The New Normal: Families, Caretakers, and Adults with Autism

Over the last several decades, the clinical prevalence of autism has increased considerably, as has the amount of popular and scientific attention directed towards the condition. However, discussions of autism tend to focus on children and finding a cause and a cure, while the growing numbers of adults diagnosed with autism have received relatively little attention. This dissertation begins with the argument that popular representations of autism are shaped by the idealism of modern medicine, and its overriding search to discover etiologies and treatments for all forms of biological difference that fall within its purview. And yet, for those responsible for adults with autism, management, care, and support are more relevant concerns to everyday experience than are cause and cure. In order to describe and analyze this everyday experience, this dissertation features a three-year ethnographic study of thirteen families with adult members with severe forms of autism. After reviewing pertinent historical and demographic information, the body of the manuscript explores: 1) the process by which caretakers negotiate between different definitions of problem behavior in the face of persistent situational complexity and ambiguity; 2) the contextual dynamics that make it possible for caretakers to perceive as innocent and/or humorous behaviors that are often viewed as atypical by others; and 3) the ways in which the experience of continued atypicality and dependency comes into conflict with popular representations of autism while at the same time highlighting the reality of the ever-looming future and the care and support required after primary caretakers are gone. At the end of the dissertation, I return to the argument that modern medical idealism discourages popular recognition that, in the case of autism, continued atypicality and dependency constitute the condition\u27s usual prognosis. I conclude with a short consideration of how the themes explored in this thesis resonate with the experiences of those living with or alongside other forms of biological difference (e.g. disability, mental illness, Alzehemier\u27s) that are currently incurable

Single block attacks and statistical tests on CubeHash

This paper describes a second preimage attack on the CubeHash cryptographic one-way hash function. The attack finds a second preimage in less time than brute force search for these CubeHash variants: CubeHash $r$/$b$-224 for $b \u3e 100$; CubeHash$r$/$b$-256 for $b \u3e 96$; CubeHash$r$/$b$-384 for $b \u3e 80$; and CubeHash$r$/$b$-512 for $b \u3e 64$. However, the attack does not break the CubeHash variants recommended for SHA-3. The attack requires minimal memory and can be performed in a massively parallel fashion. This paper also describes several statistical randomness tests on CubeHash. The tests were unable to disprove the hypothesis that CubeHash behaves as a random mapping. These results support CubeHash\u27s viability as a secure cryptographic hash function

Assessment and outcomes in mild traumatic brain injury in the Emergency Department

