Preliminary content and construct validity of a new model to differentiate research skills from evidence-based practice skills: Core, Evidence Application, Research (CEAR) Model.

BACKGROUND: Research is the scientific basis for the profession of dietetics, as it must be located and applied in evidence-based practice (EBP). EBP is often presented as a foundational skill for research. CEAR - Core, Evidence Application, Research - is a newly proposed model that separates Research and Evidence Application skills into distinct domains, jointly supported by a set of Core skills, thus acknowledging that education and advancement in one domain neither requires nor precipitates education and advancement in the other. The goal was to investigate the content and construct validity of the new CEAR Model. METHODS: A cross-sectional online survey of randomly selected dietitians in the United States was used to collect CEAR domain scores, validated measures of research or EBP skills and self-reported characteristics. Exploratory factor analysis, Cronbach's α and Pearson correlation between various tools and CEAR domains were used to assess validity and reliability. Analysis of variance (ANOVA) and multiple linear regression between CEAR domains and participant characteristics were used to assess convergent and divergent validity. RESULTS: One hundred and fifty-four responses with a valid CEAR score were received and led to a three-factor solution, supporting the theorised differentiation of research from evidence application skills (content validity). Internal reliability for the CEAR Model overall and for each domain was high. The hypothesised correlations between existing research or EBP measurement tools and the relevant CEAR domains were found (construct validity). Known groups analysis demonstrated the expected differences in CEAR domain scores based on participant characteristics. CONCLUSIONS: The CEAR Model demonstrates preliminary validity and internal reliability. It adds to the current literature by acknowledging the separateness of evidence application skills from research skills.

"Glimmers of hope and good things": Positive aspects of caregiving to autistic adolescents and young adults.

LAY ABSTRACT: We wanted to explore the positive, or rewarding, experiences of caregivers who were caring for older adolescents or young autistic adults. We surveyed 174 caregivers, asking questions about how they dealt with stressors, the support they had from people in their lives, and the different behaviors of the autistic youth they care for. Using an existing measure, as well as an open-ended question, we asked caregivers about the most rewarding aspects of caring for their youth. When examining survey responses, we found that caregivers who reported receiving more help and support from their autistic youth also reported more positive aspects related to caregiving. In response to our study's open-ended question, caregivers talked about the reward of seeing their youth grow and progress (e.g. learning new skills, reaching new milestones), described positive aspects of the relationship with their youth (e.g. sharing a special bond), and reflected on their own learning and personal growth as caregivers and people. Our findings highlight the positive, or rewarding, aspects of caregiving for autistic adolescents and young adults. This work will inform future work studying positive aspects of caring for autistic individuals and how this may impact caregivers' psychological well-being.

Determinants of COVID-19 Vaccine Hesitancy: A Cross-Sectional Study in Three Communities in the United States and Lebanon.

The COVID-19 pandemic underscores the significance of vaccine hesitancy in shaping vaccination outcomes. Understanding the factors underpinning COVID-19 vaccination hesitancy is crucial for tailoring effective vaccination strategies. This cross-sectional study, conducted in three communities across the United States and Lebanon, employed surveys to assess respondents' knowledge, attitudes, and perceptions regarding COVID-19 infection and vaccination. Among the 7196 participants, comprising 6775 from the US and 422 from Lebanon, vaccine hesitancy rates were comparable at 12.2% and 12.8%, respectively. Notably, a substantial proportion of respondents harbored misconceptions, such as attributing the potential to alter DNA (86.4%) or track individuals (92.8%) to COVID-19 vaccines and believing in the virus's artificial origins (81%). US participants had more misconceptions about the COVID-19 vaccine, such as altering DNA or causing infertility. Lebanese participants were more likely to question the origins of the virus and the speed of vaccine development. Additionally, US respondents were less worried about infection, while Lebanese respondents were more indecisive but less likely to outright reject the vaccine. Primary determinants of hesitancy included perceptions that the vaccine poses a greater risk than the infection itself (aOR = 8.7 and 9.4, respectively) and negative recommendations from healthcare providers (aOR = 6.5 and 5.4, respectively). Conversely, positive endorsements from healthcare providers were associated with reduced hesitancy (aOR = 0.02 and 0.4, respectively). Targeting healthcare providers to dispel misinformation and elucidate COVID-19 vaccine risks holds promise for enhancing vaccination uptake.

