Biomedical subjects

J S Bailey

Publications and source records attributed to J S Bailey.

At least 37 records · Page 2Linked to original sources

PubMed2001

Cell-specific transcriptional regulation of follicle-stimulating hormone-beta by activin and gonadotropin-releasing hormone in the LbetaT2 pituitary gonadotrope cell model.

FSH is secreted by gonadotropes of the anterior pituitary and plays a crucial role in mammalian reproduction. However, little is known about FSH gene regulation due to the lack of a gonadotrope cell line that synthesizes FSH. The LbetaT2 mouse pituitary cell line, isolated by targeted tumorigenesis in transgenic mice, has the characteristics of a mature gonadotrope, including expression of GnRH receptor, steroidogenic factor 1, and both the alpha- and beta-subunits of LH, but was thought not to express FSH. Using RT-PCR, we show that these cells synthesize FSH beta- subunit messenger RNA, which is induced by activin and inhibited by follistatin. Furthermore, in transient transfections an ovine FSHbeta 5'-regulatory region (5.5 kb) confers LbetaT2 cell-specific expression to a reporter gene compared with other pituitary and nonpituitary cell lines. This FSHbeta regulatory region responds to activin specifically in LbetaT2 cells, an effect that is blocked by follistatin. The LHbeta, alpha-subunit, and GnRH receptor regulatory regions are induced by activin and blocked by follistatin. Furthermore, LbetaT2 cells express the components of the activin system, and addition of follistatin alone reduces FSHbeta gene expression, demonstrating that an endogenous activin autocrine loop regulates FSH in these cells. In addition, GnRH stimulates both the FSHbeta and LHbeta regulatory regions, specifically in LbetaT2 cells. Surprisingly, GnRH induction is reduced by follistatin, suggesting its dependence on endogenous activin. As the mouse GnRH receptor promoter is inhibited by follistatin, reduction of GnRH receptor levels might be one mechanism by which follistatin interferes with GnRH induction of gonadotropin genes. In summary, LbetaT2 cells exhibit the characteristics of fully differentiated gonadotropes, including the expression of LH, FSH, GnRH receptor, and components of the activin/follistatin system, as well as display the appropriate responses to activin and GNRH:

Activin Receptors↗

PubMed2001

Sources and movement of Salmonella through integrated poultry operations: a multistate epidemiological investigation.

The prevalence of Salmonella from numerous sources in 32 integrated broiler operations of high- and low-performing broiler houses was characterized from four states across four seasons. Previous studies of Salmonella in broilers have been limited in scope, offering only a snapshot of pathogen prevalence as seen on a small number of individual farms. Twenty-six different sample types were collected from the hatchery to the end of processing, and Salmonella was found in all sample types. A total of 10,740 samples were analyzed for Salmonella, and 973 (9.1%) of these samples, including 49 of 798 (6.1%) carcass rinse samples, were Salmonella positive. Hatchery transport pads (389 of 765, 50.8%), flies (28 of 150, 18.7%), drag swabs (57 of 402, 14.2%), and boot swabs (20 of 167, 12%) were samples from which Salmonella was most frequently isolated. Thirty-six different serotypes were identified, and the most frequently encountered serotypes were Salmonella Senftenberg, Salmonella Thompson, and Salmonella Montevideo. Determining critical contaminating sources and following the movement of Salmonella through integrated poultry operations will help researchers and the industry develop practical intervention strategies.

Animals↗

PubMed2001

Colonization of broiler chicks by Salmonella typhimurium definitive phage type 104.

