Autism and anaesthesia: a simple framework for everyday practice

Key points: At least 1–2% of people are autistic. Most are adults without intellectual disability. Many are unrecognised. Autistic people are more likely to have co-occurring medical conditions; they experience well-described barriers to healthcare, adverse health outcomes and premature mortality. Illness or injury may present atypically and delayed presentation is common. Person-centred adaptations improve the experience of perioperative care. “Autistic SPACE” offers a framework for meeting the needs of autistic patients: Sensory needs, Predictability, Acceptance, Communication, Empathy

Continuous measurements of two qubits

We develop a theory of coherent quantum oscillations in two, in general interacting, qubits measured continuously by a mesoscopic detector with arbitrary non-linearity and discuss an example of SQUID magnetometer that can operate as such a detector. Calculated spectra of the detector output show that the detector non-linearity should lead to mixing of the oscillations of the two qubits. For non-interacting qubits oscillating with frequencies $\Omega_1$ and $\Omega_2$, the mixing manifests itself as spectral peaks at the combination frequencies $\Omega_1\pm \Omega_2$. Additional nonlinearity introduced by the qubit-qubit interaction shifts all the frequencies. In particular, for identical qubits, the interaction splits coherent superposition of the single-qubit peaks at $\Omega_1=\Omega_2$. Quantum mechanics of the measurement imposes limitations on the height of the spectral peaks.Comment: 14 pages, 6 figure

Decoherence of a two-qubit system with a variable bath coupling operator

We examine the decoherence of an asymmetric two-qubit system that is coupled via a tunable interaction term to a common bath or two individual baths of harmonic oscillators. The dissipative dynamics are evaluated using the Bloch-Redfield formalism. It is shown that the behaviour of the decoherence effects is affected mostly by different symmetries between the qubit operator which is coupled to the environment and temperature, whereas the differences between the two bath configurations are very small. Moreover, it is elaborated that small imperfections of the qubit parameters do not lead to a drastic enhancement of the decoherence rates.Comment: 10 pages, 5 figure

Determination of the primary structure and carboxyl pKAs of heparin-derived oligosaccharides by band-selective homonuclear-decoupled two-dimensional 1H NMR

Determination of the structure of heparin-derived oligosaccharides by 1H NMR is challenging because resonances for all but the anomeric protons cover less than 2 ppm. By taking advantage of increased dispersion of resonances for the anomeric H1 protons at low pD and the superior resolution of band-selective, homonuclear-decoupled (BASHD) two-dimensional 1H NMR, the primary structure of the heparin-derived octasaccharide ∆UA(2S)-[(1 → 4)-GlcNS(6S)-(1 → 4)-IdoA(2S)-]3-(1 → 4)-GlcNS(6S) has been determined, where ∆UA(2S) is 2-O-sulfated ∆4,5-unsaturated uronic acid, GlcNS(6S) is 6-O-sulfated, N-sulfated β-d-glucosamine and IdoA(2S) is 2-O-sulfated α-l-iduronic acid. The spectrum was assigned, and the sites of N- and O-sulfation and the conformation of each uronic acid residue were established, with chemical shift data obtained from BASHD-TOCSY spectra, while the sequence of the monosaccharide residues in the octasaccharide was determined from inter-residue NOEs in BASHD-NOESY spectra. Acid dissociation constants were determined for each carboxylic acid group of the octasaccharide, as well as for related tetra- and hexasaccharides, from chemical shift–pD titration curves. Chemical shift–pD titration curves were obtained for each carboxylic acid group from sub-spectra taken from BASHD-TOCSY spectra that were measured as a function of pD. The pKAs of the carboxylic acid groups of the ∆UA(2S) residues are less than those of the IdoA(2S) residues, and the pKAs of the carboxylic acid groups of the IdoA(2S) residues for a given oligosaccharide are similar in magnitude. Relative acidities of the carboxylic acid groups of each oligosaccharide were calculated from chemical shift data by a pH-independent method

The experiences of autistic doctors: a cross-sectional study

IntroductionMedicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap.MethodsThis is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors.ResultsWe received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3–61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called “autistic doctors” (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term “doctors with autism,” and with having attempted suicide.ConclusionAutistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce

Amphibious Seismic Survey Images Plate Interface at 1960 Chile Earthquake

The southern central Chilean margin at the site of the largest historically recorded earthquake in the Valdivia region, in 1960 (Mw = 9.5), is part of the 5000-km-long active subduction system whose geodynamic evolution is controversially debated and poorly understood. Covering the area between 36° and 40°S, the oceanic crust is segmented by prominent fracture zones. The offshore forearc and its onshore continuation show a complex image with segments of varying geophysical character, and several fault systems active during the past 24 m.y. In autumn 2001, the project SPOC was organized to study the Subduction Processes Off Chile, with a focus on the seismogenic coupling zone and the forearc. The acquired seismic data crossing the Chilean subduction system were gathered in a combined offshore-onshore survey and provide new insights into the lithospheric structure and evolution of active margins with insignificant frontal accretion