Barriers to service and unmet need among autistic adolescents and young adults.

LAY ABSTRACT: Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families.

Perceptions of Social-Emotional Learning Among K-12 Teachers in the USA During the COVID-19 Pandemic.

Social-emotional learning (SEL) is the process of acquiring and applying knowledge, skills, and attitudes to achieve long-term relational and emotional goals. Teachers often implement SEL strategies in the classroom; however, shifting to online schooling during the COVID-19 pandemic may have impacted teachers' perceptions of their abilities to implement SEL. This study was designed to identify whether and how teachers' perceptions of SEL changed since the onset of the COVID-19 pandemic. Teachers (N = 637) in the USA completed a demographic questionnaire, the Depression, Anxiety, and Stress Scale (DASS-21), and rated their beliefs about SEL during the pandemic on a modified version of the Comfort and Culture subscales of the Teacher SEL Beliefs Scale. Data were collected between September 2020 and March 2021. Teachers indicated that they felt neutral to comfortable with SEL and that they felt neutral to supported by their school culture for SEL during the pandemic. Lower depression symptoms, greater school poverty, and perceived general support (not specific to SEL) from the administration were associated with higher teacher comfort with SEL. Further, greater general support from the district and colleagues was associated with greater school culture supporting SEL during COVID-19. Results suggest that addressing teachers' internalizing symptoms and fostering a supportive work environment is important in aiding teachers in SEL implementation.

If you want to develop an effective autism training, ask autistic students to help you.

LAY ABSTRACT: Autistic university students are often left out because people do not understand autism. We wanted to help people understand autism. Most autism trainings are not made by autistic people. Autistic people know what it is like to be autistic. So autistic people may be the best teachers when it comes to teaching about autism. Autistic students and non-autistic professors made an autism training. The students made videos for the training. They also helped make questions to see what people learned from the trainings. Professors who are not autistic made a training on their own. Students in New York City tried out the trainings. After they answered questions, they did either the training the autistic students helped make or the training made by only professors. Then, they answered questions again. We learned from the students how to make our trainings better. Then, students from two universities in the United States and one university in Lebanon did our trainings and questions. Both trainings made hidden feelings about autism better. The training autistic students helped make taught students more than the training professors made on their own. The autistic-led training also helped students accept autism more. These studies show that autistic students can make autism research and trainings better. At the end of this article, autistic students share their ideas for how to make autism trainings even better in the future.

What Contributes to Stigma Towards Autistic University Students and Students with Other Diagnoses?

Little remains known about the degree to which autistic university students are stigmatized relative to students with other diagnoses. We conducted an online survey with students in New York City (n = 633) and Beirut (n = 274). Students with diagnoses that were perceived as dangerous (e.g., psychopathy) were more stigmatized than students with diagnoses that were perceived as less dangerous (e.g., autism). Disruptive autistic behaviors (described via vignettes) evoked more stigma than withdrawn behaviors. Perceived dangerousness predicted autism stigma. Greater acceptance of inequality, less openness, and lower cognitive empathy co-occurred with heightened stigma towards most conditions. Diagnostic labels were typically less stigmatized than behaviors. Findings suggest that interventions are needed to decrease stigma towards varied diagnoses in collegiate communities.

Do Implicit and Explicit Racial Biases Influence Autism Identification and Stigma? An Implicit Association Test Study.

Are implicit and explicit biases related to ASD identification and/or stigma? College students (N = 493) completed two IATs assessing implicit stigma and racial biases. They evaluated vignettes depicting a child with ASD or conduct disorder (CD) paired with a photo of a Black or White child. CD was more implicitly and explicitly stigmatized than ASD. Accurately identifying ASD was associated with reduced explicit stigma; identifying CD led to more stigma. Participants who identified as White implicitly associated the White child with ASD and the Black child with CD. A trend in the reverse direction was observed among Black participants. Implicit and explicit biases were unrelated. Findings highlight a need for trainings to ameliorate biases favoring one's in-group.

Examining the Role of Language in Play Among Children With and Without Developmental Disabilities.

