Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment

BACKGROUND

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy.

METHODS

A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II.

RESULTS

Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation.

LIMITATION

Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II.

CONCLUSION

Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

The role of tacit knowledge in communication and decision-making during emerging public health incidents

Strong communication systems for knowledge exchange are required to prevent, respond to and mitigate the effects of emerging public health incidents (EPHIs). The objective of this paper is to examine how "tacit knowledge" - implicit knowledge used to guide everyday practice - is employed in professional relationships and communication processes between public health and acute care settings. A qualitative study design was used to explore the experiences of key informants from public health and acute care settings in Ontario, Canada, to examine how specific dimensions of tacit knowledge are employed in communications about EPHIs. Twenty-six in-depth interviews were conducted from 2014 to 2015. The results describe the way in which participants employ discretion and knowledge of local context, and rely on relationships built on trust and credibility, to facilitate decision-making and communication during EPHIs. Given the uncertainty characterizing most EPHIs, communicators rely a great deal on their informal knowledge and networks which allow them to remain flexible and respond quickly to changing situations. The results reveal that communication about public health guidance during emergencies is a complex and active process that draws from past experiences of the individuals involved, and is shaped by the requirements of local circumstances. The broader implications of these findings for building resilient and responsive health systems are considered. In particular, for rethinking the authority of standardized forms of evidence in public health decision-making, and the importance of knowledge which is grounded in the uniqueness of specific local contexts.

Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed

Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.

A Phase 1 study of ARQ 087, an oral pan-FGFR inhibitor in patients with advanced solid tumours

Background:

ARQ 087 is an orally administered pan-FGFR inhibitor with multi-kinase activity. This Phase 1 study evaluated safety, pharmacokinetics, and pharmacodynamics of ARQ 087 and defined the recommended Phase 2 dose (RP2D).

Methods:

Patients with advanced solid tumours received ARQ 087 administered initially at 25 mg every other day and dose-escalated from 25 to 425 mg daily (QD) continuous dosing. FGF19, 21, 23, and serum phosphate were assessed as potential biomarkers of target engagement.

Results:

80 patients were enrolled, 61 in dose-escalation/food-effect cohorts and 19 with pre-defined tumour types in the expansion cohort. The most common ARQ 087-related adverse events were fatigue (49%), nausea (46%), aspartate aminotransferase (AST) increase (30%), and diarrhoea (23%). Four patients (5%) experienced grade 1 treatment-related hyperphosphataemia. Dose-limiting toxicity was reversible grade 3 AST increase. The RP2D was 300 mg QD. Pharmacokinetics were linear and dose-proportional from 25 to 325 mg QD, and were unaffected by food. Statistically significant changes (P-value<0.05) suggest phosphate and FGF19 levels as markers of target engagement. In 18 evaluable patients with FGFR genetic alterations, 3 confirmed partial responses (two intrahepatic cholangiocarcinomas (iCCA) with FGFR2 fusions and one urothelial cancer with FGFR2 and FGF19 amplification) and two durable stable disease at ⩾16 weeks with tumour reduction (FGFR2 fusion-positive iCCA and adrenocortical carcinoma with FGFR1 amplification) were observed.

Conclusions:

ARQ 087 had manageable toxicity at the RP2D of 300 mg QD, showed pharmacodynamics effects, and achieved objective responses, notably in patients with FGFR2 genetic alterations.

GeSn/Ge multiquantum well photodetectors on Si substrates

Vertical incidence GeSn/Ge multiquantum well (MQW) pin photodetectors on Si substrates were fabricated with a Sn concentration of 7%. The epitaxial structure was grown with a special low temperature molecular beam epitaxy process. The Ge barrier in the GeSn/Ge MQW was kept constant at 10 nm. The well width was varied between 6 and 12 nm. The GeSn/Ge MQW structures were grown pseudomorphically with the in-plane lattice constant of the Ge virtual substrate. The absorption edge shifts to longer wavelengths with thicker QWs in agreement with expectations from smaller quantization energies for the thicker QWs.

