Assessing functional relations in single-case designs: Quantitative proposals in the context of the evidence-based movement

In the context of the evidence-based practices movement, the emphasis on computing effect sizes and combining them via meta-analysis does not preclude the demonstration of functional relations. For the latter aim, we propose to augment the visual analysis to add consistency to the decisions made on the existence of a functional relation without losing sight of the need for a methodological evaluation of what stimuli and reinforcement or punishment are used to control the behavior. Four options for quantification are reviewed, illustrated, and tested with simulated data. These quantifications include comparing the projected baseline with the actual treatment measurements, on the basis of either parametric or nonparametric statistics. The simulated data used to test the quantifications include nine data patterns in terms of the presence and type of effect and comprising ABAB and multiple baseline designs. Although none of the techniques is completely flawless in terms of detecting a functional relation only when it is present but not when it is absent, an option based on projecting split-middle trend and considering data variability as in exploratory data analysis proves to be the best performer for most data patterns. We suggest that the information on whether a functional relation has been demonstrated should be included in meta-analyses. It is also possible to use as a weight the inverse of the data variability measure used in the quantification for assessing the functional relation. We offer an easy to use code for open-source software for implementing some of the quantifications.

Ewing sarcoma of the rib: respiratory tract infection as initial symptoms in a 14-year-old boy. Functional medical imaging findings

Ewing sarcoma or primitive neuroectodermal tumor (PNET) of bone is the second most common pediatric malignant bone tumor. The median age at diagnosis is 15 years and there is a male predilection of 1.5/1. The authors present the case of a 14-year-old boy with Ewing sarcoma situated on the left ninth rib which was being investigated for respiratory tract infection. Pleurisy is the most common misdiagnosis. Our case illustrates the importance of recognizing exceptional features when interpreting FDG PET or scintigraphy to prevent the misinterpretation of metastases as other etiologies, such as infection.

Comprehension of passives in Persian speaking children with ASD : an investigation of grammar in autism

Most research on the underlying causes of social and communicative impairment in autism spectrum disorders (ASD) has been devoted to pragmatic aspects of language. The present research is exploring the syntactic knowledge as a probable underlying mechanism of language deficit in ASD. Three groups comprising high-functioning ASD, low-functioning ASD, and typically developing 5-year-old Persian-speaking children were tested on comprehension of passive sentences. Results suggest that while low-functioning children with ASD might be impaired in the area of grammar, high-functioning children with ASD are not. The new results are compared to those of two recent studies on comprehension of passives in Greek-speaking and English-speaking subjects with ASD (Perovic et al., 2007; Terzi, et al., to appear).

Long-term functional improvements in the 2-year treatment of schizophrenia outpatients with olanzapine long-acting injection

BACKGROUND: Little is known about the long-term changes in the functioning of schizophrenia patients receiving maintenance therapy with olanzapine long-acting injection (LAI), and whether observed changes differ from those seen with oral olanzapine. METHODS: This study describes changes in the levels of functioning among outpatients with schizophrenia treated with olanzapine-LAI compared with oral olanzapine over 2 years. This was a secondary analysis of data from a multicenter, randomized, open-label, 2-year study comparing the long-term treatment effectiveness of monthly olanzapine-LAI (405 mg/4 weeks; n=264) with daily oral olanzapine (10 mg/day; n=260). Levels of functioning were assessed with the Heinrichs-Carpenter Quality of Life Scale. Functional status was also classified as 'good', 'moderate', or 'poor', using a previous data-driven approach. Changes in functional levels were assessed with McNemar's test and comparisons between olanzapine-LAI and oral olanzapine employed the Student's t-test. RESULTS: Over the 2-year study, the patients treated with olanzapine-LAI improved their level of functioning (per Quality of Life total score) from 64.0-70.8 (P<0.001). Patients on oral olanzapine also increased their level of functioning from 62.1-70.1 (P<0.001). At baseline, 19.2% of the olanzapine-LAI-treated patients had a 'good' level of functioning, which increased to 27.5% (P<0.05). The figures for oral olanzapine were 14.2% and 24.5%, respectively (P<0.001). Results did not significantly differ between olanzapine-LAI and oral olanzapine. CONCLUSION: In this 2-year, open-label, randomized study of olanzapine-LAI, outpatients with schizophrenia maintained or improved their favorable baseline level of functioning over time. Results did not significantly differ between olanzapine-LAI and oral olanzapine.