sm something_awful_smilies.rss By interglacial.com Published On :: New Something Awful smilies Full Article
sm Exploring local community is 'first key' to saving hospitality industry, says Thunder Bay Tourism manager By www.cbc.ca Published On :: Thu, 7 May 2020 12:14:50 EDT The tourism and hospitality industries, which play a large role in the economy of almost every community in northwestern Ontario, are taking a beating during the COVID-19 pandemic. Now, the manager of Tourism Thunder Bay is figuring out how “dire” the situation is, and what could be done to help. Full Article News/Canada/Thunder Bay
sm Comment on 12 Cool India Facts [For President Obama's Visit] – RantRave | Published Opinion. by Jenny Smith By rss-newsfeed.india-meets-classic.net Published On :: Sun, 07 Nov 2010 19:27:50 +0000 <span class="topsy_trackback_comment"><span class="topsy_twitter_username"><span class="topsy_trackback_content">12 Cool India Facts [For President Obama's Visit] – RantRave ...: Washington Post12 Cool India Facts [For Presid... http://bit.ly/dmozLC</span></span> Full Article
sm Best of the National Book Festival: Tracy K. Smith and Robert Hass, 2018 By blogs.loc.gov Published On :: Tue, 28 Apr 2020 14:00:43 +0000 Our ongoing celebration of the Library of Congress National Book Festival continues with Poets Laureate Tracy K. Smith and Robert Hass discussing the making of poetry, the position of Poet Laureate and their new books, "American Journal: Fifty Poems for Our Time" (edited by Smith) and "A Little Book on Form: An Exploration into the Formal Imagination of Poetry" (Hass), on the Poetry & Prose stage at the 2018 Festival. Full Article Authors Best of National Book Festival Books Poetry Programs
sm Seven Spots Where You Can See Big-Name Architecture in Small-Town America By www.smithsonianmag.com Published On :: Mon, 10 Feb 2020 19:01:47 +0000 From gas stations to public libraries, these celebrity architect-designed buildings are worth a road trip Full Article
sm Protein shredder in brain cells indirectly regulates fat metabolism By www.news-medical.net Published On :: Fri, 08 May 2020 21:46:58 -0400 A protein shredder that occurs in cell membranes of brain cells apparently also indirectly regulates the fat metabolism. Full Article
sm $200 cheques for Manitoba seniors draw mix of praise, criticism By www.cbc.ca Published On :: Fri, 8 May 2020 19:39:24 EDT Earlier this week, Manitoba's premier announced $200 cheques for seniors to help pay for increased costs during the COVID-19 pandemic. But some wonder if there is a better way to help those in need. Full Article News/Canada/Manitoba
sm New Shopify App Offers Local SMBs a Bridge to E-Commerce By www.ecommercetimes.com Published On :: 2020-04-30T04:00:00-07:00 Shopify has unveiled an app that lets users discover local businesses, receive relevant product recommendations from their favorite brands, check out effortlessly, and track all their online orders. It can gather and track orders automatically, but it also works without auto-tracking. Consumers can get a customized feed with deals, trending items and recommendations from their favorite stores. Full Article
sm Cavendish tourism organization hopeful but worried for 2020 season By www.cbc.ca Published On :: Fri, 8 May 2020 18:58:01 EDT Tourism Cavendish Beach says it is hopeful the Confederation Bridge and province will reopen to certain visitors as soon as it is safe to do so. Full Article News/Canada/PEI
sm Ex-FBI Agent Defends Flint Water Probe After Criticism By www.wkar.org Published On :: Tue, 02 Jul 2019 17:00:12 +0000 A former FBI agent who investigated the Flint water scandal says the team was moving toward new charges when new prosecutors took over. Full Article
sm How Do American Indians Celebrate Mother’s Day? | Smithsonian Voices | National Museum of the American Indian – Smithsonian.com By rss-newsfeed.india-meets-classic.net Published On :: Sat, 09 May 2020 00:46:36 +0000 How Do American Indians Celebrate Mother's Day? | Smithsonian Voices | National Museum of the American Indian Smithsonian.com Full Article IMC News Feed
sm Claim of unequal pay by U.S. women's soccer team dismissed by judge By www.cbc.ca Published On :: Fri, 1 May 2020 20:14:44 EDT A federal judge threw out the unequal pay claim by players on the U.S. women's national soccer team but allowed their allegation of discriminatory travel accommodations and medical support services to go to trial. Full Article Sports/Soccer
sm Why Small Caps Lag In This Economic Downturn By openmarkets.cmegroup.com Published On :: Fri, 08 May 2020 05:06:54 +0000 Since early 2019, the Russell 2000, the primary index for small cap stocks, has lagged mid and large cap benchmarks.... The post Why Small Caps Lag In This Economic Downturn appeared first on OpenMarkets. Full Article Global Finance Equities Russell 2000
sm Sask. small care home operators ask for clarity, consultation By www.cbc.ca Published On :: Fri, 8 May 2020 12:09:56 EDT Michell Jesse said the personal care home operators she represents have been frustrated trying to keep up with the government's direction during an already stressful time. Full Article News/Canada/Saskatchewan
