Open Access. Powered by Scholars. Published by Universities.®

Digital Commons Network

Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences

Western University

Keyword
Publication Year
Publication
Publication Type
File Type

Articles 1141 - 1170 of 1210

Full-Text Articles in Entire DC Network

A Mi'kmaq First Nation Cosmology: Investigating The Practice Of Contemporary Aboriginal Traditional Medicine In Dialogue With Counselling – Toward An Indigenous Therapeutics, Kisiku Sa'qawei Paq'tism Randolph Bowers Sep 2010

A Mi'kmaq First Nation Cosmology: Investigating The Practice Of Contemporary Aboriginal Traditional Medicine In Dialogue With Counselling – Toward An Indigenous Therapeutics, Kisiku Sa'qawei Paq'tism Randolph Bowers

Aboriginal Policy Research Consortium International (APRCi)

This paper explores from a Mi’kmaq and Aboriginal standpoint foundational knowledge in Indigenous therapeutics. Based on an eco-social-psycho-spiritual way of working, the article proposes Indigenous cultural models that open a window to a rich cultural repository of meanings associated with Indigenous cosmology, ontology and epistemology. The three layers of meaning, theory and practice within the symbolic ‘Medicine Lodge’ or ‘Place of The Dreaming’ give rise to ways of working that are deeply integrative and wholistic. These forms of Indigenous theory and practice have much to offer the counselling and complimentary health professions.


Multiple Mechanisms Of Consciousness: The Neural Correlates Of Emotional Awareness., Jayna M Amting, Steven G Greening, Derek G V Mitchell Jul 2010

Multiple Mechanisms Of Consciousness: The Neural Correlates Of Emotional Awareness., Jayna M Amting, Steven G Greening, Derek G V Mitchell

Brain and Mind Institute Researchers' Publications

Emotional stimuli, including facial expressions, are thought to gain rapid and privileged access to processing resources in the brain. Despite this access, we are conscious of only a fraction of the myriad of emotion-related cues we face everyday. It remains unclear, therefore, what the relationship is between activity in neural regions associated with emotional representation and the phenomenological experience of emotional awareness. We used functional magnetic resonance imaging and binocular rivalry to delineate the neural correlates of awareness of conflicting emotional expressions in humans. Behaviorally, fearful faces were significantly more likely to be perceived than disgusted or neutral faces. Functionally, …


Deficits In Attention To Emotional Stimuli Distinguish Youth With Severe Mood Dysregulation From Youth With Bipolar Disorder., Brendan A Rich, Melissa A Brotman, Daniel P Dickstein, Derek G V Mitchell, R James R Blair, Ellen Leibenluft Jul 2010

Deficits In Attention To Emotional Stimuli Distinguish Youth With Severe Mood Dysregulation From Youth With Bipolar Disorder., Brendan A Rich, Melissa A Brotman, Daniel P Dickstein, Derek G V Mitchell, R James R Blair, Ellen Leibenluft

Brain and Mind Institute Researchers' Publications

Studying attention in the context of emotional stimuli may aid in differentiating pediatric bipolar disorder (BD) from severe mood dysregulation (SMD). SMD is characterized by chronic irritability, arousal, and hyper-reactivity; SMD youth frequently receive a BD diagnosis although they do not meet DSM-IV criteria for BD because they lack manic episodes. We compared 57 BD (14.4 +/- 2.9 years old, 56% male), 41 SMD (12.6 +/- 2.6 years old, 66% male), and 33 control subjects (13.7 +/- 2.5 years old, 52% male) using the Emotional Interrupt task, which examines how attention is impacted by positive, negative, or neutral distracters. We …


Gender, Germs, And Dirt: A Case Study Of Properly Politicised Science, Sharyn Clough Jun 2010

Gender, Germs, And Dirt: A Case Study Of Properly Politicised Science, Sharyn Clough

XIV IAPh Symposium 2010

This presentation is part of the Feminist Perspectives in the Sciences: Epidemiology track.

The relatively recent increase in cases of allergies and asthma, especially in industrialised nations of the north and west, has been explained by the “hygiene hypothesis”—viz., that increased cleanliness and sanitation have unintended negative consequences for immune health—an hypothesis that has received robust epidemiological support (e.g., Platts-Mills 2002). Over the last few years, support for the hypothesis has increased with the discovery that populations regularly exposed to certain parasitic worms (helminths) have very low incidence of chronic inflammatory diseases such as Crohn’s (Elliot, Summers, and Weinstock 2007). …


Serum Lipids And Suicidality In Early Psychosis: Is There A Connection? A Preliminary Study, Amresh Srivastava, Megan Johnston, Lenore Purde, Robbie Campbell May 2010

Serum Lipids And Suicidality In Early Psychosis: Is There A Connection? A Preliminary Study, Amresh Srivastava, Megan Johnston, Lenore Purde, Robbie Campbell

Psychiatry Presentations

No abstract provided.


Physical Function During Performance-Based Tasks And Throughout Daily Life. Is It Different Across Levels Of Frailty?, Olga Theou Apr 2010

Physical Function During Performance-Based Tasks And Throughout Daily Life. Is It Different Across Levels Of Frailty?, Olga Theou

Electronic Thesis and Dissertation Repository

The overall aim of this thesis was to provide a more focused understanding about the physical function of older women across levels of frailty. The specific aims were: 1) Examine the physical function of older women across levels of frailty during performance-based tasks and throughout their normal daily life; and 2) Review the effectiveness of current exercise interventions for the management of frailty. To answer these aims an observational study of community-dwelling older women (63-100 years) from rural Greece and a comprehensive systematic review on the impact of exercise on frail older adults were conducted. The performance-based measures that had …


Hip Fracture Types In Men And Women Change Differently With Age, David A. Tanner, Marita Kloseck, Richard G. Crilly, Bert Chesworth, Jason Gilliland Mar 2010

Hip Fracture Types In Men And Women Change Differently With Age, David A. Tanner, Marita Kloseck, Richard G. Crilly, Bert Chesworth, Jason Gilliland

Health Studies Publications

BACKGROUND: Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. METHODS: …


Dual-Task Interference: The Effects Of Verbal Cognitive Tasks On Upright Postural Stability In Parkinson's Disease, J. D. Holmes, M. E. Jenkins, Andrew M. Johnson, S. G. Adams, S. J. Spaulding Feb 2010

Dual-Task Interference: The Effects Of Verbal Cognitive Tasks On Upright Postural Stability In Parkinson's Disease, J. D. Holmes, M. E. Jenkins, Andrew M. Johnson, S. G. Adams, S. J. Spaulding

Occupational Therapy Publications

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinson's disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinson's disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinson's disease demonstrated significantly reduced …


Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy Jan 2010

Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Psychiatry Presentations

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response

▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai

▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years

▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, …


Chronic Renal Disease Is More Prevalent In Patients With Hemolytic Uremic Syndrome Who Had A Positive History Of Diarrhea, Ajay P. Sharma, Guido Filler, Prabo Dwight, William F. Clark Jan 2010

Chronic Renal Disease Is More Prevalent In Patients With Hemolytic Uremic Syndrome Who Had A Positive History Of Diarrhea, Ajay P. Sharma, Guido Filler, Prabo Dwight, William F. Clark

Paediatrics Publications

Many uncontrolled studies and a subsequent meta-analysis suggest that hemolytic uremic syndrome (HUS) with a positive history for diarrhea is associated with a significant increase in chronic renal disease. Two recent controlled studies that followed children with this type of HUS after Escherichia coli O157:H7 outbreaks, and where the controls were selected from a group exposed in the outbreak, gave conflicting results. To clarify this apparent difference, we retrospectively compared a cohort of 30 children with sporadic diarrhea-positive HUS with 30 healthy controls who had no history of bloody diarrhea or HUS and who had similar age and gender. Significantly …


Hiv Testing Experiences Of Aboriginal Youth In Canada: Service Implications, Catherine Worthington, Randy Jackson, Judy Mill, Tracey Prentice, Ted Myers, Susan Sommerfeldt Jan 2010

Hiv Testing Experiences Of Aboriginal Youth In Canada: Service Implications, Catherine Worthington, Randy Jackson, Judy Mill, Tracey Prentice, Ted Myers, Susan Sommerfeldt

Aboriginal Policy Research Consortium International (APRCi)

The objective of this study was to explore HIV testing experiences and service views of Canadian Aboriginal youth in order to provide information for HIV testing services. An exploratory, mixed-method, community-based research design was used for this study. Findings reported here are from 210 survey participants who had experienced an HIV test. Youth were recruited through 11 Aboriginal organizations across Canada, including AIDS service organizations, health centers, community organizations, and friendship centers. Youth who had tested for HIV ranged in age from 15 to 30 years of age (20% were B20), and came from First Nations (75%), Me ́ tis …


Harm Or Mere Inconvenience? Denying Women Emergency Contraception, Carolyn Mcleod Jan 2010

Harm Or Mere Inconvenience? Denying Women Emergency Contraception, Carolyn Mcleod

Philosophy Publications

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.


Tobacco Use And Women’S Health: An Opportunity In International Health Promotion And A Case Study Of Tobacco Policy In Canada, Hoda Malakouti-Nejad Jan 2010

Tobacco Use And Women’S Health: An Opportunity In International Health Promotion And A Case Study Of Tobacco Policy In Canada, Hoda Malakouti-Nejad

Essay Contest 2000 - 2015

Increasing numbers of girls and women are using tobacco worldwide. As a marginalized population, women are targeted for the sale of tobacco products and social structures are organized in a manner that increases their tobacco usage. Furthermore, as a result of their anatomy and physiology, women experience greater health problems than their male counterparts when consuming the same amount of tobacco. Tobacco usage among women must be addressed globally through the lens of health promotion. Health can be increased for women, and in turn, the entire population by taking policy measures to address the issue of tobacco usage. This paper …


Uwomj Volume 79, Issue 1, Spring 2010, Western University Jan 2010

Uwomj Volume 79, Issue 1, Spring 2010, Western University

University of Western Ontario Medical Journal

Schulich School of Medicine & Dentistry


Exercise Prescription For Osteoporosis, Lora Giangregorio Jan 2010

Exercise Prescription For Osteoporosis, Lora Giangregorio

Canadian Centre for Activity and Aging Presentations

No abstract provided.


Reduced Expression Of Mir15a In The Blood Of Patients With Oral Squamous Cell Carcinoma Is Associated With Tumor Staging, Joao Artur Ricieri Brito, Carolina Cavalieri Gomes, Flavio Juliano Garcia Santos Pimenta, Alvimar Afonso Barbosa, Marco A. M. Prado, Vania F. Prado, Marcus Vinicius Gomez, Ricardo Santiago Gomez Jan 2010

Reduced Expression Of Mir15a In The Blood Of Patients With Oral Squamous Cell Carcinoma Is Associated With Tumor Staging, Joao Artur Ricieri Brito, Carolina Cavalieri Gomes, Flavio Juliano Garcia Santos Pimenta, Alvimar Afonso Barbosa, Marco A. M. Prado, Vania F. Prado, Marcus Vinicius Gomez, Ricardo Santiago Gomez

Anatomy and Cell Biology Publications

MicroRNAs (miRNAs) mirl 5a and let7a are iMportant regulators of bcl-2, ras and c-myc proteins Considering that these miRNAs are commonly altered in many human cancers and that these proteins are reported to be altered in oral squamous cell carcinoma (OSCC), we investigated them in a set of OSCC cases 'I he miRNAs as well as the proteins were evaluated in the tumor and blood of 20 patients by real-time quantitative PCR and iMmunohistochemistry, respectively The expression of nfirl5a and bcl-2 proteins in the tumors was not associated with each other or with tumor staging On the other hand, we …


Description Of Exercise Participation Of Adolescents With Cerebral Palsy Across A 4-Year Period., Laura K Brunton, Doreen J Bartlett Jan 2010

Description Of Exercise Participation Of Adolescents With Cerebral Palsy Across A 4-Year Period., Laura K Brunton, Doreen J Bartlett

Physical Therapy Publications

Purpose: The primary purposes were to describe: 1) the types of exercise participation of adolescents with cerebral palsy (CP), 2) the weekly duration of stretching, strengthening, and cardiovascular exercise, and 3) how the level of activity compares to national health guidelines.

Methods: Participants were 126 males and 104 females (14.7, SD =1.7 years) who reported on the physical activities in the previous week using a questionnaire designed for this study. Analyses comprised frequency counts and proportions, stacked bar graphs and 2-way ANOVAs of exercise participation by GMFCS and gender.

Results: There was a significant interaction of GMFCS level and gender …


Survivors On The Edge: The Lived-Experience Of Professional Musicians With Playing-Related Injuries, Christine A. Guptill Jan 2010

Survivors On The Edge: The Lived-Experience Of Professional Musicians With Playing-Related Injuries, Christine A. Guptill

Digitized Theses

The purpose of this study was to understand the lived-experience of professional instrumental musicians who have experienced playing-related injuries. This study used a hermeneutic phenomenological methodology developed to examine this lived-experience. In-depth interviews were conducted with ten professional musicians. This was followed by a focus group where preliminary findings were presented to participants and their feedback was sought. Other sources of lived-experience included participant-observation by the researcher, who is a musician and has experienced injuries; and biographic and artistic representations of musical performance and its loss, including literature, films and television.

The findings were summarized in a visual representation unique …


Resting State Default-Mode Network Connectivity In Early Depression Using A Seed Region-Of-Interest Analysis: Decreased Connectivity With Caudate Nucleus., Robyn Bluhm, Peter Williamson, Ruth Lanius, Jean Theberge, Maria Densmore, Robert Bartha, Richard Neufeld, Elizabeth Osuch Dec 2009

Resting State Default-Mode Network Connectivity In Early Depression Using A Seed Region-Of-Interest Analysis: Decreased Connectivity With Caudate Nucleus., Robyn Bluhm, Peter Williamson, Ruth Lanius, Jean Theberge, Maria Densmore, Robert Bartha, Richard Neufeld, Elizabeth Osuch

Department of Medicine Publications

AIM: Reports on resting brain activity in healthy controls have described a default-mode network (DMN) and important differences in DMN connectivity have emerged for several psychiatric conditions. No study to date, however, has investigated resting-state DMN in relatively early depression before years of medication treatment. The objective of the present study was, therefore, to investigate the DMN in patients seeking help from specialized mental health services for the first time for symptoms of depression.

METHODS: Fourteen depressed subjects and 15 matched controls were scanned using 4-T functional magnetic resonance imaging while resting with eyes closed. All but one subject was …


Early Psychosis: A Novel Gateway For Suicide Prevention, Amresh Srivastava Oct 2009

Early Psychosis: A Novel Gateway For Suicide Prevention, Amresh Srivastava

Psychiatry Presentations

No abstract provided.


What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet Oct 2009

What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet

Oncology Presentations

Management of patients who have disease relapse after completion of surgery and adjuvant chemo-radiation (CRT) is controversial.

Some oncologists would advocate intensive therapeutic intervention due to promising experience on treatment for recurrence disease while others would recommend palliative support due to the concerns for poor patient outcome post disease recurrence.

In Addition, it is not clear if patient outcome is improved post adjuvant CRT when patients at risk have resection margin involvement and if time interval to recurrence can affect patient survival post relapse.

The present study was conducted to determine what factors will affect patient outcome at relapse after …


Should Schizoaffective Disorder Be Dropped From Dsm V, Amresh Srivastava Aug 2009

Should Schizoaffective Disorder Be Dropped From Dsm V, Amresh Srivastava

Psychiatry Presentations

No abstract provided.


Post-Traumatic Stress Disorder And Health Problems Among Medically Ill Canadian Peacekeeping Veterans, Don Richardson, Jordan Pekevski, Jon D Elhai Jul 2009

Post-Traumatic Stress Disorder And Health Problems Among Medically Ill Canadian Peacekeeping Veterans, Don Richardson, Jordan Pekevski, Jon D Elhai

MacDonald Franklin OSI Research Centre

OBJECTIVE:

The aim of the present study was to examine the relationship between post-traumatic stress disorder (PTSD) symptom severity and four significant health conditions (gastrointestinal disorders, musculoskeletal problems, headaches, and cardiovascular problems).

METHOD:

Participants included 707 Canadian peacekeeping veterans with service-related disabilities, from a random, national Canadian survey, who had been deployed overseas.

RESULTS:

PTSD severity was significantly related to gastrointestinal disorders, musculoskeletal problems, and headaches, but not to cardiovascular problems. Controlling for demographic factors did not affect PTSD's relationships with the three significant health conditions.

CONCLUSIONS:

The present study supports previous work in finding consistent relations between PTSD severity …


Selecting Antidepressant Drugs For Management Of Depression In Primary Care (Part 1), Amresh Srivastava Jun 2009

Selecting Antidepressant Drugs For Management Of Depression In Primary Care (Part 1), Amresh Srivastava

Psychiatry Presentations

No abstract provided.


The Determinants Of First Nation And Inuit Health: A Critical Population Health Approach, Chantelle A.M. Richmond, Nancy A. Ross Jun 2009

The Determinants Of First Nation And Inuit Health: A Critical Population Health Approach, Chantelle A.M. Richmond, Nancy A. Ross

Aboriginal Policy Research Consortium International (APRCi)

Environmental dispossession disproportionately affects the health of Canada’s Aboriginal population, yet little is known about how its effects are sustained over time. We use a critical population health approach to explore the determinants of health in rural and remote First Nation and Inuit communities, and to conceptualize the pathways by which environmental dispossession affects these health determinants. We draw from narrative analysis of interviews with 26 Community Health Representa- tives (CHRs) from First Nation and Inuit communities across Canada. CHRs identified six health determinants: balance, life control, education, material resources, social resources, and environmental/ cultural connections. CHRs articulated the role …


Physical Activity Levels Of Older Community-Dwelling Adults Are Influenced By Summer Weather Variables, Caitlin A. Brandon, Dawn P. Gill, Mark Speechley, Jason Gilliland, Gareth R. Jones Apr 2009

Physical Activity Levels Of Older Community-Dwelling Adults Are Influenced By Summer Weather Variables, Caitlin A. Brandon, Dawn P. Gill, Mark Speechley, Jason Gilliland, Gareth R. Jones

Geography & Environment Publications

Adequate daily physical activity (PA) is important for maintaining functional capacity and independence in older adults. However, most older adults in Canada do not engage in enough PA to sustain fitness and functional independence. Environmental influences, such as warmer daytime temperatures, may influence PA participation; however, few studies have examined the effect of summertime temperatures on PA levels in older adults. This investigation measured the influence of summertime weather variables on PA in 48 community-dwelling older adults who were randomly recruited from a local seniors’ community centre. Each participant wore an accelerometer for a single 7-consecutive-day period (between 30 May …


Predictors Of Likelihood And Intensity Of Past-Year Mental Health Service Use In An Active Canadian Military Sample, Deniz Fikretoglu, Jon D Elhai, Aihua Liu, Don Richardson, David J. Pedlar Mar 2009

Predictors Of Likelihood And Intensity Of Past-Year Mental Health Service Use In An Active Canadian Military Sample, Deniz Fikretoglu, Jon D Elhai, Aihua Liu, Don Richardson, David J. Pedlar

MacDonald Franklin OSI Research Centre

Objective:
This study examined associations between sociodemographic, military, and psychiatric need variables and past-year mental health service use among active Canadian military members. The likelihood and intensity of services were examined across two provider types— mental health providers and medical providers.
Methods: Data were drawn from the first epidemiological survey of mental health in the Canadian Forces, conducted by Statistics Canada in 2002. Survey instruments included the Composite International Diagnostic Interview, which was used to assess mental health and service use.
Results: Of the 8,441 military members who participated in the survey, 14.5% (N=1,220) met criteria for having a mental …


The Influence Of The Physical Environment And Sociodemographic Characteristics On Children's Mode Of Travel To And From School, Kristian Larsen, Jason Gilliland, Peter Hess, Patricia Tucker, Jennifer Irwin, Meizi He Mar 2009

The Influence Of The Physical Environment And Sociodemographic Characteristics On Children's Mode Of Travel To And From School, Kristian Larsen, Jason Gilliland, Peter Hess, Patricia Tucker, Jennifer Irwin, Meizi He

Geography & Environment Publications

Objectives: We examined whether certain characteristics of the social and physical environment influence a child's mode of travel between home and school.

Methods: Students aged 11 to 13 years from 21 schools throughout London, Ontario, answered questions from a travel behavior survey. A geographic information system linked survey responses for 614 students who lived within 1 mile of school to data on social and physical characteristics of environments around the home and school. Logistic regression analysis was used to test the influence of environmental factors on mode of travel (motorized vs "active") to and from school.

Results: Over 62% of …


Uwomj Volume 78, Issue 3, Western University Jan 2009

Uwomj Volume 78, Issue 3, Western University

University of Western Ontario Medical Journal

Schulich School of Medicine & Dentistry


First Episode Is The Best Episode: Lessons And Limitations In Duration Of Untreated Psychosis (Dup) And Outcome In Schizophrenia, Amresh Srivastava, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy, Nilesh Shah Jan 2009

First Episode Is The Best Episode: Lessons And Limitations In Duration Of Untreated Psychosis (Dup) And Outcome In Schizophrenia, Amresh Srivastava, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy, Nilesh Shah

Psychiatry Presentations

Background: Early intervention in psychosis is an opportunity. Research ahs shown that if any thing community members can do to prevent psychosis is to report early. This has opened newer vistas for understanding the complexity of brain and behaviour in schizophrenia. At the same time it has raised the bar of expectations regarding its correlation to outcome. It finally narrows down to meaningful public campaign for awareness, which will decide success of research to clinics in schizophrenia management. Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome and provides credence to development of early intervention services. …