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Allicrombie's's Gamespot Rank
Allicrombie's Emblems
+1 Orator of Distinction
Because while everybody's got an opinion, some are better than others. This illustrious soul has volunteered to grace GameSpot's pages with an unforgettable editorial. It's the very definition of selflessness. Or, in some cases, self-indulgence.
Top 100 Community Reviewers
Power and influence. Those who rank amongst this hallowed 100 greatly benefit those searching for critical information about games. These individuals' thoughtful, analytical reviews tend to be much more detailed and sophisticated than most of the so-called professional game reviews you could find elsewhere. Sure enough, the top 100 tend to be prolific writers and avid game players.
Readers' Choice 2005 Chooser
Voted in 2005 Readers' Choice Awards.Administered to those who sounded off in GameSpot's 10th-annual Readers' Choice Awards, celebrating the best games of 2005.
Vote Rocker
For exercising one's inalienable right to vote. Rock on!
Love Song Writer
For creating song lyrics about Valentine's Day at the drop of a pin. These talented souls contributed in a Valentine Song Writing Contest!
Voted Twice
For exercising one's inalienable right to vote. Not once, but TWICE! Rock on!
Tagger Flirt
Tagger Flirt Awarded to those who've had a brush with the tagging system, enabling themselves and others to make it a wee bit easier to find certain content.
I voted
For casting your vote, here's a brand-new emblem to add to your collection. By exercising your right to vote, you've contributed to the site by letting the whole world know about what GameSpot readers really think. Make your voice heard! Vote early and vote often!
Moderator of the Month
"I would like to thank the Academy..." This moderator has been voted among our best and brightest by his or her peers, and also performed fabulously in the swimsuit competition. Lavish your affection upon this upright individual, for your community experience is enhanced by the devotion, the passion, and the mountain-fresh scent of the mod of the month.
Tolkien's Token
One broadcast to rule them all. For watching the Lord of the Rings Online live marathon with Kevin VanOrd.
Look at what we have here... Unlike real world scavengers, these players find and consume tokens. This emblem is awarded for completing the first Scavenator game on GameSpot.
I'll take "All Your Base Are Belong To Us" for $600, Rich. This user demonstrated vast gaming knowledge by participating in Brain Bust, GameSpot's first trivia challenge. And knowing is half the battle!
Virtually There: E3 2007 Nintendo Conference
Virtually There: E3 2007 Nintendo Conference. Awarded for waking up early/ditching work to tune into GameSpot's live broadcast of the E3 2007 Nintendo press conference on Wednesday, July 11.
Virtually There: E3 2007 Sony Conference.
Virtually There: E3 2007 Sony Conference. Awarded for skipping lunch to tune into GameSpot's live broadcast of the E3 2007 Sony press conference on Wednesday, July 11.
Virtually There: E3 2007 GameSpot Show Addict
Thank you, sir, may I have another? Like Lay's potato chips, these viewers couldn't just have one day of GameSpot's live stage show at E3 2007.
Player's Ball
It's a treat when famous players meet. This person did it real big with GameSpot and got wild on a Tuesday night at the GameSpot Players' Ball. Whether you saw the action from the confines of your own home or, like a true cross-country mack, stepped out into the spotlight with us live and in person, we sincerely appreciate it. If we could give you all a ride in our snotty-nosed ham sandwich with the brains blown, we totally would. That's a car, by the way.
Readers' Choice 2007 Chooser
Official Participant in 2007 Readers' Choice Awards. In a year that could only be rivaled by 1998, this user made their voice heard in GameSpot's 12th-annual Readers' Choice Awards. . . Now known as "Best of."
Fear the Reaper
What does this button do? Bearers of this emblem managed to complete the Scavenator session of September '07 with some impressive times. Live long and scavenate!
Interactive Achievement Awards 2007
Live, from Vegas, It's Thursday Night! These users tuned in to watch the 11th-annual Interactive Achievement Awards broadcast live in 2008. That Jay Mohr guy looks really familiar.
Brain Bust 2
Totally Gangster From Liberty City to San Andreas, this user competed in GameSpot's GTA-themed trivia tournament. If you think you know GTA, chances are, this person knows it better than you do . . . or lives in the right place to participate.
Ticket Holder
I Wanna Rock This user tuned in for the live broadcast of the Guitar Hero III tournament. Whether they love to watch tournaments or they can't get enough rock, we may never know.
Virtually There: E3 2008 The Big Three Conferences
Virtually There: E3 2008 The Big Three Conferences For tuning into GameSpot's E3 2008 live broadcast of all three of the manufacturer press conferences (Sony, Nintendo, and Microsoft) on July 14-15. That's dedication.
Virtually There: E3 2008 GameSpot Show Future Outlaw
Hey Louie, the man is dry. Give him one on the house, OK? These special viewers caught all three days of GameSpot's live stage show at E3 2008. They braved the good and saw the best to be the straightest shooters around. This emblem is on the house.
The Dread Hallowiener
Beware the telltale ketchup trail, of weapons you may not avail, the fear casts every face in pale, the Hallowiener comes. There is no appeasing the sausage king, in lederhosen he will bring, terror and out the screams will ring, the Hallowiener comes! So lock yourselves inside a room, while just outside his specter looms, that meaty scent which spells your doom, the Hallowiener comes.
Gears of War 2 Marathon
It's a bloodbath out there. Proud recipients of this emblem immersed themselves in our Gears of War 2 gameplay marathon. The rubber duckie was optional.
Animal Crossing City Folk Live Gameplay Marathon
Tom Nook's Still a Crook! This faithful person joined us for our live gameplay marathon of Animal Crossing City Folk. We dug up fossils together, fished together, and delighted in all things Animal Crossing.
PoP-o-Matic Emblem
You're not my donkey Like a hand-drawn helper, these users reached out and helped the prince to have an audience for his big gameplay marathon debut.
Delicious Thanksgiving
What's tastier than a GameSpot Thanksgiving? Nothing, that's what! This emblem signifies a user who consumed our content, helped vote for contest winners, and is still suffering from a turkey coma to this day.
Readers' Choice 2008 Chooser
Participant in 2008 Readers' Choice Awards. This user was caught spray painting GameSpot's wall! Or, maybe he/she voted in GameSpot's 13th-annual Readers' Choice Awards known as Best of 2008.
Game Developers Conference 2009
Virtually There: Game Developers Conference 2009. For watching GameSpot's live broadcast of the OnLive press conference at GDC 2009 and discussing this new technology in comments or in live chat.
Game Night 2009 Celebration
FIRST in 2009! Participants in our first game night of 2009 were able to defeat zombies in Left 4 Dead or they picked some zombie brains in the game night 2009 celebration trivia.
Webby Awards People's Voice 2009 Voter
It's all because of you. No, really! Thanks to you, the community, GameSpot took home the 2009 People's Voice Webby Award for Best Games-Related Website. Take that, Internet!
Remarkable Member
GameSpot stamped me as remarkable! GameSpot members who frequently contribute to the site are remarkable! Those featured in the member spotlight are hand picked. Hats off to borninvincible for creating the emblem.
Virtually There: E3 2009 Day 1
In the future, robots have come to dominate humankind. These users tuned in to Day 1 of GameSpot's E3 2009 coverage. They loudly proclaimed, "Show me the future...of gaming!"
Virtually There: E3 2009 Day 2
The great rebellion of human vs robot has begun! These users tuned in to Day 2 of GameSpot's E3 2009 coverage. They've seen glimpses of their gaming future, but they know the battle has only just begun.
Virtually There: E3 2009 Day 3
Humans have triumphed against robots, but it seems we are the greatest monsters of all. These users tuned in to Day 3 of GameSpot's E3 2009 coverage. They've seen their entire gaming future revealed before their eyes...but the long wait to play those games might drive them mad!
Virtually There: E3 2009 Sony Conference
Virtually There: E3 2009 Sony Conference For tuning into GameSpot's live broadcast of the E3 2009 Sony press conference on Tuesday, June 2.
Virtually There: E3 2009 Nintendo Conference
Virtually There: E3 2009 Nintendo Conference For tuning into GameSpot's live broadcast of the E3 2009 Nintendo press conference on Tuesday, June 2.
Virtually There: E3 2009 Microsoft Conference
Virtually There: E3 2009 Microsoft Conference For tuning into GameSpot's live broadcast of the E3 2009 Microsoft press conference on Monday, June 1.
First espisode of TOTS!
What? OTS is evolving! OTS evolved into TOTS! This savvy user watched the first episode of our newly transformed On the Spot show called Today On the Spot; short for TOTS.
Greatest Game Hero Preliminary Voter
This emblem shows that you got into GameSpot's Greatest Game Hero competition on the ground floor by voting for the 10 additional characters added to the main list. Rock the vote!
