Treating attention-deficit/hyperactivity disorder beyond symptom control alone in children and adolescents: a review of the potential benefits of long-acting stimulants

Attention-deficit/hyperactivity disorder (ADHD), one of the most common neuropsychiatric conditions of childhood, often has a chronic course and persists into adulthood in many individuals. ADHD may have a clinically important impact on health-related quality of life in children, a significant impact on parents’ emotional health and interfere with family activities/cohesion. To date, the main targets of ADHD treatment have focused on reducing the severity of symptoms during the school day and improving academic performance. However, the treatment of ADHD should reach beyond symptom control to address the issues of social competencies and improvement of health-related quality of life from the perspectives of individuals with ADHD and their families, to support them in reaching their full developmental potential. Methylphenidate (MPH) is recognised as the first-line choice of pharmacotherapy for ADHD in children and adolescents. This paper focuses on the importance and benefits to child development of ADHD symptom control beyond the school day only, i.e. extending into late afternoon and evening and uses the example of an extended-release MPH formulation (OROS® MPH) to demonstrate the potential benefits of active full day coverage (12 h) with a single daily dose. Concerns of long-term stimulant treatment are also discussed

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

ANNOTATED CORPUS AND THE EMPIRICAL EVALUATION OF PROBABILITY ESTIMATES OF GRAMMATICAL FORMS

The aim of the present study is to demonstrate the usage of an annotated corpus in the field of experimental psycholinguistics. Specifically, we demonstrate how the manually annotated Corpus of Serbian Language (Kostić, Đ. 2001) can be used for probability estimates of grammatical forms, which allow the control of independent variables in psycholinguistic experiments. We address the issue of processing Serbian inflected forms within two subparadigms of feminine nouns. In regression analysis, almost all processing variability of inflected forms has been accounted for by the amount of information (i.e. bits) carried by the presented forms. In spite of the fact that probability distributions of inflected forms for the two paradigms differ, it was shown that the best prediction of processing variability is obtained by the probabilities derived from the predominant subparadigm which encompasses about 80 % of feminine nouns. The relevance of annotated corpora in experimental psycholinguistics is discussed more in detail. Key words: annotated corpora, inflected morphology, psycholinguistics The usage of corpora in experimental psycholinguistics is not limited to mere stimulus selection that will enable balanced factorial designs. Annotated corpora can also be used for a quantitative specification of independent variables, i.e. for probability estimates of various aspects of language such as word probability, grapheme and syllable probability, the probability of inflected forms etc. Once specified in terms of probability, an independent variable used in psycholinguistic experiments can be correlated with the subject&apos;s performance, thus providing us with deeper insights about the mechanisms responsible for language processing. One of the main issues of experimental psycholinguistics is related to the processing of inflective morphology. How do we process words with inflectional 1 Address of the authors

Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review

Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising.status: publishe

Original paper PROTEIN C AS DIAGNOSTIC AND PREDICTIVE BIOMARKER OF SEPSIS DURING SEVERE INTRA-ABDOMINAL INFECTIONS

Summary: Severe intra-abdominal infections (IAI) with sepsis syndrome are still associated with high mortality rate (20 ’ 60%). This prospective study refers to diagnostic and prognostic importance of protein C detection during severe abdominal sepsis. We treated surgically 22 patients with severe IAI (mostly diffuse peritonitis with sepsis syndrome) vs. 15 patients with hernia repair (control group). During the study the next parameters were analysed: protein C, AT III, plasminogen, alpha-2 antiplasmin, HMWK, C5a, C5-B9 complements, C1-inhibitor, CRP. All the evaluated parameters were different between the study and control groups, with high statistical significance (p &lt; 0.001). The results and multivariate statistical analysis revealed the following parameters as very sensitive and important biological markers of abdominal sepsis: protein C, AT III, HMWK, C5-B9, C1-inhibitor (p &lt; 0.0001 ’ 0.026). The clinical difficulties of intra-abdominal sepsis are due to inherent problems of the limited clinical signs and the complexity of the distribution of infection. Inflammatory process is often well under way before the clinical signs and symptoms of sepsis are present. Early diagnosis of plasma proteolytic disturbances is, from the diagnostic and predictive point of view, very important in abdominal sepsis. According to multivariate statistical analysis protein C is the most significant diagnostic marker of sepsis during severe IAI (p &lt; 0.0001). Key words: protein C, biomarker, septic abdomen, sepsi

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