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Deaf individuals rely on facial expressions for emotional, social, and linguistic cues. In order to test the hypothesis that specialized experience with faces can alter typically observed gaze patterns, twelve hearing adults and twelve deaf, early-users of American Sign Language judged the emotion and identity of expressive faces (including whole faces, and isolated top and bottom halves), while accuracy and fixations were recorded. Both groups recognized individuals more accurately from top than bottom halves, and emotional expressions from bottom than top halves. Hearing adults directed the majority of fixations to the top halves of faces in both tasks, but fixated the bottom half slightly more often when judging emotion than identity. In contrast, deaf adults often split fixations evenly between the top and bottom halves regardless of task demands. These results suggest that deaf adults have habitual fixation patterns that may maximize their ability to gather information from expressive faces.

The target article by Charney on behavior genetics/genomics discusses how numerous molecular factors can inform heritability estimations and genetic association studies. These factors find application in the search for genes for behavioral phenotypes, including neuropsychiatric disorders. We elaborate upon how single causal factors can generate multiple phenotypes, and discuss how multiple causal factors may converge on common neurodevelopmental mechanisms.

Mealtimes in families with young children are increasingly of interest to nutrition and public health researchers, yet assessment tools are limited. Meals in Our Household is a new parent-report questionnaire that measures six domains: 1) structure of family meals, 2) problematic child mealtime behaviors, 3) use of food as reward, 4) parental concern about child diet, 5) spousal stress related to child's mealtime behavior, and 6) influence of child's food preferences on what other family members eat. Reliability and initial face, construct, and discriminant validity of the questionnaire were evaluated between January 2007 and December 2009 in two cross-sectional studies comprising a total of 305 parents of 3- to 11-year-old children (including 53 children with autism spectrum disorders). Internal consistencies (Cronbach's alpha) for the six domains averaged .77 across both studies. Test-retest reliability, assessed among a subsample of 44 parents who repeated the questionnaire after between 10 and 30 days, was excellent (Spearman correlations for the domain scores between two administrations ranged from 0.80 to 0.95). Initial construct validity of the instrument was supported by observation of hypothesized inter-relationships between domain scores that were of the same direction and similar magnitude in both studies. Consistent with discriminant validity, children with autism spectrum disorders had statistically significantly (P

BACKGROUND: Physical distress resulting from medical problems has been found to cause increased behaviour problems in patients with intellectual disabilities (ID). Despite this fact, little has been documented on the medical problems of individuals with ID admitted for inpatient psychiatric care. We conducted an exploratory investigation based on a retrospective chart review of the medical problems and medications for 198 people with ID who had been admitted to a specialised inpatient psychiatric unit. Most patients were referred for admission because of aggressive, disruptive and self-injurious behaviours. The average length of stay was 17.6 days.

METHODS: We tallied the total number of medical problems and medications listed in the patients' discharge summaries. Because longer stays are disruptive, costly and associated with greater overall impairment, we examined the relationship between length of stay and frequency of discharge medical diagnoses. We also assessed whether or not the number of psychoactive medications correlated with the number of medical diagnoses. The effects of other demographic and diagnostic variables on rates of medical diagnoses and medications were also evaluated, including gender, age group (16-25, 26-45, 46-60, >60), level of ID (mild, moderate or severe ID) and diagnosis of an autism spectrum disorder or Down syndrome (DS).

RESULTS: Inpatients with a higher number of medical diagnoses had longer lengths of stay (Spearman r = +0.32, P < 0.0001). There was a significant correlation between number of psychoactive medications and number of medical problems (Spearman r = +0.32, P < 0.0001). The most frequent medical comorbidity was constipation, reported in 60% of the inpatients (n = 118), while gastro-esophageal reflux disease was identified in 38% (n = 75). Older inpatients had an increased number of medical problems, as might be expected, but a diagnosis of an autism spectrum disorder, gender and level of ID had no detectible effect on rates of either medical diagnoses or medications. There were only 13 inpatients with DS; in this modest sample, it was found that they had higher rates of osteoarthritis, cardiac problems, hearing loss, hypothyroidism and sleep apnoea than peers without DS, as is consistent with previous findings on overrepresented conditions in this trisomy.

