Community-Based Early Intervention For Children With Autism Spectrum Disorder

One in 68 children has been identified with Autism Spectrum Disorder (ASD), a disorder defined by 1) deficits in social-communication and social interactions and 2) restricted, repetitive patterns of behavior, interests or activities. Research has shown that children with ASD who receive high-quality early intervention (EI) services in university-based research trials can make large gains in cognitive, communication, and adaptive behaviors skills, with positive long term effects. However, less is known about the outcomes for the over 50,000 children who receive EI in community settings. This dissertation provides initial evidence of the current state of community-based EI for children with ASD. Chapter 1 presents a meta-analysis of cognitive, communication, social, and adaptive behavior outcomes for children with ASD in community-based EI programs, and demonstrates that the gains made in the community are much smaller than those observed in university-based trials. In Chapter 2, prospective, longitudinal data collected from a local EI system is studied to understand which characteristics of preschool EI predict cognitive gains for 79 preschoolers with ASD that received publicly-funded services in classroom placements. The best predictor of gains was the utilization of recommended intervention practices to support the development of social and peer relationships. Chapter 3 discusses measurement of executive functioning (EF) among preschoolers with ASD, as executive functioning skills likely play an important role in response to EI. However existing EF measures have not been validated for use with low-functioning, nonverbal preschoolers with ASD. Results are presented from the development and the validation of a battery of nonverbal, performance-based EF tasks. These measures can be utilized in future community-based treatment trials

Comparing continuous lumbar plexus block, continuous epidural block and continuous lumbar plexus block with a parasacral sciatic nerve block on post-operative analgesia after hip arthroplasty

Study Objective: To compare post-operative analgesia obtained by continuous lumbar epidural block (CLEB) versus continuous lumbar plexus block (CLPB) versus CLPB associated with a single shot parasacral sciatic nerve block (CLEBS) after total hip arthroplasty (THA). Study design: Randomized clinical trial. Setting: Operating room, postoperative care unit, orthopedic surgical ward. Methods: 78 ASA I-III patients undergoing elective THA were randomly assigned to receive CLEB (n=24, 15-20 ml of 5 mg/ml ropivacaine, sufentanil 10 mg, clonidine 1 mg/ml), CLPB (n=22, 3mg/kg of 5 mg/ml of ropivacaine, max. 40 ml, clonidine 1 mg/ml, sufentanil 10 mg) or CLPBS (n=23, CLPB as described above; sciatic nerve: 20 ml of ropivacaine 5 mg/ml, clonidine 1 mg/ml). All patients received continuous infusion of 2 mg/ml of ropivacaine, 8 ml/h for 48 hours. Primary outcome was pain intensity assessment (VAS and VS). Secondary outcomes were postoperative total opioid consumption, hemodynamic stability, motor blockade, blood loss, intraoperative sufentanil and propofol consumption, patient satisfaction and complications. Results: VAS was lower in the CLEB group than in the CLPB and CLPBS groups respectively for 6 and 12 hours postoperatively (post-surgery p<0.001, 2h p<0.001, 6h p<0.001, 12h p<0.03)(Table 2). Moreover, CLPSB patients reported lower VAS than CLPB patients from the end of the surgery till the 12th follow up hour (Table 2). VS was lower in the CLEB group from the end of surgery to 6h postoperatively (Table 3). The CLPB group showed higher morphine consumption than the CLPSB and CLEB groups over 12 h postoperatively (p=0.05); thereafter, no statistically significant diferences were observed between groups at the end of follow up (48h) (p=0.4) (Table 4). onclusion: In conclusion, continuous lumbar plexus block in association with single shot sciatic nerve block is a valid alternative to epidural technique in managing postoperative analgesia after THA, with an improved risk-benefit balanc

The Ontology of Intentional Agency in Light of Neurobiological Determinism: Philosophy Meets Folk Psychology

