work investigating this effect, might influence the conclusions that can be drawn from the current systematic review., Results: (1) Out of the 20 studies that were relevant for examining if evidence exists for the RBIE in adults, only 11 were eligible for vote counting. Results showed that after the contingency change, the rule groups were more inclined to demonstrate behavior that was reinforced before the change, compared to their non-instructed counterparts. Critically, however, none of these studies examined if their no-instructions group was an adequate comparison group. As a result, this made it difficult to determine whether the effects that were observed in the rule groups could be attributed to the rules or instructions that were manipulated in those experiments. (2) The single study that was relevant for examining if adults suffering from psychological problems demonstrated larger levels of the RBIE, compared to their non-clinical counterparts, was not eligible for vote counting. As a result, no conclusions could be drawn about the extent to which psychological problems moderated the RBIE in that study. (3) Similar procedures and tasks have been used to examine the RBIE, but their precise parameters differ across studies; and (4) most studies report insufficient information to evaluate all relevant aspects affecting their external validity and risks of bias., Conclusions: Despite the widespread appeal that the RBIE has enjoyed, this systematic review indicates that, at present, only preliminary evidence exists for the idea that adults demonstrate the RBIE and no evidence is available to assume that psychological problems exacerbate the RBIE in adults.The systematic review was registered in PROSPERO (CRD42018088210)., Competing Interests: The authors declare there are no competing interests., (©2020 Kissi et al.)

The concept of rule-governed behavior or instructional control has been widely recognized for many decades within the behavior-analytic literature. It has also been argued that the human capacity to formulate and follow increasingly complex rules may undermine sensitivity to direct contingencies of reinforcement, and that excessive reliance upon rules may be an important variable in human psychological suffering. Although the concept of rules would appear to have been relatively useful within behavior analysis, it seems wise from time to time to reflect upon the utility of even well-established concepts within a scientific discipline. Doing so may be particularly important if it begins to emerge that the existing concept does not readily orient researchers toward potentially important variables associated with that very concept. The primary purpose of this article is to engage in this reflection. In particular, we will focus on the link that has been made between rule-governed behavior and derived relational responding, and consider the extent to which it might be useful to supplement talk of rules or instructions with terms that refer to the dynamics of derived relational responding., Competing Interests: Conflict of InterestThe authors declare that they have no conflicts of interest., (© Association for Behavior Analysis International 2020.)

Aim: We present the preliminary results of robotic-assisted laparoscopic (RAL) total and partial nephrectomy for renal malignant tumors in children., Methods: This is a prospective study of patients operated with RAL between December 2016 and September 2018. Patients with Wilms tumors were treated according to the SIOP-2001 protocol. Patient and tumor characteristics, type of surgery, surgical-related morbidity, and oncologic outcomes were recorded. Results were compared with a series of patients with similar age- and tumor-related characteristics operated during the same period by an open surgical approach., Results: Ten children underwent RAL nephrectomy with a mean age of five years (3.2-14.1 years). Total nephrectomy was done in six cases for Wilms tumor and in one case for renal sarcoma; three cases were converted. Complete removal of tumor without rupture was achieved in all cases. Postoperative course was uneventful, and patients were discharged between days 2 and 7. Neither recurrence nor medium-term complications occurred. Nine patients are alive with a median follow-up of 16 months (6-27 months) and one female died from complications of central nervous system metastases one year after surgery. When compared with the open surgical approach group, median tumor volume was smaller (P = 0.005), hospital stay was shorter (P = 0.01), and operative time was similar (P = 0.20)., Conclusions: RAL total and partial nephrectomy procedure for renal tumor in children may be an option in carefully selected cases. Indication should be discussed at tumor boards and surgery performed while adhering strictly to oncological surgical rules., (© 2019 Wiley Periodicals, Inc.)

Introduction: Prognosis of dumbbell neuroblastoma (NBL) is mainly determined by the sequelae induced by the tumor itself and the neurosurgical approach. However, after primary chemotherapy, surgical management of the residual tumor, especially the spinal canal component, remains controversial., Methods: We conducted a single-center retrospective cohort study over the last 15 years (2002-2017) including patients treated for NBL with spinal canal extension focusing on timing and type of surgery, complications, and functional and oncological follow-up., Results: Thirty-two children (14 M, 18 F) were managed for NBL, with the majority (26) presenting with NBL stroma poor while four had ganglioneuroblastoma intermixed, one nodular, and one ganglioneuroma. All but two patients received neoadjuvant chemotherapy. Upfront laminotomy for spinal cord decompression was performed in two patients; nine patients had extraspinal surgery with a follow-up neurosurgical procedure in seven cases; eight patients had initial neurosurgery followed by an extraspinal procedure, while six patients underwent a combined multidisciplinary approach. With a median follow up of 3.6 years (0.1-14.9), 29 patients (90.6) are alive and two out of three (19, 65.5%) have functional sequelae., Conclusion: Patients with NBL with persistent spinal canal extension of the tumor after neoadjuvant chemotherapy treated at our center had outcomes that compare favorably with the literature. This is likely due to the multidisciplinary approach to optimal surgical strategy and continuous evaluation of the respective risks of tumor progression. Neurological disability results from initial spinal cord compression or the radicular sacrifice required for tumor resection., (© 2019 Wiley Periodicals, Inc.)