Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced

BACKGROUND: To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS: Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS: The sample comprised 2262 children and adolescents aged 5-17\u2009years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177\u2009days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS: To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered

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

Assessment Of Weno And Sfv High-order Reconstruction Schemes For Aerodynamic Flows

An assessment of two numerical formulations for high-order reconstruction on unstructured triangular grids is performed. TheWeighted Essentially Non-Oscillatory (WENO) and the Spectral Finite Volume (SFV) methods are considered for the spatial discretization of the 2-D Euler equations. Several test cases discussed in the literature are addressed here to assess the resolution properties, effective order of accuracy and performance of the spatial discretization schemes. The study compares, in particular, results for linear and quadratic reconstructions. The test cases include problems with strong shock waves and other discontinuities which provide a comparative assessment of the resolution capability of the tested schemes for typical aerospace flows. In order to perform such comparisons different limiter formulations are considered. One of such formulations include the use of both the WENO and SFV discretization methods for reconstruction, depending on the flow characteristics, to provide a continuous high-order solution field, regardless of discontinuities. It is hoped that the results of the present effort could provide valuable guidelines for future developments regarding high-order methods for unstructured meshes.American Institute of Aeronautics and Astronautics (AIAA)Wolf, W.R., Azevedo, J.L.F., High-Order Unstructured Essentially Non Oscillatory andWeighted Essentially Non Oscillatory Schemes for Aerodynamic Flows (2006) AIAA Journal, 44 (10), pp. 2295-2310. , OctWolf, W.R., Azevedo, J.L.F., High-Order ENO and WENO Schemes for Unstructured Grids (2007) International Journal for Numerical Methods in Fluids, 55 (10), pp. 917-943. , DecBreviglieri, C., Basso, E., Azevedo, J.L.F., (2008) High-Order Unstructured Spectral Finite Volume Scheme for Aerodynamic Applications, , AIAA Paper No. 2008-7182, 26th AIAA Applied Aerodynamics Conference, Honolulu, HI, AugBreviglieri, C., Azevedo, J.L.F., Basso, E., Souza, M.A.F., Implicit High-Order Spectral Finite Volume Method for Inviscid Compressible Flows (2010) AIAA Journal, 48 (10), pp. 2365-2376. , OctBreviglieri, C., Azevedo, J.L.F., (2012) Unsteady Aerodynamic Applications Using High-Order Unstructured Grid Methods, , AIAA Paper No. 2012-0701, 50th AIAA Aerospace Sciences Meeting Including the New Horizons Forum and Aerospace Exposition, Nashville, TN, JanWoodward, P., Colella, P., The Numerical Simulation of Two-Dimensional Fluid Flow with Strong Shocks (1984) Journal of Computational Physics, 54, pp. 115-173Roe, P.L., Approximatte Riemann Solvers, Parameter Vectors, and Difference Schemes (1981) Journal of Computational Physics, 43 (2), pp. 357-372Blazek, J., (2001) Computational Fluid Dynamics: Principles and Applications, , Elsevier, Oxford, UKSoetrisno, M., Imlay, S., Roberts, D., (1994) A Zonal Implicit Procedure for Hybrid Structured-Unstructured Grids, , AIAA Paper No. 94-0645Wang, Z.J., Spectral (Finite) Volume Method for Conservation Laws on Unstructured Grids: Basic Formulation (2002) Journal of Computational Physics, 178 (1), pp. 210-251. , MayWang, Z.J., Liu, Y., Spectral (Finite) Volume Method for Conservation Laws on Unstructured Grids II: Extension to Two-Dimensional Scalar Equation (2002) Journal of Computational Physics, 179 (2), pp. 665-698. , JulKnuth, D.E., (1998) The Art of Computer Programming, , 3: Sorting and Searching (2nd ed.), Addison-Wesley, Reading, MALiu, Y., Vinokur, M., Exact Integrations of Polynomials and Symmetric Quadrature Formulas over Arbitrary Polyhedral Grids (1998) Journal of Computational Physics, 140 (1), pp. 122-147. , Febvan den Abeele, K., Lacor, C., An Accuracy and Stability Study of the 2D Spectral Volume Method (2007) Journal of Computational Physics, 226 (1), pp. 1007-1026. , SeptOllivier-Gooch, C., Quasi-ENO Schemes for Unstructured Meshes Based on Unlimited Data-Dependent Least-Squares Reconstruction (1997) Journal of Computational Physics, 133, pp. 6-17Friedrich, O., Weighted Essentially Non-Oscillatory Schemes for the Interpolation of Mean Values on Unstructured Grids (1998) Journal of Computational Physics, 144 (1), pp. 194-212. , JulyJiang, G.S., Shu, C.W., Efficient Implementation of Weighted ENO Schemes (1996) Journal of Computational Physics, 126 (1), pp. 77-99. , JuneAbgrall, R., On Essentially Non-oscillatory Schemes on Unstructured Meshes: Analysis and Implementation (1994) Journal of Computational Physics, 114, pp. 45-58Harten, A., Chakravarthy, S.R., (1991) Multi-Dimensional ENO Schemes for General Geometries, , ICASE Report 91-76Qiu, J., Shu, C.-W., A Comparison of Troubled-Cell Indicators for Runge-Kutta Discontinuous Galerkin Methods Using Weighted Essentially Nonoscillatory Limiters (2006) SIAM J. Sci. Comput, 27 (3), pp. 995-1013Bigarella, E., (2007) Advanced Turbulence Modeling for Complex Aerospace Applications, , Ph. D. Thesis, Instituto Tecnológico de Aeronáutica, São José dos Campos, SP, BrazilMcDevitt, J., Okuno, A.F., (1985) Static and Dynamic Pressure Measurements on a NACA 0012 Airfoil in the Ames High Reynolds Number Facility, , NASA TP-2485, NASA, JunEmery, A., An Evaluation of Several Differencing Methods for Inviscid Fluid Flow Problems (1968) Journal of Computational Physics, 2, pp. 306-331Sonar, T., On the Construction of Essentially Non-Oscillatory Finite Volume Approximations to Hyperbolic Conservation Laws on General Triangulations: Polynomial Recovery, Accuracy and Stencil Selection (1997) Comput. Methods Appl. Mech. Engr, 140 (2), pp. 157-18