CONCLUSIONS: In the present study, individuals with ID admitted for inpatient psychiatric care exhibited high rates of medical problems, and these were associated with duration of inpatient stay. Based on these findings, further investigation of the effects of medical problems on behaviour among individuals with ID admitted for inpatient psychiatric care is warranted.

PURPOSE: Many individuals with complex communication needs may benefit from visual aided augmentative and alternative communication systems. In visual scene displays (VSDs), language concepts are embedded into a photograph of a naturalistic event. Humans play a central role in communication development and might be important elements in VSDs. However, many VSDs omit human figures. In this study, the authors sought to describe the distribution of visual attention to humans in naturalistic scenes as compared with other elements.

METHOD: Nineteen college students observed 8 photographs in which a human figure appeared near 1 or more items that might be expected to compete for visual attention (such as a Christmas tree or a table loaded with food). Eye-tracking technology allowed precise recording of participants' gaze. The fixation duration over a 7-s viewing period and latency to view elements in the photograph were measured.

RESULTS: Participants fixated on the human figures more rapidly and for longer than expected based on the size of these figures, regardless of the other elements in the scene.

CONCLUSIONS: Human figures attract attention in a photograph even when presented alongside other attractive distracters. Results suggest that humans may be a powerful means to attract visual attention to key elements in VSDs.

The ganglionic eminence contributes cells to several forebrain structures including the cerebral cortex, for which it provides GABAergic interneurons. Migration of neuronal precursors from the retinoic-acid rich embryonic ganglionic eminence to the cerebral cortex is known to be regulated by several factors, but retinoic acid has not been previously implicated. We found retinoic acid to potently inhibit cell migration in slice preparations of embryonic mouse forebrains, which was reversed by an antagonist of the dopamine-D(2) receptor, whose gene is transcriptionally regulated by retinoic acid. Histone-deacetylase inhibitors, which amplify nuclear receptor-mediated transcription, potentiated the inhibitory effect of retinoic acid. Surprisingly, when retinoic acid signalling was completely blocked with a pan-retinoic acid receptor antagonist, this also decreased cell migration into the cortex, implying that a minimal level of endogenous retinoic acid is necessary for tangential migration. Given these opposing effects of retinoic acid in vitro, the in vivo contribution of retinoic acid to migration was tested by counting GABAergic interneurons in cortices of adult mice with experimental reductions in retinoic acid signalling: a range of perturbations resulted in significant reductions in the numerical density of some GABAergic interneuron subpopulations. These observations suggest functions of retinoic acid in interneuron diversity and organization of cortical excitatory-inhibitory balance. for Neurochemistry.

Stimulus generalization and contextual control affect the development of equivalence classes. Experiment 1 demonstrated primary stimulus generalization from the members of trained equivalence classes. Adults were taught to match six spoken Icelandic nouns and corresponding printed words and pictures to one another in computerized three-choice matching-to-sample tasks. Tests confirmed that six equivalence classes had formed. Without further training, plural forms of the stimuli were presented in tests for all matching performances. All participants demonstrated virtually errorless performances. In Experiment 2, classifications of the nouns used in Experiment 1 were brought under contextual control. Three nouns were feminine and three were masculine. The match-to-sample training taught participants to select a comparison of the same number as the sample (i.e., singular or plural) in the presence of contextual stimulus A regardless of noun gender. Concurrently, in the presence of contextual stimulus B, participants were taught to select a comparison of the same gender as the sample (i.e., feminine or masculine), regardless of number. Generalization was assessed using a card-sorting test. All participants eventually sorted the cards correctly into gender and number stimulus classes. When printed words used in training were replaced by their picture equivalents, participants demonstrated almost errorless performances.

Although stimulant medications are the mainstay of effective intervention for attention-deficit/ hyperactivity disorder (ADHD), their use presents a daunting scenario for psychiatry, nursing, and custody staff in correctional settings, where reported prevalence rates range from 9% to 45%. The reported rates, however, may overestimate actual prevalence in general and need for treatment in particular. Under a monitored protocol that required documentation of history, diagnosis, lack of response to nonstimulant treatment, and significant functional impairment, less than 1% of male inmates in the Massachusetts state prison system met criteria for treatment with stimulants. Although this protocol did not attempt to determine overall ADHD prevalence rates, the relatively low number of inmates with compelling reasons for stimulant treatment may provide a more realistic idea of the likely consequences of allowing access to this intervention.

“TerraKids” is the name of a Web site that is, for the present, purely fictional. It is a safe, secure site where 8- to 12-year-old kids become catalysts for a greener Earth by learning about the environment and the role they and their families can play in reducing global warming. Today, TerraKids exists only in thought and in this essay, but it could be live on the Web in the very near future. By making use of what we know about a science of behavior change, we can build a Web site that can help move millions of people to a greener world.

In this study, the Double ABCX model of family adaptation was used to explore the impact of severity of autism symptoms, behavior problems, social support, religious coping, and reframing, on outcomes related to family functioning and parental distress. The sample included self-report measures collected from 195 families raising school-age children with autism from racially diverse backgrounds throughout the United States.

Hierarchical regression results revealed that the Double ABCX model of family adaptation accounted for a substantial amount of the variance in family functioning (28%) and parental distress (46%).

Findings suggest that child behavior problems and reframing are most strongly associated with family outcomes. Clinical implications for working with these families, including the use of strength-based approaches, are discussed.

BACKGROUND: Despite the growing popularity of disease management programs for chronic conditions, evidence regarding the effect of these programs has been mixed. In addition, few peer-reviewed studies have examined the effect of these programs on publicly insured populations.

OBJECTIVES: To examine the effect of a telephone-based health coaching disease management program on healthcare utilization and expenditures in Medicaid members with chronic conditions.

RESEARCH DESIGN: Using a difference-in-differences analysis, we examined changes in hospitalizations, emergency department (ED) visits, ambulatory care visits, and Medicaid expenditures among program members for 1 year before and 2 years after their enrollment compared with a matched comparison group.

SUBJECTS: Medicaid members aged 18 to 64 with a diagnosis of qualifying chronic conditions and 2 acute health service events of hospitalizations and/or ED visits within a 12-month period.

RESULTS: Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures before and after program enrollment were similar between the 2 study groups. However, during the second year after enrollment, program members had a significantly smaller decrease in ED visits than the comparisons (8% in program members and 23% in comparisons, P value=0.03).

CONCLUSIONS: Compared with a matched comparison group, the telephone-based health coaching disease management program did not demonstrate significant effects on healthcare utilization and expenditures in Medicaid members with chronic conditions.

Vertebrate hearing and balance are based in complex asymmetries of inner ear structure. Here, we identify retinoic acid (RA) as an extrinsic signal that acts directly on the ear rudiment to affect its compartmentalization along the anterior-posterior axis. A rostrocaudal wave of RA activity, generated by tissues surrounding the nascent ear, induces distinct responses from anterior and posterior halves of the inner ear rudiment. Prolonged response to RA by posterior otic tissue correlates with Tbx1 transcription and formation of mostly nonsensory inner ear structures. By contrast, anterior otic tissue displays only a brief response to RA and forms neuronal elements and most sensory structures of the inner ear.

PURPOSE: Children who experience long periods of auditory deprivation are susceptible to large-scale reorganization of auditory cortical areas responsible for the perception of speech and language. One consequence of this reorganization is that integration of combined auditory and visual information may be altered after hearing is restored with a cochlear implant. Our goal was to investigate the effects of reorganization in a task that examines performance during multisensory integration.

METHODS: Reaction times to the detection of basic auditory (A), visual (V), and combined auditory-visual (AV) stimuli were examined in a group of normally hearing children, and in two groups of cochlear implanted children: (1) early implanted children in whom cortical auditory evoked potentials (CAEPs) fell within normal developmental limits, and (2) late implanted children in whom CAEPs were outside of normal developmental limits. Miller's test of the race model inequality was performed for each group in order to examine the effects of auditory deprivation on multisensory integration abilities after implantation.

RESULTS: Results revealed a significant violation of the race model inequality in the normally hearing and early implanted children, but not in the group of late implanted children.

