The Value of Caregiver Time: Costs of Support and Care for Individuals Living with Autism Spectrum Disorder

When a child is diagnosed with autism spectrum disorder, the significance of the impact that diagnosis can have on his or her family’s life is incalculable, except in one respect: cost. If that child is severely impacted and requires constant and lifelong supports, then the value of caregiver time required to support that individual is approximately $5.5 million higher than that for someone without autism. An autism diagnosis of a high-needs child at age two represents the equivalent of telling the family that they must make an immediate lump-sum investment on that day of$1.6 million, invested at a five-per-cent return, to pay for the lifetime costs of care and support their loved one will require. And that amount does not even account for added professional services, such as speech therapists, psychologists, and occupational therapists, or additional out-of-pocket expenses that may be required, such as special equipment or diets. Autism is the most common neurological condition diagnosed in children and it is now estimated that one in 88 children will be diagnosed with autism spectrum disorders. Yet, across Canada, there are significant gaps in the publicly provided support system, leaving the cost burden to be picked up by families. In the case of those individuals requiring constant support, 24 hours a day, every day, the cost of hiring caregivers alone would require an annual income of $200,000 — before a family even begins to pay for shelter, clothing, groceries and other basic necessities. Already families with severe high-needs children are more likely to experience lower income than they might otherwise, due to the extra care commitment their loved one requires. Only a very few families will have the means to afford to pay for total care. So, in most cases, the responsibility for care falls largely, if not entirely, on the family, or in a worst-case scenario, the autistic individual is left with inadequate care. Autism is an expensive condition and governments may underestimate the full cost of community-based supports needed for the vast range of unique needs of those living with autism. A scan of provincial programs finds a patchwork of unequal and incomplete supports for individuals living with autism spectrum disorders. Gaps are particularly evident once individuals leave the public school system, where they are at least provided with some form of day support. Sufficient adult day supports, evening and night supports, quality group homes, the availability of properly trained caregivers and respite services, recreational activities, post-secondary opportunities and employment supports all suffer varying levels of inadequacy across the country. As autism becomes increasingly prevalent, continuing to rely largely on family supports where community services are fragmented or unavailable is not a sustainable approach. Canadian policy-makers will need to consider the costs of a growing and aging population of individuals living with autism who need a range of supports so that adequate quality of care and a decent quality of life are enjoyed by many who remain some of this country’s most vulnerable citizens

It’s Not Just About Baby Teeth: Preventing Early Childhood Caries

Early Childhood Caries (ECC) is a serious disease that is about much more than cavities on baby teeth. In Canada, it is a growing public health problem with adverse long-term effects on children's physical, emotional and intellectual well-being. The failure to invest in preventive care has resulted in reactive, rather than proactive, measures against this disease. These measures are expensive and a needless drain on costs in the public health-care system. Children with severe ECC end up in hospital; in fact, in Canada, this disease is the most common reason children undergo day surgery. From 2010 to 2012, one in 100 children under age five required day surgery for ECC, with approximately 19,000 of these surgeries performed each year on children under age six. Canadian hospital costs for ECC day surgery in children aged one to five ranged from $1,271 to$1,963 per child, totalling $21.2 million between 2010 and 2012. Children from low-income families, along with aboriginal, immigrant and refugee children are disproportionately affected by dental disease, with between 50 per cent and 90 per cent of suffering from some form of ECC. This compares to an average of 57 per cent of children affected in the general population. A recent Alberta study indicates that when municipalities cease fluoridating their water supplies, children suffer increased levels of tooth decay. This has reignited the discussion around whether municipalities should add fluoride to the drinking water, or reinstate it in places where the water used to be fluoridated. While fluoridation can be an effective prevention strategy, this study also shows that fluoride alone is not enough. To reduce the costs and developmental consequences associated with severe ECC and improve well-being, oral health policies focused on disease prevention and health promotion are still necessary. This briefing paper provides background on the etiology, risk factors and prevalence of ECC in Canada to provide scope for the magnitude of this preventable disease in children. To address the avoidable socioeconomic costs, three areas require policy development. First is the need for increased public education and access to ECC prevention services for at-risk populations. Parents need to know they should reduce their children’s intake of sweet drinks, and avoid filling bottles with sugar water, juice or soft drinks, especially at night. They should also clean an infant’s gums with a soft toothbrush or cloth and water starting at birth. When the baby’s first tooth erupts, parents should commence daily brushing with toothpaste and book a first dental visit. Second is the need to empower health-care professionals to integrate ECC prevention in their early visits with parents of young children. Such visits are more common in family medicine, and these primary care providers can play a critical role in educating parents and promoting children’s oral health. Curriculum and continuing education for these health professions should be enhanced to emphasize ECC’s long-term health effects. Third, government should invest in preventive oral health services for children rather than relying on emergency dental care. Children should have access to early preventive dental services to instill in them habits for lifetime oral health. Provinces without universal public funding for children’s preventive dental health should remove the access barriers that children without dental insurance face