Greatest Game Hero Bracket Submitter
This emblem shows that you've submitted a bracket for GameSpot's Greatest Game Hero competition. Let's get in there and fight!
Readers' Choice 2009 Chooser
Participant in 2009 Readers' Choice Awards. "Sure, that game is good... FOR BABIES!" "That game sucks! It doesn't even have online capture the flag!" "Barbie Horse Adventure: Riding Camp just lost so much of the magic that made Barbie Horse Adventure great." And so on. These intrepid readers braved the chaos of the Readers' Choice process and let their opinions be heard above the cacophony of argumentative commenters. Congratulations, voters!
Box Art Aficionados
Saving the game boxes from extinction! Box Art Aficionados remember when games only came in boxes. To celebrate packaging while we can, this GameSpot member participates in a monthly activity in the General Games Discussion board called Box Art Hunt!
Game Developers Conference 2010
Virtually There: Game Developers Conference 2010. 'cause you were totally there, but not really. Emblem holders watched and discussed at least 1 of 4 GameSpot GDC shows.
Game Night 2010 Celebration
FIRST in 2010! Participants in our first game night of 2010 were able to frag other GameSpotters in Quake Live on Saint Patrick's day or they picked some Quake Brains by participating in the game night 2010 celebration trivia.
Valentine's Day Workshop
Read it and weep! Beware of these GameSpotters who spawned Hallmark moments with their creative Valentine's Day e-cards. Those who participated in creating Valentine's Day e-cards were both naughty and nice, and they certainly aren't afraid to share their feelings with other GameSpotters!
April Fools!
You've been spazzed!! You participated in an epic 2010 April Fools joke hosted in GameSpot's Off-Topic forum, involving two moderators spazzx625 & solidruss, whether you thought this prank rocked, or you thought it sucked rocks, you were still involved in the prank of the century! April Fools!
Game Expert
Here to save the day! Game Experts are knowledgeable and skilled masters in at least one game and have proven this by unlocking at least 75% of the achievements available for it. If you've ever got a question, a Game Expert's usually a good person to ask.
100% Club Member
The best of the best of the best, sir! Unlocking every achievement available for a game is a task that only the most dedicated of players complete, and for that we salute you.
E3 2010 Microsoft Conference Attendee
I was there for Microsoft's E3 2010 press conference! No really, I was. I even saw it live, with the Kinects and the Halos, and I've got this sweet achievement to prove it!
E3 2010 Nintendo Conference Attendee
I was there for Nintendo's E3 2010 press conference! No really, I was. I even saw it live, with the 3DSs and the Metroids, and I've got this sweet achievement to prove it!
E3 2010 Sony Conference Attendee
I was there for Sony's E3 2010 press conference! No really, I was. I even saw it live, with the Moves and the Killzones, and I've got this sweet achievement to prove it!
E3 2010 Box Seats
An undiscriminating press conference viewer. These GameSpot members couldn't get enough of the sales recaps and the new game announcements of the E3 press conferences, and so they watched them all live (and not just the big three either)!
E3 2010 Early Bird
Stays up late--sometimes! These GameSpot members tuned in to a live episode of Tonight on the Spot during E3 2010 to catch some of LA's nightlife.
E3 2010 Night Owl
Because sleep is for the weak. These GameSpot members couldn't get enough of the E3 nightlife and watched three episodes of Tonight on the Spot live.
E3 2010 Groupie
We built it and you came. The GameSpot E3 stage show is where it's at, and these members proved it by showing up for one day of our live broadcast.
E3 2010 Roadie
The world's best roadie, and E3's only hope. These dedicated GameSpot members watched all three days of the E3 2010 stage show live, proving that metal never dies.
E3 2010 Tourist
You're a tourist. I saw you at E3. These GameSpot members joined us live for a day as we crawled the E3 show floor with our interactive LiveCam Tour.
E3 2010 Vacationer
Virtually there the whole time. For these GameSpot members, it wasn't enough to see E3--they had to experience it live. With the LiveCam Tour, they were able to do just that for three whole days!
E3 2010 Special Agent
Please, just call me York. That's what everyone calls me. These insatiable GameSpot members saw every press conference, caught three episodes of Tonight on the Spot, and were there for all three days of the LiveCam Tour and E3 Stage Show when they were all live! They're true heroes, right, Zach?
E3 2010 Ballot Stuffer
Because voting once is never enough. These highly dedicated fans led their own successful grassroots campaign of one and voted in every single category of the Best of E3 2010 Awards.
Greatest Game Villain Henchman
Hey, everyone's got to start somewhere. These loyal minions created a bracket to guess at who is the most vile of them all. Let's hope they don't get caught betting against their overlords!
Mind Readers
Imagining that thou hast discovered a name - thou art a mind reader. In celebration of Halloween, this GameSpot member participated in a celebrity costume guessing game held in the Off-Topic forum!
Mwahahaha! From the dark places at the back of your fridge creeps forth this monster! FrankenTOTS! Thought you'd grab a quick bite while gaming? Well this tater has gone bad. REAL bad. Snack away if you dare! Don't worry that red stuff all over him is probably ketchup. Probably.
The Now Playing Kinector. For watching and discussing GameSpot's Now Playing Kinect marathon nearly a week before it was released!
Best of 2010 Readers' Choice Chooser
Participant in the 2010 Readers' Choice awards. Voting in only a handful of categories is for babies--babies who won't get this achievement! These dedicated not-infants voted in 80% of available categories like a grown-up.
Best of 2010 Word Spreader
Harnessing social currency to drive buzz. These users shared how they voted with their friends on Twitter or Facebook, amplifying the social experience with relevant and engaging content.
Best of 2010 Dark Horse Rider
Underdogs don't always win. That's why they're underdogs. This user voted on every category, and their choices more often than not were not the Readers' Choice winners. They chose...poorly.
Holiday Hunter
They know when we're sleeping, they know when we're awake. This GameSpot member participated in the 2010 Ornament Scavenger hunt, and checked it twice to see which staff are naughty or nice; combining Yuletide cheer with predatory stalking. Frankly, we're quite scared. GameSpot editorial and video staff who posted the holiday blogs also received the achievement. Happy Holidays!
Caught LIVE! These brave viewers watched and discussed the April Fools' Day 2011 episodes of On the Spot, Start/Select, and Crosshairs. Were they fooled? Hard to say. But we thank them for their viewership anyway! As a reward, here is a picture of an ultimate joker face, who is edible. Meet Mr. JokerTOTS!
Forum Pranks of 2011!
Stalking, Seduction & Name Calling! You participated in GameSpot's 2011 April Fools forum pranks involving an obsessive prank account stalking JodyR, and the GameSpot forum names changes. GabuEx was the driver of this prank account, and we think he made the prank believable! As for the forum name changes, we had Seduce the Mods (Ask the Mods), Mac & Cheese (PC forum), General Lack of Interest (GGD), Zoo Wars (SW), Long-gone Platforms (Legacy), and On-Topic - Religion, Dating, Politics, Proselytizing, Shopping (OT). Happy April Fool's!
Mr Riddles
Riddle me this! Mr. Riddles was no match for you. You managed to correctly deduce his curious conundrums and quizzical questions in the GameSpot Answers challenge!
Portal Kombat
FIRST in 2011! Participants and viewers who discussed our first 2011 game night webcast had the chance to play Mortal Kombat with GameSpot staff, for the most part. Since the PSN debacle occurred during this time we also offered a Mortal Kombat trivia for those who wanted to celebrate the return of game nights for the year!
E3 2011 Microsoft Conference Attendee
E3's just not the same without dudes getting chainsawed in half, amirite? I watched the Microsoft E3 2011 press conference during the week of E3, and am a better person for it.
E3 2011 Sony Conference Attendee
Demystifying rumors and speculation, one E3 at a time. I watched the Sony E3 2011 press conference during the week of E3, and am a better person for it.
E3 2011 Nintendo Conference Attendee
Another E3, another hardware announcement. I watched the Nintendo E3 2011 press conference during the week of E3, and am a better person for it.
E3 2011 LiveCam Warrior
Fear does not exist in this dojo. I watched an episode of the E3 2011 LiveCam Tour during the week of E3, because I'm the best around.
E3 2011 Stage Show Samurai
This achievement brought to you by alliteration! I watched an episode of GameSpot's Live E3 2011 Stage show during the week of E3 and secured my place amongst the samurai elite.
E3 2011 New Game Ninja
Hi, this achievement is all about ninjas, REAL NINJAS. This achievement is awesome. I followed a game announced at E3 2011 during the week of E3 and inherited REAL ULTIMATE POWER.