Traumatic brain injury (TBI) is common, affecting up to 600/100,000 people. Mild TBI accounts for up to 90% of all TBI. The Emergency Department attendance rate for head injuries is as high as 1800/100,000 population, and 15-20% of those attendances result in hospital admission. Mild TBI causes symptoms such as headaches, dizziness, disordered balance, cognitive dysfunction and depression which in turn impact on quality of life. Accurate risk assessment and prognostication of patients with acute neurological conditions in the Emergency Department is essential. This PhD consists of a systematic review that examines the hard outcome of ‘return to work’ following a mild TBI; a prospective observational cohort study that reports the difference in neurocognitive function and symptoms that patients experience at baseline and three days after mild TBI; and a prospective observational cohort study that reports the number of patients that attend the Emergency Department with seizure secondary to TBI, and the value of two biomarkers in predicting the recurrence of seizures in patients that attend the Emergency Department having had a seizure. This thesis comprises three studies in which I investigated the short and long-term effects of mild traumatic brain injury (TBI) and prognostication in seizure. In study one, I undertook a systematic review and meta-analysis to determine return to work times for adults with mild TBI. The primary objective was to determine the time taken to return to work following a mild TBI. Articles were included if they reported on adults with mild TBI and recorded the outcome return to work. Six electronic databases and eight clinical trial registries were searched. A narrative synthesis and a random-effects meta-analysis was performed. Bias was assessed using a modified version of the Newcastle Ottawa quality assessment tool. The second study was a prospective observational cohort study of adults with mild TBI and a comparison group of Emergency Department patients without brain injury. The primary outcomes were neurocognitive function and concussion symptom severity at baseline and 72 hours. Adult patients with mild TBI within the last 24 hours were included in the mild TBI group, and adults that attended the Emergency Department with trauma beneath the clavicle, or with a non-neurological medical condition, were included in the comparison group. Outcomes were measured on the Standardized Assessment of Concussion (SCA) and the Concussion Symptom Inventory (CSI) at baseline in the Emergency Department and at follow up at 72 hours. Comparisons were made between baseline and follow up, and between groups at single time points. The third study was a prospective observational cohort study designed to assess the prognostic value of the biomarkers S100B and copeptin in patients with seizure. Adult patients attending the Emergency Department with seizure of any cause were included. The primary outcome was a composite of seizure recurrence, death, hospitalisation, rehospitalisation or re-attendance at the Emergency Department at seven days. S100B and copeptin were measured in the Emergency Department. Statistical comparison of the two groups was performed, optimum thresholds of the biomarkers for diagnosing the endpoint were derived, diagnostic test characteristics were calculated, and logistic regression modelling was performed to identify variables most closely associated with the outcome. The aetiology of the seizure was identified and the proportion that had a seizure secondary to TBI was recorded. In the systematic review and meta-analysis, 14 studies were included. Three reported the average time taken to return to work, and 12 reported the proportion of patients that have returned to work by a pre-specified time point. The pooled proportion of people returned to work at one, three, six and 12 months was 56%, 75%, 83%, and 89% respectively. In the study of short-term effects of mild TBI, 240 patients were included, of which 189 had mild TBI and 51 comprised the non-brain injured comparison group. Patients with mild TBI had marked neurocognitive impairment (SAC at baseline 25 [23-27], difference in SAC score between brain injured and non-brain injured 1, p=0.02, [95% confidence interval [CI] -1.4 to -2.4]), worse symptom severity (CSI at baseline 9 [4-21], difference in CSI between brain injured and non-brain injured 9, p<0.001 [95% CI 8.4 to 13.7]), and high numbers of symptoms (number of symptoms at baseline 4 [2-8], difference between brain injured and non-brain injured 4, p<0.001 [95% CI 2.6 to 4.4]), all of which persisted at 72 hours. In the study of patients with seizures, 97 patients were recruited, of which 52% met the composite primary endpoint. No patients attended with a seizure as a consequence of TBI. S100B and copeptin were significantly higher in patients with compared to without the composite primary endpoint: 0.22 μg/L (95% CI 0.14 to 0.31) vs 0.11 μg/L (95% CI 0.08 to 0.14) (difference 0.02 μg/L, p = 0.01, 95% CI 0.02 to 0.2) for S100B; and 77.0 pmol/L (95% CI 44.3 to 109.7) vs 27.0 (95% CI 18.2 to 35.9) (difference 50 pmol/L, p = 0.004, 95% CI 16.2 to 83.8) for copeptin. Thresholds of 0.088 μg/L and 6.26 pmol/L were identified for S100B and copeptin respectively. At those thresholds, S100B sensitivity and specificity was 58% (95% CI 43-72) and 60% (95% CI 44-74); and copeptin sensitivity and specificity was 80% (95% CI 66-90) and 21% (95% CI 11-36). Epilepsy, complex partial seizure, provoked/acute symptomatic seizure, and pyrexia were identified as factors independently associated with the primary outcome but there was no additional value when the biomarkers were included in the model. In this body of work, I have shown that patients with mild traumatic brain injury have impaired neurocognitive function and a significant symptom burden that persists for several days, and in some patients is likely to persist for many months. Although most patients return to normal activities, including working, by three months after a mild traumatic brain injury, up to a tenth of patients are still unable to return to work at one year after the injury. Around half of patients that attend an Emergency Department with a seizure go on to be admitted or have another seizure by one week, but the biomarkers S100B and copeptin add no extra value to current prediction tools in identifying who will have a recurrent seizure, and few patients have a seizure secondary to TBI

Building a Better Atomic Clock

Since 1967, the Second has been defined by the CGPM as 9,192,631,770 periods of oscillation corresponding to a transition between two hyperfine levels in a Cesium atom with zero external fields. Key to this definition was the fact that as experimentalists found new and more precise ways to measure this frequency, the definition of the second would become more and more accurate with time. However, in the last 30 years, new technologies based on tunable lasers addressing optical transitions in atoms, ions, and molecules have offered an entirely new approach to defining the Second with significantly higher precision and accuracy. Here, I will show that by trapping thousands of atoms inside a specially engineered optical lattice one can create an extremely accurate frequency standard with 2 orders of magnitude improvement over current Cs standards. Furthermore, I will explain that standards based on this technology are fundamentally more stable than the primary standard by 3 orders of magnitude. Leapfrogging the currently held accuracy records of ion clocks, this work documents the first optical lattice clock to best all other atomic clock implementations, a mere 8 years after the first proof of principle experiments. In this thesis I will describe how we have overcome a number of important systematic uncertainties to achieve these results. This revolution in accuracy and precision opens the door for new experiments utilizing the clock as a probe of quantum many-body physics. To this end, a new apparatus has been designed that combines the unprecedented precision of clock experiments with the amazing progress attained in quantum gas experiments

Parents' perceived obstacles to pediatric clinical trial participation: Findings from the clinical trials transformation initiative.