The prevalence of an antibiotic-resistant strain of Salmonella Typhimurium definitive phage type 104 (DT104) has increased dramatically in recent years resulting in increased morbidity and mortality in both animals and humans. Colonization and shedding of Salmonella Typhimurium DT104 was studied in broiler chickens in two trials. In trial 1, 180 day-of-hatch chicks (n = 60 per group, n = 30 per replicate) were challenged with 10(6) CFU DT104 (wild-type isolate from poultry) or were commingled with a seeder chick challenged with 10(6) CFU DT104. In trial 2, 360 day-of-hatch chicks (n = 120 per treatment, n = 30 per rep) were divided into three groups. Chicks in the susceptible group were commingled with two seeder chicks that were orally challenged with 10(7) CFU/bird of a pan-sensitive strain of Salmonella Typhimurium DT104. Chicks in the resistant group were commingled with two seeder chicks that were orally challenged with 10(7) CFU/bird DT104 used in trial 1. For both trials, a control group was not exposed to DT104, composite fecal samples were evaluated twice weekly for levels of Salmonella shedding and 20 chicks per group were necropsied weekly and their cecal contents were cultured. At hatch all groups were colonized with naturally occurring Salmonella Senftenberg and Salmonella Mbandaka (trial 1) or Salmonella Senftenberg and Salmonella Ohio (trial 2) prior to exposure to DT104. Throughout the study, the level of Salmonella spp. shedding in feces (trial 1 means 3.1, 2.9, and 3.0 log10 CFU per g feces for challenged, seeder, and control groups, respectively) or ceca (trial 2 means 2.9. 2.9. and 2.5 log10 CFU per g ceca for resistant, susceptible, and control groups, respectively) did not differ among groups. In trial 1, colonization of DT104 remained constant at higher levels in the challenged group (mean 87%, P < 0.01), increased over time in the seeder group (10 to 50%, P < 0.02) and was not recovered from the control chicks. Salmonella Mbandaka colonization remained steady within each group with challenge and seeder groups maintaining higher levels of colonization than the control group. Salmonella Senftenberg colonization levels tended to decline (P = .058) over time in the challenged group (20 to 0%) and significantly decreased (P < 0.01) over time for both the seeder (80 to 0%) and control chicks (85 to 10%). In trial 2, the percentage of chicks colonized with susceptible DT104 declined (r = 0.90, P < 0.05) over the course of the trial from 45 to 0%, while recovery of the resistant DT104 persisted at a mean percentage of 27%. DT104 was not recovered from the control chicks. Salmonella Ohio colonization levels tended to decline (r = 0.79, P > 0.05) over time in the control group (75 to 20%) and significantly decreased (P < 0.05) over time in both susceptible and resistant groups (40 to 10%, r = 0.82 and 55 to 5%, r = 0.85, respectively). Salmonella Senftenberg was recovered from the control group at low frequency throughout the trial and was not recovered from the other groups. For either trial, no apparent affect on morbidity or mortality was observed. Introduction of DT104 by commingling may induce colonization resulting in persistent high levels of shedding in flocks simultaneously with other Salmonella species.

Animals↗

PubMed2001

Distribution of Campylobacter spp. in selected U.S. poultry production and processing operations.

A study was conducted of 32 broiler flocks on eight different farms, belonging to four major U.S. producers. The farms were studied over I complete calendar year. Overall, 28 (87.5%) of the flocks became Campylobacter positive, and only four (12.5%) remained negative throughout the 6- to 8-week rearing period. In the majority of flocks, sampled every 2 weeks throughout production, Campylobacter-positive fecal and cecal samples were not detected until 4 to 8 weeks of age. In only six of the flocks were environmental samples found to be positive before shedding of Campylobacter was detected in the birds. Even in some of the Campylobacter-negative flocks, contamination of the rearing environment was positive for Campylobacter but did not result in the birds subsequently excreting the organism. These findings are discussed in relation to U.S. husbandry practices and present uncertainty about sources of Campylobacter infection for poultry flocks. Birds were often transported to the processing plant in coops that were already contaminated with Campylobacter, and the organisms were sometimes found in samples of scald water and chill water. After chilling, the proportions of Campylobacter-positive carcasses from different producers ranged from 21.0 to 40.9%, which is lower than in other studies, and possible reasons are considered.

Age Factors↗

PubMed2000

Commercial field trial evaluation of mucosal starter culture to reduce Salmonella incidence in processed broiler carcasses.

