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

Immediate & long-term installation effects adjacent to an open-ended pile in a layered clay

Floating piles in soft soil deposits primarily mobilize their bearing capacity by means of shaft resistance. The upper part of the pile triggers a downward traction on the pile shaft whilst the lower part mobilizes the shaft friction in the soil required for the pile bearing capacity. The transition between these two modes of shaft friction is often defined as the neutral-plane. This plane, which is not at a constant level, assists in predictions of the (long-term) settlements of a pile in such a soil. Floating piles primarily occur in areas where stiffer clay layers are overlain by softer clay layers, e.g. on the west-coast of Sweden or in the Kaspian Sea. In the past the response of floating piles is extensively described using the neutral plane approach. This approach requires a reliable prediction of the soil settlements, which in turn are affected by the pile installation effects in the soil. Additional experimental evidence on the soil behaviour during, directly after installation and in the long-term is required if advanced numerical methods are considered and current analytical design methods to be improved. A novel approach to retrieve this experimental data on immediate and long-term pile installation effects in the geotechnical centrifuge is developed. An axisymmetric experimental test setup allows for measurement of full-field displacement as well as pore pressures during and after installation. This setup uses an instrumented wall with 40 pore pressure transducers. Additionally, an image sequence taken with a machine vision camera is used to extract the soil displacements by application of Particle Image Velocimetry (PIV). Due to natural low contrast of the kaolin clay used for the experiments a novel method for the application of contrasting speckle material on a clay sample is developed. This method applies the contrast material on the surface of the slurry without the need of removing the transparent window of the strongbox. Therefore tracking of the material displacements during the consolidation stage and subsequent loading stages using imaging methods is facilitated. The results of the experiments are generally in agreement with the framework reported in literature and indicate that pile installation effects, such as generation of excess pore pressure and change of the hydraulic conductivity in the soil due to remoulding, have an influence on the development on the neutral plane and therefore the prediction of the response of floating piles. Additionally, the results can be used to benchmark numerical calculations with advanced constitituve models.Geo-EngineeringGeoscience & EngineeringCivil Engineering and Geoscience

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged 6565 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan\u2013Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients