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This study explores healthcare professionals' perspectives about the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). A concurrent, qualitative-dominant mixed methods empirical study design was utilized, applying semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year co-development, implementation, and evaluation process. Surveys were also administered at three time points. Via thematic analysis, emergent qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. Interview findings reveal five emergent themes aligning with RC domains. Survey results show that healthcare professionals reported increased behavioral healthcare integration into clinic practice (p = 0.0002) and increased clinic readiness to address behavioral health needs (p = 0.0010). Effective pediatric BHI and care delivery at CHCs may rely on strong professional relationships and communication. Additional research from the patient/caregiver perspective is needed.

This article reports on a qualitative research study that explored the lived experience of seven Latinx DACA recipients. Using narrative inquiry, the study tests the Undocumented Adult Identity Development Model (Robles, 2015), a five-stage identity development model of undocumented Latinx youth. The study gives voice to the hopes, dreams, and challenges these young adults face. Findings revealed that participants demonstrated a high degree of resiliency. Ultimately, participants were able to fashion their struggles into a transformative experience that gave them hope and a positive vison for their future. Success in school and in their career was a means of protesting against the limitations placed upon them. Meaning and purpose was achieved through creating community and by taking ownership of their immigration status, through fighting for their rights and for the rights of other immigrants.

BACKGROUND Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs). METHODS FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation. RESULTS Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state’s long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children 12 years were referred for care. Children seen by BH staff on the day of referral (ie, “warm hand-off”) were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03). CONCLUSIONS Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.

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.

Asylum seekers from the Northern Triangle region in Central America, comprised of Honduras, Guatemala, and El Salvador, many of them unaccompanied minors and families with young children, are arriving at the U.S. border in record high numbers. Many of them have been exposed to trauma and violence in their country of origin and have suffered human rights abuses. Their reception in the USA is increasingly adversarial. Under the Trump administration, there has been a rise in policies that endanger the human rights of Central American immigrants and refugees. Mental health professionals can play an important role in protecting their human rights and helping them in the asylum process. They can assist asylum seekers through conducting culturally informed psychological evaluations and as expert witnesses, testifying in court and producing court reports. This paper includes an overview of the legal and international context of the asylum process and discusses geopolitical factors affecting asylum seekers from Central America. Case examples of evaluations of Central American asylum seekers that were conducted by the author are provided to illustrate key points of how social workers can assist applicants in their asylum applications, thereby supporting their human rights.

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.

This article explores points of connection between the couplets of Shakespeare’s Sonnets (1609) and the instructional literature of husbandry, arguing that Shakespeare shares with these practical genres a commitment to an aesthetic of didacticism and detachability. Through a reading of the Sonnets alongside Thomas Tusser’s Hundreth Good Pointes of Husbandrie (1557), a popular handbook composed in rhyming couplets, I argue that a poetic tradition of practical fragmentation is embedded in Shakespeare’s couplets, and helps explain a longstanding critical dissatisfaction with the sonnets’ conclusions. Attending both to the imaginative practices of husbandry and to the material forms of the printed page (specifically, practices of indentation), I argue, generates new insights into the operations of a poetic memory performed not by a whole poem, but by detachable, and so storable, fragments.

AAAS (the publisher of Science ) recently launched [www.forceforscience.org][1], a new website to facilitate science advocacy. The site offers news, resources, and information about upcoming events for both scientists and the public. By way of introduction, we asked these questions: Why is science

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.

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.