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Children in low-income families are at risk for delayed diagnosis of autism spectrum disorder (ASD). The cascade-of-care model, which examines steps of care for quality and efficacy, can identify lesions in the process for evaluation and diagnosis for children at risk for ASD. Little is known about predictors that influence key steps in this process. We performed a retrospective chart review of 110 children under age five years from an academic medical center with social communication concerns. We assessed predictors of age of referral for ASD diagnostic evaluation, time to diagnosis, and likelihood of diagnostic completion. Children with continuity of primary care were referred at an earlier age than those receiving primary care at multiple centers. Compared with children with missed visits, children attending all well-child visits had a shorter median time to diagnosis. These findings illustrate a need for primary medical homes to facilitate early and timely ASD evaluations.

This essay explores how early modern English gardening books train their readers to encounter the future. These works are plotted with the rhetoric of anticipation, teaching planting in an environment of risk, promise, disappointment, and decay, and folding readers and gardeners into the inhuman rhythms of plant time. Through an investigation of ideas about lifespan, memory, and survival in the works of orchardists William Lawson and Ralph Austen, I show how these practical engagements with planting imagine a version of time that depends as much on the recursive attachments of touch as the linear progress of sequence.

Based on individual circadian cycles and associated cognitive rhythms, humans can be classified via standardised self-reports as being early (EC), late (LC) and intermediate (IC) chronotypes. Alterations in neural cortical structure underlying these chronotype differences have rarely been investigated and are the scope of this study. 16 healthy male ECs, 16 ICs and 16 LCs were measured with a 3 T MAGNETOM TIM TRIO (Siemens, Erlangen) scanner using a magnetization prepared rapid gradient echo sequence. Data were analysed by applying voxel-based morphometry (VBM) and vertex-wise cortical thickness (CTh) analysis. VBM analysis revealed that ECs showed significantly lower grey matter volumes bilateral in the lateral occipital cortex and the precuneus as compared to LCs, and in the right lingual gyrus, occipital fusiform gyrus and the occipital pole as compared to ICs. CTh findings showed lower grey matter volumes for ECs in the left anterior insula, precuneus, inferior parietal cortex, and right pars triangularis than for LCs, and in the right superior parietal gyrus than for ICs. These findings reveal that chronotype differences are associated with specific neural substrates of cortical thickness, surface areas, and folding. We conclude that this might be the basis for chronotype differences in behaviour and brain function. Furthermore, our results speak for the necessity of considering "chronotype" as a potentially modulating factor in all kinds of structural brain-imaging experiments.

OBJECTIVES/PURPOSES OF THE STUDY: Vulvodynia is common and characterized by vulvar discomfort and pain. Yet few studies have assessed hygienic practices in relation to onset. We investigated whether hygienic behaviors were associated with the onset of vulvodynia. METHODS: We assessed self-reported history of personal hygienic behaviors, including wearing tight fitting clothing, vulva care and genital washing, pubic hair removal, douching, and powdering, a year prior to first reported onset of vulvar pain among 213 clinically confirmed cases and a similar time period among 221 general population controls. RESULTS: Compared to women who reported never wearing tight fitting jeans or pants, women wearing tight fitting jeans or pants ≥4 times per week had twice the odds of vulvodynia (95%CI: 1.14–3.95). Relative to controls, women with vulvodynia were substantially less likely to report use of soaps and gels to cleanse the vulva (95%CI 0.17–0.63). Among women who chose to remove pubic hair, those who removed pubic hair from the mons pubis compared to bikini-area only hair removal, were 74% more likely to have vulvodynia (95%CI 1.05–2.89). Finally, compared to women who reported bikini-area only hair removal less than monthly, those who removed hair from the mons pubis weekly or more were nearly 2 times more likely to be vulvodynia cases (95%CI 0.83–3.49). CONCLUSIONS: Wearing tight fitting jeans or pants and removing hair from the mons pubis area were associated with increased odds of vulvodynia. Research on how hygienic practices could influence vulvar pain in larger and more temporally addressed populations is warranted.

There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential “high priority” failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was “setting up community-based services.” Failure in “attending testing appointment” was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation—along with strategies for mitigation—were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.