Evaluating the students' perspectives of a clinic mentoring programme

The purpose of this article is to describe and examine the effectiveness of a mentoring program for third and fourth year clinical dental students. This is an educational intervention for the pre-doctoral students at the Schulich School of Dentistry. We have recently instituted this program and have developed a questionnaire to assess the student perspectives using a SWOT analysis of the strengths, weaknesses, opportunities and threats of this intervention by analyzing the quantitative and qualitative responses of the students towards their clinical education and patient management. Our findings, both quantitative and qualitative, indicated that the mentoring program was well received by most students who would like to see the program expanded. The majority of students felt that the mentoring program aligned well with comprehensive care of their patients while enhancing their clinical experience. One of the strongest areas of agreement involved the ability to discuss cases in a non-threatening environment. The SWOT analysis identified key areas for future improvements. We offer steps to successfully implement a similar program based on our findings. It is our hope that our results might be instrumental for other schools wishing to adopt a similar model which supports patient-based comprehensive care.

A phase I dose escalation study of oral c-MET inhibitor tivantinib (ARQ 197) in combination with gemcitabine in patients with solid tumors

BACKGROUND

Tivantinib (ARQ 197) is an orally available, non-adenosine triphosphate competitive, selective c-MET inhibitor. The primary objective of this study was to evaluate the safety, tolerability and to establish the recommended phase II dose (RP2D) of tivantinib and gemcitabine combination.

PATIENTS AND METHODS

Patients with advanced or metastatic solid tumors were treated with escalating doses of tivantinib (120-360 mg capsules) in combination with gemcitabine (1000 mg/m(2) weekly for 3 of 4 weeks). Different schedules of administration were tested and modified based on emerging preclinical data. Tivantinib was given continuously, twice a day (b.i.d.) for 2, 3 or 4 weeks of a 28-day cycle or on a 5-day on, 2-day off schedule (the day before and day of gemcitabine administration).

RESULTS

Twenty-nine patients were treated with gemcitabine and escalating doses of tivantinib: 120 mg b.i.d. (n = 4), 240 mg b.i.d. (n = 6) and 360 mg b.i.d. (n = 19). No dose-limiting toxicities were observed in escalation. The RP2D was 360 mg b.i.d. daily, and 45 additional patients were enrolled in the expansion cohort. Grade ≥3 treatment-related toxicities were observed in 54 of 74 (73%) patients with the most common being neutropenia (43%), anemia (30%), thrombocytopenia (28%) and fatigue (15%). There was one treatment-related death due to neutropenia. Administration of gemcitabine did not affect tivantinib concentration. Fifty-six patients were assessable for response. Eleven (20%) patients achieved a partial response and 26 (46%) had stable disease (SD), including 15 (27%) who achieved SD for over 4 months. Ten of 37 patients with clinical benefit had prior exposure to gemcitabine.

CONCLUSION

The combination of tivantinib at its monotherapy dose and standard dose gemcitabine was safe and tolerable. Early signs of antitumor activity may warrant further development of this combination in nonsmall-cell lung cancer, ovarian, pancreatic and cholangiocarcinoma.

CLINICALTRIALSGOV IDENTIFIER

NCT00874042.

A Phase-1b study of tivantinib (ARQ 197) in adult patients with hepatocellular carcinoma and cirrhosis

BACKGROUND

The mesenchymal-epithelial transition factor (MET) receptor is dysregulated in hepatocellular carcinoma (HCC), and tivantinib (ARQ 197) is an oral, selective, MET inhibitor.

METHODS

This Phase-1b study assessed tivantinib safety as primary objective in patients with previously treated HCC and Child-Pugh A or B liver cirrhosis. Patients received oral tivantinib 360 mg twice daily until disease progression or unacceptable toxicity.