A series of four paired-house studies was conducted in Arkansas, Alabama, and Georgia (two farms) to determine the efficacy of Mucosal Starter Culture (MSC) in eliminating or reducing salmonellae in broiler chickens. Randomly designated chicks were treated twice with MSC. First they were sprayed with an MSC solution using a spray vaccination cabinet in the hatchery, and then they received MSC in the first drinking water at the growing house. Chicks were grown in identically constructed and equipped paired houses managed by the same grower. At the end of grow-out, broilers were tested for the presence of salmonellae on the farm and during processing. In three trials where no hatchery salmonellae were found, less salmonellae were found on MSC-treated chickens compared to untreated chickens. On the farm at the end of grow-out, salmonellae were detected in 54 of 150 untreated control chickens compared to 40 of 180 MSC-treated chickens. In the processing plant, significantly (P < or = 0.05) more salmonellae were detected on prechill untreated control carcasses (23 of 180) compared to MSC-treated carcasses (12 of 180) and on untreated postchill processed carcasses (9 of 180) compared to MSC-treated carcasses (0 of 180). In one trial where appreciable (28% of egg shell samples) salmonellae was found before treatment with the MSC, more salmonellae were found in the treated birds than in the control birds both on the farm and after processing. These data confirm that when salmonellae levels were controlled in the hatchery, a significant reduction in the salmonellae was found on processed broiler carcasses treated with MSC and that this reduction in salmonellae was carried through processing to the final processed carcass, thus potentially reducing consumer exposure to salmonellae.

Animals↗

PubMed2000

The microbiological profile of chilled and frozen chicken.

To determine the effect of different refrigeration and freezer temperatures on the microbiological profile of chicken, 50 commercially processed broiler chickens were each split in half on the day of processing. Equal groups were held at 4, 0, -4, -12, and -18 degrees C (40, 32, 26, 10, and 0 degrees F), respectively for 7 days. One half of each group was then transferred to a 0 degrees F holding chamber for an additional 7 days. Carcass halves were rinse sampled with 100 ml of phosphate-buffered saline and the diluent sampled for mesophilic, psychrotropic, coliform, and salmonellae counts after the initial 7 days at different temperatures and after 7 additional days at -18 degrees C. Ten carcass halves were sampled on the day of processing to give baseline counts. Mesophilic bacteria counts/ml were about log 4.6 on day 0, increased by 2 log after 7 days on carcasses held at 4 degrees C, and were unchanged at all other storage temperatures. Psychrotropic counts/ml were about log 3.6 on day 0 and increased during the initial 7 days by about 3.9, 1.9, and 1.4 logs, respectively on carcasses held at 4, 0, and -4 degrees C and had less than 1 log increase at -12 and -18 degrees C. Coliform counts were about log 2.2/ml on day 0 and had declined to about log 1.5/ml or less by day 7 for all storage temperatures. Escherichia coli counts/ml were about log 2 on day 0 and were reduced about 1 log or more at other storage days. Salmonellae counts were about log 1.5 on salmonellae-positive carcasses and did not change appreciably at any storage temperature. No counts for any organism significantly changed after placement at -18 degrees C.

Animals↗

PubMed1999

Eggshell membrane structure and penetration by Salmonella typhimurium.

Eggshell membrane was removed from 10 broiler hatching eggs at approximately monthly intervals through the productive life of a commercial flock. A piece of membrane (2 by 2 cm) was used to cover an opening in an apparatus designed to test penetration by Salmonella Typhimurium. The membrane was placed between two chambers as the only means of liquid transfer. The chamber above the membrane was filled with a suspension of Salmonella Typhimurium cells. Sampling of the bottom chamber provided cultural evidence of the penetration by a marker strain of Salmonella Typhimurium. Samples were drawn at 15 min and at 1, 3, 5, 7, 12, 24, and 48 h. Following the cultural penetration experiment, the same pieces of membrane were removed and stained for microscopic examination. Membrane structure was examined with the use of a confocal laser scanning microscope. Each image consisted of a composite of eight 1-microm optical slices showing the fibers making up the outer surface of the membrane. These images were transferred to an image analysis software package that allowed the measurement of the interfiber area. No clear correlation could be made between the average size of all interfiber areas or the total interfiber area measured in the outer 8 microm of the outer membrane and the ability of Salmonella Typhimurium to penetrate the same piece of eggshell membrane.

Animals↗

PubMed1999

Mucosal competitive exclusion to reduce Salmonella in swine.

A mucosal competitive exclusion culture has been shown to reduce or eliminate Salmonella spp. in poultry. Using similar techniques, a mucosal competitive exclusion culture from swine (MCES) was produced from the cecum of a 6-week-old pig. Suckling pigs were inoculated with 5 ml of MCES by oral gavage within 6 h postfarrowing (PF) and again at 24 h PE All pigs were challenged with 10(3) CFU of Salmonella Choleraesuis at 48 h PF by intranasal instillation, including pigs from two sows that had not been given MCES. Clinical signs and rectal swabs were monitored daily, and pigs were allowed to suckle throughout the experiment. All pigs underwent necropsy on day 7 PF, and presence of Salmonella was determined in both qualitative (10 tissues) and quantitative (two tissues) samples. Clinical signs were inapparent in all pigs throughout the experiment. Recovery of Salmonella from rectal swabs was variable. However, 28% of the gut tissues were positive from the MCES-treated pigs versus 79% from the control pigs. A 2- to 5-log10 reduction of Salmonella in the cecal contents or ileocolic junction was observed in the MCES-treated pigs when compared with the controls. These data indicate that use of MCES may be a useful approach for control of Salmonella.

Animals↗

PubMed1998

Effect of Salmonella in young chicks on competitive exclusion treatment.

The potential of Salmonella contamination in hatching cabinets to 1) generate seeder chicks and 2) interfere with the efficacy of competitive exclusion (CE) treatments was investigated in six experiments. Hatchery-generated seeder: chicks were produced by hatching in the same hatcher with inoculated eggs (immersed in a 1.0 x 10(5) cfu/mL suspension of Salmonella typhimurium or inoculated with 10(5) to 10(6) cells on the air cell membrane). Salmonella spread through the hatching cabinet to chicks hatching from uninoculated eggs in adjacent trays. In two experiments, Salmonella was isolated from 31 and 100% of the chick rinses after the birds were held in groups for 3 d in isolation units. When these hatchery-generated seeder chicks were stocked in floor pens at a 1:10 ratio with uncontaminated contact chicks, the pen environment became contaminated to the extent that greater than 50% of the contact chicks became contaminated. In two experiments with only one to three inoculated eggs per 200 egg hatching cabinet, 98% of uninoculated chicks were intestinally colonized with Salmonella after the birds were held 1 wk in isolation cabinets. This hatchery-acquired Salmonella substantially reduced the effectiveness of subsequent CE treatments to prevent Salmonella colonization of the young chicks. These studies demonstrate that control of Salmonella in hatching cabinets is critically important for control of Salmonella in broilers.

Animals↗

PubMed1998

Effect of yeast-supplemented feed on Salmonella and Campylobacter populations in broilers.

The effect of the yeast, Saccharomyces boulardii, on experimental cecal colonization of broilers with Salmonella typhimurium and Campylobacter jejuni was investigated. Duplicate pens of broiler chicks were given ad libitum access to a standard feed supplemented with no yeast (control), or 1 g (1x), or 100 g (100x) dried S. boulardii/kg feed. All chicks except negative controls were challenged on Day 4 with 3.2 x 10(8) cfu S. typhimurium and 6.5 x 10(8) cfu C. jejuni by oral gavage. After 3 wk, the broilers were euthanatized and ceca were aseptically removed and analyzed for Salmonella and Campylobacter. Frequency of Salmonella colonization was significantly (P < 0.05) reduced due to yeast treatment. Of the positive control birds, 70% were colonized with Salmonella; whereas only 20 and 5% of the 1x and 100x yeast-treated birds were colonized. Mean number of Salmonella per gram of ceca and contents were log 1.64, 0.35, and 0.15, respectively, for the control, 1x, and 100x yeast-treated birds. Campylobacter colonization was not significantly affected by yeast treatment. Similar results were obtained from a second trial conducted in larger isolation floor pens.

Animal Feed↗

PubMed1998

Eggshell characteristics and penetration by Salmonella through the productive life of a broiler breeder flock.

Egg weight, specific gravity, conductance, and ability of Salmonella to penetrate the shell and membranes were determined for hatching eggs from a commercial broiler breeder flock. Thirty unsanitized eggs were sampled on Weeks 29, 34, 39, 42, 48, 52, and 56 of flock age for specific gravity and conductance. An additional 10 intact eggs were inoculated with Salmonella by a temperature differential immersion method for 1 min. Eggs were then emptied of contents and filled with a selective medium that allowed visualization of Salmonella growth on the inside of the shell and membrane complex. Over the 27-wk sampling period, egg weight increased from 56 to 66 g and was positively correlated with hen age (r = 0.96, P < 0.05). However, neither specific gravity (ranging from 1.077 to 1.082) nor eggshell conductance (ranging from 14.7 to 17.9 mg weight loss/d per torr) showed any clear trend throughout the life of the flock despite the increase in egg weight. Conductance values were not correlated with specific gravity. The number of eggs positive for Salmonella penetration after 24 h incubation showed a general upward trend with flock age; however, penetration frequency and hen age were not found to be significantly correlated (P > 0.05). No relationship was found between egg specific gravity, conductance, or egg weight and the likelihood of Salmonella to penetrate the eggshell. Because shell characteristics did not change over time and the penetration patterns did vary, it is likely that factors other than specific gravity and conductance were involved in the penetration of eggshells by Salmonella.