Due to its increasing prevalence, Type 2 diabetes mellitus (T2DM) represents a major health challenge for modern society. Despite it being of fundamental interest, only a few MRI studies have conducted statistical analyses to draw scientifically valid conclusions about the complex interplay of T2DM and its associated clinical, structural, functional, metabolite, as well as cognitive distortions. Therefore, a systematic review of 68 manuscripts, following the PRISMA guidelines, was conducted. Notably, although the associations between imaging, clinical, and cognitive variables are not fully homogeneous, findings show a clear trend towards a link between altered brain structure and a decline in cognitive processing ability. The results of the review highlight the heterogeneity of the methods used across manuscripts in terms of assessed clinical variables, imaging, and data analysis methods. This is particularly significant as, if the subjects' criteria are not carefully considered, results are easily prone to confounding factors.

Human cognition relies on attentional capacities which, among others, are influenced by factors like tiredness or mood. Based on their inherent preferences in sleep and wakefulness, individuals can be classified as specific "chronotypes". The present study investigated how early, intermediate and late chronotypes (EC, IC, LC) differ neurally on an attention-to-motion task. Twelve EC, 18 IC and 17 LC were included into the study. While undergoing functional magnetic resonance imaging (fMRI) scans, subjects looked at vertical bars in an attention-to-motion task. In the STATIONARY condition, subjects focused on a central fixation cross. During Fix-MOVING and Attend-MOVING, bars were moving horizontally. Only during the Attend-MOVING, subjects were required to attend to changes in the velocity of bars and indicate those by button presses. A two-way repeated measures ANOVA probed group by attentional load effects. The dorsolateral prefrontal cortex (DLPFC), insula and anterior cingulate cortex showed group by attention specific activations. Specifically, EC and LC presented attenuated DLPFC activation under high attentional load (Attend-MOVING), while EC showed less anterior insula activation than IC. LC compared to IC exhibited attenuation of superior parietal cortex. Our study reveals that individual sleep preferences are associated with characteristic brain activation in areas crucial for attention and bodily awareness. These results imply that considering sleep preferences in neuroimaging studies is crucial when administering cognitive tasks. Our study also has socio-economic implications. Task performance in non-optimal times of the day (e.g. shift workers), may result in cognitive impairments leading to e.g. increased error rates and slower reaction times.

Sleep and wakefulness are crucial prerequisites for cognitive efficiency, the disturbances of which severely impact performance and mood as present e.g. after time zone traveling, in shift workers or patients with sleep or affective disorders. Based on their individual disposition to sleep and wakefulness, humans can be categorized as early (EC), late (LC) or intermediate (IC) chronotypes. While ECs tend to wake up early in the morning and find it difficult to remain awake beyond their usual bedtime, LCs go to bed late and have difficulties getting up. Beyond sleep/wake timings, chronotypes show distinct patterns of cognitive performance, gene expression, endocrinology and lifestyle. However, little is known about brain structural characteristics potentially underlying differences. Specifically, white matter (WM) integrity is crucial for intact brain function and has been related to various lifestyle habits, suggesting differences between chronotypes. Hence, the present study draws on Diffusion Tensor Imaging as a powerful tool to non-invasively probe WM architecture in 16 ECs, 23 LCs and 20 ICs. Track-based spatial statistics highlight that LCs were characterized by WM differences in the frontal and temporal lobes, cingulate gyrus and corpus callosum. Results are discussed in terms of findings reporting late chronotypes to exhibit a chronic form of jet lag accompanied with sleep disturbances, vulnerability to depression and higher consumption of nicotine and alcohol. This study has far-reaching implications for health and the economy. Ideally, work schedules should fit in with chronotype-specificity whenever possible.

Despite the relationship between brain structure and function being of fundamental interest in cognitive neuroscience, the relationship between the brain's white matter, measured using fractional anisotropy (FA), and the functional magnetic resonance imaging (fMRI) blood oxygen level dependent (BOLD) response is poorly understood. A systematic review of literature investigating the association between FA and fMRI BOLD response was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Web of Knowledge databases were searched up until 22.04.2016 using a predetermined set of search criteria. The search identified 363 papers, 28 of which met the specified inclusion criteria. Positive relationships were mainly observed in studies investigating the primary sensory and motor systems and in resting state data. Both positive and negative relationships were seen in studies using cognitive tasks. This systematic review suggests that there is a relationship between FA and the fMRI BOLD response and that the relationship is task and region dependent. Behavioural and/or clinical variables were shown to be essential in interpreting the relationships between imaging measures. The results highlight the heterogeneity in the methods used across papers in terms of fMRI task, population investigated and data analysis techniques. Further investigation and replication of current findings are required before definitive conclusions can be drawn.

