Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced

BACKGROUND: To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS: Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS: The sample comprised 2262 children and adolescents aged 5-17\u2009years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177\u2009days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS: To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered

Play and the exhibition:the problematic fun of showcasing of videogames in informal and formal contexts

Video games are inherently problematic as cultural artefacts, presenting issues of stability, currency, interaction and participation (to name but a few) in their curation. These issues are not necessarily unique to video games in an exhibition context, but their combination with the on-going debate about the status of video games as an art form inspire discussion and debate. Despite the issues presented by video games, there have been countless video game exhibitions in formal and informal contexts, typically focussing upon the historical narrative around games or their position as artefacts with cultural value. It is only in the last few years that artistic and academic study of this problematic field has developed traction, through both an emerging body of literature looking to formalise video games exhibitions practices and practitioner debate. 2019 sees the inaugural Game Arts International Assembly “a think tank for the international games arts ecosystem” bringing together leading curators and makers working at the forefront of public display of interactive arts and playful media.This paper contributes to the developing body of knowledge which analyses video games exhibition methods by formalising and evaluating the methods utilised within informal and formal contexts of video games exhibition from the perspective of reception theory. The study of both large scale exhibition such as those orchestrated by the Victoria and Albert museum and the Smithsonian American Art Museum alongside the one night indie game night or play party is a unique contribution to the field, with studies typically focussing on approaches within one given context. Reception theory provides a lens through which the active participative role of the attendee or visitor in meaning making can be evaluated and allows consideration of the connection between selected methods of exhibition and the resulting meaning making opportunities possible for a range of potential audiences

Costs Associated with Low Birth Weight in a Rural Area of Southern Mozambique

BACKGROUND: Low Birth Weight (LBW) is prevalent in low-income countries. Even though the economic evaluation of interventions to reduce this burden is essential to guide health policies, data on costs associated with LBW are scarce. This study aims to estimate the costs to the health system and to the household and the Disability Adjusted Life Years (DALYs) arising from infant deaths associated with LBW in Southern Mozambique. METHODS AND FINDINGS: Costs incurred by the households were collected through exit surveys. Health system costs were gathered from data obtained onsite and from published information. DALYs due to death of LBW babies were based on local estimates of prevalence of LBW (12%), very low birth weight (VLBW) (1%) and of case fatality rates compared to non-LBW weight babies [for LBW (12%) and VLBW (80%)]. Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Direct and indirect household costs for routine health care were 24.12 US$(CI 95$ (CI 95% 6.33; 10.72). Of the 3,322 live births that occurred in one year in the study area, health system costs associated to LBW (routine health care and excess morbidity) and DALYs were 169,957.61 US$ (CI 95% 144,900.00; 195,500.00) and 2,746.06, respectively. CONCLUSIONS: This first cost evaluation of LBW in a low-income country shows that reducing the prevalence of LBW would translate into important cost savings to the health system and the household. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care

Is it in the Game? Reconsidering play spaces, game definitions, theming and sports videogames

From the very first days of digital gaming, sport-themed videogames have been a constant and ever-popular presence. However, compared with many other genres of games, sports-themed videogames have remained relatively under-research. Using the case of ‘sports videogames’ this paper advocates a critical and located approach to understanding videogames and gameplay. Unlike many existing theorisations of gameplay, such as the ‘magic circle’ (Huizinga 1949 [1938]), which theorise play as a break from ordinary life, this paper argues for a consideration of play as a continuation of ‘the control of the established order’ (Lefebvre (1991 [1974]: 383). It argues that many videogames, and in particular sports videogames, can be understood as ‘themed’ spaces; which share similarities to other themed locations, such as fast-food restaurants and theme parks. These are ‘non-places’ (Augé 1995) themed to provide a sense of individuality, control and escape in a society that increasingly offers none

Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012-2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to \u20ac574 and \u20ac830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (\u20ac929) compared to those treated with psychological interventions alone (\u20ac590; p=0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD

Smart home platform supporting decentralized adaptive automation control

Smart Home is an exemplar application domain of the Internet of Things (IoT). In particular, smart home automation processes that manage the interactions with the home devices and integrate all their (possibly interfering) services, introduce new challenges and call for modern engineering practices, software platforms, and computational intelligence. A key example is the need to achieve a more efficient integration between design and runtime aspects in the automation process, taking into account that unanticipated situations can occur in the home environment and require a smart home system to deal with them at runtime. In this paper, using an application example, we foresee how to architect future smart home systems in order to endow them with self-adaptation capabilities allowing decentralized control and device interconnection. Namely, we propose to exploit feedback control loop architectures (e.g., composite MAPE feedback loops) to design and manage the home automation processes, as alternative software architectural solutions to those of smart home platforms currently available

FTA Highlight No.2 – Tree Seed and Seedling Systems for Resilience and Productivity

The work of the CGIAR Research Program on Forests, Trees and Agroforestry (FTA) on tree seed systems — the authors’ shorthand for the means through which growers obtain access to tree-planting materials, either seeds or seedlings — has sought to address significant constraints in the diversity and genetic quality of the tree seeds and seedlings that are being supplied. These concerns are exacerbated by an increase in demand for germplasm to meet huge global forest landscape restoration commitments and other tree-planting targets. Over the last decade, FTA has worked on twin concerns in this regard: first, how to make available quality tree-planting material; and second, how to ensure that tree seeds and seedlings are planted in the right places for the right purposes. It has addressed availability through building stakeholder partnerships and model tree seed systems; delivering improved “orphan” (under-researched) tree crops through supporting breeding and its impact; mainstreaming food trees through nurseries; conserving and making available diverse tree germplasm to support delivery and use; and developing policies to support the effective supply of tree seeds and seedlings. It has supported better decision making through building information platforms to support tree-planting choices and tree seed system operations; designing maps to guide tree seed and seedling distribution that is suited to current and predicted future climatic conditions; and releasing statistical packages to guide appropriate tree planting and assess the impacts of this planting in terms of benefits such as additional carbon sequestered and extra soil protected. This work is the foundation of local and global economic and environmental benefits of huge significance. It supports climate change mitigation and adaptation, restores landscapes and conserves biodiversity, and provides healthy foods and other products for local and global communities. This publication focuses on FTA’s work in these areas. Future directions for work identified include a closer analysis of the relative importance of supply side versus demand-side measures for mainstreaming improved tree genetic materials by growers; working with investors to improve tree seed quality at the project design stage of tree-planting programmes; and scaling up existing tree seed systems experience to burgeoning forest landscape restoration and broader tree planting initiatives. This scaling up will involve further engagement with major global initiatives such as the Bonn Challenge, the UN Decade on Ecosystem Restoration 2021–2030, and the Global Plan of Action on Forest Genetic Resources