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To describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.
Medical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.
A retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.
319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.
58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.
Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.
Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.
In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.
Patients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.
Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.
The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.
The intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.
Emergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.
Machines incorporating techniques from artificial intelligence and machine learning can work with human users on a moment-to-moment, real-time basis to generate creative outcomes, performances and artefacts. We define such systems collaborative, creative AI systems, and in this article, consider the theoretical and practical considerations needed for their design so as to support improvisation, performance and co-creation through real-time, sustained, moment-to-moment interaction. We begin by providing an overview of creative AI systems, examining strengths, opportunities and criticisms in order to draw out the key considerations when designing AI for human creative collaboration. We argue that the artistic goals and creative process should be first and foremost in any design. We then draw from a range of research that looks at human collaboration and teamwork, to examine features that support trust, cooperation, shared awareness and a shared information space. We highlight the importance of understanding the scope and perception of two-way communication between human and machine agents in order to support reflection on conflict, error, evaluation and flow. We conclude with a summary of the range of design challenges for building such systems in provoking, challenging and enhancing human creative activity through their creative agency.
The competitive adsorption of lung surfactant (LS) and albumin at the air-liquid interface and the ability of polyethylene glycol (PEG) to mediate LS adsorption are analyzed using pressure area isotherms and grazing incidence x-ray diffraction (GIXD). The addition of albumin drastically reduces the amount of LS on the interface and slightly increases the LS lattice spacing. The addition of PEG restores the characteristic LS peaks, yielding a slightly more compact lattice. The scattering results are consistent with recent work which proposed that albumin creates a physical barrier which eliminates LS adsorption and that PEG enhances LS adsorption but does not significantly change LS surface ordering.
Immobilization of adsorbed Cs+ and Sr2+ on a molybdenum-doped, hexagonal tungsten bronze (HTB)-polyacrylonitrile (PAN) composite adsorbent can be achieved by heating in air at temperatures in the range 600 – 1200 °C. Thermal treatment of the parent composite material at 800 – 1000 °C undergoes a ca. 60% reduction in volume and retains its spherical morphology. For materials prepared at 800 – 1200 °C the full complement of Cs+ and the majority of Sr2+ partition into HTB phases (A∼0.16-0.3MO3; A = Cs, Sr, Na; M = Mo,W), along with sodium cations. The presence of high concentrations of Na+ relative to either Cs+ or Sr2+ does not appear to interfere with the formation of the HTB phase. The fraction (f) of Cs+ and Sr2+ leached from the tungstate phase assemblages is better or comparable with cesium hollandite (Cs0.8Ba0.4Ti8O18; f = ca. 8 × 10−5; rate = <1.2 × 10−4 g m−2d−1) and strontium titanate (SrTiO3; f = 3.1 × 10−3; rate = 2.63 × 10−4 g m−2 day×1), respectively, using a modified PCT test. Furthermore, where aggressive leaching conditions are employed (0.1M HNO3; 150 oC; 4 days), the tungstate phase assemblages display leach resistance orders of magnitude better than the reference phases (Cs+ - f = ca. 5 × 10−3; rate = ca. 1.4 × 10−3 g m−2 day−1; Sr2+ - f = ca. 8 × 10−2; rate = ca. 2.5 × 10−2 g m−2 day−1).
Nd-bearing zirconolite was leached at 90°C for 157 days in 0.001M citric acid under single-pass-flow-through conditions (modified MCC-4 protocol). Three different flow rates were used, ranging in an order of magnitude from 10 mL per day to 100 mL per day, to determine the effect of the rate of leachant replenishment on the durability of the zirconolite. Results of previous studies on the role of complexing agents on the leaching behaviour of single-phase zirconolite have been included in the discussion.
The pH of the citric acid solution was adjusted to 5 using KOH, mimicking that of the water in the parallel tests, to avoid the influence of pH on chemical durability of the zirconolite.
Simulated groundwater containing 0.001M citric acid at 90°C led to congruency in elemental releases and a diminution of release rate with time of about an order of magnitude, reaching virtual constancy after about 50 to 60 days to a level of about 10−5 g m−2 day−1. The most significant finding was that the elemental release rates of Nd, Ti and Zr (and Ca and Al where detected) were similar for all flow rates. Clearly, varying flow rate by up to an order of magnitude had no effect on elemental releases i.e. there is no solubility limit control on releases at 0.001M citric acid concentration.
An important finding of previous studies using identical leaching protocols with 0.001M citric acid, and inferred in our latest investigations reported here, was that there is no secondary layer development at the surface of the zirconolite to affect leach rates. In contrast, parallel tests carried out in deionised water instead of citric acid showed that hydroxides form in situ on the zirconolite surface, effectively forming hydrolysed zirconolite. This controls further dissolution of the zirconolite matrix due to the solubility limit being reached with respect to the hydrolysed phases rather than with zirconolite. Complexation by citrate ions prevents such control by hydrolysed species on zirconolite solubility.
Even under the more aggressive conditions imposed in these studies (0.001M citric acid), and regardless of flow rate of the leachant, elemental releases from zirconolite are very low for a candidate wasteform and demonstrate its attributes as a ceramic-based wasteform for the containment of actinides.
Immobilization of adsorbed Cs+ and Sr2+ on a molybdenum-doped, hexagonal tungsten bronze (HTB)-polyacrylonitrile (PAN) composite adsorbent can be achieved by heating in air at temperatures in the range 600 - 1200 °C. Thermal treatment of the parent composite material at 800 – 1000 °C undergoes a ca. 60% reduction in volume and retains its spherical morphology. For materials prepared at 800 – 1200 °C the full complement of Cs+ and the majority of Sr2+ partition into HTB phases (A∼0.16-0.3MO3; A = Cs, Sr, Na; M = Mo,W), along with sodium cations. The presence of high concentrations of Na+ relative to either Cs+ or Sr2+ does not appear to interfere with the formation of the HTB phase. The fraction (f) of Cs+ and Sr2+ leached from the tungstate phase assemblages is better or comparable with cesium hollandite (Cs0.8Ba0.4Ti8O18; f = ca. 8 × 10−5; rate = <1.2 × 10−4 g m−2d−1) and strontium titanate (SrTiO3; f = 3.1 × 10−3; rate = 2.63 × 10−4 g m−2day−1), respectively, using a modified PCT test. Furthermore, where aggressive leaching conditions are employed (0.1M HNO3; 150 °C; 4 days), the tungstate phase assemblages display leach resistance orders of magnitude better than the reference phases (Cs+ - f = ca. 5 × 10−3; rate = ca. 1.4 × 10−3 g m−2day−1; Sr2+ - f = ca. 8 × 10−2; rate = ca. 2.5 × 10−2 g m−2day−1).
Geopolymers should be serious waste form candidates for intermediate level waste (ILW), insofar as they are more durable than Portland cement and can pass the PCT-B test for high-level waste. Thus an alkaline ILW could be considered to be satisfactorily immobilised in a geopolymer formulation. However a simulated Hanford tank waste was found to fail the PCT-B criterion even for a waste loading as low as 5 wt%, very probably due to the formation of a soluble sodium phosphate compound(s). This suggests that it could be worth developing a “mixed” GP waste form in which the amorphous material can immobilise cations and a zeolitic component to immobilise anions. The PCT -B test is demonstrably subject to significant saturation effects, especially for relatively soluble waste forms.
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