This article reports on an original research study about consumer attitudes toward and preferences about their mental health care. It provides empirical findings that demonstrate that deriving information directly from consumers of mental health services offers an important perspective on what services and interventions are necessary to promote psychosocial rehabilitation. Drawing on a research study of self-perception of needs among a sample of 133 consumers diagnosed with serious mental illness and who have been discharged to the community, the findings suggest that consumers view their lives holistically and complexly with an equal concern for their social as well as clinical needs. Engraining consumers as partners in planning treatment is essential if relevant services are to be provided.

Objective: The aim of this study was to investigate the relationship between mental illness identity, shame, secrecy, public stigma, and disclosure amongst college students. Participants included 1393 college students from five postsecondary institutions.Methods: Structural equation modeling was used to examine two path models predicting disclosure and desire to join a program aiding with disclosure.Results: Variables found to be significant in predicting disclosure included mental illness identity and public stigma. In turn, desire for disclosure predicted desire to join a program aiding in disclosure. Gender and race/ethnic differences were observed, with men and Whites more likely to want to disclose a mental illness or join a program aiding with disclosure compared with women and non-Whites, respectively.Conclusions: These findings suggest that some college students may find programs aiding in disclosure useful in assisting them to achieve their desire to be “out” with their mental illness.

The first edition of Community Mental Health quickly established itself as one of the most comprehensive and timely books about mental health practice in community settings. Readers will find that this new edition is also on the leading edge of the field, providing the most up-to-date research and treatment models in the field. Experts from a wide range of professions – social work, nursing, psychology, psychiatry, public health, sociology, and law – explore the major trends, best practices, and policy issues shaping community mental health services today. Coverage of each topic shifts the focus from management to recovery in the treatment of chronically mentally ill patients. Coverage of organizational and policy issues gives students a head start on mastering the overarching factors that shape their field. This book offers the greatest breadth of coverage available, including hot-button topics like the following: evidence-based treatments neuropsychiatric perspectives Diversity Substance abuse New chapters cover a variety of special populations, which ensures students are prepared to work with a wide range of issues, including: returning veterans military families and families of the mentally ill people affected by the "Great Recession" teenagers children the homeless Students preparing to become mental health professionals, practitioners in community mental health settings, and policy planners and advocates engaged in the evaluation and development of programs in the human services will find this text to be an invaluable resource in their training and work. A collection of supplemental resources are available online to benefit both instructors and students. Instructors will find PowerPoint slides and test banks to aid in conducting their courses, and students can access a library of helpful learning activities, suggested readings and resources, and a glossary of important terms. These materials can be accessed at http://www.routledgementalhealth.com/cw/rosenberg.

S U N D A Y 348 CAN Pollen Reports from 120 MILES Away Correctly Reflect LOCAL Pollen Activity? Shaylar Padgett, MD, Girish V. Vitalpur, MD, FAAAAI, Kirsten Kloepfer, MD, MS, Frederick E. Leickly, MD, MPH, FAAAAI; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, Indiana University, Indianapolis, IN, Riley Hospital for Children at Indiana University Health North, Carmel, IN. RATIONALE: On the AAAAI’s National Allergy Bureau (NAB) webpage, information on pollen activity for Indianapolis is often extrapolated from data from Dayton, Ohio, 120 miles away. The purpose of this project was to compare type and quantity of pollen between Indianapolis and Dayton in 2013 and 2014. METHODS: Pollen data were analyzed from April, May, and June, in 2013 and 2014, for both cities. Pollen counts were obtained from the NAB webpage and from the Dayton Regional Air Pollution Control Agency, which uses a Burkhard sampler. Local Indianapolis pollen count data was obtained via Rotorod and posted daily on a webpage. RESULTS: For the time frame reviewed, Dayton’s pollen informationwas available for 62 days in 2013 and 2014. In Indianapolis, pollen data was available for 86 days in 2013, and 89 days in 2014. Tree pollen specieswere similar in both areas. In Dayton, tree pollens were detected on all monitored days. However, in Indianapolis, tree pollens were detected on 65% of reported days in 2013 and 80% in 2014. In Dayton, grass pollens were detected on 50% of reported days in 2013, and 65% in 2014. In Indianapolis, grass pollens were detected 66%of reported days in 2013 and 52% in 2014. Weed pollens were detected in both sites, with plantain and nettle found in early May 2014 in Indianapolis. CONCLUSIONS: Within similar regions, and from year-to-year, pollen counts can vary by type, quantity, and timing. Local pollen counting stations are needed to improve allergy care.