sm Bengals tap Heisman Trophy winner Joe Burrow as 1st pick of 2020 NFL Draft By www.cbc.ca Published On :: Thu, 23 Apr 2020 20:58:38 EDT In this most unique of drafts, filled with technological concerns and even uncertainty when real football might return, there was one constant Thursday night: Joe Burrow. Full Article Sports/Football/NFL
sm Vancouver Asian Film Festival launches anti-racism video campaign in wake of rising hate crimes By www.cbc.ca Published On :: Fri, 8 May 2020 21:19:12 EDT Hate crimes against Vancouver's Asian communities have increased since the early days of the outbreak and the #Elimin8hate campaign is an effort to combat that and comfort victims. Full Article News/Canada/British Columbia
sm Despotism and Democracy in the Age of the Virus By www.nytimes.com Published On :: Fri, 24 Apr 2020 19:49:45 GMT The battle for humanity and solidarity in the post-American world. Full Article
sm Curbside pickup a 'baby step in the right direction' for small stores closed by COVID-19 By www.cbc.ca Published On :: Thu, 7 May 2020 16:30:47 EDT Curbside pickups offer a bit of hope after months of being shuttered by COVID-19, but while retailers are happy to start getting back to business some are raising questions of fairness and access to opportunity. Full Article News/Canada/Hamilton
sm Releasing bank buffers to cushion the crisis - a quantitative assessment By www.bis.org Published On :: 2020-05-05T14:00:00Z Banks globally entered the Covid-19 crisis with roughly US$ 5 trillion of capital above their Pillar 1 regulatory requirements. The amount of additional lending will depend on how hard banks' capital is hit by the crisis, on their willingness to use the buffers and on other policy support. In an adverse stress scenario such as the savings and loan crisis, banks' usable buffers would decline to US$ 800 billion, which could support US$ 5 trillion of additional loans (6% of total loans outstanding). Yet in a severely adverse scenario, similar to the Great Financial Crisis, the corresponding figures would be only US$ 270 billion and US$ 1 trillion (1.3% of total loans). Full Article
sm Effects of Covid-19 on the banking sector: the market's assessment By www.bis.org Published On :: 2020-05-07T14:30:00Z Banks' performance on equity and debt markets since the Covid-19 outbreak has been on a par with that experienced after the collapse of Lehman Brothers in 2008. During the initial phase, the market sell-off swept over all banks, which underperformed significantly relative to other sectors. Still, markets showed some differentiation by bank nationality, and credit default swap (CDS) spreads rose the most for those banks that had entered the crisis with the highest level of credit risk. The subsequent stabilisation, brought about by forceful policy measures since mid-March, has favoured banks with higher profitability and healthier balance sheets. Less profitable banks saw their long-term rating outlooks revised to negative. And the CDS spreads of the riskiest banks continued increasing even through the stabilisation phase. Full Article
sm Monetary policy gradualism and the nonlinear effects of monetary shocks By www.bancaditalia.it Published On :: 2020-04-01T00:00:00Z Bank of Italy Working Papers by Luca Metelli, Filippo Natoli and Luca Rossi Full Article
sm Winter, spring All-Sportsmanship Teams announced By news.psu.edu Published On :: Fri, 17 Apr 2020 09:06 -0400 On the fourth day of NCAA Division III Week on Thursday, April 16, the Allegheny Mountain Collegiate Conference released its All-Sportsmanship teams for winter and spring sports. Between winter and spring sports, a total of nine Penn State Altoona student-athletes were selected as representatives to the teams. Full Article
sm Apple extends dominant smartwatch market lead in Q1 By appleinsider.com Published On :: Wed, 06 May 2020 20:19:35 -0400 Apple Watch extended its lead over smartwatch market competitors during the first quarter of 2020, according to new statistics from research firm Strategy Analytics, with Apple's wearable now accounting for more than 55% of the whole. Full Article Apple Watch
sm Apple's iPhone 11 captures 68% of India's 'ultra-premium' smartphone market By appleinsider.com Published On :: Fri, 08 May 2020 21:15:35 -0400 While Apple has yet to make substantial inroads into India's mainstream smartphone market, the tech giant's latest flagship iPhones continue to dominate top-tier category sales. Full Article iPhone
sm Small visit - big help! By feedproxy.google.com Published On :: Wed, 28 Aug 2013 08:55:12 +0000 She only came for a week, but impacted lives of several families with children with autism. Isabel Black shares about her experiences in Montenegro. Full Article
sm Baptisms at the beach By feedproxy.google.com Published On :: Tue, 22 Nov 2016 21:42:45 +0000 Mozaik church, pioneered by the OM team in Bar, Montenegro, has recently baptised seven new believers in the Adriatic sea, at the beach. Full Article