RESULTS

Among 21 HCC patients, common drug-related adverse events (AEs) were neutropaenia, anaemia, asthenia, leucopaenia, anorexia, diarrhoea, and fatigue. No drug-related worsening of liver function or performance status occurred, but one Child-Pugh B patient experienced drug-related bilirubin increase. Four patients had drug-related serious AEs, including one neutropaenia-related death. Haematologic toxicities were more frequent than in previous tivantinib studies but were manageable with prompt therapy. Best response was stable disease (median, 5.3 months) in 9 of 16 evaluable patients (56%). Median time to progression was 3.3 months.

CONCLUSION

Tivantinib demonstrated a manageable safety profile and preliminary antitumour activity in patients with HCC and Child-Pugh A or B cirrhosis.

Mechanisms linking obesity, inflammation and altered metabolism to colon carcinogenesis

Due to its prevalence, obesity is now considered a global epidemic. It is linked to increased risk of colorectal cancer, the third most common cancer and the second leading cause of death among adults in Western countries. Obese adipose tissue differs from lean adipose tissue in its immunogenic profile, body fat distribution and metabolic profile. Obese adipose tissue releases free fatty acids, adipokines and many pro-inflammatory chemokines. These factors are known to play a key role in regulating malignant transformation and cancer progression. Obese adipose tissue is infiltrated by macrophages that participate in inflammatory pathways activated within the tissue. Adipose tissue macrophages consist of two different phenotypes. M1 macrophages reside in obese adipose tissue and produce pro-inflammatory cytokines, and M2 macrophages reside in lean adipose tissue and produce anti-inflammatory cytokines, such as interleukin-10 (IL-10). The metabolic networks that confer tumour cells with their oncogenic properties, such as increased proliferation and the ability to avoid apoptosis are still not well understood. We review the interactions between adipocytes and immune cells that may alter the metabolism towards promotion of colorectal cancer.

Emergency Medical Services: a resource for victims of domestic violence?

BACKGROUND

Domestic violence (DV), also known as intimate partner violence (IPV), is one of the leading causes of serious injury among women of childbearing age. As first responders on the scene during DV calls where personal injuries have occurred, Emergency Medical Services (EMS) could routinely identify, report and assist victims of violence. Yet, little is known of the prevalence of DV calls in EMS practice, Emergency Medical Technicians' (EMT) knowledge and comfort in responding to such calls, or how they care for victims.

METHOD

The objectives of this study were to assess EMTs' knowledge of and experience with providing care to victims of DV in the province of Ontario, Canada. Data were gathered through an online, short-answer survey. Survey data were analysed using basic frequency displays, and descriptive statistics are reported.

RESULTS

Almost 500 EMTs participated in this study, the vast majority of whom (90%) attended at least one DV call in the preceding year, with 65% attending between 10 and 20 DV calls. The majority of respondents (84.5%) wished for more education and training on the issue.

CONCLUSION

EMTs have frequent contact with victims of DV yet have received little education about the issue. The majority of those surveyed would like specific education and training on DV.

Heart rate monitoring as a reliable tool for assessing energy expenditure in obese individuals

Previous studies have suggested the use of the FlexHR method for predicting daily energy expenditure in various populations. We investigated the stability of the relation between oxygen consumption (VO2) and heart rate (HR) in obese subjects undergoing a fitness and weight reduction program. Eleven obese (BMI>30) healthy subjects (6 males, 5 females) were recruited from a Wellness program. Subjects performed a laboratory calibration procedure between HR and VO2 in resting and exercising conditions, before starting the Wellness program (Stage I) and after reducing 10% of their initial body weights (BW) within 6 months (Stage II). Mean BW, BMI and % body fat were reduced by 13.1±4.4 kg, 4.2±1.4 kg.m-2 and 6.8±4.1%, respectively, for all parameters (P<0.001). Mean peak VO2 increased from 31.3±7.1 at the beginning to 37.2±7.3 mL.kg-1.min-1 at the end of the intervention period (P<0.01). The mean flex HR point changed from 96±14 to 86±15 beats.min-1 (P<0.05). There were no significant individual differences in the HR-VO2 prediction equations derived from the laboratory calibrations in either stage. In conclusion, the relationship between HR and VO2 consumption remains stable during a time period of weight reduction. The use of the FlexHR method for predicting energy expenditure by heart rate monitoring is recommended for subjects undergoing a weight-reduction program. It should be taken in account, however, that an increase in aerobic capacity, in parallel to changes in body weight and composition, might cause a decrease in the flex point.

Studies of operant and reflexive key pecks in the pigeon

The duration of pigeons' key pecks was studied in three experiments. Experiment I revealed that key pecks early in exposure to continuous reinforcement were of short duration, as were key pecks observed on an omission procedure in which pecks prevented food delivery. Key pecks later in exposure to continuous reinforcement, and those that occurred on positive automaintenance procedures, were of long duration. In Experiment II, pigeons were exposed to fixed-interval and fixed-ratio reinforcement schedules, and durations were recorded separately for each quarter of each interval or ratio. On fixed interval, durations were shorter in the first quarter of each interval than in subsequent quarters; on fixed ratio, durations were longer in the first quarter of the ratio than in subsequent quarters. These data parallel observations of concurrent operant responding and salivation in dogs. In Experiment III, pigeons were exposed to a discrete trial, differential-reinforcement-of-low-rate 6-sec schedule. Durations of responses in the first 2 sec of the trial were substantially shorter than those of responses that occurred later. The data from all three experiments support the view that the pigeon's "key peck" actually consists of two subclasses of peck, one reflexive and one operant.

Two types of pigeon key pecking: suppression of long- but not short-duration key pecks by duration-dependent shock

The key pecking of eight pigeons was maintained on a variable-interval 1-minute schedule of food reinforcement. Sometimes, all responses between 35 and 50 milliseconds in duration produced a shock; sometimes, all responses between 10 and 25 milliseconds produced a shock; sometimes, shocks were produced by pecks without regard to duration (nondifferential punishment), and sometimes shocks were delivered independently of responding. Punishment of 35- to 50-millisecond responses selectively suppressed those responses, while punishment of 10- to 25-millisecond responses and nondifferential punishment suppressed responding overall but did not suppress responses of particular duration. Punishment of 35- to 50-millisecond responses suppressed key pecking slightly less than did nondifferential punishment. Punishment of 10- to 25-millisecond responses and response-independent shock produced roughly equal amounts of suppression, substantially less than the other punishment procedures. The data support the view that there are at least two kinds of key peck, identifiable on the basis of duration, one of which (short duration) is insensitive to its consequences.

Stimulus-reinforcer contingencies and local behavioral contrast

Four pigeons were exposed to a series of multiple schedules of variable-interval reinforcement in which pecks were required on one key (operant key) and components were signalled on a second key (signal key). Four additional pigeons experienced identical conditions, except that a yoking procedure delivered food on variable-time schedules, with no key pecks required. One of the components of the multiple schedule was constant throughout the experiment as a variable-interval (or variable-time) 30-second schedule. Operant-key responding during the constant component was uniform throughout the component, uninfluenced by changes in the duration of the variable component, and only slightly influenced by changes in reinforcement frequency correlated with the variable component. By comparison, signal-key response rate during the constant component was highest at the onset of the component, was higher when the variable component was 60-sec long than when it was 1-sec long, and was higher when no reinforcement occurred in the variable component than when reinforcement was scheduled in the variable component. These characteristics of signal-key pecking matched characteristics of local positive behavioral contrast. These data are taken to support the "additivity theory" of behavioral contrast and to suggest that Pavlovian stimulus-reinforcer relations contribute primarily to the phenomenon of local positive contrast.

Effects of reinforcement magnitude on pigeons' preference for different fixed-ratio schedules of reinforcement

In concurrent, two-member chains, the completion of one or the other of two initial percentage fixed-interval 90-sec links produced a terminal link in which the completion of a fixed ratio produced food reinforcement. The fixed ratios and the duration of reinforcement in the terminal links were varied. Relative response rate in initial links was proportional to the relative reinforcement duration per ratio response (reinforcement duration divided by fixed ratio) in terminal links. The rate of responding in the terminal fixed-ratio links was insensitive to both ratio size and reinforcement duration and therefore did not vary sufficiently to distinguish between responses per reinforcement and immediacy of reinforcement as controlling variables in terminal links.

Interval and ratio reinforcement of a complex sequential operant in pigeons

Pigeons were required to produce exactly four pecks on each of two keys in any order for reinforcement. Correct response sequences were reinforced on either fixed-interval two-minute or fixed-ratio four schedules, with each correct sequence treated as a single response. Each pigeon developed a particular dominant sequence that accounted for more than 80% of all sequences. Sequence stereotypy was relatively unaffected by the temporal properties of the fixed-interval and fixed-ratio schedules. Response time (time from the first response in each sequence to the last) was also relatively unaffected by the temporal properties of the schedules. In contrast, response latency (time from end of one sequence to the beginning of the next) was markedly affected by the schedules. Latencies were long early in the interreinforcement interval and got shorter as the interreinforcement interval progressed. These data suggest that stereotyped response sequences become functional behavioral units, resistant to disruption or alteration by reinforcement variables that ordinarily influence the temporal spacing of individual responses.

The role of the response-reinforcer contingency in negative automaintenance

When a response key is briefly illuminated before a grain reinforcer is presented, key pecking is reliably developed and maintained in pigeons, even if pecking prevents reinforcement (negative automaintenance). This experiment demonstrated that pigeons are sensitive to a negative response-reinforcer contingency, even though it does not eliminate responding. Within individual pigeons, two kinds of trials were compared: red key trials, in which reinforcement was negatively contingent on responding, and white key trials, in which reinforcement was unrelated to responding. Reinforcement frequency in non-contingent trials was yoked to the obtained reinforcement frequency in negatively contingent trials. All eight pigeons pecked substantially more on the non-contingent key than on the negative key, and preferred the non-contingent key to the negative key on occasional "choice" trials where both were presented together. When the stimuli correlated with the two conditions were reversed, the pigeons' behavior also shifted. These response differences are taken as evidence that pigeons are sensitive to the negative response-reinforcer contingency.

The maintenance of key pecking by stimulus-contingent and response-independent food presentation

Three naive pigeons were exposed to a series of two-component multiple schedules of response-independent food presentation. The component schedules were sometimes identical (non-differential procedures) and sometimes different (differential procedures). High rates of key pecking were maintained in all the differential procedures, and pecking decreased substantially in non-differential procedures, even when the frequency of food presentation in non-differential procedures was higher than in differential procedures. It is suggested that the high rates of key pecking were maintained not by adventitious response-reinforcer contingencies, but by differential contingencies between the stimulus (keylight) and food. The role of such contingencies in the phenomenon of behavioral contrast is discussed.

Discrete-trials spaced responding in the pigeon: the dependence of efficient performance on the availability of a stimulus for collateral pecking

Four pigeons were exposed to a discrete-trial schedule in which only responses spaced by at least 6 sec were reinforced. After 45, fifty-trial sessions, they failed to meet the spacing requirement in over 90% of the trials. When an alternative, non-contingent key (pecks on which had no consequence) was illuminated concurrently with the first key, the spacing performance of the three pigeons that pecked the non-contingent key improved so that they were obtaining 75% of the possible reinforcers. These data demonstrated the importance of collateral behavior in mediating spaced performance. It was suggested that pigeons may successfully refrain from responding on the spacing procedure only when another stimulus correlated with reinforcement is available for pecking, and that the form that collateral behavior takes may, in general, be non-arbitrary, and species dependent.