Animals↗

PubMed1998

On the effects of noncontingent delivery of differing magnitudes of reinforcement.

We conducted a parametric analysis of response suppression associated with different magnitudes of noncontingent reinforcement (NCR). Participants were 5 adults with severe or profound mental retardation who engaged in a manual response that was reinforced on variable-ratio schedules during baseline. Participants were then exposed to NCR via multielement and reversal designs. The fixed-time schedules were kept constant while the magnitude of the reinforcing stimulus was varied across three levels (low, medium, and high). Results showed that high-magnitude NCR schedules produced large and consistent reductions in response rates, medium-magnitude schedules produced less consistent and smaller reductions, and low-magnitude schedules produced little or no effect on responding. These results suggest that (a) NCR affects responding by altering an establishing operation (i.e., attenuating a deprivation state) rather than through extinction, and (b) magnitude of reinforcement is an important variable in determining the effectiveness of NCR.

Adult↗

PubMed1998

Detection of Salmonella cells within 24 to 26 hours in poultry samples with the polymerase chain reaction BAX system.

BAX, a commercial polymerase chain reaction-based system, was evaluated to determine the efficacy of the system with different concentrations of Salmonella cells in mixed cultures and compared to conventional methods for detection of inoculated Salmonella cells from poultry samples. When present in enrichment broths at levels of 10(5), 10(4), and 10(3) CFU/ml, Salmonella cells were detected in 100, 93, and 41% of samples, respectively. Salmonella cells were detected in 23 of 150 (15%) processed chicken rinse samples with the BAX system compared to 18 of 150 (12%) samples with conventional methods. Salmonella cells were detected in 28 of 50 (56%) ground turkey samples with the BAX system compared to 25 of 50 (50%) samples with conventional methods. Overall there was a 97% method agreement. One false-negative and two false-positive results were obtained with the BAX. Band sizes and intensity of the polymerase chain reaction product were shown to be correlated with estimated numbers of Salmonella CFU present in the enriched and inoculated samples. The assay was able to detect 10(4) Salmonella CFU/ml of enrichment medium, which allows consistent detection of Salmonella cells within 24 to 26 h. The high degree of sensitivity and specificity of the BAX system make it a reliable alternative to conventional bacterial cultural methods.

Animals↗

PubMed1997

Charles Drew and the origins of deep hypothermic circulatory arrest.

Convinced that the high risk of operation using the early heart-lung machines was due to a toxic effect of the oxygenators in use in the 1950s, Charles Drew of Westminster Hospital in London devised a circulatory support system in which the patient's own lungs functioned as the oxygenator. With this support, body temperature was reduced to the point where circulatory arrest could be tolerated for the time required to carry out the intracardiac operation. He used only this technique for the rest of his surgical career, a period of 22 years. We have attempted to record how this came to pass and to describe the qualities of this man that led him to be original and creative.

Animals↗

PubMed1997

Effect of cloacal plugging on microbial recovery from partially processed broilers.

Experiments were performed to test the contribution of bacteria contained in the intestinal tract of broilers at the beginning of processing to counts on the exterior of modified New York-dressed carcasses. Thirty-two birds were processed for each of seven replications. Within each replication, batches of four birds were electrocuted, scalded, and picked, with batches alternating between treatment and control groups. Treated birds were cloacally plugged with rayon fiber tampons prior to electrocution to prevent escape of intestinal contents during scalding and picking. Control birds were processed in the same manner, except that cloacal plugs were inserted immediately after defeathering to reduce escape of intestinal contents during sampling. Gram-negative enteric bacteria and Campylobacter spp. were enumerated on carcasses by whole carcass rinse procedure and in cecal contents. Counts were converted to log10 and subjected to analysis of variance. Cecal levels of Gram-negative enterics were significantly higher for plugged birds, but there was not a significant difference between levels of cecal Campylobacter spp. between treatment groups. Plugging before electrocution resulted in significantly lower levels (2.5 vs 3.0 log10 cfu/mL) of Campylobacter spp. and Gram-negative enteric bacteria (3.0 vs 3.4 log10 cfu/mL) in carcass rinses of treatment birds than in those of controls. All carcasses were positive for Gram-negative enterics. Cloacal plugging resulted in significantly lower incidence of Campylobacter spp. carcass contamination as determined by chi-square. Intestinal carriage of both campylobacters and Gram-negative enteric bacteria appears to influence the microbial quality of the carcass during processing.