sm Using SOLIDWORKS’ Smart Dimension Tool When Sketching Arcs & Circles By blogs.solidworks.com Published On :: Mon, 23 Mar 2020 15:00:23 +0000 This helpful #TechTip is brought to you by our Training Manager John Setzer, and covers using the smart dimension tool when sketching arcs and circles. Find more options available to you, when you want to create a dimension and don’t Author information GSC GSC fuels customer success with 3D engineering solutions for design, simulation, data management, electrical schematics, PCB, technical documentation, and 3D printing, as well as the most comprehensive consulting, technical support, and training in the industry. As a leading provider of SOLIDWORKS solutions, HP, and Markforged 3D printing technologies, GSC’s world-class team of dedicated professionals have helped numerous companies innovate and increase productivity by leveraging advanced technologies to drive 3D business success. Founded in 1989, GSC is headquartered in Germantown, WI. For more information about GSC, please visit www.gsc-3d.com. The post Using SOLIDWORKS’ Smart Dimension Tool When Sketching Arcs & Circles appeared first on SOLIDWORKS Tech Blog. Full Article SOLIDWORKS Tips & Tricks Sketching Smart Dimensions SOLIDWORKS Sketches tutorial
sm The Patent Troll Smokescreen By www.nytimes.com Published On :: Sat, 24 Oct 2015 02:42:07 GMT Legislative “reform” is hurting legitimate inventors. Full Article
sm Baptism on the ballfield By feedproxy.google.com Published On :: Wed, 03 Jan 2018 23:11:42 +0000 OM Hungary’s baseball ministry celebrates brothers in Christ and starts new family outreach. Full Article
sm A Cosmetic End to Madagascar’s Crisis? By feedproxy.google.com Published On :: Mon, 19 May 2014 09:23:00 GMT Madagascar’s recent elections marked an ostensible return to democracy, but unless the new government works hard to implement meaningful political, economic and social reforms, the prospect of further crisis is just a matter of time. Full Article
sm Smiles on the sea shore By feedproxy.google.com Published On :: Fri, 06 Dec 2013 17:43:51 +0000 Hope of Israel summer outreach team experiences opposition in Tiberius. However, it doesn't keep them from worshipping and sharing about Jesus. Full Article
sm ‘Addicted to evangelism’ By feedproxy.google.com Published On :: Thu, 12 Dec 2013 16:52:43 +0000 The 2013 Hope of Israel team shows motivation and unity during a month of intense ministry. Full Article
sm The meaning of baptism By feedproxy.google.com Published On :: Fri, 20 Mar 2015 13:32:09 +0000 A public baptism ceremony at the river becomes an opportunity to teach an onlooker about the true meaning of baptism. Full Article
sm A small Christmas miracle By feedproxy.google.com Published On :: Wed, 21 Jan 2015 18:05:35 +0000 God answers the prayers of OM Guatemala and a partnering church with a Christmas celebration for children and families with OM’s Project Rescue. Full Article
sm Smooth Sailing By feedproxy.google.com Published On :: Fri, 17 Nov 2006 14:57:51 +0000 Atlantic Crossing :: Making Logos II shipshape for a longer voyage Full Article
sm Service Use Classes Among School-aged Children From the Autism Treatment Network Registry By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND AND OBJECTIVES: Use of specific services may help to optimize health for children with autism spectrum disorder (ASD); however, little is known about their service use patterns. We aimed to (1) define service use groups and (2) determine associations of sociodemographic, developmental, behavioral, and health characteristics with service use groups among school-aged children with ASD. METHODS: We analyzed cross-sectional data on 1378 children aged 6 to 18 years with an ASD diagnosis from the Autism Speaks Autism Treatment Network registry for 2008–2015, which included 16 US sites and 2 Canadian sites. Thirteen service use indicators spanning behavioral and medical treatments (eg, developmental therapy, psychotropic medications, and special diets) were examined. Latent class analysis was used to identify groups of children with similar service use patterns. RESULTS: By using latent class analysis, school-aged children with ASD were placed into 4 service use classes: limited services (12.0%), multimodal services (36.4%), predominantly educational and/or behavioral services (42.6%), or predominantly special diets and/or natural products (9.0%). Multivariable analysis results revealed that compared with children in the educational and/or behavioral services class, those in the multimodal services class had greater ASD severity and more externalizing behavior problems, those in the limited services class were older and had less ASD severity, and those in the special diets and/or natural products class had higher income and poorer quality of life. CONCLUSIONS: In this study, we identified 4 service use groups among school-aged children with ASD that may be related to certain sociodemographic, developmental, behavioral, and health characteristics. Study findings may be used to better support providers and families in decision-making about ASD services. Full Article
sm Weight Management in Primary Care for Children With Autism: Expert Recommendations By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP’s 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families. Full Article