The moot point of the Western philosophical rhetoric about free will consists in examining whether the claim of authorship to intentional, deliberative actions fits into or is undermined by a one-way causal framework of determinism. Philosophers who think that reconciliation between the two is possible are known as metaphysical compatibilists. However, there are philosophers populating the other end of the spectrum, known as the metaphysical libertarians, who maintain that claim to intentional agency cannot be sustained unless it is assumed that indeterministic causal processes pervade the action-implementation apparatus employed by the agent. The metaphysical libertarians differ among themselves on the question of whether the indeterministic causal relation exists between the series of intentional states and processes, both conscious and unconscious, and the action, making claim for what has come to be known as the event-causal view, or between the agent and the action, arguing that a sort of agent causation is at work. In this paper, I have tried to propose that certain features of both event-causal and agent-causal libertarian views need to be combined in order to provide a more defendable compatibilist account accommodating deliberative actions with deterministic causation. The ‘‘agent-executed-eventcausal libertarianism’’, the account of agency I have tried to develop here, integrates certain plausible features of the two competing accounts of libertarianism turning them into a consistent whole. I hope to show in the process that the integration of these two variants of libertarianism does not challenge what some accounts of metaphysical compatibilism propose—that there exists a broader deterministic relation between the web of mental and extra-mental components constituting the agent’s dispositional system—the agent’s beliefs, desires, short-term and long-term goals based on them, the acquired social, cultural and religious beliefs, the general and immediate and situational environment in which the agent is placed, etc. on the one hand and the decisions she makes over her lifetime on the basis of these factors. While in the ‘‘Introduction’’ the philosophically assumed anomaly between deterministic causation and the intentional act of deciding has been briefly surveyed, the second section is devoted to the task of bridging the gap between compatibilism and libertarianism. The next section of the paper turns to an analysis of folk-psychological concepts and intuitions about the effects of neurochemical processes and prior mental events on the freedom of making choices. How philosophical insights can be beneficially informed by taking into consideration folk-psychological intuitions has also been discussed, thus setting up the background for such analysis. It has been suggested in the end that support for the proposed theory of intentional agency can be found in the folk-psychological intuitions, when they are taken in the right perspective

Real-time monitoring of metabolic function in liver-on-chip microdevices tracks the dynamics of mitochondrial dysfunction

Microfluidic organ-on-a-chip technology aims to replace animal toxicity testing, but thus far has demonstrated few advantages over traditional methods. Mitochondrial dysfunction plays a critical role in the development of chemical and pharmaceutical toxicity, as well as pluripotency and disease processes. However, current methods to evaluate mitochondrial activity still rely on end-point assays, resulting in limited kinetic and prognostic information. Here, we present a liver-on-chip device capable of maintaining human tissue for over a month in vitro under physiological conditions. Mitochondrial respiration was monitored in real time using two-frequency phase modulation of tissue-embedded phosphorescent microprobes. A computer-controlled microfluidic switchboard allowed contiguous electrochemical measurements of glucose and lactate, providing real-time analysis of minute shifts from oxidative phosphorylation to anaerobic glycolysis, an early indication of mitochondrial stress. We quantify the dynamics of cellular adaptation to mitochondrial damage and the resulting redistribution of ATP production during rotenone-induced mitochondrial dysfunction and troglitazone (Rezulin)-induced mitochondrial stress. We show troglitazone shifts metabolic fluxes at concentrations previously regarded as safe, suggesting a mechanism for its observed idiosyncratic effect. Our microfluidic platform reveals the dynamics and strategies of cellular adaptation to mitochondrial damage, a unique advantage of organ-on-chip technology

Service Level Constrained Inventory Systems

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151878/1/poms13060_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151878/2/poms13060.pd

An Agent-Based Approach to Self-Organized Production

The chapter describes the modeling of a material handling system with the production of individual units in a scheduled order. The units represent the agents in the model and are transported in the system which is abstracted as a directed graph. Since the hindrances of units on their path to the destination can lead to inefficiencies in the production, the blockages of units are to be reduced. Therefore, the units operate in the system by means of local interactions in the conveying elements and indirect interactions based on a measure of possible hindrances. If most of the units behave cooperatively ("socially"), the blockings in the system are reduced. A simulation based on the model shows the collective behavior of the units in the system. The transport processes in the simulation can be compared with the processes in a real plant, which gives conclusions about the consequencies for the production based on the superordinate planning.Comment: For related work see http://www.soms.ethz.c

Modeling Supply Networks and Business Cycles as Unstable Transport Phenomena

Physical concepts developed to describe instabilities in traffic flows can be generalized in a way that allows one to understand the well-known instability of supply chains (the so-called ``bullwhip effect''). That is, small variations in the consumption rate can cause large variations in the production rate of companies generating the requested product. Interestingly, the resulting oscillations have characteristic frequencies which are considerably lower than the variations in the consumption rate. This suggests that instabilities of supply chains may be the reason for the existence of business cycles. At the same time, we establish some link to queuing theory and between micro- and macroeconomics.Comment: For related work see http://www.helbing.or