Enrollment of children into pediatric clinical trials remains challenging. More effective strategies to improve recruitment of children into trials are needed. This study used in-depth qualitative interviews with parents who were approached to enroll their children in a clinical trial in order to gain an understanding of the barriers to pediatric clinical trial participation. Twenty-four parents whose children had been offered the opportunity to participate in a clinical trial were interviewed: 19 whose children had participated in at least 1 clinical trial and 5 who had declined participation in any trial. Each study aspect, from the initial explanation of the study to the end of the study, can affect the willingness of parents to consent to the proposed study and future studies. Establishing trust, appropriate timing, a transparent discussion of risks and benefits oriented to the layperson, and providing motivation for children to participate were key factors that impacted parents' decisions. In order for clinical trial accrual to be successful, parents' priorities and considerations must be a central focus, beginning with initial trial design. The recommendations from the parents who participated in this study can be used to support budget allocations that ensure adequate training of study staff and improved staffing on nights and weekends. Studies of parent responses in outpatient settings and additional inpatient settings will provide valuable information on the consent process from the child's and parent's perspectives. Further studies are needed to explore whether implementation of such strategies will result in improved recruitment for pediatric clinical trials

Transient crosslinking kinetics optimize gene cluster interactions

Our understanding of how chromosomes structurally organize and dynamically interact has been revolutionized through the lens of long-chain polymer physics. Major protein contributors to chromosome structure and dynamics are condensin and cohesin that stochastically generate loops within and between chains, and entrap proximal strands of sister chromatids. In this paper, we explore the ability of transient, protein-mediated, gene-gene crosslinks to induce clusters of genes, thereby dynamic architecture, within the highly repeated ribosomal DNA that comprises the nucleolus of budding yeast. We implement three approaches: live cell microscopy; computational modeling of the full genome during G1 in budding yeast, exploring four decades of timescales for transient crosslinks between 5k bp domains in the nucleolus on Chromosome XII; and, temporal network models with automated community detection algorithms applied to the full range of 4D modeling datasets. The data analysis tools detect and track gene clusters, their size, number, persistence time, and their plasticity. Of biological significance, our analysis reveals an optimal mean crosslink lifetime that promotes pairwise and cluster gene interactions through "flexible" clustering. In this state, large gene clusters self-assemble yet frequently interact, marked by gene exchanges between clusters, which in turn maximizes global gene interactions in the nucleolus. This regime stands between two limiting cases each with far less global gene interactions: with shorter crosslink lifetimes, "rigid" clustering emerges with clusters that interact infrequently; with longer crosslink lifetimes, there is a dissolution of clusters. These observations are compared with imaging experiments on a normal yeast strain and two condensin-modified mutant cell strains, applying the same image analysis pipeline to the experimental and simulated datasets

Cross-checking to reduce adverse events resulting from medical errors in the emergency department: study protocol of the CHARMED cluster randomized study

International audienceBackgroundMedical errors and preventable adverse events are a major cause of concern, especially in the emergency department (ED) where its prevalence has been reported to be roughly of 5–10 % of visits. Due to a short length of stay, emergency patients are often managed by a sole physician – in contrast with other specialties where they can benefit from multiples handover, ward rounds and staff meetings. As some studies report that the rate and severity of errors may decrease when there is more than one physician involved in the management in different settings, we sought to assess the impact of regular systematic cross-checkings between physicians in the ED.DesignThe CHARMED (Cross-checking to reduce adverse events resulting from medical errors in the emergency department) study is a multicenter cluster randomized study that aim to evaluate the reduction of the rate of severe medical errors with implementation of systematic cross checkings between emergency physician, compared to a control period with usual care. This study will evaluate the effect of this intervention on the rate of severe medical errors (i.e. preventable adverse events or near miss) using a previously described two-level chart abstraction. We made the hypothesis that implementing frequent and systematic cross checking will reduce the rate of severe medical errors from 10 to 6 % - 1584 patients will be included, 140 for each period in each center.DiscussionThe CHARMED study will be the largest study that analyse unselected ED charts for medical errors. This could provide evidence that frequent systematic cross-checking will reduce the incidence of severe medical errors

The Ursinus Weekly, April 9, 1962

Junior class goes Parisian for Sunnybrook event Friday • Wurster elected YMCA president • Dr. Helfferich elected as UCC educators treasurer • Coeds tap Taney, Hartzell, Andrews for prexy posts • Pre-medicals hear Hahneman\u27s Bondi on chemotherapy • Sophomores slate weekend wingding • Thousands visit science fair at Ursinus College • Forum to present Sokoloffs in piano recital Wednesday • Pi Nu will sponsor music month here • Weekly banquet is Swint\u27s swansong • Moll announces MSGA now accepting petitions for 1962 membership • Editorial: A matter of policy; Is it worth it, men? • Letters to the editor • Next war praised; Bravo for Mackey • Meistersinger reports progress of New England tour via phone call • Conservative coed goes Dixie-way • Fighting Shaner leads Siebmen in sloppy 11-7 victory over Dickinson • Cindermen drop practice meet to Lehighers, 64 to 54 • Intramural corner • Dryfoos named outstanding player by coaches of MAC college division • Snyder places second in chess tournament • Greek gleanings • Miss Pennsylvania betroths UC grad • Final student concert spots Prokofieff work • Graduate grantshttps://digitalcommons.ursinus.edu/weekly/1316/thumbnail.jp

What's in a number? Problems with counting traumatic brain injuries.

In perspective - No abstract available