sm Factors Associated With Seizure Onset in Children With Autism Spectrum Disorder By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND AND OBJECTIVES: Children with autism spectrum disorder (ASD) have a higher prevalence of epilepsy compared with general populations. In this pilot study, we prospectively identified baseline risk factors for the development of seizures in individuals with ASD and also identified characteristics sensitive to seizure onset up to 6 years after enrollment in the Autism Speaks Autism Treatment Network. METHODS: Children with ASD and no history of seizures at baseline who either experienced onset of seizures after enrollment in the Autism Treatment Network or remained seizure free were included in the analysis. RESULTS: Among 472 qualifying children, 22 (4.7%) experienced onset of seizures after enrollment. Individuals who developed seizures after enrollment exhibited lower scores at baseline on all domains of the Vineland Adaptive Behavior Scales, greater hyperactivity on the Aberrant Behavior Checklist (25.4 ± 11.8 vs 19.2 ± 11.1; P = .018), and lower physical quality of life scores on the Pediatric Quality of Life Inventory (60.1 ± 24.2 vs 76.0 ± 18.2; P < .001). Comparing change in scores from entry to call-back, adjusting for age, sex, length of follow-up, and baseline Vineland II composite score, individuals who developed seizures experienced declines in daily living skills (–8.38; 95% confidence interval –14.50 to –2.50; P = .005). Adjusting for baseline age, sex, and length of follow-up, baseline Vineland II composite score was predictive of seizure development (risk ratio = 0.95 per unit Vineland II composite score, 95% confidence interval 0.92 to 0.99; P = .007). CONCLUSIONS: Individuals with ASD at risk for seizures exhibited changes in adaptive functioning and behavior. Full Article
sm Agitation in Patients With Autism Spectrum Disorder Admitted to Inpatient Pediatric Medical Units By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 OBJECTIVES: Our goals for this study were to characterize the frequency of agitation in patients with autism spectrum disorder (ASD) admitted to an inpatient pediatric medical unit and to identify risk factors associated with agitation. METHODS: Through a retrospective chart review, we identified every patient between 8 and 19 years of age with a documented ASD diagnosis admitted to a pediatric medical unit over a 5-year period. We performed a detailed review of each admission, with a focus on factors hypothesized to be correlated with risk of agitation. RESULTS: One or more episode of agitation occurred during 37 (12.4%) of the 299 admissions and for 31 (18.5%) of the 168 patients who met inclusion criteria. History of agitation (risk ratio 21.9 [95% confidence interval 5.4–88.3] for history of severe agitation; P < .001) and documented sensory sensitivities (risk ratio 2.3 [95% confidence interval 1.3–3.8]; P < .001) were associated with a significantly increased risk of agitation during admission. History of past psychiatric admissions was associated with increased risk before, but not after, controlling for history of agitation and sensory sensitivities. Psychiatric comorbidity, intellectual disability, acute pain on admission, number of preadmission psychotropic medications, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ASD diagnosis, age, and sex were not significantly associated with increased risk. CONCLUSIONS: Hospitalization can be challenging for patients with ASD. A subset of these patients experience episodes of agitation during admission, posing a safety risk to patients and staff. Characterizing risk factors associated with these behaviors may allow for identification of at-risk patients and guide targeted intervention to prevent negative behavioral outcomes. Full Article
sm Therapy and Psychotropic Medication Use in Young Children With Autism Spectrum Disorder By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND AND OBJECTIVES: Guidelines suggest young children with autism spectrum disorder (ASD) receive intensive nonpharmacologic interventions. Additionally, associated symptoms may be treated with psychotropic medications. Actual intervention use by young children has not been well characterized. Our aim in this study was to describe interventions received by young children (3–6 years old) with ASD. The association with sociodemographic factors was also explored. METHODS: Data were analyzed from the Autism Speaks Autism Treatment Network (AS-ATN), a research registry of children with ASD from 17 sites in the United States and Canada. AS-ATN participants receive a diagnostic evaluation and treatment recommendations. Parents report intervention use at follow-up visits. At follow-up, 805 participants had data available about therapies received, and 613 had data available about medications received. RESULTS: The median total hours per week of therapy was 5.5 hours (interquartile range 2.0–15.0), and only 33.4% of participants were reported to be getting behaviorally based therapies. A univariate analysis and a multiple regression model predicting total therapy time showed that a diagnosis of ASD before enrollment in the AS-ATN was a significant predictor. Additionally, 16.3% of participants were on ≥1 psychotropic medication. A univariate analysis and a multiple logistic model predicting psychotropic medication use showed site region as a significant predictor. CONCLUSIONS: Relatively few young children with ASD are receiving behavioral therapies or total therapy hours at the recommended intensity. There is regional variability in psychotropic medication use. Further research is needed to improve access to evidence-based treatments for young children with ASD. Full Article
