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The prevalence of Autism Spectrum Disorder (ASD) is growing rapidly, affecting 1 in 59 children in the United States in 2018. Individuals with ASD currently receive fragmented care that threatens their health and well-being. Challenges of autism care include disconnections between the medical system and school supports, poor care coordination between primary care and specialists, and saturation of neuropsychiatry-based centers' capacity to care for the ASD population. ASD treatment also lacks of a coordinated system of care for patients' multi-system comorbidities. Families are calling for an ASD care delivery system to meet their needs and the needs of their children. To serve people with ASD and their medical and other providers, we propose a coordinated approach to care grounded in primary care. We call the model the "Systematic Network of Autism Primary Care Services (SYNAPSE)." We develop the model by applying the frameworks of "coproduction" of care and chronic disease management. In this Commentary we discuss the model's rationale, underpinnings, and the implications for clinical practice. We advance these ideas to align with policy makers' recognition of the importance of primary care for ASD, as reflected by the most recent Interagency Autism Coordinating Committee (IACC) meeting at the National Institute of Mental Health.

Describes a two-pronged program at Dartmouth Medical School (New Hampshire) for teaching quality improvement to medical students: one component requires all students to participate in an improvement project at their community-based physician preceptor sites; the other component, an elective, has students develop an improvement plan for the preceptor site, implement it, and write up their experiences. (Author/DB)

Arctic ship traffic has increased significantly due to continuous sea ice loss and resource extraction. The shipping sector is an important contributor to atmospheric emissions of nitrogen oxides (NO x) and sulphur dioxide (SO 2), and an increase in ship activity will lead to significant increases in these emissions. However, there is a lack of studies linking ship activities and the associated emissions with recent Arctic resource development activities. This study aims to assess the relationship between sector-specific developments (fishing, tourism, trade, oil, gas, mining, and "others") and ship traffic, and the associated emissions from 2013 to 2023 along the Northern Sea Route (NSR), using time series analysis and linear regression. In addition, the relationships were further used to predict future ship-associated emissions by 2030, utilizing a combination of regression models and Holt-Winters' trend and seasonal forecast. Results showed a 61% increase in distance travelled, 115% increase in NO x emissions, and 68% increase in SO 2 emissions from 2013 to 2023. A strong positive linear relationship between oil and gas production and the ship-associated emissions of NO x and SO 2 was found, with a coefficient of determination as high as 0.97. The oil sector emerged as the largest contributor to emissions from 2017 onward. Projections indicate that NO x and SO 2 emissions will be more than doubled, reaching 12,400 and 1200 tonnes, respectively, by 2030, of which the oil sector accounts for 45 and 61% of the total emissions. This highlights the need for further emissions reduction measures, especially with expanding Arctic oil projects, in order to mitigate the environmental impact of increased resource-driven shipping along the NSR. • Arctic ship traffic and the associated emissions have steadily increased since 2013. • Ship emissions has a strong positive correlation with oil and gas production. • Oil-related shipping is the main driver to increased emissions of NO x and SO 2. • NO x and SO 2 emissions may more than double by 2030. • Projections highlights the urgency for further emissions reduction measures. [ABSTRACT FROM AUTHOR]

In the maritime industry, it is of vital importance that personnel onboard ships are familiarized with the ship’s layout, along with safety equipment and processes for safeguarding of the individual seafarer and the ship’s crew. In fact, international maritime regulations require that all personnel employed or engaged on a seagoing ship receive proper familiarization training. However, several studies have identified lack of familiarization as a contributing factor to maritime incidents. There are several challenges associated with the current familiarization practices: cost, difficulty in optimizing planning, variation in practices in familiarization and the experience of the facilitator of familiarization process. This paper presents a study consisting of 58 students comparing traditional and virtual familiarization. No overall difference was found between real and virtual familiarization overall, although some differences were found for single waypoints. Individual differences were more important than treatment, indicating that virtual familiarization can perform on par with traditional approaches. [ABSTRACT FROM AUTHOR]

Massachusetts health care reform, designed to expand coverage and access to care for vulnerable populations, serves as the model for national health reform in the United States that will be implemented in 2014. Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform. Using a quasi-experimental design that included all acute care hospitals in the state, we calculated changes in mean inpatient and outpatient volumes, revenue, and operating margins at SNH from the pre-reform (Fiscal Year 2006) to the post-reform (Fiscal Year 2009) period. We contrasted these changes with contemporaneous changes occurring among non-safety net hospitals (NSNH) using a difference-in-differences approach. We found that SNH in Massachusetts continue to play a disproportionately large role in caring for disadvantaged patients after reform, but that their financial performance has declined considerably compared with NSNH. Ongoing reform efforts in the United States should account for continued SNH demand among the most vulnerable patients and should be designed so as not to undermine the financial stability of SNH that meet this demand. [ABSTRACT FROM AUTHOR]

In 2005, draft guidelines were published for reporting studies of quality improvement as the initial step in a consensus process for development of a more definitive version. The current article contains the revised version, which we refer to as Standards for QUality Improvement Reporting Excellence (SQUIRE). This narrative progress report summarizes the special features of improvement that are reflected in SQUIRE and describes major differences between SQUIRE and the initial draft guidelines. It also explains the development process, which included formulation of responses to informal feedback, written commentaries, and input from publication guideline developers; ongoing review of the literature on the epistemology of improvement and methods for evaluating complex social programs; and a meeting of stakeholders for critical review of the guidelines' content and wording, followed by commentary on sequential versions from an expert consultant group. Finally, the report discusses limitations of and unresolved questions about SQUIRE; ancillary supporting documents and alternative versions under development; and plans for dissemination, testing, and further development of SQUIRE. [ABSTRACT FROM AUTHOR]

Connecting organization and issue-centered strategies for the improvement of health care with health professional development strategies offers an exciting opportunity for the next efforts to improve health care. [ABSTRACT FROM AUTHOR]