We used a validated agent-based model—Socio-Emotional CONcern DynamicS (SECONDS)—to model real-time playful interaction between a child diagnosed with Autism Spectrum Disorders (ASD) and its parent. SECONDS provides a real-time (second-by-second) virtual environment that could be used for clinical trials and testingprocess-orientedexplanationsofASDsymptomatology.Weconductednumerical experiments with SECONDS (1) for internal model validation comparing two parental behavioral strategies for stimulating social development in ASD (play-centered vs. initiative-centered) and (2) for empirical case-based model validation. We compared 2,000 simulated play sessions of two particular dyads with (second-by-second) time-series observations within 29 play sessions of a real parent-child dyad with ASD on six variables related to maintaining and initiating play. Overall, both simuladistributions. Given the idiosyncratic behaviors expected in ASD, the observed correspondence is non-trivial. Our results demonstrate the applicability of SECONDS to parent-child dyads in ASD. In the future, SECONDS could help design interventions for parental care in ASDted dyads provided a better fit to the observed dyad than reference null
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Background: Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited. Aim: To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home. Design: Systematic review and meta-analysis. Data sources: MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently. Results: About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34–0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07–0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26–3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23–18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time. Conclusion: Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
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