Development of complex, stereotyped behavior in pigeons

A pigeon's peck on one key moved a light down one position in a 5x5 matrix of lights, while a peck on another key moved the light across one position. Reinforcement depended upon the occurrence of four pecks on each key (moving the matrix light from the top left to the bottom right), and a fifth peck on either key ended a trial without food. Though there were 70 different sequences that led to reinforcement, each of 12 pigeons developed a particular, stereotyped sequence which dominated its behavior (Experiment 1). Extinction produced substantial increases in sequence variability (Experiment 2). Removal of the matrix cues disrupted performance, though it partially recovered with extended training (Experiment 3). The pigeons did not master a contingency which required a different sequence on the current trial than on the previous one (Experiment 4), though they were able to learn to emit sequences which began with either left-left or left-right response patterns (Experiment 5). The experiments suggest that contingencies of reinforcement may contribute to the creation of complex units of behavior, and that stereotypy may be a likely consequence of contingent reinforcement.

Discriminative stimulus location as a determinant of positive and negative behavioral contrast in the pigeon

Four pigeons were exposed to a series of two-component multiple schedules of reinforcement that ordinarily yield positive and negative behavioral contrast. The stimuli that signalled the component schedules were sometimes located on the response key and sometimes off. Positive behavioral contrast was observed only when the stimuli were on the key. Negative contrast was observed independent of stimulus location. These data suggest that positive and negative contrast may be causally unrelated, and support an account of contrast in terms of the summation of key pecks that are separately controlled by response-reinforcer and stimulus-reinforcer dependencies.

Behavioral contrast in the pigeon: a study of the duration of key pecking maintained on multiple schedules of reinforcement

Pecks on an operant key were reinforced on either multiple variable-interval variable-interval or multiple variable-interval extinction schedules of reinforcement. The stimuli that signalled the multiple-schedule components were located on a second key (signal key), and a changeover delay prevented reinforcement of signal key-peck-operant key-peck sequences. No behavioral contrast was observed on the operant key, and appreciable responding to the signal key occurred during the variable-interval component of the multiple variable-interval extinction procedure. Peck durations on the signal key were markedly shorter than peck durations on the operant key. Moreover, most responses on the signal key occurred just after the multiple-schedule components changed. These data support an account of behavioral contrast in terms of the summation of pecks that are separately controlled by stimulus-reinforcer and response-reinforcer dependencies, and suggest that the stimulus-reinforcer dependency is responsible primarily for local contrast. In addition, the data suggest that pecks that are controlled by these two dependencies may belong to topographically different classes.

Failure to produce response variability with reinforcement

Two experiments attempted to train pigeons to produce variable response sequences. In the first, naive pigeons were exposed to a procedure requiring four pecks on each of two keys in any order, with a reinforcer delivered only if a given sequence was different from the preceding one. In the second experiment, the same pigeons were exposed to this procedure after having been trained successfully to alternate between two specific response sequences. In neither case did any pigeon produce more than a few different sequences or obtain more than 50% of the possible reinforcers. Stereotyped sequences developed even though stereotypy was not reinforced. It is suggested that reinforcers have both hedonic and informative properties and that the hedonic properties are responsible for sterotyped repetition of reinforced responses, even when stereotypy is negatively related to reinforcer delivery.

Allocation of complex, sequential operants on multiple and concurrent schedules of reinforcement

Pigeons could produce food by pecking exactly four times on each of two keys, in any order. In the first experiment, these response sequences were reinforced on a series of multiple schedules of variable-interval reinforcement. In the second experiment, these response sequences were reinforced on a series of concurrent schedules of reinforcement. In both experiments, highly stereotyped response sequences developed. If these response sequences were treated as individual responses, the resulting data conformed to what is typically reported in studies of multiple and concurrent schedules involving individual responses. For example, behavioral contrast was observed with the multiple schedules, and matching was observed with the concurrent schedules. However, schedule manipulation had no effect on within-sequence characteristics of responses like accuracy, stereotypy, or rate. These data constitute further evidence that response sequences can become functional behavioral units.