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Background: Within the field of plastic and craniofacial surgery, Joseph G. McCarthy, M.D. and Henry K. Kawamoto Jr., M.D., D.D.S. have both dedicated a significant portion of their career, time, and effort to mentoring the next generation of surgeons. Our study reflects the impact of these generational mentors by analyzing the career paths and academic contributions of their graduate plastic and craniofacial surgeon mentees. It also highlights the unique mentorship styles of Drs. McCarthy and Kawamoto. Methods: Academic productivity of trainees under Drs. Kawamoto and McCarthy who completed a craniofacial fellowship (n = 81) or plastic surgery residency (n = 270) from 1984 to 2016 were assessed using institutional records. Curriculum vitae, practice websites, and personal correspondence were used to record practice type, geographic location, academic titles, societal leadership roles, mission trip involvement, and bibliometric data (publications, citations, h-index, grants). Results: The craniofacial fellows studied had a mean time since completion of fellowship training of 21 ± 11 years. Three-fourths had active craniofacial practices (75.3%) and over half of the fellows continued to practice in an academic setting (56.8%). The majority continued their surgical practice in the United States with a distribution of 24.7% in the Northeast, 29.6% in the South, 11.1% in the Midwest, and 25.9% in the West. Many became Division/Department Chiefs (42.0%), Craniofacial Directors (45.7%) and professional societal leaders (49.4%). Many sustained research productivity with an average of 77 ± 136 publications; 2070 ± 5459 citations; and h-index of 17 ± 16. An additional analysis of plastic surgery residents showed almost as robust of an academic interest: 34.5% were appointed Chief; 52 ± 95 mean publications; 1808 ± 4517 citations; and h-index of 15 ± 15. These numbers superseded other plastic surgery graduates. Conclusions: The McCarthy and Kawamoto craniofacial fellows and plastic surgery residents were noted to have impressive academic records. Mentorship relationships should be envisioned as a 2-way “Give-Get” relationship that will improve clinical skills, research productivity, and patient care.

Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.

In 2018, four deadly (Mw 6.2 to 6.9) earthquakes struck the north coast of Lombok Island, on 28 July, 5August, and 19 August, distributed between the Flores back-arc thrust and the Rinjani-Samalas volcanic complex, causing hundreds of fatalities and extensive damage. We performed a comprehensive analysis of relocated aftershocks, static coulomb stress changes, and co-seismic and post-seismic deformation, to improve our understanding of this earthquake sequence. The fault geometries and slip distributions of the three mainshocks are modelled by inverting the co-seismic deformation imaged using an interferometric analysis of Sentinel-1 synthetic aperture radar (InSAR) measurements, based on rectangular dislocations embedded in a multi-layered elastic half-space. The earthquake sequence aftershocks were analysed using an unsupervised learning method (ST-DBSCAN) to cluster these relocated aftershocks so that we can identify the source of each aftershock. We used a time-series consisting of 658 descending and 370 ascending Sentinal-1 InSAR interferograms to investigate the time-dependent post-seismic deformation in the two years following the Lombok 2018 earthquake sequence, deriving a combined model that simulates the viscoelastic relaxation and afterslip simultaneously. The Coulomb stress change modelling based on the co-seismic and post-seismic rupture models indicates about 1 MPa of extensional stress change at 10 to 20 km of depth and 0.5 Mpa extensional stress change at 15 to 25 km of depth around the Barujari Crater region, respectively, which affects the open of the magma conduct, reflected as caldera-scale deflation and inflation. To quantify the influence of the earthquake sequence on the spatiotemporal deformation pattern of the volcano edifice, we extended our InSAR time-series range forward to the year 2014, just prior to the two eruptions that occurred on 25th October 2015 and 1st August 2016, and perform Principal Component Analysis to investigate the time-dependent inflation and deflation signals. We modelled the volume change and the location of the volcano pressure source for a better understanding of how changes in the magma body and magma movement may have been influenced by the 2018 Lombok earthquake sequence. A double-source compound model is used to invert the parameters of the magma chamber, including a shallow Moji point pressure source centred at 1.3 km north of the Barujari cone, and a deep source centred at 1.5 km northeast of the Rinjani cone, at ~3.9 km and ~3.5 km depth below the sea level respectively. We also used a uniform sill and dike combined model to interpret the co-eruptive signals surrounding the observed eruptive fissures. Our best-fit dike is nearly vertical, reaching a depth of 2 km below sea level with an opening of 8.5 cm, and the sill is at the depth of 3.1 km with a contraction of 40 cm.

