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Disruptive behaviors (DBs) are common in children with autism, affecting child and family quality of life. Parent-mediated interventions (PMIs) are a cost-effective and accessible way to decrease DBs. COVID-19 increased need for telehealth interventions. This study explored a group delivery of an evidence-based PMI (RUBI), delivered face-to-face and virtually in Israel, before and during the pandemic. Fifty-five families of children with autism and DB participated, 24 receiving face-to-face intervention and 31 receiving virtual. Outcome measures included the Aberrant Behavior Checklist and Home Situations Questionnaires. Results indicate reduction of DBs across groups, with > 50% of treatment-responders showing reliable change. This study is the first to assess RUBI outside the US among a sociodemographically diverse population, in both in-person and virtual contexts.

ObjectiveThis population-based, matched cohort study aimed to evaluate utilization of health care services by mothers of children with major congenital anomalies (MCAs), compared to mothers of children without MCAs over a 20-year post-birth time horizon in Denmark.MethodsOur analytic sample included mothers who gave birth to an infant with a MCA (n = 23,927) and a cohort of mothers matched to them by maternal age, parity and infant's year of birth (n = 239,076). Primary outcomes were period prevalence and mothers' quantity of health care utilization (primary, inpatient, outpatient, surgical, and psychiatric services) stratified by their child's age (i.e., ages 0-6 = before school, ages 7-13 = pre-school + primary education, and ages 14-18 = secondary education or higher). The secondary outcome measure was length of hospital stays. Outcome measures were adjusted for maternal age at delivery, parity, marital status, income quartile, level of education in the year prior to the index birth, previous spontaneous abortions, maternal pregnancy complications, maternal diabetes, hypertension, alcohol-related diseases, and maternal smoking.ResultsIn both cohorts the majority of mothers were between 26 and 35 years of age, married, and employed, and 47% were primiparous. Mothers of infants with anomalies had greater utilization of outpatient, inpatient, surgical, and psychiatric services, compared with mothers in the matched cohort. Inpatient service utilization was greater in the exposed cohort up to 13 years after a child's birth, with the highest risk in the first six years after birth [adjusted risk ratio, 1.13; 95% confidence interval (CI), 1.12-1.14], with a decrease over time. Regarding the quantity of health care utilization, the greatest difference between the two groups was in inpatient service utilization, with a 39% increased rate in the exposed cohort during the first six years after birth (adjusted rate ratio, 1.39; 95% CI, 1.37-1.42). During the first 6 years after birth, mothers of children with anomalies stayed a median of 6 days (interquartile range [IQR], 3-13) in hospital overall, while the comparison cohort stayed a median of 4 days (IQR, 2-7) in hospital overall. Rates of utilization of outpatient clinics (adjusted rate ratio, 1.36; 95% CI, 1.29-1.42), as well as inpatient (adjusted rate ratio, 1.77; 95% CI, 1.68-1.87), and surgical services (adjusted rate ratio, 1.33; 95% CI, 1.26-1.41) was higher in mothers of children with multiple-organ MCAs during 0 to 6 years after birth. Among mothers at the lowest income levels, utilization of psychiatric clinic services increased to 59% and when their child was 7 to 13 years of age (adjusted rate ratio, 1.59; 95% CI, 1.24-2.03).ConclusionMothers of infants with a major congenital anomaly had greater health care utilization across services. Health care utilization decreased over time or remained stable for outpatient, inpatient, and surgical care services, whereas psychiatric utilization increased for up to 13 years after an affected child's birth. Healthcare utilization was significantly elevated among mothers of children with multiple MCAs and among those at the lowest income levels.

