Predicting intervention use in autistic children : demographic and autism-specific characteristics

LAY ABSTRACT: Autism is a condition that is characterised by social communication difficulties and restrictive and repetitive behaviours or interests. Autism can present in many different ways and various interventions are available. Some interventions are conventional, and they are recommended to be used for children with autism (guideline therapies) or for other disorders such as anxiety or attention-deficit hyperactivity disorder (mainstream therapies or medication), while others are less conventional (other therapies or medication, they are discouraged, unknown or alternative). Little is known about who chooses which intervention. This study found that most autistic children use some kind of intervention. Children who attend special education or have an additional diagnosis (other than autism) tend to receive more therapies, while children with a lower IQ receive fewer therapies. Older children, children with a higher IQ and girls are more likely to use conventional (mainstream or guideline) therapies. Children whose parents have a lower educational level are more likely to have used conventional medication. Whereas, children with more sensory issues (e.g. sensitivity to sound, smell or movement) were more likely to have used unconventional medication. This study found that other autism-related characteristics such as the number of autism symptoms, social skills and repetitive and restrictive behaviours were not related to the interventions used. More treatments focussed on multiple problems should be available for children with autism who have additional difficulties

Electrical Impedance Tomography as a monitoring tool during weaning from mechanical ventilation:an observational study during the spontaneous breathing trial

Background: Prolonged weaning from mechanical ventilation is associated with poor clinical outcome. Therefore, choosing the right moment for weaning and extubation is essential. Electrical Impedance Tomography (EIT) is a promising innovative lung monitoring technique, but its role in supporting weaning decisions is yet uncertain. We aimed to evaluate physiological trends during a T-piece spontaneous breathing trail (SBT) as measured with EIT and the relation between EIT parameters and SBT success or failure. Methods: This is an observational study in which twenty-four adult patients receiving mechanical ventilation performed an SBT. EIT monitoring was performed around the SBT. Multiple EIT parameters including the end-expiratory lung impedance (EELI), delta Tidal Impedance (ΔZ), Global Inhomogeneity index (GI), Rapid Shallow Breathing Index (RSBIEIT), Respiratory Rate (RREIT) and Minute Ventilation (MVEIT) were computed on a breath-by-breath basis from stable tidal breathing periods. Results: EELI values dropped after the start of the SBT (p &lt; 0.001) and did not recover to baseline after restarting mechanical ventilation. The ΔZ dropped (p &lt; 0.001) but restored to baseline within seconds after restarting mechanical ventilation. Five patients failed the SBT, the GI (p = 0.01) and transcutaneous CO2 (p &lt; 0.001) values significantly increased during the SBT in patients who failed the SBT compared to patients with a successful SBT. Conclusion: EIT has the potential to assess changes in ventilation distribution and quantify the inhomogeneity of the lungs during the SBT. High lung inhomogeneity was found during SBT failure. Insight into physiological trends for the individual patient can be obtained with EIT during weaning from mechanical ventilation, but its role in predicting weaning failure requires further study.</p

Experimental determination of pressure coefficients for flood loading of walls of Dutch terraced houses

Failure of residential buildings during floods is an important cause of damage and loss of life. In the case of the Netherlands, the collapse of buildings is implicitly included in current damage and mortality curves since these are generated from historical data. However, the Netherlands has not experienced destructive flooding since 1953, so damage functions for modern buildings do not exist. Therefore, this paper assesses the effect of floods on modern Dutch residences with laboratory tests and structural models in order to formulate physically-based fragility curves. The results gathered are also applicable to similarly-built masonry and cavity-wall rowhouses elsewhere. Almost half of the Dutch population live in terraced houses (also known as townhouses or rowhouses), of which the critical failure mechanism during a flood is out-of-plane bending of the load-bearing walls. Failure of these structural elements should be analysed with the pressure coefficient, Cp, instead of the currently used drag coefficient, CD, because wall collapse is more likely than displacement of the entire structure. This paper describes the quantification of both coefficients by conducting flume experiments on rectangular boxes with different geometries and orientations. Higher drag coefficients are derived from the experiments than provided by FEMA, resulting in higher hydrodynamic loads on the residences. The physical approach to evaluate the collapse of residences is exemplified with a case study of the three most common type of residences in the Netherlands. Structural analyses of their load-bearing walls subjected to a hydrostatic and hydrodynamic load perpendicular to the wall show failure due to milder flood conditions than the current damage curves do for all case study residences. A sensitivity analysis shows an important influence of wall thickness, initial axial loading of the wall, and the flood water level inside the residence

Diagnostic accuracy and cost-effectiveness of dermoscopy in primary care: a cluster randomized clinical trial

BackgroundThe dermoscope improves general practitioners' (GP) sensitivity for melanoma. However, diagnostic accuracy (DA) and cost-effectiveness of the dermoscope in primary care for the evaluation of all skin lesions suspected of malignancy remains unknown. ObjectivesTo determine the DA and cost-effectiveness of the dermoscope in primary care for skin lesions suspected of malignancy. MethodsIn a cluster randomized clinical trial, 48 Dutch general practices were randomized to either intervention group using a dermoscope or control group using only naked-eye examination. A total of 194 lesions from 170 patients in the intervention group and 222 lesions from 211 patients in the control group were analysed for DA and cost-effectiveness. ResultsThe percentage of correctly diagnosed lesions in intervention group and control group was 50.5% and 40.5% respectively. This was 61.5% and 22.2% for melanomas. In the intervention group, three malignancies were treated with the expectative treatment option compared to none in the control group. The odds ratio (OR) of a correct diagnosis in the intervention group, compared to control group, was 1.51 (95% CI: 0.96-2.37) P=0.07. Consequently, the relative risk was 1.25. The incremental cost-effectiveness ratio was Euro89 (95% CI -Euro60 to Euro598), indicating that using a dermoscope costs an additional Euro89 for one additional correctly diagnosed patient. Additional analyses showed better effects of dermoscopy compared to the control group for 98% of the bootstrap resamples. ConclusionsThe probability of a correct diagnosis was 1.25 times higher using a dermoscope than without a dermoscope. Although this difference is marginally not statistically significant, dermoscopy in general practice appears to be cost effective. We therefore think that GPs should be trained to use a dermoscope, although they should realize that even with the use of a dermoscope not all lesions will be diagnosed correctly

Influence of load interdependencies of flood defences on probabilities and risks at the Bovenrijn/IJssel area, The Netherlands

In the Netherlands, flood risk analysis is usually carried out for a location, without considering potential flood defence failures in upstream areas. This may result in significant over- or underestimation of flood risks. The effect of upstream failures on failure probabilities and flood risks in other areas is called load interdependence of flood defences. This effect can be both positive and negative: loads on a certain defence can increase and decrease due to failures upstream. In this research a framework was developed which enables the consideration of these interdependencies in a probabilistic framework. This was done by using Monte Carlo with Importance Sampling and a fast inundation model, which enables considering many scenarios with many different breaches. The case considered was the Bovenrijn/IJssel area in the Netherlands, a lowland river area where dike breaches can have both positive and negative effects on the loads on other flood defence elements. The risk estimates and changes in water level probabilities in the considered area show a clear interrelation between loads on different elements of the flood defence system and demonstrate that the effects of dike breaches on loads and risks on other locations cannot be ignored in flood risk analysis.Hydraulic EngineeringCivil Engineering and Geoscience

De nieuwe volksgezondheidsexpert als gamechanger in een stevige preventie-infrastructuur [The new public health expert as gamechanger in a strong infrastructure for prevention]

De afgelopen decennia is vooral aandacht besteed aan het ontwikkelen van de inhoud van het vak van preventie en gezondheidsbevordering (GB). Er is nauwelijks geïnvesteerd in de professional zelf en in voldoende professionals om preventie en GB impact te laten hebben. De huidige complexe volksgezondheidsproblemen vragen echter om kundige professionals die weten hoe complexe vraagstukken aangepakt kunnen worden. De gamechanger voor de volksgezondheid 2030 die wij voorstellen is een netwerk van een nieuw type volksgezondheidsexperts die vanuit een collectieve benadering en gesteund door een stevige preventiestructuur collectieve impact kunnen realiseren. English abstract: In recent decades, particular attention has been paid to developing the content of the profession of prevention and health promotion (HP). Hardly any investment has been made in the professional himself and in sufficient professionals to allow prevention and HP to have an impact. However, today's complex public health problems require skilled professionals who know how to tackle complex issues. The 2030 gamechanger for public health that we propose is a network of a new type of public health experts who can realize collective impact from a collective impact approach and supported by a solid infrastructure for prevention

Experimental determination of pressure coefficients for flood loading of walls of Dutch terraced houses

Failure of residential buildings during floods is an important cause of damage and loss of life. In the case of the Netherlands, the collapse of buildings is implicitly included in current damage and mortality curves since these are generated from historical data. However, the Netherlands has not experienced destructive flooding since 1953, so damage functions for modern buildings do not exist. Therefore, this paper assesses the effect of floods on modern Dutch residences with laboratory tests and structural models in order to formulate physically-based fragility curves. The results gathered are also applicable to similarly-built masonry and cavity-wall rowhouses elsewhere. Almost half of the Dutch population live in terraced houses (also known as townhouses or rowhouses), of which the critical failure mechanism during a flood is out-of-plane bending of the load-bearing walls. Failure of these structural elements should be analysed with the pressure coefficient, Cp, instead of the currently used drag coefficient, CD, because wall collapse is more likely than displacement of the entire structure. This paper describes the quantification of both coefficients by conducting flume experiments on rectangular boxes with different geometries and orientations. Higher drag coefficients are derived from the experiments than provided by FEMA, resulting in higher hydrodynamic loads on the residences. The physical approach to evaluate the collapse of residences is exemplified with a case study of the three most common type of residences in the Netherlands. Structural analyses of their load-bearing walls subjected to a hydrostatic and hydrodynamic load perpendicular to the wall show failure due to milder flood conditions than the current damage curves do for all case study residences. A sensitivity analysis shows an important influence of wall thickness, initial axial loading of the wall, and the flood water level inside the residence.Applied MechanicsHydraulic Structures and Flood Ris