Anxiety and ASD: Current Progress and Ongoing Challenges

Symptoms of anxiety add significant burden to many autistic individuals and their loved ones. There is an urgent need for better understanding of the unique underlying mechanisms of anxiety in ASD, and for the development of more specific assessment methods and treatment recommendations. This special issue brings together 24 articles grouped into three themes; mechanisms, measurement, and intervention. The result is a review of current anxiety research in ASD that is both broad and deep. Key themes include recognition of the importance individual differences in aetiology and presentation of anxiety in ASD, the need for a more nuanced understanding of the interactions between anxiety and characteristics of ASD and the need to develop appropriately adapted treatments. This special issue of the Journal of Autism and Developmental Disorders (JADD) aims to showcase the most recent research on anxiety in ASD. Around 50% of autistic individuals will experience anxiety that significantly impacts on their daily lives and the lives of their loved ones. When present, anxiety reduces quality of life and interferes with education, employment, and achievement of potential. The urgent need to address this pressing clinical issue was highlighted by the Autistica Priority Setting Partnership (2015), undertaken in collaboration with the autism community in the UK, which identified mental health concerns as the top priority for autism research with specific emphasis on the development of interventions to reduce anxiety identified as amongst the top five research priorities. The idea for this Special Issue arose as a consequence of discussions which took place at the Anxiety and ASD Special Interest Group at the International Meeting for Autism Research in 2015, with the call for papers issued in summer of 2015. We have been privileged to receive very many high quality submissions, all of which have been subjected to standard peer review processes. The outcome of this endeavour is this special issue, comprising 24 excellent papers from the leading international researchers in the field. Our aspiration was to present to JADD readership the most up-to-date scientific and methodological developments in the field. The papers included in this special issue fall into three broad themes: (1) mechanisms and correlates underpinning the development and maintenance of anxiety in ASD, (2) issues with measurement, assessment, and stability of anxiety in ASD, and (3) interventions for anxiety for autistic people

Pediatric Oncology Nurses’ Perceptions of Prognosis-Related Communication

Background Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. Findings Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. Discussion Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations

The effect of 'becoming' on trans* legal recognition

This thesis focuses on law’s conception of trans* embodiment and explores how the treatment of trans* lives by law exposes the existentially limiting understandings of ‘sex’ and ‘gender’ that underpin legal thinking. The thesis considers these limits on understanding to be problematic and limiting for the trans* community and uses theory to explore and advance a more appropriate and fluid scheme for legal recognition. Chapter one pays particular attention to the Gender Recognition Act 2004. It will be argued that it is based on the idea of the ‘authentic transsexual’ which, in the case of the Act, is founded on the separation of ‘sex’ and ‘gender’ and the construction of sex as dimorphic biological fact. Chapter two introduces and explores the idea of ‘becoming’ which can be used to re-figure what it means to be trans*. ‘Becoming’ can de-essentialise trans* lives in law and path the way for a more transformatory and fluid politics of recognition. Chapter three introduces a model of recognition that could be introduced in Scotland that is responsive to the self understood in terms of ‘becoming’. It will be argued that the model of self-identification and multiple gender scheme proposed balances trans* need for rights and protection with the demand that their sense of being and right to self-determination be protected. Finally, it is argued that this model is a necessary intermediate step in the move toward a post-gender world

Linking child travel routes and routine health data

ABSTRACT Objectives Linking routinely collected health and environment data can allow for large scale evaluations of how our environment impacts our health. Our data linkage approach advances previous research where residence-based environmental exposures were anonymously linked in the SAIL databank using Residential Anonymous Linking Fields (RALFs). The dose-response relationship between exposure to food and dietary intake has not been widely investigated. Previous research found conflicting views on whether increased environmental exposure to unhealthy food contributes to higher BMIs. This may have been due to different methodological approaches, including imprecise exposures, small numbers, and the use of self-reported BMIs. Approach This investigation calculated food exposure environments for routes from all homes to and from school. A Geographic Information System was used to calculate the environmental exposures along all potential routes up to a maximum age-appropriate walking distance from each school. Once within the SAIL databank we selected relevant routes using linked demographic and pupil datasets. To maintain privacy, the primary (doctoral) researcher generating the environmental exposures, did not have access to the final household-level exposure data in their identifiable form. The researcher automated their method so a second researcher could run the GIS analysis. Accuracy of modelled exposures will be compared with actual routes collected from GPS traces of children walking to school. Results Removing access to the final identifiable household-level route exposures enabled the primary researcher to complete analysis on the combined household and individual-level data within the secure environment. The environmental exposures were linked with routine health data from the SAIL databank; including BMI as an indicator of obesity. BMI data for 4-5 year olds, and a sample of 1300 13-14 year olds were linked to associated environmental exposures. Conclusion Depending on modelled accuracy, a GIS and data linkage approach may allow the investigation of natural experiments and intervention evaluation at the scale of the total population. This is the first step towards anonymously modelling part of the daily exposure environment using routine data. A limitation is the lack of routinely collected BMI data for older children and teenagers an age when they are more likely to have the option to choose to buy food on the school route. This work will have many potential applications, including the delivery and evaluation of multiple school and workplace commuting interventions

The Sense of an Audience: Spectators and Spectatorship in Early Modern England.