CONCLUSION: These results suggest that coactivation to multi-modal sensory input cannot explain the decreased reaction times to multi-modal input in late implanted children. These results are discussed in regards to current models for coactivation to redundant sensory information.

Nurses' fear of blame following a medication event and confusion about the error-reporting requirements of multiple regulatory bodies that oversee nursing practice and nursing home operations can stifle the discussion and analysis of medication administration events to promote patient safety. The Massachusetts Board of Registration in Nursing and the University of Massachusetts Medical School Center for Health Policy and Research convened the Massachusetts Medication Safety Alliance, a 15-member collaborative of regulatory agencies and long-term care providers, to develop the Nurse-Employer Medication Safety Partnership Model to cultivate a safety culture in Massachusetts nursing homes that supports voluntary medication-event recognition and disclosure by nurses. A proactive approach to the Board's public protection mission, the model will promote public safety through early intervention and quality improvement. To guide the model's development, the Alliance assessed the perceptions of 1,286 nurses working in 109 Massachusetts nursing homes, finding more than half rated their practice environment as punitive and identified fears of blame, disciplinary action, and lawsuits as barriers to medication-event reporting.

To address the mental health needs of children and adolescents, Patient-Centered Medical Homes (PCMHs) need the capacity to screen for and detect significant mental health symptoms at the earliest stages of expression, the ability to develop treatment plans with patients and families, and systems to monitor and guide treatment over time. Given the complex nature of children’s mental health issues, primary care providers cannot be expected to perform these functions without the help of specialized child psychiatry resources offered in a collaborative fashion. PCMHs need access to consultation services and specialized care coordination.

In this article we provide an overview of the different study designs commonly utilized in carrying out clinical and public health research and of the points to consider in reviewing these study designs. The design and conduct of cross-sectional health surveys, case-control, prospective, and case-crossover observational studies, and randomized controlled trials, are discussed in this review article. It is hoped that careful attention to the concerns we have raised will lead to the design and conduct of high-quality research projects and their write-up.

BACKGROUND:

The present feasibility study describes engagement and spread of a Twitter-based core-strengthening challenge.

METHODS:

A challenge that entailed completing a core-strengthening exercise using a hashtag (#PlankADay) was circulated via Twitter. We surveyed users who joined during the first 2 months of the challenge to describe their characteristics, including social support for exercise and to what extent they invited others to join. We continued to track total users for 10 months.

RESULTS:

Of 407 individuals who joined in the first 2 months, 105 completed surveys. Among these, 81% were female and 86% Caucasian and mean age was 35.8. 72% participated for at least 1 month and 47% participated for at least 2 months. Survey participants reported that the challenge increased their enjoyment of abdominal exercise. Of the 68% of participants who invited others to participate, 28% recruited none, 66% recruited 1-5 users, and 6% recruited 10 or more users. Participants reported that online friends provided as much positive social support for exercise as family and in-person friends. In 14 months, 4,941 users produced 76,746 tweets and mean total tweets per user was 15.86 (SD = 75.34; range= 1-2888).

CONCLUSION:

Online social networks may be a promising mechanism to spread brief exercise behaviors.

OBJECTIVES: Our community health center attempted to meet public health goals for encouraging exercise in adult patients vulnerable to obesity, diabetes, hypertension, and other chronic diseases by partnering with a local YMCA.

METHODS: During routine office visits, providers referred individual patients to the YMCA at no cost to the patient. After 2 years, the YMCA instituted a $10 per month patient copay for new and previously engaged health center patients.

RESULTS: The copay policy change led to discontinuation of participation at the YMCA by 80% of patients. Patients who persisted at the YMCA increased their visits by 50%; however, more men than women became frequent users after institution of the copay. New users after the copay were also more likely to be younger men. Thus the copay skewed the population toward a younger group of men who exercised more frequently. Instituting a fee appeared to discourage more tentative users, specifically women and older patients who may be less physically active.

CONCLUSIONS: Free access to exercise facilities (rather than self-paid memberships) may be a more appropriate approach for clinicians to begin engaging inexperienced or uncertain patients in regular fitness activities to improve health.