The tectonic setting of Timor–Leste and Eastern Indonesia comprises of a complex transition from oceanic lithosphere subduction to arc-continental collision. To better understand the deformation and convergent-zone structure of the region, we derive a new catalog of earthquake hypocenters and magnitudes from a temporary deployment of five years of continuous seismic data using an automated processing procedure. This includes a machine-learning phase picker, EQTransformer, and a sequential earthquake association and location workflow. We detect and locate ∼19,000 events during 2014–2018, which demonstrates that it is possible to characterize earthquake sequences from raw seismic data using a well-trained machine-learning picker for a complex convergent plate setting. This study provides the most complete catalog available for the region for the duration of the temporary deployment, which includes a complex pattern of crustal events across the collision zone and into the back-arc, as well as abundant deep slab seismicity.

The COVID‐19 pandemic has posed unique challenges for families and caregivers, as well as for autism‐focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in‐person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family‐centered system of care. Lay Summary Physical distancing and the abrupt end to in‐person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family‐centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path.

Background Heightened motor activity is a hallmark of attention-deficit/hyperactivity disorder (ADHD), yet high activity levels are also often reported in young children with autism spectrum disorder (ASD). It is currently unclear whether increased motor activity represents a distinct versus shared early predictor of ASD and ADHD; no prior studies have directly examined this prospectively. We investigated differences in longitudinal patterns of objectively measured motor activity during early development. Methods Participants included 113 infants at high and low risk for ASD or ADHD. Continuous motion-based activity was recorded using tri-axial accelerometers at 12, 18, 24, and 36 months of age. At 36 months, participants were categorized into one of three outcome groups: ASD (n = 19), ADHD Concerns (n = 17), and Typically Developing (TD; n = 77). Group differences in trajectories of motor activity were examined in structured and semistructured contexts. Associations with behaviors relevant to ASD, ADHD, and general development were also examined. Results In both structured and semistructured contexts, both the ASD and ADHD Concerns groups exhibited heightened activity relative to the TD group by 18 months; the ASD group exhibited higher activity than the ADHD Concerns group at 24-36 months in the structured context only. Attention/behavior regulation, nonverbal, and verbal development-but not social engagement-were differentially associated with objectively measured activity by outcome group across contexts. Conclusions Overactivity may be a shared, rather than distinct, precursor of atypical development in infants/toddlers developing ASD and concerns for ADHD, emerging as early as 18 months. Group differences in overactivity may be context-specific and associated with different underlying mechanisms.

Objective Children with Sickle Cell Disease (SCD), who are predominantly Black, face academic disparities in part because of the impact of longstanding racially biased education systems. Adverse systemic factors in addition to neurologic complications put children with SCD at risk for poor academic outcomes. Providing caregivers with information on how to select quality schools and advocate for their child's specific educational needs may influence academic outcomes and reduce educational disparities. We aimed to provide information to caregivers of children with SCD on school selection/quality, enrollment, and special education options. Methods Forty-six caregivers of children with SCD between the ages of 2 and 5:11 years participated in a structured informational session. Caregivers' sense of empowerment regarding educational options for their child was assessed via survey before and after the structured informational session. Results Caregivers reported feeling more informed and empowered following their participation in an informational session on school selection/quality, enrollment, and special education options for their child than before the informational session. Conclusions It is essential that families of children with SCD have the knowledge, skills, and sense of empowerment to access quality schools beginning in early childhood. Future research will determine if this intervention will improve children's access to academic support and academic outcomes. We theorize improvements in academic outcomes along with addressing systemic disparities may ultimately create a positive impact on vocational and quality of life outcomes in the lives of children with SCD.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent childhood disorders, affecting approximately 8% of children in the United States.1 Although it is not typically diagnosed until around age 7 years, consensus is growing that symptoms emerge much earlier.2 Despite this, our knowledge continues to be relatively limited with respect to early indicators of ADHD, or the potential for early interventions for the condition.

Sensory processing differences are widely reported in autism. However, our understanding of sensory profiles in this population has been complicated due to the heterogeneous presentation of sensory symptoms. We addressed this by using latent profile analysis, allowing for the identification of more homogeneous sensory classes in a large cohort ( n = 211 (52 females), 2–4 years) of autistic children using subscale scores from the Short Sensory Profile. Based on the patterns of both severity and sensory modality, four classes emerged: Moderate/Mixed (35.5%), Severe/Mixed (8.5%), Moderate/Broad (14.6%), and Low/Mixed (41.1%). While a subset of children displayed normative sensory-related behaviors, the majority showed a combination of both hypo- and hyper-reactivity across various sensory modalities. Subsequent analyses showed that the class characterized by Severe/Mixed sensory differences exhibited greater problems in a variety of areas such as social and adaptive skills and attention-deficit/hyperactivity disorder symptoms, whereas the Low/Mixed class showed overall fewer problems. Identification of homogeneous classes may be useful for neurophysiological/imaging studies focusing on studying underlying mechanisms linked with specific sensory patterns. These findings may help clinicians identify children with particular sensory profiles that might relate to other social, adaptive, or behavioral domains with potential implications for intervention. Lay abstract Research has found differences in responding to various sensory stimuli among autistic individuals, which are associated with social and adaptive skills. However, our understanding of sensory profiles in autism has been complicated due to the variable presentation of sensory symptoms. One way to better understand variability in sensory symptoms is to use advanced statistical approaches, such as latent profile analysis, that allow for the identification of more similar sensory classes in otherwise variable groups. We used the Short Sensory Profile to identify homogeneous classes of sensory reactivity in autistic children based on both severity and modality and examined whether sensory classes differed in terms of autism characteristics, adaptive skills, and attention-deficit/hyperactivity disorder symptoms. Based on the pattern of both severity and modality, four sensory classes emerged and were named Moderate/Mixed (35.5%; probable-to-definite differences in all modalities except in movement sensitivity and low energy/weakness), Severe/Mixed (8.5%; definite sensory differences in all modalities except in low energy/weakness), Moderate/Broad (14.6%; probable-to-definite differences in all modalities), and Low/Mixed (41.1%; typical scores in most modalities with probable differences in taste/smell sensitivity, under-responsive/seeks sensation, and auditory filtering). The Severe/Mixed class exhibited greater problems in a variety of areas such as social, adaptive, and attention-deficit/hyperactivity disorder symptoms, whereas the Low/Mixed class showed overall fewer problems. This may provide insight for clinicians and researchers aiming to understand whether autistic children who exhibit distinct sensory patterns are more or less likely to also experience social, adaptive, and/or attention/behavior-related difficulties.

Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL) and is characterized by epidermotrophism of malignant CD4+ T-lymphocytes. When MF advances to a recurrent stage, patients require treatment with systemic therapies such as vorinostat, a histone deacetylase inhibitor. While vorinostat has been shown to exhibit anti-tumor activity in MF, its exact molecular mechanism has yet to be fully discerned. In the present study, we examined the transcriptomic and proteomic profiles of vorinostat treatment in two MF cell lines, Myla 2059 and HH. We find that vorinostat downregulates CTLA-4, CXCR4, and CCR7 in both cell lines, but its effect on several key pathways differs between the two MF cell lines. For example, vorinostat upregulates CCL5, CCR5, and CXCL10 expression in Myla cells but downregulates CCL5 and CXCL10 expression in HH cells. Furthermore, vorinostat upregulates IFN-γ and IL-23 signaling and downregulates IL-6, IL-7, and IL-15 signaling in Myla cells but does not affect these pathways in HH cells. Although Myla and HH represent established MF cell lines, their distinct tumor origin from separate patients demonstrates that inherent phenotypic variations within the disease persist, underscoring the importance of using a variety of MF cells in the preclinical development of MF therapeutics.