sm Patient- and Family-Centered Care in the Emergency Department for Children With Autism By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND: Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD. METHODS: Qualitative interviews were conducted with parents and ED service providers, drawing on a grounded theory approach. Interviews were audio recorded, transcribed verbatim, and analyzed by using established constant comparison methods. Data were reviewed to appraise the reported presence or absence of PFCC components. RESULTS: Fifty-three stakeholders (31 parents of children with ASD and 22 ED service providers) participated in interviews. Results revealed the value of PFCC in autism-based ED care. Helpful attributes of care were a person-centered approach, staff knowledge about ASD, consultation with parents, and a child-focused environment. Conversely, a lack of staff knowledge and/or experience in ASD, inattention to parent expertise, insufficient communication, insufficient family orientation to the ED, an inaccessible environment, insufficient support, a lack of resources, and system rigidities were identified to impede the experience of care. CONCLUSIONS: Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities. Full Article
sm Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND AND OBJECTIVES: Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up. METHODS: Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time. RESULTS: Both groups improved during active treatment in all subdomains of parent stress (β = –1.42, –1.25, –0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = –0.62 and –0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = –1.91 and –1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems. CONCLUSIONS: Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described. Full Article
sm Parent Perceptions About Communicating With Providers Regarding Early Autism Concerns By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND: Long delays between parents’ initial concerns about their children’s development and a subsequent autism spectrum disorder (ASD) diagnosis are common. Although discussions between parents and providers about early ASD concerns can be difficult, they are critical for initiating early, specialized services. The principles of shared decision-making can facilitate these discussions. This qualitative study was designed to gain insights from parents of young children with ASD about their experiences communicating with primary care providers with the goal of identifying strategies for improving conversations and decision-making regarding the early detection of ASD. METHODS: Three 2-hour focus groups were conducted with 23 parents of children with ASD <8 years old. Qualitative analysis employed an iterative and systematic approach to identify key themes related to parents’ experiences. RESULTS: Eight themes related to communication about early ASD concerns emerged: characteristics of the child that caused parental concerns, the response of others when the parent brought up concerns, how concerns were brought up to the parent by others, parental responses when others mentioned concerns, information seeking, barriers to and facilitators of acting on concerns, and recommendations to providers. Parent responses suggest the need for increased use of shared decision-making strategies and areas for process improvements. CONCLUSIONS: Primary care providers can play a key role in helping parents with ASD concerns make decisions about how to move forward and pursue appropriate referrals. Strategies include responding promptly to parental concerns, helping them weigh options, and monitoring the family’s progress as they navigate the service delivery system. Full Article
