The influence of air attenuation in characteristic curve for mammographic screen-film system

マンモグラフィ専用装置を使用して，距離法で低エネルギー領域のX線におけるマンモグラフィ用増感紙／フィルムシステムの特性曲線を得るためには，空気滅弱の影響を考慮する必要がある。その影響について，実効エネルギーから空気減弱分を補正，照射線量測定による補正，Bednarek法を応用した新距離法の3種類の方法を使って検討した。さらに，一般撮影装置でも，マンモ用システムに対して距離法で特性曲線を作成し，エネルギ ーの変化による影響についても検討した。その結果，3方法の特性曲線およびグラディエント曲線は，新距離法が高濃度域でわずかにずれるもののほぼ一致した。新距離法に対する平均階調度，最大階調度の最大誤差は，2.7％，0.2％であり，一般撮影用装置の距離法と3方法との間では，一般撮影用装置の距離法に対して最大誤差は2.7％，1.5％であった。以上のことから，エネルギーの変化による特性曲線への影響はほとんどなく，低エネルギー領域での特性曲線は空気特配の補正を行うことのみで得られると考えられる。It is necessary to take air attenuation into account when we use inverse square sensitometry to obtain characteristic curve for the mammographic screen-film system at low x-ray energies as used with the dedicated unit. Three kinds of the inverse square sensitometry approach of correcting by air attenuation obtained from effective energy, of correcting by exposure dosimetry and of using modified the technique of Bednarek were employed to investigated the influence of x-ray energy in the characteristic curves for the mammographic screen-film system. In addition, the inverse square sensitometry with the general radiographic unit was employed and the influence of x-ray high energy in the characteristic curves was also investigated for the same screeri-film system. Though characteristic curves and gradient curves of the new inverse square sensitometry were a little lower than the others in high-density region, the curves with three kinds of methods almost coincided. Maximum relative errors of average gradient and maximum gradient for modified the technique of Bednarek were found to be 2.7% and 0.2% among the others respectively. Moreover, maximum relative errors of gradient and maximum gradient for the inverse square sensitometry with the general radiographic unit were 2.7% and 1.5% among three kinds of methods with the dedicated unit respectively. It was considered that the characteristic curves for the mammographic screen-film　system were little influenced by x-ray energy and could be obtained only by correcting　air attenuation from above results

Non-pharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD)

edition: 1ststatus: publishe

Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD)

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD

Behavioral Interventions in Attention-Deficit/ Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials Across Multiple Outcome Domains

OBJECTIVE: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes. METHOD: A systematic search in PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales). RESULTS: Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31). CONCLUSION: In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.status: publishe

Cognitive Training for Attention-Deficit/Hyperactivity Disorder:Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials

Objective: the authors performed meta-analyses of randomized controlled trials to examine the effects of cognitive training on attention-deficit/hyperactivity disorder (ADHD) symptoms, neuropsychological deficits, and academic skills in children/adolescents with ADHD.Method: the authors searched Pubmed, Ovid, Web of Science, ERIC, and CINAHAL databases through May 18, 2014. Data were aggregated using random-effects models. Studies were evaluated with the Cochrane risk of bias tool.Results: sixteen of 695 nonduplicate records were analyzed (759 children with ADHD). When all types of training were considered together, there were significant effects on total ADHD (standardized mean difference [SMD] = 0.37, 95% CI = 0.09–0.66) and inattentive symptoms (SMD = 0.47, 95% CI = 0.14–0.80) for reports by raters most proximal to the treatment setting (i.e., typically unblinded). These figures decreased substantially when the outcomes were provided by probably blinded raters (ADHD total: SMD = 0.20, 95% CI = 0.01–0.40; inattention: SMD = 0.32, 95% CI = ?0.01 to 0.66). Effects on hyperactivity/impulsivity symptoms were not significant. There were significant effects on laboratory tests of working memory (verbal: SMD = 0.52, 95% CI = 0.24–0.80; visual: SMD = 0.47, 95% CI = 0.23–0.70) and parent ratings of executive function (SMD = 0.35, 95% CI = 0.08–0.61). Effects on academic performance were not statistically significant. There were no effects of working memory training, specifically on ADHD symptoms. Interventions targeting multiple neuropsychological deficits had large effects on ADHD symptoms rated by most proximal assessors (SMD = 0.79, 95% CI = 0.46–1.12).Conclusion: despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on blinded measures. Approaches targeting multiple neuropsychological processes may optimize the transfer of effects from cognitive deficits to clinical symptom

Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD)

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.</p