Treatment planning for children with attention-deficit/hyperactivity disorder: treatment utilization and family preferences

William B Brinkman, Jeffery N EpsteinDepartment of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USABackground: Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often results in child and family functional impairments. Although there are evidence-based treatment modalities available, implementation of and persistence with treatment plans vary with patients. Family preferences also vary and may contribute to variability in treatment utilization.Objective: The objective of this study is to describe the evidence-based treatments available for ADHD, identify patterns of use for each modality, and examine patient and parent treatment preferences.Method: Literature review.Results: Treatment options differ on benefits and risks/costs. Therefore, treatment decisions are preference sensitive and depend on how an informed patient/parent values the tradeoffs between options. Literature on patient and parent ADHD treatment preferences is based on quantitative research assessing the construct of treatment acceptability and qualitative and quantitative research that assesses preferences from a broader perspective. After a child is diagnosed with ADHD, a variety of factors influence the initial selection of treatment modalities that are utilized. Initial parent and child preferences are shaped by their beliefs about the nature of the child's problems and by information (and misinformation) received from a variety of sources, including social networks, the media, and health care providers. Subsequently, preferences become further informed by personal experience with various treatment modalities. Over time, treatment plans are revisited and revised as families work with their health care team to establish a treatment plan that helps their child achieve goals while minimizing harms and costs.Conclusions: Studies have not been able to determine the extent to which utilization rates are consistent with the underlying distribution of informed patient/parent treatment preferences. There are challenges to ensure that patient/parent preferences are consistently well informed, elicited, and discussed in the treatment planning process. Interventions are needed to promote such interactions.Keywords: attention-deficit/hyperactivity disorder, ADHD, adherence, preferences, physician–patient/parent communication, collaborative/shared decision makin

Late Cretaceous Plesiosaur Teeth from Axel Heiberg Island, Nunavut, Canada

We report the discovery of Late Cretaceous plesiosaur teeth from non-marine strata on Axel Heiberg Island in the Canadian High Arctic. In comparison to other plesiosaur teeth, these specimens are most similar to the teeth of elasmosaurs: they have a smooth outer surface and crenulated inner surface, with crenulations that extend nearly to the tip of the tooth. Comparisons with elasmosaurid fossils elsewhere indicate that the Axel Heiberg teeth are from juveniles. The presence of a plesiosaur in nonmarine strata on Axel Heiberg Island supports the suggestion that juvenile elasmosaurs frequently inhabited freshwater environments. The temporal distribution of the Axel Heiberg specimens and other occurrences from the High Arctic suggests that elasmosaurids may have expanded their range during a time of extreme climatic warmth.On signale la découverte de dents de plésiosaure du Crétacé supérieur d’une strate non marine à l’île Axel Heiberg, dans l’Extrême-Arctique canadien. Comparativement aux autres dents de plésiosaures, ces spécimens ressemblent beaucoup aux dents d’elasmosaures : leur surface extérieure est lisse et leur surface intérieure est crénelée, les crénulations s’étendant presque jusqu’à la pointe de la dent. Après avoir comparé ces spécimens aux fossiles d’elasmosaures trouvés ailleurs, on a remarqué que les dents trouvées à Axel Heiberg sont les dents de juvéniles. La présence d’un plésiosaure dans une strate non marine de l’île Axel Heiberg vient étayer la suggestion selon laquelle des elasmosaures juvéniles évoluaient souvent dans les milieux dulçaquicoles. La répartition temporelle des spécimens d’Axel Heiberg et d’autres occurrences de l’Extrême-Arctique laissent suggérer que les elasmosaures auraient pu étendre leur parcours au cours d’une période d’extrême chaleur climatique

Side Cutting Biopsy Needle for Endoscopes

Develop a side cutting biopsy needle that fits through the working channel of the endoscope similar to stereotactic needle with syringe suction to overcome the small biopsy samples due to instrument size limitations. The problem users are facing is that the biopsy samples through the endoscope are small secondary to instrument size limitations. The idea for this problem is to develop a side cutting biopsy needle that fits through the working channel of the endoscope similar to stereotactic needle, syringe suction

Bounds on Dimension Reduction in the Nuclear Norm

$\newcommand{\schs}{\scriptstyle{\mathsf{S}}_1}$For all $n \ge 1$, we give an explicit construction of $m \times m$ matrices $A_1,\ldots,A_n$ with $m = 2^{\lfloor n/2 \rfloor}$ such that for any $d$ and $d \times d$ matrices $A'_1,\ldots,A'_n$ that satisfy \|A'_i-A'_j\|_{\schs} \,\leq\, \|A_i-A_j\|_{\schs}\,\leq\, (1+\delta) \|A'_i-A'_j\|_{\schs} for all $i,j\in\{1,\ldots,n\}$ and small enough $\delta = O(n^{-c})$, where $c> 0$ is a universal constant, it must be the case that $d \ge 2^{\lfloor n/2\rfloor -1}$. This stands in contrast to the metric theory of commutative $\ell_p$ spaces, as it is known that for any $p\geq 1$, any $n$ points in $\ell_p$ embed exactly in $\ell_p^d$ for $d=n(n-1)/2$. Our proof is based on matrices derived from a representation of the Clifford algebra generated by $n$ anti-commuting Hermitian matrices that square to identity, and borrows ideas from the analysis of nonlocal games in quantum information theory.Comment: 16 page