E3 2011 Game Gladiator - Gold
Are you not entertained? I followed 20 games featured at E3 2011 during the week of E3, and now not even the emperor can touch me.
Best of E3 2011 Readers' Choice Chooser
Participant in the Best of E3 2011 Readers' Choice awards. I voted for every category in the Best of E3 2011 awards and made my voice heard.
Comic-Con 2011 Costumed Crusader
Who wants to go fight some crime? I watched an episode of GameSpot's Live Stage show during Comic-Con and un-did some evil-doers!
Greatest Game Sidekick Broter
Sick voting, bro! This user owned the poll booth and voted for 64 sidekick in the character vote phase.
Virtual V.I.P
Its like you were there! You tuned in to our awesome SDCC 2011 Coverage but you wouldn't just crash a party like this, you were class and signed your RSVP through Face Book.
Super Tweet
These super individuals have this emblem because they tweeted or posted a fuse update about a super power and how they would use it, for good or evil.
Greatest Game Sidekick Peer Pressure
What's the matter, bro? You can totally handle that! This user told their friends about the character voting phase by using our Facebook button.
Greatest Game Sidekick Bracket Bender
Have you seen my bracket, bro? It's straight baller! This user predicted the greatest sidekick and created a bracket. Let the bropacalypse begin!
Greatest Game Sidekick Brodeo
"I hope you're a vet, 'cause these pythons are SICK!" This user ranked in the top 1000 and dominated in All Time Greatest Game Sidekick.
Greatest Game Sidekick Ice Cold
Icing bros since 1872. This user outbroneuvered and outscored the GameSpot staff team at their own game.
Greatest Game Sidekick Pack Leader
Alpha One of the wolf pack. This user defeated all of their friends on the scoreboard. You must have more than ten friends to qualify.
Greatest Game Sidekick True Bro
"Negative, Ghost Rider, the pattern is full." This user managed to pick the overall competition winner, but they scored less than 100 points.
Users with this emblem are totally in Sync with GameSpot.
Here there be Pirates!
This emblem goes to those who shared their Best pirate themed joke with the GameSpot Community on National Talk Like a Pirate Day!
Toy Story
The tale of a Photo Gallery and a box hunt, what was the result? An emblem for those crafty enough to find all of them. Big thanks to gmax for making this one!
Big Stories in Little Tokyo
This emblem belongs to those who wrote about their best idea for a JRPG or blogged about their experiences and impressions of our live stream for TGS 2011. Created by the awesome mod gmax!
Top 10 Spookiest Characters
Something scary is creeping under your bed... These GameSpotters blogged about their top 10 scariest video game spookies!
EVO 2011 Secret Fighter
Are they legendary as they say? Only few know the truth! This emblem belongs to those who have been chatting or commenting on a specific time while watching the EVO 2011 Championship Series. Created by SQUALL20XX
Readers' Choice Chooser
Take that, not-democracy! This user took the system into their own hands by voting in at least one category in Best of 2011.
Readers' Choice Clairvoyant
It's just like in that one movie with Nicky Cage. This user voted for a game in a category in which that game also won the Readers' Choice award.
Dark and Stormy Night
OooooooooOOOOOooooohhh These users participated in the Halloween story telling activity on Fuse.
Trick or Treat - Off Topic
This emblem goes to the Off Topic members who WON the Trick or Treat activity for Halloween 2011. -Emblem created by Chicknfeet
Scary Book Box Art Hunt
This emblem is for the GameSpotters who participated in the Scary Book Box Art Hunt in the Off Topic Forum. -Emblem By Chicknfeet
E3 2012 Nintendo Conference Attendee
This viewer proudly exclaimed, "My body is ready!" and tuned into this year's Nintendo press conference hoping to see what wonderful turns of phrase Reggie Fils-Aime would add to the popular lexicon this year. Oh, and they probably wanted to see the Wii U as well.
E3 2012 Connoisseur of the Arts
E3 is about a lot of things (exhaustion, hot dogs, etc.) but if you can boil it down to its absolute purest form, it's a about the art. So that's why this viewer tuned into GameSpot's live stage show--so they could see the art live as it happened.
E3 2012 Literature Enthusiast - Day 3
Taking a break from watching YouTube videos of kittens playing with a ball of yarn, this viewer made the excellent decision to read the fine E3 coverage on GameSpot's official E3 site on day three of E3.
E3 2012 Literature Enthusiast - Day 2
Taking a break from watching YouTube videos of kittens playing with a ball of yarn, this viewer made the excellent decision to read the fine E3 coverage on GameSpot's official E3 site on day two of E3.
E3 2012 Literature Enthusiast - Day 4
Taking a break from watching YouTube videos of kittens playing with a ball of yarn, this viewer made the excellent decision to read the fine E3 coverage on GameSpot's official E3 site on day four of E3.
Comic-Con 2012 Stage Show
Comic-Con is a place of dreams and magic, much like the GameSpot live stage show. For example, by watching our live show, you'll magically get this emblem, something that (almost) everyone dreams of!
Comic-Con 2012 LiveCam Tour
With a world population of upwards of seven billion people, it's fair to say that the vast majority will never get to experience Comic-Con firsthand, so the GameSpot LiveCam Tour may be your only chance!
Comic-Con 2012 - Day 1
There are many things to do with the internet, from watching videos of cute animals yawning to shooting digital bullets at total strangers and calling them names. This user chose to spend some time on GameSpot's official Comic-Con site on day one, and for this we salute you.
Comic-Con 2012 - Day 2
There are many things to do with the internet, from watching videos of pop-tart cats in space to sending requests for help minding your farm. This user chose to spend some time on GameSpot's official Comic-Con site on day two, and for this we salute you.
Comic-Con 2012 - Day 3
There are many things to do with the internet, from watching videos of people replying to videos that they don't know anything about to conspiring to send rappers to Alaska. This user chose to spend some time on GameSpot's official Comic-Con site on day three, and for this we salute you.
Comic-Con 2012 - Day 4
There are many things to do with the internet, from watching videos of people screaming about video games to sending and receiving friend requests. This user chose to spend some time on GameSpot's official Comic-Con site on day four, and for this we salute you.
Retro World
Totally Retro These emblem holders contributed to the massive list of retro classics for GameSpot's Gaming History Show. Emblem Created by tmaclabi
2012 Comic-Con Costume Contest
Fame hit them like a ton of pixels. This emblem was awarded to those who participated in the 2012 Celebrity Comic-Con Costume Contest. By GameSpotter tmaclabi
Pirate Day 2012 Emblem
Yarrrrrrr This emblem be for those salty dog that be up to some mischief on th' GameSpot forums with their scurvy jokes, silly pirate names, and strange pirate facts.
Hey look, it's a totally original dude wearing armor. With a huge gun and a helmet (a visor?). And he's riding a unicorn. This user was granted this magical emblem for not having any of their user profile images hosted on untrusted websites during The Great Purge of March 2013.
Will you be my player 2?
This emblem goes out to all those love birds who shared with us their favorite video game valentine, or simply stopped by to say Happy Valentines Day.
E3 2013 Microsoft Press Conference
Awarded to users who watched the Microsoft press conference during E3 2013.
E3 2013 Sony Press Conference
Awarded to users who watched the Sony press conference during E3 2013.
E3 2013 Stage 1
Awarded to users who watched Stage 1 of GameSpot's live show during E3 2013.
E3 2013 Stage 2
Awarded to users who watched Stage 2 of GameSpot's live show during E3 2013.
E3 2013 LiveCam
Awarded to users who watched GameSpot's live show floor camera during E3 2013.


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Although we don't believe in timing the market or panicking over market movements, we do like to keep an eye on big changes -- just in case they're material to our investing thesis.
What: Shares of implantable medical device maker Cyberonics (UNKNOWN:CYBX.DL) jumped as much as 10% today following the announcement that a lawsuit had been dropped against the company.
So what: The lawsuit, brought forth by Andrew Hagerty, a former sales representative of Cyberonics, had claimed wrongful termination and included, according to an Associated Press report, "allegations of broad-based improprieties in terms of sales and marketing practices at the company." Today, Cyberonics announced that the lawsuit was voluntarily dropped, although the company notes the suit could be refiled at any time and he may pursue a resolution through arbitration.
Now what: One lawsuit may not seem like much, but the simple fact that it's gone, especially when the suit had damaging sales and marketing allegations mixed in, is a big plus for Cyberonics. In terms of the company itself, I see strong demand for its vagal nerve stimulation therapy system as the population ages, but I have a hard time getting over the valuation hump with Cyberonics at 26 times forward earnings after today's pop. If the economy were in better shape I might have more lenience, but even after today's jump I'd rather stay on the sidelines.