sm Families Experiences With Family Navigation Services in the Autism Treatment Network By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 BACKGROUND AND OBJECTIVES: Families of children with autism spectrum disorder (ASD) often experience challenges navigating multiple systems to access services. Family navigation (FN) is a model to provide information and support to access appropriate services. Few studies have been used to examine FN’s effectiveness for families of children with ASD. This study used mixed methods to (1) characterize FN services received by a sample of families in the Autism Treatment Network; (2) examine change in parent-reported activation, family functioning, and caregiver strain; and (3) explore families’ experiences with FN services. METHODS: Family characteristics and parent outcomes including parent activation, family functioning, and caregiver strain were collected from 260 parents in the Autism Treatment Network. Descriptive statistics and linear mixed models were used for aims 1 and 2. A subsample of 27 families were interviewed about their experiences with FN services to address aim 3. RESULTS: Quantitative results for aims 1 and 2 revealed variability in FN services and improvement in parent activation and caregiver strain. Qualitative results revealed variability in family experiences on the basis of FN implementation differences (ie, how families were introduced to FN, service type, intensity, and timing) and whether they perceived improved skills and access to resources. CONCLUSIONS: Findings suggest FN adaptations occur across different health care delivery systems and may result in highly variable initial outcomes and family experiences. Timing of FN services and case management receipt may contribute to this variability for families of children with ASD. Full Article
sm Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 CONTEXT: Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD). OBJECTIVES: We systematically reviewed evidence for universal screening of children for ASD in PC. DATA SOURCES: We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature. STUDY SELECTION: We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings. DATA EXTRACTION: At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS: We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm. LIMITATIONS: Potential limitations include publication bias, selective reporting within studies, and a constrained search. CONCLUSIONS: ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4 Full Article
sm Disparities in Service Use Among Children With Autism: A Systematic Review By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 CONTEXT: Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services. OBJECTIVE: We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status. DATA SOURCES: Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services. STUDY SELECTION: Included studies addressed at least one key question and met eligibility criteria. DATA EXTRACTION: Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate. RESULTS: Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care. LIMITATIONS: The body of literature on this topic is small; hence it served as a limitation to this review. CONCLUSIONS: The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions. Full Article
sm Family Engagement in the Autism Treatment and Learning Health Networks By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 Family involvement in the Autism Intervention Research Network on Physical Health, the Autism Treatment Network, and the Autism Learning Health Network, jointly the Autism Networks, has evolved and grown into a meaningful and robust collaboration between families, providers, and researchers. Family involvement at the center of the networks includes both local and national network-wide coproduction and contribution. Family involvement includes actively co-authoring research proposals for large grants, equal membership of network committees and workgroups, and formulating quality improvement pathways for local recruitment efforts and other network initiatives. Although families are involved in every aspect of network activity, families have been the driving force of specifically challenging the networks to concentrate research, education, and dissemination efforts around 3 pillar initiatives of addressing comorbidities of anxiety, attention-deficit/hyperactivity disorder, and irritability in autism during the networks’ upcoming funding cycle. The expansion of the networks’ Extension for Community Healthcare Outcomes program is an exciting network initiative that brings best practices in autism care to community providers. As equal hub members of each Extension for Community Healthcare Outcomes team, families ensure that participants are intimately cognizant of family perspectives and goals. Self-advocacy involvement in the networks is emerging, with plans for each site to have self-advocacy representation by the spring of 2020 and ultimately forming their own coproduction committee. The Autism Treatment Network, the Autism Intervention Research Network on Physical Health, and the Autism Learning Health Network continue to be trailblazing organizations in how families are involved in the growth of their networks, production of meaningful research, and dissemination of information to providers and families regarding emerging work in autism spectrum disorders. Full Article
