Young in Class: Implications for Inattentive/Hyperactive Behaviour of Canadian Boys and Girls

Using data from the Statistics Canada National Longitudinal Survey of Children and Youth (NLSCY), this paper investigates the impact of school entry age on inattentive/hyperactive behaviours. We employ both a cross-provinces-time differences-in-differences approach, and a within-province regression discontinuity design. We find that being young in class causes greater inattentive/hyperactive behaviour, exacerbating any inattentive/hyperactive behavior exhibited prior to school entry. These results also also hold in sibling fixed effect models. Though we do not find gender differences in the effects, because boys are more likely to be inattentive/hyperactive at school entry, they are more affected. These effects persist into early adolescence

ADHD in children and young people: prevalence, care pathways & service provision

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common childhood behavioural disorder – systematic reviews indicate that the community prevalence of ADHD globally is between 2% to 7%, with an average of around 5%. In addition, a further 5% of children have significant difficulties with over-activity, inattention and impulsivity that are just sub-threshold to meet full diagnostic criteria for ADHD. Estimates of the administrative (clinically diagnosed and/or recorded) prevalence vary worldwide and although increasing over time, ADHD is still relatively under-recognised and under-diagnosed in most countries, particularly in girls and older children. ADHD often persists into adulthood and is a risk factor for other mental health disorders and negative outcomes including educational under-achievement, difficulties with employment and relationships, and criminality. The timely recognition and treatment of children with ADHD-type difficulties provides an opportunity to improve their long-term outcomes. This review includes a systematic review of the community and administrative prevalence of ADHD in children and adolescents; an overview of the barriers to accessing care for ADHD; a description of costs associated with ADHD; and a broad discussion of evidence-based pathways for the delivery of clinical care, including a focus on key issues for two specific age groups - pre-school children and adolescents requiring transition of care from child to adult services

Differences in the angiographic evaluation of coiled cerebral aneurysms between a core laboratory reader and operators: results of the Cerecyte Coil Trial.

BACKGROUND AND PURPOSE: Independent evaluation of angiographic images is becoming widely applied in the assessment of treatment outcomes of cerebral aneurysms. In the current study, we assessed the agreement between an independent core laboratory and the operators regarding angiographic appearance in a recent randomized, controlled trial. MATERIALS AND METHODS: Data were derived from the Cerecyte Coil Trial. Angiographic images of each coiled aneurysm, taken immediately after embolization and at 5- to 7-month follow-up, were evaluated by the operator at the treating center and by an independent neuroradiologist at the core laboratory. For the purpose of this study, images were interpreted on a 3-point scale to provide uniformity for analysis; grade 1: complete occlusion, grade 2: neck remnant; and grade 3: sac filling. "Unfavorable angiographic appearance" was defined as grade 3 at follow-up or interval worsening of grade between the 2 time points. RESULTS: The study included 434 aneurysms. Immediately after embolization, grade 3 was reported by operators in 39 (9%) compared with 52 (12%) by the core laboratory (P = .159). On follow-up, grade 3 was reported by operators in 44 (10%) compared with 81 (19%) by the core laboratory (P < .0001). Overall, operators noted unfavorable angiographic appearance in 78 (18%) compared with 134 (31%) by the core laboratory (P < .0001). At every time point, agreement between the core laboratory and the operators was slight. CONCLUSIONS: Unfavorable angiographic appearance was noted almost twice as frequently by an independent core laboratory as compared with the operators. Planning of trials and interpretation of published studies should be done with careful attention to the mode of angiographic appearance interpretation

Hemodynamic Analysis of Fast and Slow Aneurysm Occlusions By Flow Diversion in Rabbits

Purpose: To assess hemodynamic differences between aneurysms that occlude rapidly and those occluding in delayed fashion after flow diversion in rabbits. Methods: Thirty-six elastase-induced aneurysms in rabbits were treated with flow diverting devices. Aneurysm occlusion was assessed angiographically immediately before they were sacrificed at 1 (n=6), 2 (n=4), 4 (n=8) or 8 weeks (n=18) after treatment. The aneurysms were classified into a fast occlusion group if they were completely or near completely occluded at 4 weeks or earlier and a slow occlusion group if they remained incompletely occluded at 8 weeks. The immediate post-treatment flow conditions in aneurysms of each group were quantified using subject-specific computational fluid dynamics and statistically compared. Results: Nine aneurysms were classified into the fast occlusion group and six into the slow occlusion group. Aneurysms in the fast occlusion group were on average significantly smaller (fast=0.9 cm, slow=1.393 cm, p=0.024) and had smaller ostia (fast=0.144 cm2, slow=0.365 cm2, p=0.015) than aneurysms in the slow occlusion group. They also had a lower mean posttreatment inflow rate (fast=0.047 mL/s, slow=0.155 mL/s, p=0.0239), kinetic energy (fast=0.519 erg, slow=1.283 erg, p=0.0468), and velocity (fast=0.221 cm/s, slow=0.506 cm/s, p=0.0582). However, the differences in the latter two variables were only marginally significant. Conclusions: Hemodynamic conditions after flow diversion treatment of cerebral aneurysms in rabbits are associated with the subsequent aneurysm occlusion time. Specifically, smaller inflow rate, kinetic energy, and velocity seem to promote faster occlusions, especially in smaller and small-necked aneurysms. These results are consistent with previous studies based on clinical series