The Children's Sleep Habits Questionnaire (CSHQ) is often used to assess sleep in children with autism spectrum disorder (ASD), but little is known about its factor structure in younger children with ASD. We evaluated alternative factor structures and measurement invariance for CSHQ items in 2- to 4-year-olds with ASD or typical development (TD). Bifactor models indicated subscales' variance was subsumed by a general factor predominantly reflecting sleep initiation and nighttime awakening items. A factor consisting of 7 of these items was measurement invariant across ASD and TD. Thus, comparisons between young children with ASD and TD is appropriate for a measure composed of 7 CSHQ items relating to sleep initiation and awakenings but not for other CSHQ item composites.

By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.

OBJECTIVE: We evaluated trajectories of attention-deficit/hyperactivity (ADHD)-relevant behaviors in a sample of infants at high and low familial risk for ADHD who were prospectively evaluated at 12, 18, and 24 months of age. METHOD: Participants included 43 infants at risk for ADHD based on family history (i.e., diagnosed first-degree relative) and 40 low-risk infants (i.e., no family history of ADHD). Instances of inattention, out-of-seat, and grabbing behavior were coded from video; analogous constructs were rated by examiners unaware of familial risk status after completing structured standardized assessments with the infants/toddlers. At the end of each study visit, examiners solicited parents’ concerns about their child’s behavior. Differences in ADHD-related behaviors and parent concerns were examined between 12 to 24 months of age. RESULTS: Infants with an older sibling or parent diagnosed with ADHD were distinguishable from infants with no family history of ADHD as early as 12 months of age based on directly-observed and examiner reports of behavior, particularly with respect to hyperactive-impulsive behavior. Parents of infants at familial risk for ADHD also reported significantly more behavior/temperament concerns as early as 12 months of age compared to parents of infants at low risk for ADHD. CONCLUSIONS: These findings highlight the ability to detect genetic liability for ADHD by the end of the first year of life, suggesting that well-designed family risk studies of ADHD are feasible and may be clinically valuable. They also suggest the potential for earlier detection of risk for ADHD than has previously been possible.

Rinjani volcano is a highly active volcano located on Lombok Island in eastern Indonesia which has experienced ten eruptions in the last 100 years. Between 2014 and 2020, this stratovolcano has erupted twice, on 25th October 2015; and on 1st August 2016. Both eruptions lasted approximately two months, with activity concentrated in the volcanoes central Barujari Crater region. In 2018, four deadly (Mw 6.2 to 6.9) earthquakes struck the north coast of Lombok Island on 28th July, 5th August, and 19th August, causing hundreds of fatalities and extensive damage. These earthquakes also resulted in the remobilization of ash deposits on the flanks of Rinjani volcano located on the north island as landslides. Our InSAR-based finite fault rupture modelling suggests the estimated maximum fault slip of 1.4 m, 2.3 m, and 2.5 m for the three mainshocks located on southward dipping fault planes to the northwest-northeast of the Rinjani volcano occurred at depths of ~15 km, 12 km, and 32 km, respectively. Coulomb stress change modelling based on the these rupture models indicates about 1 MPa of extensional stress change at 10 to 20 km of depth around the crater region was observed, which may promote opening of the magma conduit. The short distance between the peak slip region and the volcano, as well as the stress change, raises the question of whether the earthquake sequence may have influenced the spatio-temporal deformation pattern of the Rinjani volcano.We use an InSAR time-series, consisting of 658 descending and 370 ascending Sentinal-1 interferograms to investigate the time-dependent inflation and deflation signals around the crater region generated by the 2015, 2016 eruptions and the 2018 earthquakes. We analyse the average inflation/deflation rate and the cumulative displacements in different periods between 2014 and 2020 to quantify the volcano deformation before and after the 2018 earthquake sequence. Our preliminary results reveal that the crater region has undergone rapid inflation of up to 20 mm/yr through the 2014 to 2017 period, before significantly slowing to ~10 mm/yr over the 2017 to 2018 period. During the first three months following the 2018 earthquake sequence, a noticeable deflation of the edifice was detected, followed by gentle inflation lasting until late 2020. These results imply that the influence of the 2018 earthquakes acted to reduce the pressure in the reservoir, at least temporarily. We will present results from modelling the volume change and the location of the volcano pressure source for better understanding how changes in the magma body and magma movement may have been influenced by the 2018 Lombok earthquake sequence.