Evidence of two-dimensional macroscopic quantum tunneling of a current-biased DC-SQUID

The escape probability out of the superconducting state of a hysteretic DC-SQUID has been measured at different values of the applied magnetic flux. At low temperature, the escape current and the width of the probability distribution are temperature independent but they depend on flux. Experimental results do not fit the usual one-dimensional (1D) Macroscopic Quantum Tunneling (MQT) law but are perfectly accounted for by the two-dimensional (2D) MQT behaviour as we propose here. Near zero flux, our data confirms the recent MQT observation in a DC-SQUID \cite{Li02}.Comment: 4 pages, 4 figures Accepted to PR

Dishevelled genes mediate a conserved mammalian PCP pathway to regulate convergent extension during neurulation

The planar cell polarity (PCP) pathway is conserved throughout evolution, but it mediates distinct developmental processes. In Drosophila, members of the PCP pathway localize in a polarized fashion to specify the cellular polarity within the plane of the epithelium, perpendicular to the apicobasal axis of the cell. In Xenopus and zebrafish, several homologs of the components of the fly PCP pathway control convergent extension. We have shown previously that mammalian PCP homologs regulate both cell polarity and polarized extension in the cochlea in the mouse. Here we show, using mice with null mutations in two mammalian Dishevelled homologs, Dvl1 and Dvl2, that during neurulation a homologous mammalian PCP pathway regulates concomitant lengthening and narrowing of the neural plate, a morphogenetic process defined as convergent extension. Dvl2 genetically interacts with Loop-tail, a point mutation in the mammalian PCP gene Vangl2, during neurulation. By generating Dvl2 BAC (bacterial artificial chromosome) transgenes and introducing different domain deletions and a point mutation identical to the dsh1 allele in fly, we further demonstrated a high degree of conservation between Dvl function in mammalian convergent extension and the PCP pathway in fly. In the neuroepithelium of neurulating embryos, Dvl2 shows DEP domain-dependent membrane localization, a pre-requisite for its involvement in convergent extension. Intriguing, the Loop-tail mutation that disrupts both convergent extension in the neuroepithelium and PCP in the cochlea does not disrupt Dvl2 membrane distribution in the neuroepithelium, in contrast to its drastic effect on Dvl2 localization in the cochlea. These results are discussed in light of recent models on PCP and convergent extension

Pathway-GPS and SIGORA: identifying relevant pathways based on the over-representation of their gene-pair signatures

peer-reviewedMotivation. Predominant pathway analysis approaches treat pathways as collections of individual genes and consider all pathway members as equally informative. As a result, at times spurious and misleading pathways are inappropriately identified as statistically significant, solely due to components that they share with the more relevant pathways. Results. We introduce the concept of Pathway Gene-Pair Signatures (Pathway-GPS) as pairs of genes that, as a combination, are specific to a single pathway. We devised and implemented a novel approach to pathway analysis, Signature Over-representation Analysis (SIGORA), which focuses on the statistically significant enrichment of Pathway-GPS in a user-specified gene list of interest. In a comparative evaluation of several published datasets, SIGORA outperformed traditional methods by delivering biologically more plausible and relevant results. Availability. An efficient implementation of SIGORA, as an R package with precompiled GPS data for several human and mouse pathway repositories is available for download from http://sigora.googlecode.com/svn/

A WZW model based on a non-semi-simple group

We present a conformal field theory which desribes a homogeneous four dimensional Lorentz-signature space-time. The model is an ungauged WZW model based on a central extension of the Poincar\'e algebra. The central charge of this theory is exactly four, just like four dimensional Minkowski space. The model can be interpreted as a four dimensional monochromatic plane wave. As there are three commuting isometries, other interesting geometries are expected to emerge via $O(3,3)$ duality.Comment: 8 pages, phyzzx, IASSNS-HEP-93/61 Texable versio

Nodes of the Gap Function and Anomalies in Thermodynamic Properties of Superfluid 3^3He

Departures of thermodynamic properties of three-dimensional superfluid $^3$He from the predictions of BCS theory are analyzed. Attention is focused on deviations of the ratios $\Delta(T=0)/T_c$ and $[C_s(T_c)-C_n(T_c)]/C_n(T_c)$ from their BCS values, where $\Delta(T=0)$ is the pairing gap at zero temperature, $T_c$ is the critical temperature, and $C_s$ and $C_n$ are the superfluid and normal specific heats. We attribute these deviations to the momentum dependence of the gap function $\Delta(p)$, which becomes well pronounced when this function has a pair of nodes lying on either side of the Fermi surface. We demonstrate that such a situation arises if the P-wave pairing interaction $V(p_1,p_2)$, evaluated at the Fermi surface, has a sign opposite to that anticipated in BCS theory. Taking account of the momentum structure of the gap function, we derive a closed relation between the two ratios that contains no adjustable parameters and agrees with the experimental data. Some important features of the effective pairing interaction are inferred from the analysis.Comment: 17 pages, 4 figure