“The Sense of an Audience: Spectators and Spectatorship in Early Modern England” makes visible a figure that early modern scholarship on theater and audiences has largely overlooked: the discursive or theoretical spectator. As the commercial theater developed and prospered in sixteenth- and seventeenth-century England, there arose a concomitant cultural preoccupation with the theatrical spectator and the complex processes of engagement that the theater both cultivated and demanded. Discourses about theater audiences (who they were, what they did and what they might do) proliferated in moral, legal and artistic circles. As these discourses circulated and intersected, they produced a set of ideas about the spectator unique to the period. Rather than simply reflective of “real” early modern spectators, I argue that the discursive spectator took shape alongside the phenomenological one and, moreover, played as significant a role in shaping early modern viewers and viewing practices as did changes to staging technologies, exhibition practices and generic experimentation. Although audience studies and film studies have theorized the spectator, these fields tend to focus on the role of twentieth-century mediums (film, television and most recently the computer) in producing the mass-culture viewer. This emphasis has led to a mistaken idea that the discursive spectator is the product of modernity. Fearing anachronism, early modern scholars have preferred demographic studies of audience to theoretical engagements with the “effects” of spectatorship. While demographic work provides an invaluable snapshot, it does not account for the ways that the spectator is as much an idea as a material presence. While a few studies, using critical tools sharpened by film studies, have attempted to explore the dynamics that existed among author, text and audience, these analyses often obscure the ways in which early modern subjects themselves understood the spectator. Rather than relying exclusively on an historical or theoretical methodology, my dissertation historicizes theory itself, by reframing spectatorship as a subject of inquiry that has been shaped not only by changes in entertainment technologies but also by the interaction of groups and individuals with different forms of cultural production.Ph.D.English Language & LiteratureUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/64674/1/ajrodger_2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/64674/2/ajrodger_1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/64674/3/ajrodger_3.pd

Daily exposure to the retail food environment and the association with child BMI

Background The dose-response relationship between exposure to food environments and obesity has not been widely investigated. This study examined whether increased retail food environment (RFE) exposure in children was associated with a larger body mass index (BMI). Objectives Generate household level daily exposure to the RFE for children aged 11-13 years and link these environmental exposure with health data in an anonymised data safe haven. Methods Individually tailored environmental exposures were calculated in a GIS for home and school locations, and modelled walking routes to and from school. Local Authority food outlet data were used to generate the temporally accurate exposures. Exposures were linked to individual level health data in the SAIL databank for a cohort of individuals from south Wales aged 11-13 years, with BMI measurements. A fully adjusted multilevel regression model was fitted to investigate the association of RFE exposure with BMI. Findings Home exposure and exposure along the walk to school was significantly greater for children living in deprived catchments, compared with affluent school catchments (t = -5.25, p<0.05; t = -0.277, p<0.05, respectively). The RFE exposure along the walk home was the only environmental exposure positively associated with a higher BMI (0.22, p<0.05). Conclusions Increased BMI was associated with greater REF exposure along the walk home from school. The findings suggest that the walk home from school may be important for developing interventions and policies to discourage unhealthy eating. Research should be undertaken to better understand child purchasing habits

Prospectus, November 8, 1995

https://spark.parkland.edu/prospectus_1995/1028/thumbnail.jp

Linking household level GIS-generated environmental exposure scores with individual level anonymised health data

Introduction The dose-response relationship between exposure to food and BMI, has not been widely investigated. Furthermore, household-level, GIS-generated food environment exposure scores have not previously been linked with individual-level, anonymised BMI data. This study linked GIS-generated residential level environmental exposure scores with historical anonymised, health data held in the SAIL databank. Objectives and Approach Household level GIS-generated exposure data for a region of about 1 million people were anonymised into SAIL using the ‘split-file’ method. All individuals living in the 633,884 homes at the time of data collection (2009-2010) were flagged using a population register. Separately, a cohort of 1147, 11-13 year old pupils were linked to their health data before joining to their environmental exposures. Two subgroups were established within the linked dataset: individuals living at 4.8km or less from the school they attended were assumed to walk to school (“walkers”) and pupils who lived further than 4.8km were flagged as “non-walkers”. Results A total of 916 pupils (80%) were successfully linked to the population register. The BMIs were collected in 2009-2010, but more recent data is likely to have a greater proportion of successful links (more recently, 97% of individuals and their health data have been linked to their home and exposures in SAIL). Erroneous BMIs were removed (n=33, 2.9%). Anonymised exposure data were linked with the remaining 883 (77%) individuals. The dataset contained 352 males (39.9%) and 531 females (60.1%); of these, 38% were from deprived areas and 62% lived in affluent areas. There were 431 (48.8%) pupils in the “walkers” group and 452 (51.2%) in the “non-walkers” group. In the “walkers” group, 13% were obese compared with 22% of “non-walkers” (chi-squared = 12.3, p <0.05). Conclusion/Implications We generated novel regional exposures to combine with historical anonymised health data. Household and individual level linkage of environmental data to health cohorts contributed to the literature to help develop beneficial societal policies. We recommend routine national collections of height and weight for children to allow longitudinal retrospective analyses

Linking environment and health data to investigate the association between access to unhealthy food and child BMI

Introduction Modelling the daily exposure environment provides evidence for policy and practice. However, the dose-response relationship between exposure to food environments and obesity has not been widely investigated. This study investigated whether increased retail food environment (RFE) exposure in children was associated with a larger body mass index (BMI). Objectives and Approach Individually tailored environmental exposures were calculated in a GIS for home and school locations, and modelled walking routes to and from school. Exposures were linked to individual level health data in the SAIL databank for a cohort of individuals aged 11-13 years from south Wales who had BMI measurements. A fully adjusted multilevel regression model was fitted to investigate the association of RFE exposure with BMI. Based on the distance individuals lived from school, we investigated differences between children who have the potential to walk to school (“walkers” lived 4.8km). Results Home exposure and exposure along the walk to school was significantly greater for children living in deprived catchments, compared with children living in affluent school catchments (t = -5.25, p Conclusion/Implications Increased BMI was associated with greater RFE exposure along the walk home from school. The findings suggest that the walk home from school should be the focus for developing interventions and policies to discourage unhealthy eating. Research should be undertaken to better understand child purchasing habits