DNA-based screening in individuals without known risk factors potentially identifies those who may benefit from genetic counseling, early medical interventions, and/or avoidance of late or missed diagnoses. While not currently in widespread usage, technological advances in genetic analysis overcome barriers to access by enabling less labor-intensive and more cost-efficient means to discover variants of clinical importance. This study describes the technical validation of a 430-gene next-generation sequencing based assay, GeneCompassTM, indicated for the screening of healthy individuals in the areas of actionable health risks, pharmaceutical drug response, and wellness traits. The test includes genes associated with Mendelian disorders and genetic susceptibility loci, encompassing 14 clinical areas and pharmacogenetic variants. The custom-designed target enrichment capture and bioinformatics pipelines interrogate multiple variant types, including single nucleotide variants, insertions/deletions (indels), copy number variants, and functional haplotypes (star alleles), including tandem alleles and structural variants. Validation was performed against reference DNA from three sources: 1000 Genomes Project (n = 3), Coriell biobank (n = 105), and previously molecularly characterized biological specimens: blood (n = 15) and saliva (n = 11). Analytical sensitivity and specificity for single nucleotide variants (SNVs) were 97.57% and 99.99%, respectively, and for indels were 74.57% and 97.34%, respectively. This study demonstrates the validity of an NGS assay for genetic screening and the broadening of access to preventative genomics.

Studies evaluating change in autism symptom severity across the lifespan have yielded inconsistent results, making it difficult to assess the prevalence of meaningful change in autism symptom severity, and what characterizes it. Better understanding the ways in which autism symptoms change over time is crucial, with important implications for intervention. Synthesizing information across past studies, autism symptom severity change (especially decreases) appears common, though stability of symptoms is also frequent. Symptom severity change is characterized by variability in patterns of change between different individuals (between-person), variability in change within a person's trajectory across time (within-person), and variability in change patterns across symptom domains (i.e., social-communication, restricted/repetitive behaviors). Variability in severity change is likely impacted by differences in person-level characteristics (e.g., sex, IQ, sociodemographic factors) as well as developmental processes across time. Numerous methodological issues may impact our ability to understand how common change in symptom severity is, including varying measurement tools, analytic approaches, and change patterns between symptom domains across time. Potential implications of better understanding and characterizing symptom severity change include incorporation of severity change patterns and predictors of change into research on biomarkers, and consideration of such predictors as moderators or mediators of change in clinical practice.

Background TPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes (B-scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months. Methods One hundred and four participants with bilateral moderate to severe knee cartilage defects were randomized to receive TPX-100 (200 mg) or placebo. Each subject’s contralateral placebo-treated knee served as a paired internal control. After MRI quality control, 78/93 subjects (84%; 156 knees) were analyzed for quantitative femoral B-score and cartilage thickness. All analyses were performed centrally, blind to treatment assignment and clinical data. Results TPX-100-treated knees (n = 78) demonstrated a statistically significant decrease in pathologic bone shape change compared with placebo-treated knees at 6 and 12 months: 0.0298 (95% C.I. − 0.037, 0.097) vs 0.1246 (95% C.I. 0.067, 0.182) (P = 0.02), and 0.0856 (95% C.I. 0.013, 0.158) vs. 0.1969 (95% C.I. 0.123, 0.271) (P = 0.01), respectively. The correlation between bone shape change and medial and total tibiofemoral cartilage thickness changes at 12 months was statistically significant in TPX-100-treated knees (P < 0.01). Conclusions This is the first report of a potential therapy demonstrating a significant effect on bone shape measured by B-score in knee OA. These data, in combination with previously reported statistically significant and clinically meaningful improvements in WOMAC physical function versus placebo, support TPX-100 as a candidate for disease modification in knee OA. Trial registration NIH ClinicalTrials.gov, NCT01925261. Registered 15 August 2013

We evaluated repetitive behavior with objects in infants at risk for autism spectrum disorder (ASD) from 9 to 36 months of age, and associations between early repetitive behavior and social engagement. Infant siblings of children with ASD (high-risk) or typical development (low-risk) were administered a task eliciting repetitive object use at 9, 12, 15, 18, 24, and 36 months of age. Infants (n = 147) were classified into 1 of 3 outcome groups at 36 months: Low-Risk Non-ASD (n = 58), High-Risk Non-ASD (n = 72), and ASD (n = 17). Behavior was coded from video for frequencies of unusual visual inspection, spinning, and rotating behaviors. Differences in unusual visual inspection were most prominent, consistent, and present earliest: At 9 months, the ASD group engaged in this behavior more frequently than both other groups, persisting through 36 months. Differences in frequencies of spinning and rotating were later-appearing, more time-limited, and/or related to familial ASD risk rather than ultimate diagnosis. Sensitivity and specificity estimates for the presence of unusual visual inspection at 9 months of age were in the moderate range (.60 and .68, respectively) for ASD versus Low-Risk Non-ASD comparisons, generally increasing over time. Unusual visual inspection at 9 months predicted 12-month social behavior controlling for 9-month social behavior, but not vice versa, with no evidence of moderation by ASD diagnosis. In summary, unusual visual inspection of objects is present and stable by 9 months of age in infants developing ASD and predicts reduced social engagement three-months later. Close monitoring of this behavior may aid early detection. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Author(s): Young, Gregory S; Constantino, John N; Dvorak, Simon; Belding, Ashleigh; Gangi, Devon; Hill, Alesha; Hill, Monique; Miller, Meghan; Parikh, Chandni; Schwichtenberg, AJ; Solis, Erika; Ozonoff, Sally | Abstract: BackgroundSigns of autism are present in the first 2nyears of life, but the average age of diagnosis lags far behind. Instruments that improve detection of autism risk in infancy are needed. This study developed and tested the psychometric properties of a novel video-based approach to detecting ASD in infancy.MethodsA prospective longitudinal study of children at elevated or lower risk for autism spectrum disorder was conducted. Participants were 76 infants with an older sibling with ASD and 37 infants with no known family history of autism. The Video-referenced Infant Rating System for Autism (VIRSA) is a web-based application that presents pairs of videos of parents and infants playing together and requires forced-choice judgments of which video is most similar to the child being rated. Parents rated participants on the VIRSA at 6, 9, 12, and 18nmonths of age. We examined split-half and test-retest reliability; convergent and discriminant validity; and sensitivity, specificity, and negative and positive predictive value for concurrent and 36-month ASD diagnoses.ResultsThe VIRSA demonstrated satisfactory reliability and convergent and discriminant validity. VIRSA ratings were significantly lower for children ultimately diagnosed with ASD than children with typical development by 12nmonths of age. VIRSA scores at 18nmonths identified all children diagnosed with ASD at that age, as well as 78% of children diagnosed at 36nmonths.ConclusionsThis study represents an initial step in the development of a novel video-based approach to detection of ASD in infancy. The VIRSA's psychometric properties were promising when used by parents with an older affected child, but still must be tested in community samples with no family history of ASD. If results are replicated, then the VIRSA's low-burden, web-based format has the potential to reduce disparities in communities with limited access to screening.

In this paper, we examined how food insecurity can affect international migration aspirations and subsequent actions taken in preparation to move internationally from Sub-Saharan Africa. Drawing on a conceptual framework of the determinants of migration, we developed a three-stage regression model and tested it using data from the 2014 Gallup World Poll. The results indicate that multiple determinants play different roles in the migration decision process, which is characterized by aspirations, planning and final decision to migrate. Specifically, food insecurity is an important determinant of both the desire and the decision to migrate: food insecurity raises the probability of desiring to migrate internationally, with the probability of the desire increasing along with the severity of food insecurity. However, the probability of actually deciding to migrate internationally decreased as food insecurity worsened. These findings are in line with migration literature stating that the very poor, despite wishing to migrate, face tremendous constraints in transforming this desire into concrete decisions. Our results suggest that removing or reducing constraints to migration will benefit the poorest/most food insecure and highlight the need for an increased and effective coordination between food security and international migration policy agendas.

Achieving sufficient, safe, continuously-available drinking water services in rural areas is a challenge, in high- and especially low-and middle-income countries. External support programs (ESPs) - which may include administrative, financial, and technical assistance - have been hypothesized to contribute to sustainable rural water services. While there are many descriptions of ESPs, a standard terminology and typology of ESP activities does not exist and the effect of ESP activities on system sustainability remains inadequately characterized. We conducted a systematic review of ESPs for rural drinking water systems to identify ESP terminology and describe ESP activities. Findings from 218 publications from low-, middle-, and high-income countries were analyzed. ESP terms were used inconsistently between regions and income classifications. There were few studies describing ESP activities related to mechanized piped water systems. Few studies quantitatively assess the effect of ESPs. Those that did found positive associations with functionality, household satisfaction, household participation, and financial stability. This review is the first comprehensive evaluation of the ESP literature and we derive a definition of external support programs and typology of ESP activities from the descriptions of ESPs. A common understanding of ESPs facilitates discussion and knowledge transfer between stakeholders. Consistent terminology creates a foundation for adapting ESPs to water services in community institutions and for mechanized piped water systems.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are both neurodevelopmental disorders originating in childhood with high associated impairments and public health significance. There has been growing recognition of the frequent co-occurrence, and potential interrelatedness, between ADHD and ASD without intellectual disability. In fact, the most recent (5th) edition of the DSM is the first to allow ADHD and ASD to be diagnosed in the same individual. The study of transdiagnostic features in ADHD and ASD is important for understanding, and treating, these commonly co-occurring disorders. Social impairment is central to the description and prognosis of both disorders, and many youth with some combination of ADHD and ASD present to clinics for social skills training interventions. However, the aspects of social functioning that are impaired may have both shared and distinct features between the two disorders, relating to some overlapping and some diverse etiologies of social problems in ADHD compared to ASD. These findings have implications for interventions to address social problems in youth with these conditions. We conclude with a discussion about areas for future research and novel intervention targets in youth with ADHD, ASD, and their comorbidity.

Diminished response to name, a potential early marker of autism spectrum disorder (ASD), may also indicate risk for other disorders characterized by attention problems, including attention-deficit/hyperactivity disorder (ADHD). Using a familial risk design, we examined whether response to name ability at 6, 12, 18, 24, and 36months of age differed between three 36-month outcome groups: ASD, ADHD Concerns, or a Comparison group. Persistent differences between the ASD and Comparison groups were evident beginning at 12months; differences between the ADHD Concerns and Comparison groups were evident between 12 and 18months only. Results suggest that response to name may be a general marker for ASD and ADHD risk in infancy but a specific indicator of ASD by 24-months.

Description of the methodology.

Context.—Despite several studies focusing on the validation of whole slide imaging (WSI) across organ systems or subspecialties, the use of WSI for specific primary diagnosis tasks has been underexamined.Objective.—To assess pathologist performance for the histologic subtyping of individual sections of ovarian carcinomas using a light microscope and WSI.Design.—A panel of 3 experienced gynecologic pathologists provided reference subtype diagnoses for 212 histologic sections from 109 ovarian carcinomas based on optical microscopy review. Two additional attending pathologists provided diagnoses and also identified the presence of a set of 8 histologic features important for ovarian tumor subtyping. Two experienced gynecologic pathologists and 2 fellows reviewed the corresponding WSI images for subtype classification and feature identification.Results.—Across pathologists specialized in gynecologic pathology, concordance with the reference diagnosis for the 5 major ovarian carcinoma subtypes was significantly higher for a pathologist reading on a microscope than each of 2 pathologists reading on WSI. Differences were primarily due to more frequent classification of mucinous carcinomas as endometrioid with WSI. Pathologists had generally low agreement in identifying histologic features important to ovarian tumor subtype classification with either an optical microscopy or WSI. This result suggests the need for refined histologic criteria for identifying such features. Interobserver agreement was particularly low for identifying intracytoplasmic mucin with WSI. Inconsistencies in evaluating nuclear atypia and mitoses with WSI were also observed.Conclusions.—Further research is needed to specify the reasons for these diagnostic challenges and to inform users and manufacturers of WSI technology.