Craving more input? Start by adding Cyberonics to your free and personalized watchlist so you can keep up on the latest news with the company.

subset: commoncrawl


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TaylorMade SLDR MINI DRIVER
TaylorMade SLDR MINI DRIVER
SLDR Mini Driver: Finally, a 3-wood Designed for the Tee
TaylorMade noticed that TOUR pros and better amateurs hit their 3-wood off the tee a lot more frequently than from the fairway, so we embraced that insight and created a new golf club that incorporates our cutting edge metalwood technology, including the distance-enhancing Speed Pocket, and sized it between a 3-wood and 460cc driver. We call it the SLDR Mini Driver, it's incredibly accurate and longer off the tee than a 3-wood.
At 260cc, the SLDR Mini Driver's footprint is larger, and face deeper, than a 160cc 3-wood. That gives you more stability and forgiveness on mis-hits and allows you to tee the ball higher, which makes the it easier to launch off the tee than a 3-wood. The SLDR Mini Driver has a low-forward CG like the rest of TaylorMade's SLDR metalwoods, and a Speed Pocket too, which promotes more ball speed and less spin to give you more distance when you loft up.
In addition, the SLDR Mini Driver's relatively short shaft (43.5" compared to 45.5" for the average driver) gives you the added clubhead control necessary to help you hit the ball straighter. There's more. The Mini Driver's sole, smaller than a driver's, is designed to make it easy to hit this club off the deck. That's why, even though it's called a SLDR Mini Driver, you're going to want to replace your 3-wood with it. Then you'll have a great option for long, accurate tee shots when placement in the fairway is vital. And you've got the perfect club for getting home in two on those previously unreachable par-5s. Because everything that makes the SLDR Mini Driver long and accurate off the tee makes it long and accurate off the turf too.
We have two models, Standard and TP. The Standard model is equipped with a lighter, driver-weight shaft, while the TP has a heavier, 3-wood-weight shaft.


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Hello again! Yesterday I posted about some really annoying things you should avoid doing in the team game Overwatch. Today I have tips for things that you should do, and gameplay options you should use in order to be more aware of what's going on. Awareness of your surroundings is important! Not just your own situation and where your enemies are, but also what's going on with the rest of your team.
Use the Scoreboard
Blizzard never actually tells you this in the tutorial – why would they want to teach you anything aside from basic moving and shooting controls?! – but you can bring up the Scoreboard in game by pressing the Tab key (unless you've unbound it).
The Scoreboard isn't just about your ego and seeing how many gold medals you have, it also tells you a lot about what's going on in the game.
- You can see who is dead, on your own team and the enemy team (they have an X through their portrait)
- You can see if people on your team have their ult ready (see the blue checkmark under Pharah)
- You can see who, on either team, is on fire (another thing Blizz never explains to new players)
- You can quickly see team comps and be aware of when someone has switched heroes (or tell when the only support on your team has switched to Hanzo)
The Scoreboard is transparent, so you can still see what's going on. I find myself pressing Tab a lot during games.
Kill Feed Display
The Kill Feed Display is in the top right of your screen. If it's not go into Options > Gameplay and turn it on. I find a lot of people either don't have this on, or just don't pay attention to it. Like the people who yell "Where are my heals?!" when the healer has just died. Or the people who yell "Tracer's low!" and go off to chase her when someone else has already finished her off in a hallway somewhere. Knowing who has just been killed is important for deciding how aggressive or defensive to be.
Allied Health Bars
Healers and a couple other characters (I think) can always see the health bars of their allies, but this is a good thing for anyone to see. Go to Options > Controls and turn on Allied Health Bars. Knowing more about the status of everyone on your team can only help. You can help someone getting low with an enemy is harassing them, tanks can put some form of shield on/in front of them, Solider can put down a heal, Roadhog can take care of his own health when others are low and need the heals. Health bars – they're not just for healers!
Keep an Eye on the Clock
Overwatch is a lot like football – clock management can win you games. Different kinds of play are better at the (possible) end of a match than at the beginning. In a point capture match, as the clock is running down the most important thing is to either keep the point in your possession by keeping the other team off it, or get your butt on the other team's point to prevent the match from ending. You know someone has no awareness of the clock when they yell at Mei for walling a lone hero approaching your point when there's only a couple seconds left. Yeah, they may have cost you an elim, but that wall let the clock run out.
It's also very important to watch that Overtime countdown. The point/payload is always the most important thing, but being on it in Overtime is especially necessary.
Be on Voice Chat
I know not everyone will like this one but, at least in Comp, you should always be in voice chat. Even if you're not going to talk, listening is important. Generally the more constructive communication and sharing of information there is in a game, the better the chances of winning.


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A statement of reaffirmation for this policy was published at
This policy is a revision of the policy in
Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening
Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. This statement provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.
- development
- developmental disorders
- developmental screening
- disabilities
- children with special health care needs
- early intervention
- medical home
Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home1 and an appropriate responsibility of all pediatric health care professionals. Delayed or disordered development can be caused by specific medical conditions and may indicate an increased risk of other medical complications. Delayed or disordered development may also indicate an increased risk of behavior disorders or associated developmental disorders. Early identification should lead to further evaluation, diagnosis, and treatment. Early intervention is available for a wide range of developmental disorders; their prompt identification can spur specific and appropriate therapeutic interventions. Identification of a developmental disorder and its underlying etiology may also affect a range of treatment planning, from medical treatment of the child to family planning for his or her parents.
Current detection rates of developmental disorders are lower than their actual prevalence, which suggests that the challenges to early identification of children with developmental disorders have not been overcome.2–4 A recent survey of American Academy of Pediatrics (AAP) members revealed that despite publication of the 2001 policy statement "Developmental Surveillance and Screening of Infants and Young Children"5 and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems.2 This 2006 statement replaces the 2001 policy statement and provides an algorithm as a strategy to support health care professionals in developing a pattern and practice of attention to development that can and should continue well beyond 3 years of age.
We recommend that developmental surveillance, as described later, be incorporated at every well-child visit. Any concerns raised during surveillance should be promptly addressed. In addition, standardized developmental screening tests should be administered regularly at the 9-, 18-, and 30-month* visits. Pediatric health care professionals may also find it useful to conduct school-readiness screening before the child's attendance at preschool or kindergarten. These recommendations represent our consensus; further research to evaluate the effectiveness of the proposed approach and available screening tools is encouraged. Separate recommendations aimed at the screening of children for behavioral and emotional disorders are also under consideration by the AAP and are not included in this document.
The detection of developmental disorders is an integral component of well-child care. Title V of the Social Security Act (42 USC Chapter 7, Subchapter V §§701-710 [1989]) and the Individuals With Disabilities Education Improvement Act (IDEA) of 2004 (Pub L No. 108-446) reaffirm the mandate for child health professionals to provide early identification of, and intervention for, children with developmental disabilities through community-based collaborative systems. The medical home is the ideal setting for developmental surveillance and screening of children and adolescents. Parents expect their medical home, as the site of their child's continuous and comprehensive care, to be interested in children's development throughout childhood and adolescence, to competently identify developmental strengths and weaknesses, and to be knowledgeable of available community resources to facilitate referrals when needed.
Developmental screening is included in the AAP "Recommendations for Preventive Pediatric Health Care"6 or "periodicity schedule" and is further recommended by the 2 current AAP compilations of well-child care guidelines: Bright Futures7 and Guidelines for Health Supervision III.8 In collaboration with other experts in child health care, the AAP is currently revising Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. It is hoped that the third edition of Bright Futures being developed by the AAP and the revised periodicity schedule will be consistent with the recommendations of this document.
Note Regarding Language
Within the context of this document, clear distinctions have been drawn among (1) surveillance, the process of recognizing children who may be at risk of developmental delays, (2) screening, the use of standardized tools to identify and refine that recognized risk, and (3) evaluation, a complex process aimed at identifying specific developmental disorders that are affecting a child. These definitions build on existing definitions.9 In a further effort to ensure clarity throughout the document, we have purposefully avoided the term "assessment." Although the Individuals With Disabilities Education Improvement Act of 2004—and others—use "assessment" as a synonym for "evaluation," this usage is not universally shared.
"Developmental delay" is used in this statement for the condition in which a child is not developing and/or achieving skills according to the expected time frame. The terms "delayed development," "disordered development," and "developmental abnormality" are used synonymously. "Developmental disorder" and "developmental disability" refer to a childhood mental or physical impairment or combination of mental and physical impairments that result in substantial functional limitations in major life activities.10
1. Pediatric Patient at Preventive Care Visit
Developmental concerns should be included as one of several health topics addressed at each pediatric preventive care visit throughout the first 5 years of life (see Fig 1). 6 Many children are born with risk factors that predispose them to delayed development and developmental disorders; other children will show delayed or disordered development in early childhood, which if undetected and untreated, can contribute to early school failure and attendant social and emotional problems. Some children will have delayed development attributable to a specific medical condition for which medical treatments may be indicated. Early therapeutic intervention may be available for a wide range of developmental disorders.
