Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

Background: Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood.Methods: Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs.GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics.Results: Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed.Conclusion: This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.

Effect of road quality in structural health monitoring under operational conditions

The effect of unevenness in a bridge deck for the purpose of Structural Health Monitoring (SHM) under operational conditions is studied in this paper. The moving vehicle is modelled as a single degree of freedom system traversing the damaged beam at a constant speed. The bridge is modelled as an Euler-Bernoulli beam with a breathing crack, simply supported at both ends. The breathing crack is treated as a nonlinear system with bilinear stiffness characteristics related to the opening and closing of crack. The unevenness in the bridge deck considered is modelled using road classification according to ISO 8606:1995(E). Numerical simulations are conducted considering the effects of changing road surface classes from class A - very good to class E - very poor. Cumulant based statistical parameters, based on a new algorithm are computed on stochastic responses of the damaged beam due to passages of the load in order to calibrate the damage. Possibilities of damage detection and calibration under benchmarked and non-benchmarked cases are considered. The findings of this paper are important for establishing the expectations from different types of road roughness on a bridge for damage detection purposes using bridge-vehicle interaction where the bridge does not need to be closed for monitoring.

Effects of vehicle speed in structural health monitoring from operational conditions of bridges

The effects of vehicle speed for Structural Health Monitoring (SHM) of bridges under operational conditions are studied in this paper. The moving vehicle is modelled as a single degree oscillator traversing a damaged beam at a constant speed. The bridge is modelled as simply supported Euler-Bernoulli beam with a breathing crack. The breathing crack is treated as a nonlinear system with bilinear stiffness characteristics related to the opening and closing of crack. The unevenness of the bridge deck is modelled using road classification according to ISO 8606:1995(E). The stochastic description of the unevenness of the road surface is used as an aid to monitor the health of the structure in its operational condition. Numerical simulations are conducted considering the effects of changing vehicle speed with regards to cumulant based statistical damage detection parameters. The detection and calibration of damage at different levels is based on an algorithm dependent on responses of the damaged beam due to passages of the load. Possibilities of damage detection and calibration under benchmarked and non-benchmarked cases are considered. Sensitivity of calibration values is studied. The findings of this paper are important for establishing the expectations from different vehicle speeds on a bridge for damage detection purposes using bridge-vehicle interaction where the bridge does not need to be closed for monitoring. The identification of bunching of these speed ranges provides guidelines for using the methodology developed in the paper.

Towards persistent structural health monitoring through sustainable wireless sensor networks

This paper documents the design, implementation and characterisation of a wireless sensor node (GENESI Node v1.0), applicable to long-term structural health monitoring. Presented is a three layer abstraction of the hardware platform; consisting of a Sensor Layer, a Main Layer and a Power Layer. Extended operational lifetime is one of the primary design goals, necessitating the inclusion of supplemental energy sources, energy awareness, and the implementation of optimal components (microcontroller(s), RF transceiver, etc.) to achieve lowest-possible power consumption, whilst ensuring that the functional requirements of the intended application area are satisfied. A novel Smart Power Unit has been developed; including intelligence, ambient available energy harvesting (EH), storage, electrochemical fuel cell integration, and recharging capability, which acts as the Power Layer for the node. The functional node has been prototyped, demonstrated and characterised in a variety of operational modes. It is demonstrable via simulation that, under normal operating conditions within a structural health monitoring application, the node may operate perpetually.

Bridge-vehicle interaction for structural health monitoring: potentials, applications, and limitations

Structural Health Monitoring (SHM) is an integral part of infrastructure maintenance and management systems due to socio-economic, safety and security reasons. The behaviour of a structure under vibration depends on structure characteristics. The change of structure characteristics may suggest the change in system behaviour due to the presence of damage(s) within. Therefore the consistent, output signal guided, and system dependable markers would be convenient tool for the online monitoring, the maintenance, rehabilitation strategies, and optimized decision making policies as required by the engineers, owners, managers, and the users from both safety and serviceability aspects. SHM has a very significant advantage over traditional investigations where tangible and intangible costs of a very high degree are often incurred due to the disruption of service. Additionally, SHM through bridge-vehicle interaction opens up opportunities for continuous tracking of the condition of the structure. Research in this area is still in initial stage and is extremely promising. This PhD focuses on using bridge-vehicle interaction response for SHM of damaged or deteriorating bridges to monitor or assess them under operating conditions. In the present study, a number of damage detection markers have been investigated and proposed in order to identify the existence, location, and the extent of an open crack in the structure. The theoretical and experimental investigation has been conducted on Single Degree of Freedom linear system, simply supported beams. The novel Delay Vector Variance (DVV) methodology has been employed for characterization of structural behaviour by time-domain response analysis. Also, the analysis of responses of actual bridges using DVV method has been for the first time employed for this kind of investigation.

Health care and neoliberalism in Ireland: withholding the gift and corrupting the social contract

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Using four case studies, this thesis uses a historical genealogical approach to explain the evolution of Ireland's particular version of health care provision. The total social fact of the gift relationship, central to all human relations, will be used to form a theoretical and conceptual framework on which to build an analysis of Ireland's health and welfare conditions. Additionally, social contract theory will enable an examination of the role of solidarity in relation to social expectations around health care provision. Through the analysis of these cases, the complex matrix of the influential forces that have shaped current conditions are exposed and revealed, enabling a critical understanding of the extent of acquiescence to the inequitable system that arguably exists. The vulnerability of citizens in need of care to the external and global effects of market forces and neoliberalism, therefore, becomes central to any argument for state-provided health and welfare. The hegemony of such forces can be seen to influence the manner in which the idea of individual self-reliance, in place of collective solidarity, is conceptualised and subsequently infiltrated into a range of aspects of the social world. For example, the particular discourse of the market and of economic concerns succeeds in shaping understandings of responsibilities around central areas of health and welfare. Similarly the 'possessor principle' can be seen to be misplaced within the context of health and social care, but yet has become normalised within this discourse. Within this matrix of complex influencing factors, the welfare state struggles to impose a balance between market values and social values. Responsibilities of the state to support and compensate its citizens for the ills of the market have become devalued, as the core values of classical liberalism have become distorted beyond recognition, leaving instead bare neoliberal concerns. This thesis traces the genealogical origins of this transition within the recent history of Irish health care and thereby reveals the embedding of individualism in place of solidarity, the on going reneging of the social contract and the corruption of the gift relationship.