We examined the relationship between video-based media viewing (screen time), behavioral outcomes, and language development in 120 36-month-old children with a family history of Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD) or no family history of either condition. Participants were classified into one of three diagnostic groups: ASD (n = 20), ADHD Concerns (children with elevated ADHD symptoms; n = 14), or Comparison (n = 86). Children in the ADHD Concerns group spent more time viewing screen media than Comparison children. Increased screen time was associated with lower receptive and expressive language scores across groups. Future longitudinal studies are needed to determine the direction of effects and causality.

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are believed to share partially overlapping causal mechanisms suggesting that early risk markers may also overlap. Using latent profile analysis (LPA) in a sample of infants enriched for ASD and ADHD, we first examined the number of distinct groups of 3-year-old children, based on ADHD and ASD symptomatology. To investigate early predictors of ASD and ADHD symptom profiles, we next examined differences in trajectories of infant behaviors among the LPA classes spanning general development, negative affect, attention, activity level, impulsivity, and social behavior. Participants included 166 infants at familial risk for ASD (n= 89), ADHD (n= 38), or low-risk for both (n= 39) evaluated at 12, 18, 24, and 36 months of age. A three-class solution was selected reflecting aTypically Developing(TD) class (low symptoms;n= 108), anADHDclass (high ADHD/low ASD symptoms;n= 39), and anASDclass (high ASD/ADHD symptoms;n= 19). Trajectories of infant behaviors were generally suggestive of a gradient pattern of differences, with the greatest impairment within theASDclass followed by theADHDclass. These findings indicate a mixture of overlapping and distinct early markers of preschool ASD- and ADHD-like profiles that can be difficult to disentangle early in life.

BackgroundRapid and easy COVID-19 diagnostic testing is essential to controlling the pandemic and facilitating safe resumption of clinical care, employment and other social activities.MethodsThis study was conducted to validate an self-administrable saliva-based RT-qPCR test for the SARS-CoV2 virus under controlled laboratory conditions (analytical validation) according to federal guidance. An additional clinical study assessed positive (n = 34) and negative (n = 57) nasopharyngeal swab samples collected contemporaneously with saliva samples. Assessments for analytical specificity, sensitivity, cross reactivity and sample stability to simulate shipping conditions were conducted.ResultsPositive and negative agreement with third-party laboratory results were reported as 97.1% and 96.5–98.2%, respectively. Limit of detection was established at 5 copies/µL. Stability through simulated shipping conditions found 100% concordance up to 56 hours after collection. Discussion: These data validate a self-collected saliva-based COVID-19 RT-qPCR assay that performs comparably well to an assay of health care-provider administered nasopharyngeal swab samples. Accordingly, the United States Food and Drug Administration granted emergency use authorization in June 2020. Use of the saliva-based assay overcomes barriers to the necessary widespread testing, including strained health care resources, supply chain disruptions of laboratory materials, testing and protective equipment and exposure risks due to close interpersonal contact.

ObjectiveThe present study aimed to determine the relationship among food insecurity, social support and mental well-being in sub-Saharan Africa, a region presenting the highest prevalence of severe food insecurity and a critical scarcity of mental health care.DesignFood insecurity was measured using the Food Insecurity Experience Scale (FIES). Social support was assessed using dichotomous indicators of perceived, foreign perceived, received, given, integrative and emotional support. The Negative and Positive Experience Indices (NEI and PEI) were used as indicators of mental well-being. Multilevel mixed-effect linear models were applied to examine the associations between mental well-being and food security status, social support and their interaction, respectively, accounting for random effects at country level and covariates.ParticipantsNationally representative adults surveyed through Gallup World Poll between 2014 and 2016 in thirty-nine sub-Saharan African countries (n 102 235).ResultsThe prevalence of severe food insecurity was 39 %. The prevalence of social support ranged from 30 to 72 % by type. In the pooled analysis using the adjusted model, food insecurity was dose-responsively associated with increased NEI and decreased PEI. Perceived, integrative and emotional support were associated with lower NEI and higher PEI. The differences in NEI and PEI between people with and without social support were the greatest among the most severely food insecure.ConclusionsBoth food insecurity and lack of social support constitute sources of vulnerability to poor mental well-being. Social support appears to modify the relationship between food security and mental well-being among those most affected by food insecurity in sub-Saharan Africa.