2. Perform Surveillance
Developmental surveillance is a flexible, longitudinal, continuous, and cumulative process whereby knowledgeable health care professionals identify children who may have developmental problems. Surveillance can be useful for determining appropriate referrals, providing patient education and family-centered care in support of healthy development, and monitoring the effects of developmental health promotion through early intervention and therapy.
A great breadth and depth of information is considered in comprehensive developmental surveillance; it is important to note, however, that much of this information (eg, static risk factors such as low birth weight, results of previous screenings) will accumulate within the child's health record, where it can be reviewed and flagged as necessary before the visit.
There are 5 components of developmental surveillance: eliciting and attending to the parents' concerns about their child's development; documenting and maintaining a developmental history; making accurate observations of the child; identifying risk and protective factors; and maintaining an accurate record of documenting the process and findings.
Eliciting and Attending to the Parents' Concerns
Parents and child health professionals have valuable observation skills, and they share the goal of ensuring optimal health and developmental outcome for the child. In the optimal situation, the child health professional elicits parental observations, experiences, and concerns and recognizes that parental concerns mandate serious attention. The literature suggests that posing simple questions to parents related to concerns about the child's development, learning, or behavior can elicit quality information.11–13 Health care professionals might ask, for example, "Do you have any concerns about your child's development? Behavior? Learning?" Asking parents specifically about their child's behavior can yield valuable information regarding development, because parents do not necessarily differentiate between behavior and development, and developmental delays often manifest through behavior. The absence of parental concern does not preclude the possibility of serious developmental delays.14 The health care professional must attend to all aspects of developmental surveillance.
Maintaining a Developmental History
"What changes have you seen in your child's development since our last visit?" A developmental history, updated through this or similar questions, should be a component of any history taken during a well-child visit and can assist a child health professional in identifying developmental abnormalities that warrant further investigation. Age-specific queries, such as asking whether the child is walking or pointing, are also valuable.
In addition to attending to delayed development—whereby children acquire skills more slowly than their peers—child health professionals should give equal consideration to other developmental abnormalities.15 Deviations in development, whereby children develop skills out of the usual sequence, are recognized in disorders such as cerebral palsy and autism. Dissociation—differing rates of development in different developmental spheres—commonly occurs with developmental disorders. Children with mental retardation or autistic spectrum disorders, for example, commonly display normal motor skills and delayed language development. Conversely, children with cerebral palsy of the spastic diplegic type often display delayed motor skills with normal language function. Regression, the loss of developmental skills, is a very serious developmental problem suggestive of an active, ongoing neurologic problem.
Making Accurate and Informed Observations of the Child
As trained and experienced professionals, pediatricians and other child health professionals have the expertise and comparative knowledge to identify developmental concerns. A careful physical and developmental examination within the context of the preventive care visit is integral to developmental surveillance.16 Limited evidence suggests that observation of the parent-child interaction may aid in identifying children with delayed development.17
Identifying the Presence of Risk and Protective Factors
A risk assessment is an important part of developmental surveillance. Environmental, genetic, biological,16,18 social, and demographic factors19 can increase a child's risk for delays in development. Multiple risk factors can amplify each other.20,21 Children with established risk factors may be referred directly for developmental evaluation or may require developmental surveillance at more frequent intervals than children without risk factors.
Child health professionals should identify protective factors as well as risk factors in children's lives. Strong connections within a loving, supportive family, along with opportunities to interact with other children and grow in independence in an environment with appropriate structure, are important assets in a child's life. These factors, associated with resiliency in older children, are important components in each family's story.22
Documenting the Process and Findings
Medical charts, in paper or electronic form, should document all surveillance and screening activities during preventive care visits. In addition, specific actions taken or planned, such as scheduling an earlier follow-up visit, scheduling a visit to discuss developmental concerns more fully, or referrals to medical specialists or early childhood programs and specialists, should also be noted. A paper medical chart might contain a "developmental growth chart" on which the results of developmental surveillance and formal screens are recorded in relationship to the child's age and the dates at the time the findings were obtained. An electronic chart, on the other hand, may allow for the development of a form on which developmental findings and plans are recorded and from which prompts for further action may occur automatically. Recent technologies that automate developmental risk assessments within the waiting room through computer-interpreted paper forms or information kiosks are also increasingly commonplace. We encourage continued development and scientific evaluation of these technologies given their potential to facilitate the process of developmental surveillance and screening.
3. Does Surveillance Demonstrate Risk?
The concerns of both parents and child health professionals should be included in determining whether surveillance suggests that the child may be at risk of developmental problems. If parents or the child health professional express concern about the child's development, a developmental screening to address the concern specifically should be conducted. This screening may require a separate visit; if so, the visit should be held as soon as possible.
Reassurance has a role in the clinical encounter but varies depending on the progress and outcome of developmental surveillance. Reassurance should be rooted in and reference the findings of developmental surveillance. If, for example, developmental surveillance indicates that the child is at low risk of a developmental disorder, reassurance can be offered with caution and a planned outcome. Specific, simple, age-specific developmental goals can be identified, and parents can be encouraged to schedule recheck appointments if the child is not attaining those goals. In reassuring the parents, the pediatrician should emphasize the importance of continual surveillance and screening.
4. Is This a 9-, 18-, or 30-Month* Visit?
All children, most of whom will not have identifiable risks or whose development appears to be proceeding typically, should receive periodic developmental screening using a standardized test. In the absence of established risk factors or parental or provider concerns, a general developmental screen is recommended at the 9-, 18-, and 30-month* visits. Consideration of a number of factors, including the time available to focus on developmental concerns during a routine pediatric visit, led to these recommended ages.
Nine months of age: At 9 months of age, many issues involving motor skills development can be reliably identified. A 9-month screening provides an additional opportunity to attend to the child's visual and hearing abilities. Early communication skills may be emerging—evidence suggests symptoms of autism, such as lack of eye contact, orienting to name being called, or pointing, may be recognizable in the first year of life.23,24 Early intervention to address specific developmental disorders is available to infants from birth and should be accessed to address any delays detected at 9 months.25 At-risk 9-month-old infants should also be referred to early intervention programs if not previously referred. The 9-month preventive care visit also provides a good opportunity for the child health professional to educate parents about developmental screening and to encourage parents to pay special attention to communication and language skills. Social and nonverbal communication, including vocalizations and gestures, are important aspects of emerging communication that can be assessed at 9 months. Because of the rapid development of motor, language, and cognitive skills, parents should be encouraged to express any concerns they have about their child's progress rather than waiting until the 18-month visit. The AAP brochure Is Your One-Year Old Communicating With You?26 might be distributed at the 9-month visit to educate parents about communication and target any concerns they have. (If practices have eliminated the 9-month visit, this screening should be performed at the 12-month visit.)
Eighteen months of age: Delays in communication and language development are often evident by 18 months of age. Mild motor delays that were undetected at the 9-month screening may be more apparent at 18 months of age. Medical interventions for motor disorders have been shown to be effective in children at 18 months of age, and effective early intervention for delayed language development is also available.27 In addition to a general developmental screening tool, an autism-specific tool should be administered to all children at the 18-month visit.28 Symptoms of autism are often present at this age, and effective early intervention strategies are available.29
Thirty months* of age: By 30 months of age, most motor, language, and cognitive delays may be identified with screening instruments, leading to evaluation of and intervention for those children with delayed development. A 30-month visit focusing on child development and developmental screening would allow the health care provider to devote special attention to this area. Therefore, addition of this preventive care visit to the periodicity schedule is being considered by Bright Futures.
When child health professionals use only clinical impressions rather than formal screening, estimates of children's developmental status are much less accurate.30 Including developmental screening tools at targeted developmental ages is intended to enhance the precision of the developmental surveillance process. These recommended ages for developmental screening are suggested only as a starting point for children who appear to be developing normally; surveillance should continue throughout childhood, and screenings should be conducted anytime that concerns are raised by parents, child health professionals, or others involved in the care of the child. At the 4-year visit, a screening for school readiness is appropriate.
5a and 5b: Administer Screening Tool
Developmental screening is the administration of a brief standardized tool that aids the identification of children at risk of a developmental disorder. Many screening tools can be completed by parents and scored by nonphysician personnel; the physician interprets the screening results.