sm Improving Behavior Challenges and Quality of Life in the Autism Learning Health Network By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 OBJECTIVES: To summarize baseline data and lessons learned from the Autism Learning Health Network, designed to improve care and outcomes for children with autism spectrum disorder (ASD). We describe challenging behaviors, co-occurring medical conditions, quality of life (QoL), receipt of recommended health services, and next steps. METHODS: A cross-sectional study of children 3 to 12 years old with ASD receiving care at 13 sites. Parent-reported characteristics of children with ASD were collected as outcome measures aligned with our network’s aims of reducing rates of challenging behaviors, improving QoL, and ensuring receipt of recommended health services. Parents completed a survey about behavioral challenges, co-occurring conditions, health services, and the Patient-Reported Outcomes Measurement Information System Global Health Measure and the Aberrant Behavior Checklist to assess QoL and behavior symptoms, respectively. RESULTS: Analysis included 530 children. Challenging behaviors were reported by the majority of parents (93%), frequently noting attention-deficit/hyperactivity disorder symptoms, irritability, and anxiety. Mean (SD) scores on the Aberrant Behavior Checklist hyperactivity and irritability subscales were 17.9 (10.5) and 13.5 (9.2), respectively. The Patient-Reported Outcomes Measurement Information System Global Health Measure total score of 23.6 (3.7) was lower than scores reported in a general pediatric population. Most children had received recommended well-child (94%) and dental (85%) care in the past 12 months. CONCLUSIONS: This baseline data (1) affirmed the focus on addressing challenging behaviors; (2) prioritized 3 behavior domains, that of attention-deficit/hyperactivity disorder, irritability, and anxiety; and (3) identified targets for reducing severity of behaviors and strategies to improve data collection. Full Article
sm The Autism Treatment Network: Bringing Best Practices to All Children With Autism By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 The Autism Treatment Network and Autism Intervention Research Network on Physical Health were established in 2008 with goals of improving understanding of the medical aspects of autism spectrum disorders. Over the past decade, the combined network has conducted >2 dozen clinical studies, established clinical pathways for best practice, developed tool kits for professionals and families to support better care, and disseminated these works through numerous presentations at scientific meetings and publications in medical journals. As the joint network enters its second decade continuing this work, it is undergoing a transformation to increase these activities and accelerate their incorporation into clinical care at the primary care and specialty care levels. In this article, we describe the past accomplishments and present activities. We also outline planned undertakings such as the establishment of the Autism Learning Health Network, the increasing role of family members as co-producers of the work of the network, the growth of clinical trials activities with funding from foundations and industry, and expansion of work with primary care practices and autism specialty centers. We also discuss the challenges of supporting network activities and potential solutions to sustain the network. Full Article
sm Maternal and Child Health Bureaus Autism Research Program By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:42-07:00 OBJECTIVES: To provide an overview and quantitatively demonstrate the reach of the Health Resources and Services Administration’s Maternal and Child Health Bureau autism research program. METHODS: We reviewed program reports and internal data from 59 autism research grantees. The US federal Interagency Autism Coordinating Committee’s strategic plan questions were used as a framework to highlight the contributions of the autism research program in advancing the field. RESULTS: The autism research program grantees advance research in several ways. Grantees have strengthened the evidence for autism interventions by conducting 89 studies at 79 distinct research sites. A total of 212 708 participants have enrolled in autism research program studies and 361 researchers have contributed to furthering autism research. The program addresses topics that align with the majority of the Interagency Autism Coordinating Committee’s priority topic areas, including advancements in treatments and interventions, services and supports, and identifying risk factors. Grantee products include 387 peer-reviewed publications, 19 tools, and 13 practice guidelines for improving care and intervention practices. CONCLUSIONS: The autism research program has contributed to medical advances in research, leveraged innovative training platforms to provide specialized training, and provided access to health services through research-based screening and diagnostic procedures. Autism research program studies have contributed to the development of evidence-based practice guidelines, informed policy guidelines, and quality improvement efforts to bolster advancements in the field. Although disparities still exist, the Health Resources and Services Administration’s Maternal and Child Health Bureau can reduce gaps in screening and diagnosis by targeting interventions to underserved populations including minority and rural communities. Full Article