Purpose Play is a critical aspect of children's development, and researchers have long argued that symbolic deficits in play may be diagnostic of developmental disabilities. This study examined whether deficits in play emerge as a function of developmental disabilities and whether our perceptions of play are colored by differences in language and behavioral presentations. Method Ninety-three children participated in this study (typically developing [TD]; n = 23, developmental language disorders [DLD]; n = 24, attention-deficit/hyperactivity disorder [ADHD]; n = 26, and autism spectrum disorder [ASD]; n = 20). Children were videotaped engaging in free-play. Children's symbolic play (imagination, organization, elaboration, and comfort) was scored under conditions of both audible language and no audible language to assess diagnostic group differences in play and whether audible language impacted raters' perception of play. Results Significant differences in play were evident across diagnostic groups. The presence of language did not alter play ratings for the TD group, but differences were found among the other diagnostic groups. When language was audible, children with DLD and ASD (but not ADHD) were scored poorly on play compared to their TD peers. When language was not audible, children with DLD were perceived to play better than when language was audible. Conversely, children with ADHD showed organizational deficits when language was not available to support their play. Finally, children with ASD demonstrated poor play performance regardless of whether language was audible or not. Conclusions Language affects our understanding of play skills in some young children. Parents, researchers, and clinicians must be careful not to underestimate or overestimate play based on language presentation. Differential skills in language have the potential to unduly influence our perceptions of play for children with developmental disabilities.

Using Telehealth to address disparities in cognitive, language, and emotion regulation problems in young children: A case illustration using the INvesT model.

Over the past decade, there has been a rise in the prevalence of developmental disabilities. Early diagnosis and access to healthcare services are essential for children with developmental delays to optimize development. For families living in poverty, accessing specialized assessment/intervention services for children with developmental disabilities is often a formidable task. In this study, we provide preliminary evidence for the implementation of a developmental risk assessment screening questionnaire using a telehealth format to address the gap in access to services in a community clinic serving a low-income urban neighborhood. Ninety-seven caregivers of children between 12 months and 7 years of age participated in this study. Caregivers completed the risk assessment screening questionnaire using an iPad that was available to them at the clinic. Results showed that while only 11% of caregivers indicated they were initially concerned about their child's overall development, completion of the focused risk assessment resulted in a completely different picture. Fifty percent of caregivers reported that their child had three or more concerns in at least one area of development that would warrant further evaluation. Alerting both families and professionals to these concerns as early as possible may position the family and child to receive the much-needed services that have the potential to mitigate more serious developmental problems. This article discusses the promising role that Telehealth can play in providing screening services for all families, but especially low-income urban households.

Factors underlying cross-cultural differences in stigma toward autism among college students in Lebanon and the United States.

Although stigma negatively impacts autistic people globally, the degree of stigma varies across cultures. Prior research suggests that stigma may be higher in cultures with more collectivistic orientations. This study aimed to identify cultural values and other individual differences that contribute to cross-cultural differences in autism stigma (assessed with a social distance scale) between college students in Lebanon (n = 556) and those in the United States (n = 520). Replicating prior work, stigma was lower in women than men and in the United States relative to Lebanon. Heightened autism knowledge, quality of contact with autistic people, openness to experience, and reduced acceptance of inequality predicted lower stigma. Collectivism was not associated with heightened stigma. Findings highlight the need to address structural inequalities, combat harmful misconceptions, and foster positive contact to combat stigma.

Associations Between Manual Dexterity and Language Ability in School-Age Children.

Purpose: We aimed to determine whether individual differences in manual dexterity are associated with specific language skills (nonword repetition, receptive vocabulary, and receptive grammar) after controlling for nonverbal abilities (visual-spatial working memory and intelligence). Method: We assessed manual dexterity using the pegboard task and examined relationships with verbal and nonverbal abilities in a diverse community sample of children (N = 63, mean age = 8;2 [year;months], range: 6;0-10;8) varying in language ability (Comprehensive Evaluation of Language Fundamentals-Fourth Edition core language score M = 105, range: 62-126; Semel, Wiig, & Secord, 2003). Results: Correlational analyses indicated significant relationships between manual dexterity and performance on tests of nonword repetition, receptive vocabulary, receptive grammar, and nonverbal intelligence, after controlling for multiple comparisons. In regression analyses, manual dexterity remained a significant predictor of nonword repetition after controlling for nonverbal abilities and age. In contrast, manual dexterity was no longer significant in predicting receptive vocabulary or grammar when nonverbal intelligence was included as a factor in the model. Conclusions: These findings build on prior work implicating poor fine motor control in child language disorders by identifying a robust relationship between manual dexterity and nonword repetition. Relationships between manual dexterity and receptive language abilities appear to be indirect and mediated by nonword repetition. For clinicians, the results underscore the importance of screening children with poor fine motor control for concomitant language impairments.

Bullying and Identity Development: Insights from Autistic and Non-autistic College Students.

Reduced cognitive empathy may put autistic people at risk for bullying. We compared interpretations of bullying provided by 22 autistic and 15 non-autistic college students. Autistic (and non-autistic) students reported less severe bullying in college relative to earlier in development. Chronic bullying was associated with improvements in self-descriptions and self-acceptance. Autistic students who were chronically bullied were more likely to self-identify as autistic when asked to explain their disability. Autistic and non-autistic students demonstrated similar levels of cognitive empathy, providing no evidence that a "double empathy problem" contributes to bullying for all autistic individuals. Findings suggest that recovery from bullying can contribute to resilience and that autistic people gain insights about bullying and how to overcome it with development.

Designing a Summer Transition Program for Incoming and Current College Students on the Autism Spectrum: A Participatory Approach.

Students with Autism Spectrum Disorder (ASD) face unique challenges transitioning from high school to college and receive insufficient support to help them navigate this transition. Through a participatory collaboration with incoming and current autistic college students, we developed, implemented, and evaluated two intensive week-long summer programs to help autistic students transition into and succeed in college. This process included: (1) developing an initial summer transition program curriculum guided by recommendations from autistic college students in our ongoing mentorship program, (2) conducting an initial feasibility assessment of the curriculum [Summer Transition Program 1 (STP1)], (3) revising our initial curriculum, guided by feedback from autistic students, to develop a curriculum manual, and (4) pilot-testing the manualized curriculum through a quasi-experimental pre-test/post-test assessment of a second summer program [Summer Transition Program 2 (STP2)]. In STP2, two autistic college students assumed a leadership role and acted as "mentors" and ten incoming and current autistic college students participated in the program as "mentees." Results from the STP2 pilot-test suggested benefits of participatory transition programming for fostering self-advocacy and social skills among mentees. Autistic and non-autistic mentors (but not mentees) described practicing advanced forms of self-advocacy, specifically leadership, through their mentorship roles. Autistic and non-autistic mentors also described shared (e.g., empathy) and unique (an intuitive understanding of autism vs. an intuitive understanding of social interaction) skills that they contributed to the program. This research provides preliminary support for the feasibility and utility of a participatory approach in which autistic college students are integral to the development and implementation of programming to help less experienced autistic students develop the self-advocacy skills they will need to succeed in college.

Statistical Learning in Specific Language Impairment and Autism Spectrum Disorder: A Meta-Analysis.

Impairments in statistical learning might be a common deficit among individuals with Specific Language Impairment (SLI) and Autism Spectrum Disorder (ASD). Using meta-analysis, we examined statistical learning in SLI (14 studies, 15 comparisons) and ASD (13 studies, 20 comparisons) to evaluate this hypothesis. Effect sizes were examined as a function of diagnosis across multiple statistical learning tasks (Serial Reaction Time, Contextual Cueing, Artificial Grammar Learning, Speech Stream, Observational Learning, and Probabilistic Classification). Individuals with SLI showed deficits in statistical learning relative to age-matched controls. In contrast, statistical learning was intact in individuals with ASD relative to controls. Effect sizes did not vary as a function of task modality or participant age. Our findings inform debates about overlapping social-communicative difficulties in children with SLI and ASD by suggesting distinct underlying mechanisms. In line with the procedural deficit hypothesis (Ullman and Pierpont, 2005), impaired statistical learning may account for phonological and syntactic difficulties associated with SLI. In contrast, impaired statistical learning fails to account for the social-pragmatic difficulties associated with ASD.

Epidemiology of bloodstream infections caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York.

