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Organizational behavior management (OBM) is a scientific approach to understanding behavior and its relation to the workplace. As a natural science it relies on the use of sound experimental resear...

Direct support professionals (DSPs) play a critical role in health-related outcomes for individuals with intellectual and developmental disabilities (IDD) who reside in congregate living settings. Large behavioral healthcare organizations often rely on staff to function as peer trainers for newly hired DSPs. Organizations should adopt empirically supported training techniques to prepare peer trainers for their role and develop systems to ensure ongoing integrity of the training system. The purpose of this program description is to summarize consultation activities that attempted to create these systems.Staff members were trained to function as peer trainers, an assessment was conducted to determine the barriers to training in the natural environment, and a systems-level intervention informed by the assessment was implemented to improve peer trainer integrity.The assessment revealed peer trainers were often unaware when they were expected to train and did not receive feedback or programmed consequences for training newly hired DSPs. A systems-level intervention containing a prompt (reminder) about upcoming training and feedback plus a monetary incentive produced improvements in trainer integrity.A systems-level intervention based on an assessment can improve peer trainer integrity. Ensuring peer trainer integrity increases the likelihood that newly hired DSPs will implement health-related protocols with individuals with IDD.

The quality and frequency of positive interactions between staff and consumers are related to reductions in consumer problem behavior and increases in other desired outcomes, such as leisure and self-help skills. Unfortunately, the frequency with which group home staff positively interact with consumers is often low and regularly requires intervention. We evaluated the effects of technology-based self-monitoring on positive interactions between staff and consumers during consumer leisure time. Participant data were collected off-site through video recordings from cameras already present in the group homes. During baseline, participant interactions were low. Upon introduction of an intervention containing self-monitoring completed via a tablet device, staff interactions increased and maintained when the intervention was in effect. Supplemental feedback via text message was provided to two of the three participants to reach criterion. These findings demonstrate the utility of technology-based self-monitoring for some individuals to increase positive staff–consumer interactions in group homes.

The science of behavior has effectively addressed many areas of social importance, including the performance management of staff working in human-service settings. Evidence-based performance management entails initial preservice training and ongoing staff support. Initial training reflects a critical first training component and is necessary for staff to work independently within an organization. However, investment in staff must not end once preservice training is complete. Ongoing staff support should follow preservice training and involves continued coaching and feedback. The purpose of this article is to bridge the research-to-practice gap by outlining research-supported initial training and ongoing staff support procedures within human-serving settings, presenting practice guidelines, and sharing information about easy-to-implement ways practitioners may stay abreast of current research.

This book is a treasure trove of information to help practitioners and organizational leaders improve services for individuals with intellectual and developmental disabilities (IDD) by applying organizational behavior management (OBM) practices. The present chapter supplements this information by providing recommendations for advancing OBM practice and research within IDD service settings. We accomplish this aim by sharing practical strategies for strengthening the IDD workforce and describing peer review, the use of performance scorecards, and strategic planning within a behavioral systems approach.

Disagreement exists on effective and sensitive outcome measures in neuropathy associated with impaired glucose tolerance (IGT). Nerve conduction studies and skin biopsies are costly, invasive and may have their problems with reproducibility and clinical applicability. A clinical measure of neuropathy that has sufficient sensitivity and correlates to invasive measures would enable significant future research.Data was collected prospectively on patients with IGT and symptomatic early neuropathy (neuropathy symptoms2years) and normal controls. The seven scales that were examined were the Neuropathy Impairment Score of the Lower Limb (NIS-LL), Michigan Diabetic Neuropathy Score (MNDS), modified Toronto Clinical Neuropathy Scale (mTCNS), Total Neuropathy Score (Clinical) (TNSc), The Utah Early Neuropathy Scale (UENS), the Early Neuropathy Score (ENS), and the Neuropathy Disability Score (NDS).All seven clinical scales were determined to be excellent in discriminating between patients with neuropathy from controls without neuropathy. The strongest discrimination was seen with the mTCNS. The best sensitivity and specificity for the range of scores obtained, as determined by using receiver operating characteristic curves, was seen for the mTCNS followed by the TNSc. Most scales show a stronger correlation with measures of large rather than small fiber neuropathy.All seven scales identify patients with neuropathy. For the purpose of screening potential patients for a clinical study, the mTCNS followed by the TNSc would be most helpful to select patients with neuropathy.

A computational model of the non-nucleoside inhibitor 8-Cl TIBO complexed with HIV-1 reverse transcriptase (RT) was constructed in order to determine the binding free energies. Using Monte Carlo simulations, both free energy perturbation and linear response calculations were carried out for the transformation of wild-type RT to two key mutants, Y181C and L100I. The newer linear response method estimates binding free energies based on changes in electrostatic and van der Waals energies and solvent-accessible surface areas. In addition, the change in stability of the protein between the folded and unfolded states was estimated for each of these mutations, which are known to emerge upon treatment with the inhibitor. Results from the calculations revealed that there is a large hydrophobic contribution to protein stability in the native, folded state. The calculated absolute free energies of binding from both the linear response, and also the more rigorous free energy perturbation method, gave excellent agreement with the experimental differences in activity. The success of the relatively rapid linear response method in predicting experimental activities holds promise for estimating the activity of the inhibitors not only against the wild-type RT, but also against key protein variants whose emergence undermines the efficacy of the drugs.

The energies and physical descriptors for the binding of 21 novel 1-(2,6-difluorobenzyl)-2-(2,6-difluorophenyl)-benzimidazole (BPBI) analogs to HIV-1 reverse transcriptase (RT) variants Y181C, L100I, V106A, and K103N have been determined using Monte Carlo (MC) simulations. The crystallographic structure of the lead compound, 4-methyl BPBI, was used as a starting point to model the inhibitors in both the mutant bound and the unbound states. The energy terms and physical descriptors obtained from the calculations were reasonably correlated with the respective experimental EC50 values for the inhibitors against the various mutant RTs. Using the linear response correlations from the calculations, 2 novel BPBI inhibitors have been designed and simulations have been carried out. The results show the computed deltaG(binding) values match the experimental data for the analogs. Given the ongoing problem with drug resistance, the ability to predict the activity of novel analogs against variants prior to synthesis is highly advantageous.