There is growing interest in nonconvex minimax problems that is driven by an abundance of applications. Our focus is on nonsmooth, nonconvex-strongly concave minimax, thus departing from the more common weakly convex and smooth models assumed in the recent literature. We present proximal gradient schemes with either parallel or alternating steps. We show that both methods can be analyzed through a single scheme within a unified analysis that relies on expanding a general convergence mechanism used for analyzing nonconvex, nonsmooth optimization problems. In contrast to the current literature, which focuses on the complexity of obtaining nearly approximate stationary solutions, we prove subsequence convergence to a critical point of the primal objective and global convergence when the latter is semialgebraic. Furthermore, the complexity results we provide are with respect to approximate stationary solutions. Lastly, we expand the scope of problems that can be addressed by generalizing one of the steps with a Bregman proximal gradient update, and together with a few adjustments to the analysis, this allows us to extend the convergence and complexity results to this broader setting. Funding: The research of E. Cohen was partially supported by a doctoral fellowship from the Israel Science Foundation [Grant 2619-20] and Deutsche Forschungsgemeinschaft [Grant 800240]. The research of M. Teboulle was partially supported by the Israel Science Foundation [Grant 2619-20] and Deutsche Forschungsgemeinschaft [Grant 800240]. [ABSTRACT FROM AUTHOR]

Abstract: Mini-module aging tests with differently interconnected heterojunction solar cells having industrially viable copper metallization are presented. The plating process comprises 3 steps: firstly, screen printing of a seed-grid layout using a copper-based paste, followed by deposition of a dielectric layer over the entire wafer surface, and finally, selective copper electrodeposition on grid positions. Modules with Smartwire interconnection, fabricated with M6 half-cells, are stable in extended TC and PID tests. DH degradation is at 5% after 2700 h (glass-glass modules without edge sealing). Shingle modules, realized in collaboration with CEA INES and AMAT, exhibit notably higher fill factor compared to reference modules with screen-printed silver paste. This improvement is attributed to the superior line conductivity achieved with plated copper. TC stability of shingle modules is very good, whereas after 2000 h damp-heat aging more than 2% loss in fill factor is observed. Using pattern-transfer-printing technology narrow, high aspect-ratio lines have been obtained: with a seed-grid of pure copper paste, reinforced with electrodeposited copper. Line dimensions and line resistance as well as first cell results are presented.

Rationale: Home mechanical ventilation (HMV) is an advanced medical therapy offered to children with medical complexity. Despite the growing pediatric HMV population in North America, there are limited studies describing healthcare use and predictors of highest costs using robust health administrative data. Objectives: To describe patterns of healthcare use and costs in children receiving HMV over a 14-year period in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study (April 1, 2003, to March 31, 2017) of children aged 0–18 years receiving HMV via invasive mechanical ventilation or noninvasive ventilation. Paired t tests compared healthcare system use and costs 2 years before and 2 years after HMV approval. We developed linear models to analyze variables associated with children in the top quartile of health service use and costs. Results: We identified 835 children receiving HMV. In the 2 years after HMV approval compared with the 2 years prior, children had decreased hospitalization days (median, 9 [interquartile range, 3–30] vs. 29 [6–99]; P < 0.0001) and intensive care unit admission days (6.6 [1.9–18.0] vs. 17.1 [3.3–70.9]; P < 0.0001) but had increased homecare service approvals (195 [24–522] vs. 40 [12–225]; P < 0.0001) and outpatient pulmonology visits (3 [1–4] vs. 2 [1–3]; P < 0.0001). Total healthcare costs were higher in the 2 years after HMV approval (mean, CAD$164,892 [standard deviation, CAD$214,187] vs. CAD$128,941 [CAD$194,199]; P < 0.0001). However, all-cause hospital admission costs were reduced (CAD$66,546 [CAD$142,401] vs. CAD$81,578 [CAD$164,672]; P < 0.0001). The highest total 2-year costs were associated with invasive mechanical ventilation (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.24–5.31; reference noninvasive ventilation), number of medical devices at home (OR, 1.63; 95% CI, 1.35–1.96; reference no technology), and increased healthcare costs in the year before HMV initiation (OR, 2.23; 95% CI, 1.84–2.69). Conclusions: Children progressing to the need for HMV represent a worsening in their respiratory status that will undoubtedly increase healthcare use and costs. We found that the initiation of HMV in these children can reduce inpatient healthcare use and costs but can still increase overall healthcare expenditures, especially in the outpatient setting. [ABSTRACT FROM AUTHOR]