A review of the economic burden of ADHD

Attention-deficit hyperactivity disorder (ADHD) is a common disorder that is associated with broad functional impairment among both children and adults. The purpose of this paper is to review and summarize available literature on the economic costs of ADHD, as well as potential economic benefits of treating this condition. A literature search was performed using MEDLINE to identify all published articles on the economic implications of ADHD, and authors were contacted to locate conference abstracts and articles in press that were not yet indexed. In total, 22 relevant items were located including published original studies, economic review articles, conference presentations, and reports available on the Internet. All costs were updated and presented in terms of year 2004 US dollars. A growing body of literature, primarily published in the United States, has demonstrated that ADHD places a substantial economic burden on patients, families, and third-party payers. Results of the medical cost studies consistently indicated that children with ADHD had higher annual medical costs than either matched controls (difference ranged from $503 to$1,343) or non-matched controls (difference ranged from $207 to$1,560) without ADHD. Two studies of adult samples found similar results, with significantly higher annual medical costs among adults with ADHD (ranging from $4,929 to$5,651) than among matched controls (ranging from $1,473 to$2,771). A limited number of studies have examined other economic implications of ADHD including costs to families; costs of criminality among individuals with ADHD; costs related to common psychiatric and medical comorbidities of ADHD; indirect costs associated with work loss among adults with ADHD; and costs of accidents among individuals with ADHD. Treatment cost-effectiveness studies have primarily focused on methylphenidate, which is a cost-effective treatment option with cost-effectiveness ratios ranging from $15,509 to$27,766 per quality-adjusted life year (QALY) gained. As new treatments are introduced it will be important to evaluate their cost-effectiveness to provide an indication of their potential value to clinicians, patients, families, and third-party payers

Fastener apparatus

A fastening apparatus is adapted to be inserted and removed from one side of a work piece having an opposite side which is substantially inaccessible to a worker. A first, externally threaded member is threadingly engaged with a receiving structure, and a second member is inserted within corresponding seats or grooves for interlocking the two members. In the preferred embodiment diverting seats are provided for forming the second member into locking engagement between the receiving structure and the first member. In one embodiment, seat structures are provided for engaging frangible panels or the like for high temperature applications

The Fatigue Associated with Depression Questionnaire (FAsD): responsiveness and responder definition

PURPOSE: The Fatigue Associated with Depression Questionnaire (FAsD) was developed to assess fatigue and its impact among patients with depression. The purpose of this study was to examine the questionnaire’s responsiveness to change and identify a responder definition for interpretation of treatment-related changes. METHODS: Data were collected at baseline and at 6 weeks from patients with depression starting treatment with a new antidepressant. RESULTS: Of the 96 participants, 55.2% were women, with a mean age of 43.4 years. The total score and both subscales demonstrated statistically significant change with moderate to large effect sizes (absolute values ≥0.76). FAsD change scores were significantly correlated with change on the Brief Fatigue Inventory (r ≥ 0.73; p < 0.001). FAsD mean change scores discriminated among patient subgroups differing by degree of improvement in patient- and clinician-reported fatigue and depression. Responder definition for the two subscales and total score (0.67, 0.57, 0.62) was estimated primarily based on mean change among patients who reported a small but important improvement in fatigue. DISCUSSION: The FAsD was responsive to change, and the responder definition may be used when interpreting treatment-related change. Results add to previous findings suggesting the FAsD is a useful measure of fatigue among patients with depression

The intramembrane protease SPPL2a promotes B cell development and controls endosomal traffic by cleavage of the invariant chain

Peer reviewe

Issues and challenges in the application of Husserlian phenomenology to the Lived Experience of Hate Crime and Its Legal Aftermath

The field of hate crime research addresses the presence, sources and impact of particular types of expressions of prejudice, often perceived as particularly damaging and hurtful forms of interpersonal abuse and violence. Little, if any, credible academic research seeks to vindicate the specific racist, gendered and other vicious prejudices articulated by many perpetrators of hate crime. In turn, this raises the reflexive question of the possibilities of researchers themselves ever being able to adopt a truly "unprejudiced" approach to the presence of such damaging prejudices. Can this goal be realised without a researcher necessarily losing an experientially-grounded understanding of what these meanings, values and purposes have come to mean, and how they are themselves interpretatively re-constituted anew, including within the lived experience of victims, witnesses, police, prosecutors, judges and victim support workers? A possible philosophically-informed approach to the dilemmas posed by this topic is offered by Husserl's phenomenology. Husserl's perpetually unfinished philosophical methodology strives, with concerted if sometimes tragic reflective rigor, to "suspend," "bracket out" and "neutralise" those core presuppositions constitutive of the research field that typically pre-judge precisely whatever demands to be questioned and explored in a radically non-prejudicial manner. This study critically explores the possibilities, reflective stages and theoretical limitations of a sympathetically reconstructed Husserlian approach to hate crime, itself understood as a would-be qualitative "science of consciousness." It argues that despite its manifest tensions, gaps, ambiguities and internal contradictions, aspects of the Husserlian philosophical approach directed towards the different levels of experienced hate crime still retain the potential to both challenge and advance our understanding of this topic. It is the "instructive" part of "instructive failure" that this article highlights

Collaboration and critique

What is the place for critical ethnography in global health and other related forms of international intervention? This essay explores this question through my experience collaborating with a nongovernmental organization (NGO) working to improve children’s well-being in El Salvador and with a team of quantitatively oriented researchers evaluating the NGO’s project. I adopt as an analytic lens one of the metrics the researchers used – the Battelle Developmental Inventory – in order to explore the possibilities for dialogue among quantitative and qualitative methods (and researchers). At issue is the place that critique can have in such dialogues, particularly when the aims of NGOs, public health researchers, and ethnographers can sometimes be at odds. Ultimately, I make the case that viewing critique as a praxis, keeping an eye on the commensurability of aims, and being prepared for occasional productive friction are some practical steps for bringing critical ethnographic perspectives into contact with interventions

Manufacturing A Consumer Culture Through Materialism and Consumerism

University of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/156367/1/Matza-Final_Thesis_Paper.pd

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): a short‐term cost‐effectiveness analysis in the UK setting

Aim: To evaluate the cost‐effectiveness of IDegLira versus basal‐bolus therapy (BBT) with insulin glargine U100 plus up to 4 times daily insulin aspart for the management of type 2 diabetes in the UK. Methods: A Microsoft Excel model was used to evaluate the cost‐utility of IDegLira versus BBT over a 1‐year time horizon. Clinical input data were taken from the treat‐to‐target DUAL VII trial, conducted in patients unable to achieve adequate glycaemic control (HbA1c &lt;7.0%) with basal insulin, with IDegLira associated with lower rates of hypoglycaemia and reduced body mass index (BMI) in comparison with BBT, with similar HbA1c reductions. Costs (expressed in GBP) and event‐related disutilities were taken from published sources. Extensive sensitivity analyses were performed. Results: IDegLira was associated with an improvement of 0.05 quality‐adjusted life years (QALYs) versus BBT, due to reductions in non‐severe hypoglycaemic episodes and BMI with IDegLira. Costs were higher with IDegLira by GBP 303 per patient, leading to an incremental cost‐effectiveness ratio (ICER) of GBP 5924 per QALY gained for IDegLira versus BBT. ICERs remained below GBP 20 000 per QALY gained across a range of sensitivity analyses. Conclusions: IDegLira is a cost‐effective alternative to BBT with insulin glargine U100 plus insulin aspart, providing equivalent glycaemic control with a simpler treatment regimen for patients with type 2 diabetes inadequately controlled on basal insulin in the UK

Utilities associated with subcutaneous injections and intravenous infusions for treatment of patients with bone metastases

Introduction: Although cost−utility models are often used to estimate the value of treatments for metastatic cancer, limited information is available on the utility of common treatment modalities. Bisphosphonate treatment for bone metastases is frequently administered via intravenous infusion, while a newer treatment is administered as a subcutaneous injection. This study estimated the impact of these treatment modalities on health state preference. Methods: Participants from the UK general population completed time trade-off interviews to assess the utility of health state vignettes. Respondents first rated a health state representing cancer with bone metastases. Subsequent health states added descriptions of treatment modalities (ie, injection or infusion) to this basic health state. The two treatment modalities were presented with and without chemotherapy, and infusion characteristics were varied by duration (30 minutes or 2 hours) and renal monitoring. Results: A total of 121 participants completed the interviews (52.1% female, 76.9% white). Cancer with bone metastases had a mean utility of 0.40 on a standard utility scale (1 = full health; 0 = dead). The injection, 30-minute infusion, and 2-hour infusion had mean disutilities of −0.004, −0.02, and −0.04, respectively. The mean disutility of the 30-minute infusion was greater with renal monitoring than without. Chemotherapy was associated with substantial disutility (−0.17). When added to health states with chemotherapy, the mean disutilities of injection, 30-minute infusion, and 2-hour infusion were −0.02, −0.03, and −0.04, respectively. The disutility associated with injection was significantly lower than the disutility of the 30-minute and 2-hour infusions (P , 0.05), regardless of chemotherapy status. Conclusion: Respondents perceived an inconvenience with each type of treatment modality, but injections were preferred over infusions. The resulting utilities may be used in cost−utility models examining the value of treatments for the prevention of skeletal-related events in patients with bone metastases