BACKGROUND: In the United States, bloodstream infections (BSIs) are predominated by Staphylococcus aureus. The proportion of community-acquired methicillin-resistant S aureus (MRSA) BSI is on the rise. The goal of this study is to explore the epidemiology of BSI caused by S aureus within Staten Island, New York. METHODS: This is a case-case-control study from April 2012-October 2014. Cases were comprised of patients with BSI secondary to MRSA and methicillin-sensitive S aureus (MSSA). The control group contained patients who were hospitalized during the same time period as cases but did not develop infections during their stay. Two multivariable models compared each group of cases with the uninfected controls. RESULTS: A total of 354 patients were analyzed. Infections were community acquired in 76% of cases. The major source of BSI was skin-related infections (n = 76). The first multivariable model showed that recent central venous catheter placement was an independent infection risk factor (odds ratio [OR] = 80.7; 95% confidence interval [CI], 2.2-3,014.1). In the second model, prior hospital stay >3 days (OR = 4.1; 95% CI, 1.5-5.7) and chronic kidney disease (OR = 3.0; 95% CI, 1.01-9.2) were uniquely associated with MSSA. Persistent bacteremia, recurrence, and other hospital-acquired infections were more likely with MRSA BSI than MSSA BSI. CONCLUSION: Most infections were community acquired. The presence of a central venous catheter constituted a robust independent risk factor for MRSA BSI. Patients with MRSA BSI suffered worse outcomes than those with MSSA BSI.

[Phototherapeutic keratectomy (PTK) and bullous keratopathy: case report]. / Ceratectomia fototerapêutica (PTK) e ceratopatia bolhosa: relato de caso.

The objective is to evaluate the effects of phototherapeutic keratectomy (PTK) in bullous keratopathy patients. Phototherapeutic keratectomy was performed in a pseudophakic patient with corneal decompensation after lens extraction, with the excimer laser Nidek EC 5000 after manual corneal epithelial debridement. There was no pain after fifteen days the laser application and during the eight months of follow-up. Visual acuity was unchanged. The phototherapeutic keratectomy excimer laser must be considered one more alternative for pain treatment in bullous keratopathy of pseudophakic patients.

Phonological Priming With Nonwords in Children With and Without Specific Language Impairment.

PURPOSE: The cross-modal picture-word interference task is used to examine contextual effects on spoken-word production. Previous work has documented lexical-phonological interference in children with specific language impairment (SLI) when a related distractor (e.g., bell) occurs prior to a picture to be named (e.g., a bed). In the current study, the authors examined whether interference also arises with nonwords as distractors. METHOD: In Study 1, children with SLI (N = 20; ages 7;1 [years;months] to 11;0) and age-matched controls named pictures accompanied by (a) phonologically related nonwords, (b) unrelated nonwords, or (c) the word go (baseline). Stimulus asynchrony (SA) varied across blocks with distractors occurring prior to (-300 ms, -100 ms) or after (+100 ms, +300 ms) the pictures. In Study 2, a cross-sectional sample of children (N = 48, 5;3 to 10;9) and adults (N = 16) performed the same task. RESULTS: Child and adult control participants showed phonological priming (not interference) at early and late SAs, whereas children with SLI showed priming only at late SAs. Effect sizes correlated with language skills (Clinical Evaluation of Language Fundamentals-Fourth Edition scores; Semel, Wiig, & Secord, 2003). In the cross-sectional sample, anticipatory priming at SA -300 varied with age, with larger effects in older children. CONCLUSIONS: Children with SLI utilize phonological information when it is available just in time for word production but fail to anticipate upcoming stimuli. Poor anticipatory processing may adversely affect language fluency in children with SLI.

A Cross-Cultural Comparison of Knowledge and Stigma Associated with Autism Spectrum Disorder Among College Students in Lebanon and the United States.

Although misconceptions associated with ASD are apparent worldwide, they may differ across cultures. This study compares knowledge and stigma associated with ASD in a country with limited autism resources, Lebanon, and a country with substantial autism resources, the United States (US). College students in the US (N = 346) and Lebanon (N = 329) completed assessments of knowledge and stigma associated with ASD before and after an online ASD training. Although students in the US exhibited higher overall knowledge and lower stigma towards ASD, certain misconceptions were more apparent in the US than in Lebanon. Participation in the training was associated with decreased stigma and increased knowledge in both countries. Thus, online training may be useful for increasing understanding about ASD internationally.