Enhancing Teacher Quality Through Knowledge- and Skills-Based Pay

The 1989 Education Summit established the National Education Goals that spurred states to set standards and assess educational outcomes (Patton and Thompson, 1999). A decade into standards-based reform, the 1999 Education Summit identified two important policy areas that have emerged to carry out these goals: teacher quality and accountability (National Education Summit, 1999). Research supports the important relationship between teacher quality and student achievement (Darling-Hammond and Ball, 1998; Ferguson and Ladd, 1996; Sanders and Horn, 1994; Wright, Horn, and Sanders, 1997). Concerns about teacher quality led the National Commission on Teaching and America’s Future to recommend that states and districts consider better ways of linking pay to the development of teacher knowledge and skills (National Commission on Teaching and America’s Future, 1996). Exploring better ways of using pay to enhance teacher quality is also supported, to varying degrees, by teacher unions and associations. Knowledge- and skills-based pay systems are emerging as a potentially promising way of leveraging the investment in teacher pay to improve teacher quality and to provide clearer signals to teachers about how they should focus their professional energies. This CPRE Policy Brief reports on our experiences in working with policymakers and studying knowledge- and skills-based pay systems. We provide guidance on important design issues for these systems, and recommend ways state and district policymakers can strengthen the capacity for and pursue knowledge- and skills-based pay

Super and massive AGB stars - IV. Final fates - Initial to final mass relation

We explore the final fates of massive intermediate-mass stars by computing detailed stellar models from the zero age main sequence until near the end of the thermally pulsing phase. These super-AGB and massive AGB star models are in the mass range between 5.0 and 10.0 Msun for metallicities spanning the range Z=0.02-0.0001. We probe the mass limits M_up, M_n and M_mass, the minimum masses for the onset of carbon burning, the formation of a neutron star, and the iron core-collapse supernovae respectively, to constrain the white dwarf/electron-capture supernova boundary. We provide a theoretical initial to final mass relation for the massive and ultra-massive white dwarfs and specify the mass range for the occurrence of hybrid CO(Ne) white dwarfs. We predict electron-capture supernova (EC-SN) rates for lower metallicities which are significantly lower than existing values from parametric studies in the literature. We conclude the EC-SN channel (for single stars and with the critical assumption being the choice of mass-loss rate) is very narrow in initial mass, at most approximately 0.2 Msun. This implies that between ~ 2-5 per cent of all gravitational collapse supernova are EC-SNe in the metallicity range Z=0.02 to 0.0001. With our choice for mass-loss prescription and computed core growth rates we find, within our metallicity range, that CO cores cannot grow sufficiently massive to undergo a Type 1.5 SN explosion.Comment: 15 pages, 7 figures, accepted for publication in MNRA

Primordial to extremely metal-poor AGB and Super-AGB stars: White dwarf or supernova progenitors?

Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars ( Z ¿ 10 ¿5 ) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z = 10 ¿5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z = 10 ¿5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10 ¿5 . We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.Peer ReviewedPostprint (author's final draft

Laying the Foundation for Policy: Measuring Local Prevalence for Autism Spectrum Disorder

Claims have been made that families with children living with autism spectrum disorders (ASD) have been migrating to Alberta because of higher funding available for ASD supports compared to other provinces. The legitimacy of these claims, along with many others about the adequacy or inadequacy of funding for supporting persons living with ASD, has not been evaluated because we simply don’t know how many people in Alberta are living with ASD. Typically in Canada, ASD prevalence is reported in national figures, based on international estimates. Canadian prevalence estimates for ASD are needed. With no national surveillance system in place, national estimates are difficult to determine. In addition, such broad measurements are problematic as they may not adequately inform the service delivery needs for specific jurisdictions. A new study shows that 1,711, or 1 in 94, school age children in the Calgary region have an ASD diagnosis. As this number matches what is often reported for the national prevalence of ASD, it suggests that Alberta’s relatively higher ASD funding is not inducing in-migration of families seeking better support. The data also show that the prevalence is higher in elementary-grade children, with a diagnosis in one of every 86 children. In the senior grades, there are significantly fewer students with ASD diagnoses, specifically within the Calgary Board of Education. There is no evident reason for diagnoses to seemingly dematerialize in the older grades. These students could be dropping out or choosing home-schooling in greater numbers. Possibly there has been an increase in prevalence. These prevalence estimates help to inform the demand for special-needs services within the local school system. In addition, there is growing concern that upon graduation there is a “support cliff” resulting from a less systematized, less generous support system available for adults with neurodevelopmental disability. Families that need support for ASD face enough challenges; it is critical for policy-makers to be aware of the extent of the situation in their own jurisdiction so as to develop the right kinds of supports for these families

Transganglionic transport of HRP from the circumvallate papilla of the rat

To learn whether horseradish peroxidase (HRP) injections in gustatory papillae on the tongue can be used to study central topographical projections of taste buds and papillae, injections were made into the circumvallate papilla in rats. Labeled central projections after papilla injections were compared to projections after applying HRP to the cut glossopharyngeal nerve. Papilla injections result in HRP transport by afferent and efferent fibers of the glossopharyngeal nerve, and the pattern of central projections is similar to that after labeling the cut nerve. Projections include a separation in the brainstem of afferent, dorsally located fibers and efferent, ventrally located fibers. Afferent fibers project to the solitary nucleus and the trigeminal system. Efferent projections label muscle motorneurons in the nucleus ambiguus and the cells of origin of parasympathetic preganglionic fibers, which form the inferior salivatory nucleus. The parasympathetic neurons labeled after papilla projections are preganglionic fibers to Remak's ganglia in the tongue; postganglionic fibers of these ganglia are the secretomotor supply to the von Ebner's glands. In summary, injections of HRP into gustatory papillae reliably label central projections of the papilla and can be used for studies to discern topography in central projections of the taste system. Injections into the circumvallate papilla also have demonstrated that the parasympathetic neurons innervating von Ebner's glands are located in the inferior salivatory nucleus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25463/1/0000001.pd