Analysis of Variance↗

PubMed1997

Relationship between aerobic bacteria, salmonellae and Campylobacter on broiler carcasses.

Broiler carcasses were removed from commercial processing lines immediately after defeathering, before chilling, and after chilling to determine whether any relationship exists between aerobic bacteria and the human enteropathogens salmonellae and Campylobacter. In two experiments, a whole carcass rinse procedure was used to sample 30 carcasses after defeathering, 90 carcasses before chilling, and 90 carcasses after chilling, for a total of 210 different carcasses. Aerobic bacteria and Campylobacter spp. were enumerated and the incidence of salmonellae was determined. Salmonellae and Campylobacter incidences were 20 and 94%, respectively, for all carcasses sampled. After picking, neither salmonellae-positive nor Campylobacter-positive carcasses had mean aerobic most probable number (MPN) values that were different from carcasses negative for those organisms. Immediately before chilling, aerobic and Campylobacter counts were 7.12 and 5.33 log10 cfu per carcass, respectively. Immersion chilling reduced aerobic counts by approximately 1.8 log and Campylobacter by 1.5 log, with no change in salmonellae-positive carcasses. There was no difference in aerobic or Campylobacter counts between carcasses that were positive or negative for salmonellae at any of the sampling locations, nor was any correlation found between levels of aerobic organisms and Campylobacter. Carcasses with aerobic counts above the mean or more than one standard deviation above the mean also failed to show any correlation. Discriminant analysis indicated error rates as high as 50% when numbers of aerobic bacteria were used to predict incidence of salmonellae or Campylobacter on individual carcasses. Aerobic bacteria are not suitable as index organisms for salmonellae or Campylobacter on broiler carcasses.

Animals↗

PubMed1997

Yeast treatment to reduce Salmonella and Campylobacter populations associated with broiler chickens subjected to transport stress.

The prevalence of Campylobacter and Salmonella on retail poultry carcasses remains a significant public health concern. The stresses associated with transporting poultry prior to slaughter have been shown to increase pathogen populations both in the intestinal tract and on the carcass exterior. The yeast, Saccharomyces boulardii, was evaluated for its ability to reduce populations of Salmonella and Campylobacter in broiler chickens subjected to transport stress. Chicks, inoculated with individual strains of Salmonella and Campylobacter were held for 6 wk and then divided into two groups with half of the chickens receiving 10% dried yeast in the feed for 60 h. The birds were then caged and transported to simulate commercial conditions. After euthanatizing the birds, the ceca were aseptically removed and analyzed for Salmonella and Campylobacter. With no yeast treatment, transport stress caused the Salmonella colonization frequency to increase more than fivefold, from 3.3 to 16.7%. Yeast treatment significantly reduced the frequency of Salmonella colonization to lower than prestress levels, as no Salmonella were recovered from the ceca of these birds (P < 0.05). Similar results were obtained from birds challenged with a mixture of Salmonella and Campylobacter strains. Before transport, 53.3% of these chickens were positive for Salmonella. Transport stress increased the colonization rate to 67.5% in control birds, whereas the colonization of yeast-treated chickens decreased to 40% (P < 0.05). Frequency of Campylobacter isolation from the ceca was not affected by treatment, but Campylobacter populations present in the ceca were significantly reduced in the mixed strain trial (P < 0.05).

Analysis of Variance↗

PubMed1996

A brief behavior therapy protocol for Tourette syndrome.

The purpose of this study was to examine the efficacy of a brief behavior therapy protocol for Tourette Syndrome. The nasal tic frequency of a 9-year-old male was assessed using a nine-session protocol with alternating treatments and reversal-design components. The results indicated that the participant's tics were reduced by approximately 70%. The behavior change was successfully maintained at a one-month follow-up. Social validity and consumer satisfaction measures confirmed the social significance of the behavior change.

Awareness↗