Developmental screening does not result in either a diagnosis or treatment plan but rather identifies areas in which a child's development differs from same-age norms. Developmental screening that targets the area of concern is indicated whenever a problem is identified during developmental surveillance. Because development is dynamic in nature and surveillance and screening have limits, periodic screening with a validated instrument should occur so that a problem not detected by surveillance or a single screening can be detected by subsequent screening. Repeated and regular screening is more likely than a single screening to identify problems, especially in later-developing skills such as language. Waiting until a young child misses a major milestone such as walking or talking may result in late rather than early recognition, increasing parental dissatisfaction and anxiety and depriving the child and family of the benefits of early identification and intervention.
Table 1 provides a list of developmental screening tools; a discussion of how to choose an appropriate screening tool is included in "Implementing the Algorithm."
6a and 6b: Are the Screening-Tool Results Positive/Concerning?
When the results of the periodic screening tool are normal, the child health professional can inform the parents and continue with other aspects of the preventive visit. Normal screening results provide an opportunity to focus on developmental promotion. However, when a screening tool is administered because of concerns about development, an early return visit to provide additional developmental surveillance should be scheduled even if the screening-tool results do not indicate a risk of delay.
7. Make Referrals for Developmental and Medical Evaluations and Early Developmental Intervention/Early Childhood Services
If screening results are concerning, the child should be scheduled for developmental and medical evaluations. These evaluations may occur at a different visit or series of visits or often in a different setting by other professionals. The separate box in which these steps are placed in the algorithm (Fig 1) is intended to represent the possibility that these actions will occur at a different time and location. However, they should be scheduled as quickly as possible, and professionals should coordinate activities and share findings.
8. Developmental and Medical Evaluations
Developmental Evaluation
When developmental surveillance or screening identifies a child as being at high risk of a developmental disorder, diagnostic developmental evaluation should be pursued. This evaluation is aimed at identifying the specific developmental disorder or disorders affecting the child, thus providing further prognostic information and allowing prompt initiation of specific and appropriate early childhood therapeutic interventions.
Children with neurodevelopmental disorders also often have other associated developmental or behavior disorders.31–33 Identification of these disorders can lead to further evaluation and treatment. Pediatric subspecialists such as neurodevelopmental pediatricians, developmental and behavioral pediatricians, child neurologists, pediatric physiatrists, or child psychiatrists can perform the developmental diagnostic evaluation, as can other early childhood professionals in conjunction with the child's primary care provider. Such early childhood professionals include early childhood educators, child psychologists, speech-language pathologists, audiologists, social workers, physical therapists, and occupational therapists, ideally working with families as part of an interdisciplinary team and with the medical home.
Medical Evaluation
In addition to the developmental evaluation, a medical diagnostic evaluation to identify an underlying etiology should be undertaken. This evaluation should consider biological, environmental, and established risk factors for delayed development.34–37 Vision screening and objective hearing evaluation; review of newborn metabolic screening and growth charts; and an update of environmental, medical, family, and social history for additional risk factors are integral to this evaluation.
A comprehensive medical evaluation is essential whenever a delay is confirmed. This evaluation varies somewhat with the risk factors and findings and may include brain imaging, electroencephalogram (EEG), genetic testing, and/or metabolic testing.37
Identification of an etiology may provide parents with a greater depth of understanding of their child's disability. Identifying an etiology also can affect various aspects of treatment planning, including specific prognostic information, genetic counseling around recurrence risk and family planning, specific medical treatments for improved health and function of the child, and therapeutic intervention programming.38 An underlying etiology will be identified in approximately one quarter of cases of delayed development, with higher rates (>50%) in children with global developmental delays and motor delays and lower rates (<5%) in children with isolated language disorders.39
This evaluation can be performed by a trained and skilled pediatrician; a pediatric subspecialist such as a neurodevelopmental pediatrician, child neurologist, or developmental/behavioral pediatrician; or through affiliated medical professionals such as pediatric geneticists or physiatrists. The primary care provider within the medical home should develop an explicit comanagement plan with the specialist(s).
Early Developmental Intervention/Early Childhood Services
Early intervention programs can be particularly valuable when a child is first identified to be at high risk of delayed development, because these programs often provide evaluation services and can offer other services to the child and family even before an evaluation is complete.25 These services can include developmental therapies, service coordination, social work services, assistance with transportation and related costs, family training, counseling, and home visits. The diagnosis of a specific developmental disorder is not necessary for an early intervention referral to be made. Child health professionals should realize that a community-based early intervention evaluation may not address children with specific medical risks, and further developmental and medical evaluation will often be necessary for children with established delays.
Establishing an effective and efficient partnership with early childhood professionals is an important ingredient of successful care coordination for children within the medical home. The partnership is built on shared interest in the developmental outcomes of children and recognition of the different skill sets of child health professionals and educators. For additional information regarding care coordination, see the AAP policy statement "Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children With Special Health Care Needs."40
Given the variety of community settings in which health care is provided, the pediatrician may consult early childhood professionals who work in specialized health care centers, university centers, early intervention programs, early childhood educational programs, or private practices. Whenever possible, communities should coordinate resources; this is especially true in preventing delays in care or unnecessary duplication of service.
The child's medical charts, whether electronic or paper, should be organized to create a system that guarantees continuity of care, especially when the child is referred to specialists and/or community agencies. In addition, a means of incorporating information about a child's developmental status from sources outside the medical home should be available. The child health care chart should be designed to alert the clinician if further attention is needed between regular periodic visits.
9. Is a Developmental Disorder Identified?
If a developmental disorder is identified, the child should be identified as a child with special health care needs, and chronic-condition management should be initiated (see No. 10 below). If a developmental disorder is not identified through medical and developmental evaluation, the child should be scheduled for an early return visit for further surveillance, as mentioned previously. More frequent visits, with particular attention paid to areas of concern, will allow the child to be promptly referred for further evaluation if any additional evidence of delayed development or a specific disorder emerges.
10. Identify as a Child With Special Health Care Needs and Initiate Chronic-Condition Management
When a child is discovered to have a significant developmental disorder, that child becomes a child with special health care needs even if that child does not have a specific disease etiology identified. Such a child should be identified by the medical home for appropriate chronic-condition management and regular monitoring and entered into the practice's children and youth with special health care needs registry.41 Every primary care practice should create a registry for the children in the practice who have special health care needs.
The medical home provides a triad of key primary care services including preventive care, acute illness management, and chronic-condition management. A program of chronic-condition management provides proactive care for children and youth with special health care needs, including condition-related office visits, written care plans, explicit comanagement with specialists, appropriate patient education, and effective information systems for monitoring and tracking.
Management plans should be based on a comprehensive needs assessment conducted with the family. Management plans should include relevant, measurable, and valid outcomes. These plans must be reviewed on a regular basis and updated as necessary. The child health professional should actively participate in all care-coordination activities for children who have complex health conditions in addition to developmental problems. Decisions regarding appropriate therapies and their scope and intensity should be determined in consultation with the child's family, therapists, and educators (including early intervention or school-based programs) and should be based on knowledge of the scientific evidence for their use.
Children with established developmental disorders often benefit from referral to community-based family support services such as respite care, parent-to-parent programs, and advocacy organizations. Some children may qualify for additional benefits such as supplemental security income, public insurance, waiver programs, and state programs for children and youth with special health care needs (Title V). Parent organizations, such as Family Voices, and condition-specific associations can provide parents with information and support and can also provide an opportunity for advocacy.
Choosing Developmental Screening Tools
Although all developmental screening tools are designed to identify children with potentially delayed development, each one approaches the task in a different way. There is no universally accepted screening tool appropriate for all populations and all ages. Currently available screening tools vary from broad general developmental screening tools to others that focus on specific areas of development, such as motor or communication skills. Their psychometric properties vary widely in characteristics such as their standardization, the comparison group used for determining sensitivity and specificity, and population risk status.
Broad screening tools should address developmental domains including fine and gross motor skills, language and communication, problem solving/adaptive behavior, and personal-social skills. Screening tools also must be culturally and linguistically sensitive. Many screening tools are available, and the choice of which tool to use depends on the population being screened, the types of problems being screened for in that population, administration and scoring time, any administration training time, the cost of the tool, and the possibilities for adequate payment.
Screening tests should be both reliable and valid, with good sensitivity and specificity.
Reliability is the ability of a measure to produce consistent results.
The validity of a developmental screening test relates to its ability to discriminate between a child at a determined level of risk for delay (ie, high, moderate) and the rest of the population (low risk).
Sensitivity is the accuracy of the test in identifying delayed development.
Specificity is the accuracy of the test in identifying individuals who are not delayed.
