Attitudes and practices of general practitioners in the diagnosis and management of attention-deficit/hyperactivity disorder

Objective: To assess understanding of, and actual and potential roles in management of attention-deficit/hyperactivity disorder (ADHD) among GPs. Methods: A cross-sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self-perceived information and training needs. Results: Three hundred and ninety-nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD. Conclusions: General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services.

Harmful drinking in military veterans with post-traumatic stress disorder: Association with the D2 dopamine receptor A1 allele

Aims: The frequency of the Taq I A alleles (A1 and A2) of the D2 dopamine receptor (DRD2) gene was examined in Caucasian post-traumatic stress disorder (PTSD) patients and controls. Results: In 91 PTSD patients, the frequency of the A1 allele was higher (P = 6.12 x 10(-3)) than in the 51 controls. In the 38 PTSD harmful drinkers (greater than or equal to60 g alcohol/day), A1 allelic frequency was higher (P = 3.91 x 10(-2)) than in the 53 non-harmful drinkers (

Carbamazepine augmentation for schizophrenia: How good is the evidence?

Background: Augmentation strategies in schizophrenia treatment remain an important issue because despite the introduction of several new antipsychotics, many patients remain treatment resistant. The aim of this study was to undertake a systematic review and meta-analysis of the safety and efficacy of one frequently used adjunctive compound: carbamazepine. Data sources and study selection: Randomized controlled trials comparing carbamazopine (as a sole or as an adjunctive compound) with placebo or no intervention in participants with schizophrenia or schizoaffective disorder were searched for by accessing 7 electronic databases, cross-referencing publications cited in pertinent studies, and contacting drug companies that manufacture carbamazepine. Method: The identified studies were independently inspected and their quality assessed by 2 reviewers, Because the study results were generally incompletely reported, original patient data were requested from the authors; data were received for 8 of the 10 randomized controlled trials included in the present analysis, allowing for a reanalysis of the primary data. Dichotomous variables were analyzed using the Mantel-Haenszel odds ratio and continuous data were analyzed using standardized mean differences, both specified with 95% confidence intervals. Results: Ten studies (total N = 283 subjects) were included. Carbamazepine was not effective in preventing relapse in the only randomized controlled trial that compared carbamazepine monotherapy with placebo. Carbamazepine tended to be less effective than perphenazine in the only trial comparing carbamazepine with an antipsychotic. Although there was a trend indicating a benefit from carbamazepine as an adjunct to antipsychotics, this trend did not reach statistical significance. Conclusion: At present, this augmentation strategy cannot be recommended for routine use. The most promising targets for future trials are patients with excitement, aggression, and schizoaffective disorder bipolar type.

Play Preferences and Behavior of Preschool Children with Autistic Spectrum Disorder in the Clinical Environment

The play of children with autistic spectrum disorder (ASD) is a valuable medium for assessment and intervention, and its analysis has the potential to aid diagnosis. This study investigated spontaneous play behavior and play object preferences for 24 preschool children with ASD in a typical occupational therapy clinical environment. Play behavior was rated and choice of play object noted at 10-second intervals from a 15-minute video recording of unstructured play. Statistical analyses indicated that play behavior was consistent with descriptions in the literature. In addition, the children demonstrated clear preferences for play objects in the form of popular characters (e.g., Thomas the Tank Engine) and those with sensorimotor properties. We propose that the inclusion of preferred play objects in a clinical environment may increase intrinsic motivation to play, and thereby enhance assessment and intervention.

Rites of passage: Understanding participation of children with developmental coordination disorder

Children with developmental coordination disorder (DCD) experience difficulty participating in the typical activities of childhood and are known to have a more sedentary pattern of activities than their peers. Little research has been done to investigate the impact of these deficits on the lives of children with DCD and the importance of their participation in the typical activities of childhood. This qualitative study explored the impact of the disorder and the importance of participation for children with DCD from the perspective of the parent. Twelve in-depth interviews were conducted with parents of children with DCD who attended a university clinic specializing in using the Cognitive Orientation to daily Occupational Performance (COOP) approach, a cognitive-based intervention. Findings revealed that incompetence in everyday activities had serious negative effects for the children. Conversely, intervention that was focused on enablement at the activity and participation level had a significant positive impact on the children's quality of life. Emerging themes highlighted the notion that performance competency played an important role in being accepted by peers and being able to be part of the group. As well, parents reported that successful participation built confidence in their children and allowed them to try other new activities. The World Health Organization's International Classification of Functioning, Disability, and Health provides a unique framework for analyzing and understanding the impact of the physical disability on the lives of families with children with DCD. Results illustrate how intervention that focuses on enabling children to choose their own functional goals in the area of physical activity has important implications for enabling participation and building the social networks of children with DCD. (C) 2003 Elsevier B.V. All rights reserved.

Motor and functional skills of children with developmental coordination disorder: A pilot investigation of measurement issues

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Pea-body Developmental Motor Scales (fine motor total score) (M = 85.65, SD = 12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M = 96.15, SD = 10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M = 49.98, SD = 16.62) and mobility function (M = 54.71, SD = 3.99), however, self-care function was below the average range for age (M = 38.01, SD = 12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed. (C) 2003 Elsevier B.V. All rights reserved.

The role of disorder on the AC and DC electrical conductivity of vapour grown carbon nanofibre/epoxy composites

Four dispersion methods were used for the preparation of vapour grown carbon nanofibre (VGCNF)/epoxy composites. It is shown that each method induces certain levels of VGCNF dispersion and distribution within the matrix, and that these have a strong influence on the composite electrical properties. A homogenous VGCNF dispersion does not necessarily imply higher electrical conductivity. In fact, it is concluded that the presence of well distributed clusters, rather than a fine dispersion, is more important for achieving larger conductivities for a given VGCNF concentration. It is also found that the conductivity can be described by a weak disorder regime.

Modelling of n-stage Blumlein stacked lines for bipolar pulse generation

A Blumlein line is a particular Pulse Forming Line, PFL, configuration that allows the generation of high-voltage sub-microsecond square pulses, with the same voltage amplitude as the dc charging voltage, into a matching load. By stacking n Blumlein lines one can multiply in theory by n the input dc voltage charging amplitude. In order to understand the operating behavior of this electromagnetic system and to further optimize its operation it is fundamental to theoretically model it, that is to calculate the voltage amplitudes at each circuit point and the time instant that happens. In order to do this, one needs to define the reflection and transmission coefficients where impedance discontinuity occurs. The experimental results of a fast solid-state switch, which discharges a three stage Blumlein stack, will be compared with theoretical ones.

Solid-State Bipolar Marx Generator with Voltage Droop Compensation

This paper addresses the voltage droop compensation associated with long pulses generated by solid-stated based high-voltage Marx topologies. In particular a novel design scheme for voltage droop compensation in solid-state based bipolar Marx generators, using low-cost circuitry design and control, is described. The compensation consists of adding one auxiliary PWM stage to the existing Marx stages, without changing the modularity and topology of the circuit, which controls the output voltage and a LC filter that smoothes the voltage droop in both the positive and negative output pulses. Simulation results are presented for 5 stages Marx circuit using 1 kV per stage, with 1 kHz repetition rate and 10% duty cycle.

Solid-State Bipolar Marx Converter with Output Transformer and Energy Recovery

The purpose of this paper is to present and discuss a general HV topology of the solid-state Marx modulator, for unipolar or bipolar generation connected with a step-up transformer to increase the output voltage applied to a resistive load. Due to the use of an output transformer, discussion about the reset of the transformer is made to guarantee zero average voltage applied to the primary. It is also discussed the transformer magnetizing energy recovering back to the energy storage capacitors. Simulation results for a circuit that generates 100 kV pulses using 1000 V semiconductors are presented and discussed regarding the voltage and current stress on the semiconductors and result obtained.

Comando e monitorização com PIC do conversor modulador bipolar

O presente trabalho apresenta a análise, o projecto, a implementação e os ensaios de um protótipo de comando e monitorização dum conversor de potência, um gerador modulador bipolar, através de microcontroladores PIC. Foram desenvolvidos os circuitos de comando e respectivo protótipo, o circutiro de aquisição de sinal e o sftware para comandar e monitorizar o conversor modulador bipolar.

Fast optimum-predictive control and capacitor voltage balancing strategy for bipolar back-to-back NPC converters in high-voltage direct current transmission systems

Multilevel power converters have been introduced as the solution for high-power high-voltage switching applications where they have well-known advantages. Recently, full back-to-back connected multilevel neutral point diode clamped converters (NPC converter) have been used inhigh-voltage direct current (HVDC) transmission systems. Bipolar-connected back-to-back NPC converters have advantages in long-distance HVDCtransmission systems over the full back-to-back connection, but greater difficulty to balance the dc capacitor voltage divider on both sending and receiving end NPC converters. This study shows that power flow control and dc capacitor voltage balancing are feasible using fast optimum-predictive-based controllers in HVDC systems using bipolar back-to-back-connected five-level NPC multilevel converters. For both converter sides, the control strategytakes in account active and reactive power, which establishes ac grid currents in both ends, and guarantees the balancing of dc bus capacitor voltages inboth NPC converters. Additionally, the semiconductor switching frequency is minimised to reduce switching losses. The performance and robustness of the new fast predictive control strategy, and its capability to solve the DC capacitor voltage balancing problem of bipolar-connected back-to-back NPCconverters are evaluated.

HVDC transmission systems: Bipolar back-to-back diode clamped multilevel converter with fastoptimum-predictive control and capacitor balancing strategy

Voltage source multilevel power converter structures are being considered for high power high voltage applications where they have well known advantages. Recently, full back-to-back connected multilevel neutral diode clamped converters (NPC) have been used in high voltage direct current (HVDC) transmission systems. Bipolar back-to-back connection of NPCs have advantages in long distance HVDC transmission systems, but highly increased difficulties to balance the dc capacitor voltage dividers on both sending and receiving end NPCs. This paper proposes a fast optimum-predictive controller to balance the dc capacitor voltages and to control the power flow in a long distance HVDCsystem using bipolar back-to-back connected NPCs. For both converter sides, the control strategy considers active and reactive power to establish ac grid currents on sending and receiving ends, while guaranteeing the balancing of both NPC dc bus capacitor voltages. Furthermore, the fast predictivecontroller minimizes the semiconductor switching frequency to reduce global switching losses. The performance and robustness of the new fast predictive control strategy and the associated dc capacitors voltage balancing are evaluated. (C) 2011 Elsevier B.V. All rights reserved.