If a test incorrectly identifies a child as delayed, it will result in overreferrals. If a test incorrectly identifies a child as normal, it results in underreferrals. For developmental screening tests, scoring systems must be developed that minimize underreferrals and overreferrals. Trade-offs between sensitivity and specificity occur when devising these scoring systems. Sensitivity and specificity levels of 70% to 80% have been deemed acceptable for developmental screening tests.42 These values are lower than generally accepted for medical screening tests because of the challenges inherent in measuring child development and the absence of specific curative and clearly effective treatments. However, combining developmental surveillance and periodic screening increases the opportunity for identification of undetected delays in early development. Overidentification of children using standardized screening tools may indicate that this group of children includes some with below-average development and/or significant psychosocial risk factors.43 These children may benefit from other community programs as well as closer monitoring of their development by their families, pediatric health professionals, and teachers or caregivers.
Table 1 provides a list of developmental screening tools and their psychometric testing properties. These screening tools vary widely in their psychometric properties. This list is not exhaustive; other standardized, published tools are available. We look forward to further evaluation/validation of available screening instruments as well as the continued development of new tools with stronger properties. Child health professionals are encouraged to familiarize themselves with a variety of screening tools and choose those that best fit their populations, practice needs, and skill level.
Incorporating Surveillance and Screening in the Medical Home
A quality-improvement approach may be the most effective means of building surveillance and screening elements into the process of care in a pediatric office.44 Improving developmental screening and surveillance should be regarded as a "whole-office" endeavor and not simply a matter of clinician continuing education or the addition of tasks to well-child visits. Front-desk procedures, such as appropriate scheduling for screening visits and procedures for flagging children with established risk factors, need to be explicitly designed by the office staff. Nonphysician staff may need training in the administration of developmental screening tools. The input of consumers is crucial to developing an effective system and can be accomplished by adding a parent to an office planning team, by using parent focus groups, or by administering parent questionnaires. Specific to developmental screening could be consumer opinion about preferences for completing questionnaires in the office or before the visit, how they would like to be informed about the results of screening, how parents of children with identified conditions associated with developmental delay would like to have their children's development monitored, or feedback on parental satisfaction with their child's developmental screening or feedback on the referral process.
Screening Payment
Separate Current Procedural Terminology (CPT)45 codes (see Table 2) exist for developmental screening (96110: developmental testing; limited) and testing (96111: developmental testing; extended). The relative values for these codes are published in the Medicare Resource-Based Relative Value Scale and reflect physician work, practice expenses, and professional liability expenses. Table 2 outlines the appropriate codes to use when billing for the processes described in the algorithm. Health plans are encouraged to adhere to CPT guidelines and provide coverage and payment for developmental screening and testing.
Billing processes related to developmental screening and surveillance should be carefully reviewed to ensure that appropriate CPT codes are used to document screening procedures and ensure proper payment. CPT code 96110 for limited developmental testing does not include any payment for medical provider services. The expectation is that a nonphysician will administer the screening tool to the parent and then score their responses. The physician reviews and interprets the screening results; the physician's work is included in the evaluation and management code used for the child's visit. Medicaid may not pay separately for developmental screening when provided as part of early and periodic screening, diagnostic, and treatment services. If non-Medicaid carriers are involved, the preventive care code is used with the modifier 25 appended and 96110 listed for each screening tool administered. The CPT code 96111, extended developmental testing, includes medical provider work. This code would more appropriately be used when the medical provider observes the child performing a task and demonstrating a specific developmental skill.
The codes in Table 2 may be applicable to the phases of developmental surveillance, screening, and evaluation described in the proposed algorithm (Fig 1).
Developmental surveillance should be a component of every preventive care visit. Standardized developmental screening tools should be used when such surveillance identifies concerns about a child's development and for children who appear to be at low risk of a developmental disorder at the 9-, 18-, and 30-month* visits.
When a child has a positive screening result for a developmental problem, developmental and medical evaluations to identify the specific developmental disorders and related medical problems are warranted. In addition, children who have positive screening results for developmental problems should be referred to early developmental intervention and early childhood services and scheduled for earlier return visits to increase developmental surveillance.
Children diagnosed with developmental disorders should be identified as children with special health care needs; chronic-condition management for these children should be initiated.
For the Medical Home
Perform developmental surveillance at every preventive visit throughout childhood, and ensure that such surveillance includes eliciting and attending to parents' concerns, obtaining a developmental history, making accurate and informed observations of the child, identifying the presence of risk and protective factors, and documenting the process and findings.
Administer a standardized developmental screening tool for children who appear to be at low risk of a developmental disorder at the 9-, 18-, and or 30-month* visits and for those whose surveillance yields concerns about delayed or disordered development.
Schedule early return visits for children whose surveillance raises concerns that are not confirmed by a developmental screening tool.
Refer children about whom developmental concerns are raised to early intervention and early-childhood programs.
Coordinate developmental and medical evaluations for children who have positive screening results for developmental disorders.
Initiate a program of chronic-condition management for any child identified with a developmental disorder.
Document all surveillance, screening, evaluation, and referral activities in the child's health chart.
Establish working relationships with state and local programs, services, and resources.
Use a quality-improvement model to integrate surveillance and screening into office procedures and to monitor their effectiveness and outcomes.
For Policy and Advocacy
Provide appropriate payment for developmental surveillance, screening, and evaluation.
Teach child health professionals, through training and continuing education programs, to conduct developmental surveillance and screening as an integral responsibility of the medical home.
For Research and Development
Develop information systems and data-gathering tools to automate the algorithm recommended by this policy statement for ease and consistency of use.
Expand the evidence base for the effectiveness of developmental surveillance activities.
Improve the effectiveness of developmental screening tools in the identification of children with developmental disorders in the medical home.
Expand the evidence base for the use and effectiveness of the proposed algorithm, including the optimal timing of the recommended developmental screening.
Council on Children With Disabilities
John C. Duby, MD
Paul H. Lipkin, MD, PRC Chairperson
Section on Developmental and Behavioral Pediatrics
Michelle M. Macias, MD
Lynn M. Wegner, MD
Bright Futures Steering Committee
Paula Duncan, MD
Joseph F. Hagan, Jr, MD
Medical Home Initiatives for Children With Special Needs Project Advisory Committee
W. Carl Cooley, MD
Nancy Swigonski, MD, MPH
Paul G. Biondich, MD, MS
Partnership for Policy Implementation (PPI)
Donald Lollar, EdD
Centers for Disease Control and Prevention
Jill Ackermann
Amy Brin, MA
Mary Crane, PhD, LSW
Amy Gibson, MS, RN
Stephanie Mucha Skipper, MPH, Principal Staff
Darcy Steinberg-Hastings, MPH
Melissa Capers, MA, MFA
↵* Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.
↵† Numbers and headings refer to steps in the algorithm (Fig 1).
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- Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics.1995;95 :829– 836
- ↵Glascoe FP. The value of parents' concerns to detect and address developmental and behavioural problems. J Paediatr Child Health.1999;35 :1– 8
- ↵King TM, Rosenberg LA, Fuddy L, McFarlane E, Sia C, Duggan AK. Prevalence and early identification of language delays among at-risk three year olds. J Dev Behav Pediatr.2005;26 :293– 303
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- ↵Bear LM. Early identification of infants at risk for developmental disabilities. Pediatr Clin North Am.2004;51 :685– 701
- ↵Dinkevich E, Ozuah PO. Well-child care: effectiveness of current recommendations. Clin Pediatr (Phila).2002;41 :211– 217
- ↵Boyle RJ. Effects of certain prenatal drugs on the fetus and newborn. Pediatr Rev.2002;23 :17– 24
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- ↵Escalona SK. Babies at double hazard: early development of infants at biologic and social risk. Pediatrics.1982;70 :670– 676
- ↵National Research Council and Institute of Medicine, Committee on Integrating the Science of Early Childhood Development. From Neurons to Neighborhoods: The Science of Early Childhood Development. Shonkoff JP, Phillips DA, eds. Washington, DC: National Academies Press; 2000
- ↵Maestro S, Muratori F, Cesari A, et al. Course of autism signs in the first year of life. Psychopathology.2005;38 :26– 31
- ↵Zwaigenbaum L, Bryson S, Rogers T, Roberts W, Brian J, Szatmari P. Behavioral manifestations of autism in the first year of life. Int J Dev Neurosci.2005;23 :143– 152
- ↵American Academy of Pediatrics, Committee on Children With Disabilities. Role of the pediatrician in family-centered early intervention services. Pediatrics.2001;107 :1155– 1157
- ↵American Academy of Pediatrics. Is Your One-Year Old Communicating With You? [brochure]. Elk Grove Village, IL: American Academy of Pediatrics; 2005
- ↵Lipkin PH, Schertz M. An assessment of the efficacy of early intervention programs. In: Capute AJ, Accardo PJ, eds. Neurodevelopmental Disabilities in Infancy and Childhood. Baltimore, MD: Paul H. Brookes; 2006: In press
- ↵American Academy of Pediatrics, Committee on Children With Disabilities. Technical report: the pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics.2001;107(5) . Available at: www.pediatrics.org/cgi/content/full/107/5/e85
- ↵National Research Council, Committee on Educational Interventions for Children With Autism. Educating Children With Autism. Lord C, McGee JP, eds. Washington, DC: National Academies Press; 2001
- ↵Werner EE, Honzik MP, Smith RS. Prediction of intelligence and achievement at ten years from twenty months pediatric and psychologic examinations. Child Dev.1968;39 :1063– 1075
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- ↵Nickel RE, Desch LW. The Physician's Guide to Caring for Children With Disabilities and Chronic Conditions Baltimore, MD: Paul H. Brookes; 2000
- ↵Tjossem TD. Intervention Strategies for High Risk Infants and Young Children Baltimore, MD: University Park Press; 1976
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- ↵Shevell M, Ashwal S, Donley D, et al. Practice parameter: evaluation of the child with global developmental delay. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology.2003;60 :367– 380
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- ↵McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics.1998;102 :137– 140
- ↵Barnes KE. Preschool Screening: The Measurement and Prediction of Children At-Risk Springfield, IL: Charles C. Thomas; 1982
- ↵Glascoe FP. Are overreferrals on developmental screening tests really a problem? Arch Pediatr Adolesc Med.2001;155 :54– 59
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- ↵American Medical Association. Current Procedural Terminology (CPT) 2005. Chicago, IL: American Medical Association; 2005
- Copyright © 2006 by the American Academy of Pediatrics


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Title: Partridge in a Pear Tree (1986)Artist: Elaine HarrisonDescription: Color block print on black paper. Tipped onto folding card. Image measures 4 x 6".
Elaine Harrison (1915-2003) spent most of her working life as a teacher in Summerside. Although she was with the PEI Art Society in the 1950s, it wasn't until her retirement from teaching in 1968 that she devoted most of her time to writing, and painting. She was inspired by the work of the Group of Seven and iconic artists such as Tom Thomson and Emily Carr. Over time, Harrison's painting style evolved. In later years, she rarely used brushes, preferring to apply paint with a pallet knife. Harrison's works are vigorous, direct, colourful, abstracted impressions of her favourite subjects: the red cliffs and shorelines near her summer home in Fernwood; the stands of hardwood trees near her home in Bedeque, PEI; Island harbours; and her many cats. A retrospective exhibition entitled, Elaine Harrison: I Am an Island That Dreams, was held in the Art Gallery of the Confederation Centre of the Arts in Charlottetown in 2011/12.


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Meal Timing on Glucose and Hyperandrogenism in PCOS Women (MealTimePCOS)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01711476
Recruitment Status : Unknown
Verified January 2013 by Daniela Jakubowicz, MD, Hospital de Clinicas Caracas.
Recruitment status was: Recruiting
First Posted : October 22, 2012
Last Update Posted : January 23, 2013
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
The objective of this study is to investigate the effects of two isocaloric maintenance diets with different meal timing distribution on insulin resistance hyperandrogenism and cytochrome P450c17 alpha activity in lean PCOS women.
The investigators hypothesis is that in lean PCOS women a Breakfast Diet (BD) which consist in high calorie breakfast and reduced dinner, vs Dinner Diet (DD) which consist in high calorie dinner with reduced breakfast; the BD will improve glucose and insulin response to OGTT and would decrease the hyperandrogenism and cytochrome P450c17 alpha activity.
|Condition or disease
|Polycystic Ovary Syndrome (PCOS) Women
|Behavioral: Placebo Comparator: Lifestyle counseling Dinner Diet ARM 2 Other: Active Comparator: Lifestyle counseling ARM 1
|Not Applicable
Hyperinsulinemia plays a central role in the pathogenesis in obese as well as in lean PCOS women. These women are insulin resistant and have compensatory hyperinsulinemia that stimulates ovarian cytochrome P450c17 alpha activity that in turn stimulates ovarian androgen concentrations.
In obese PCOS women, weight loss improves insulin resistance and hyperandrogenism, resulting in improvement of clinical symptoms.
Since lean PCOS women do not have the option of weight loss, it is important to know if composition and meal timing distribution may influence glucose metabolism and hyperandrogenism and cytochrome P450c17 alpha activity. We hypothesized that a timing pattern of increased nutrient intake of protein and carbohydrates in the morning, with decreased caloric intake at night would improve insulin sensitivity and hyperandrogenism in lean women with PCOS
|Study Type :
|Interventional (Clinical Trial)
|Estimated Enrollment :
|60 participants
|Intervention Model:
|Parallel Assignment
|None (Open Label)
|Primary Purpose:
|Official Title:
|Influence of Meal Timing on Glucose Metabolism and Hyperandrogenism in Lean Women With Polycystic Ovary Syndrome
|Study Start Date :
|October 2012
|Actual Primary Completion Date :
|January 2013
|Estimated Study Completion Date :
|January 2013
Active Comparator: Lifestyle counseling ARM 1
Arm 1 Breakfast Diet The arm 1 will be assigned to eat High calorie breakfast (800kcal) and reduced dinner (200 kcal) During 90 days from baseline to the end of the trial (day 90)
Other: Active Comparator: Lifestyle counseling ARM 1
In the Arm 1 we will measure androgen levels and insulin and glucose response to OGTT at baseline DAY 0 and after 90 days on the dinner diet (Day 90) for comparison Also we will evaluate by weekly progesterone the ovulatory events
Other Name: Lean PCOS women in ARM 1 will be assigned to Breakfast diet from Day 0 to day 90 of the study
Placebo Comparator: Lifestyle counseling ARM 2
Lean PCOS women in the Arm 2 will be assigned to do a dinner diet from day 0 to day 90 of the trial
Behavioral: Placebo Comparator: Lifestyle counseling Dinner Diet ARM 2
In this Arm 2 group the PCOS will be assigned to dinner diet and we will compare the androgen levels Day 0 to androgen after DAY 90 of this diet also we will compare Glucose and Insulin response to OGTT Day 0 and Day 90, and ovulatory frequency along alll the 90 days of the Dinner diet
Other Name: The lean PCOS patients assigned to dinner diet
- Changes in Androgens and 17 alpha hydroxyprogesterone serum levels [ Time Frame: 90 days ]The androgens (testosterone, free testosterone, DHEA-S, androstenedione)and 17 alpha hydroxyprogesterone will be measured at baseline and again will be measured at the end of the trial by day 90. In both groups or Arms one on breakfast diet and the other on dinner diet.
- Glucose and Insulin Response to OGTT [ Time Frame: 90 ]Glucose and Insulin Response to OGTT will be measured at baseline and again will be repeated after 90 days of the trial for comparison One group will be assigned to breakfast diet and the other group to dinner diet
- Ovulatory frequency [ Time Frame: 90 days ]From baseline (day O) to the end of the study (day 90) progesterone will be quantified weekly to assess the ovulation in both of the group (The ovulation in the breakfast diet group will be compared to that of the dinner diet group)
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:
|22 Years to 50 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
lean women with Polycystic Ovary BMI below 25 kg/m2 Testosterone above 1.0 ng/ml 17 Oh progesterone below 200 ng/ml US of Polycystic Ovaries
Exclusion Criteria:
Obesity BMI above 25 kg/m2 Diabetes Mellitus Other endocrine disease like hypothyroidism, late onset adrenal hyperplasia Pregnancy Contraceptive or other hormonal treatment
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01711476
|Contact: Daniela Jakubowicz, MD
|Daniela Jakubowicz
|Caracas, San Bernardino, Venezuela, 410
|Principal Investigator: Daniela Jakubowicz, MD
|Principal Investigator:
|Daniela Jakubowicz, MD
|Hospital de Clinicas Caracas
|Responsible Party:
|Daniela Jakubowicz, MD, MD, Hospital de Clinicas Caracas
|ClinicalTrials.gov Identifier:
|NCT01711476 History of Changes
|Other Study ID Numbers:
|First Posted:
|October 22, 2012 Key Record Dates
|Last Update Posted:
|January 23, 2013
|Last Verified:
|January 2013
Polycystic Ovary Syndrome
Pathologic Processes
Ovarian Cysts
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Gonadal Disorders
Endocrine System Diseases
46, XX Disorders of Sex Development
Disorders of Sex Development
Urogenital Abnormalities
Adrenogenital Syndrome
Congenital Abnormalities
Complement Factor H
Complement Inactivating Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs