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Forearm and wrist fractures are the most common fractures in children. Compared with adults, children have different fracture patterns, and their bones have better remodelling potential. Despite the frequency of injuries, until recently there has been little evidence to guide treatment, with considerable variation in practice. The "British Orthopaedic Association Standard for Trauma (BOAST): Early Management of Paediatric Forearm Fractures" has provided the orthopaedic community with coherent standards for management of angulated but not off-ended fractures. However, there are areas that still cause controversy among clinicians. This article aims to simplify the topic by providing junior trainees with an up-to-date overview of classifications, assessment, and management options for paediatric forearm fractures. [ABSTRACT FROM AUTHOR]

• Honokiol increased spontaneous post-synaptic activities on SG neurons. • Honokiol increased both glycinergic and GABAergic miniature post-synaptic currents. • Honokiol mediated postsynaptic effect on SG neurons involved in both GABA and glycine receptors. • Honokiol potentiated both GABA A - and glycine receptor-mediated responses on SG neurons. • Honokiol suppressed spontaneous neuronal firing on SG neurons in inflammatory pain model mice. Inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA) and glycine are known to be abundant in the substantia gelatinosa (SG) of the trigeminal subnucleus caudalis (Vc). Thus, it has been recognized as an initial synaptic site for regulating orofacial nociceptive stimuli. Honokiol, a principal active ingredient derived from the bark of Magnolia officinalis, has been exploited in traditional remedies with multiple biological effects, including anti-nociception on humans. However, the anti-nociceptive mechanism of honokiol on SG neurons of the Vc remains fully elusive. In this study, effects of honokiol on SG neurons of the Vc in mice were investigated using the whole-cell patch-clamp method. In a concentration-dependent manner, honokiol significantly enhanced frequencies of spontaneous postsynaptic currents (sPSCs) that were independent of action potential generation. Notably, honokiol-induced increase in the frequency of sPSCs was attributed to the release of inhibitory neurotransmitters through both glycinergic and GABAergic pre-synaptic terminals. Furthermore, higher concentration of honokiol induced inward currents that were noticeably attenuated in the presence of picrotoxin (a GABA A receptor antagonist) or strychnine (a glycine receptor antagonist). Honokiol also exhibited potentiation effect on glycine- and GABA A receptor-mediated responses. In inflammatory pain model, the increase in frequency of spontaneous firing on SG neurons induced by formalin was significantly inhibited by the application of honokiol. Altogether, these findings indicate that honokiol might directly affect SG neurons of the Vc to facilitate glycinergic and GABAergic neurotransmissions and modulate nociceptive synaptic transmission against pain. Consequently, the inhibitory effect of honokiol in the central nociceptive system contributes to orofacial pain management. [ABSTRACT FROM AUTHOR]

The study assessed the impacts of an adjusted cropping calendar on the welfare of rice farming households in the Mekong River Delta (MRD) of Vietnam in the 2019/20 Winter–Spring (W-S) crop season. Some farmers in the study area practiced early planting as an adaptation strategy to avoid the risk of saline intrusion during the 2019–2020 El Niño. The study randomly surveyed 1,176 rice farmers in three MRD provinces, namely, Long An, Kien Giang, and Soc Trang, of which 412 were early planters and 764 were non-early planters. Propensity score matching was applied to explore the effects of early planting on the rice yield and rice farming income. Early planting during the 2019/20 W-S season produced (i) an increase in rice farming income of VND 22.8–24.6 million per farmer or VND 8.62–8.77 million per hectare; (ii) an increase in the annual rice farming income of VND 13.7–17.1 million per farmer or VND 3.2–4.3 million per hectare; and (iii) an increase in rice yield by 5.29–5.67 tons per farmer or 2.51–2.59 tons per hectare. The findings confirm that adjusting the rice cropping calendar as an adaptation strategy against salinity can improve rice farmers' production and income. [ABSTRACT FROM AUTHOR]

Women from refugee backgrounds generally experience poorer pregnancy-related outcomes compared to host populations. To examine the trend and disparities in adverse perinatal outcomes among women of refugee background using population-based data from 2003 to 2017. A population-based cross-sectional study of 754,270 singleton births in Victoria compared mothers of refugee backgrounds with Australian-born mothers. Inferential statistics, including Pearson chi-square and binary logistic regression, were conducted. Multiple logistic regression was conducted to explore the relationship between adverse perinatal outcomes and the women's refugee status. Women of refugee background had higher odds of adverse neonatal and maternal outcomes, including stillbirth, neonatal death, low APGAR score, small for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and maternal admission to intensive care compared to Australian-born women. However, they had lower odds of neonatal admission to intensive care, pre-eclampsia, and maternal postnatal depression. The trend analysis showed limited signs of gaps closing over time in adverse perinatal outcomes. Refugee background was associated with unfavourable perinatal outcomes, highlighting the negative influence of refugee status on perinatal health. This evidences the need to address the unique healthcare requirements of this vulnerable population to enhance the well-being of mothers and newborns. Implementing targeted interventions and policies is crucial to meet the healthcare requirements of women of refugee backgrounds. Collaborative efforts between healthcare organisations, government agencies and non-governmental organisations are essential in establishing comprehensive support systems to assist refugee women throughout their perinatal journey. [ABSTRACT FROM AUTHOR]

• Cross-Cultural Exploration: The study delves into the perceptions of critical thinking skills among Malaysian and Vietnamese undergraduate students, offering a unique cross-cultural perspective. • Diverse Participants: In-depth interviews were conducted with 16 participants, including first-year and final-year undergraduates, presenting a wide spectrum of high-order thinking skills. • Phenomenographic Approach: Employing the phenomenographic approach, the research uncovers three fundamental conceptions of critical thinking skills, nested within three overarching domains: cognitive, dispositional, and spoken discourse. • Cognitive Dimensions: Within the cognitive domain, the study reveals two distinct approaches: the idealistic and the realistic. These approaches emphasize the theoretical and practical dimensions of critical thinking, offering insights into students' ability to analyze complex concepts and solve intricate problems. • Dispositional Insights: The dispositional domain uncovers the dichotomy of collectivist and individualist perspectives. It highlights how students approach critical thinking within group dynamics and as independent thinkers, shedding light on their motivations and attitudes. • Spoken Discourse: In the spoken discourse domain, two distinct approaches emerge: the product-oriented and the process-oriented. These approaches emphasize the tangible outcomes and cognitive processes of critical thinking, respectively. • Tailoring Pedagogy: The study's findings underscore the importance of customizing pedagogical instruction to accommodate the diverse perspectives and methodologies employed by students in their approach to critical thinking skills. Educators are encouraged to adapt their teaching strategies to align with students' multifaceted modes of critical thinking across various academic levels. This research endeavors to delve into the nuanced perceptions of critical thinking skills held by undergraduate students in Malaysia and Vietnam. The study employs a robust research methodology, involving in-depth interviews with a cohort of 16 participants, drawn from both first-year and final-year undergraduates. Through the rigorous application of the phenomenographic approach, the investigation uncovers three fundamental conceptions of critical thinking skills, categorized within three overarching domains: cognitive, dispositional, and spoken discourse. Within the cognitive domain, two distinctive approaches surface: the idealistic and the realistic. The idealistic perspective underscores the theoretical and aspirational dimensions of critical thinking, spotlighting students' capacity to dissect intricate concepts, establish interconnections between seemingly disparate ideas, and generate innovative solutions to multifaceted problems. Conversely, the realistic approach recognizes the evolution of critical thinking skills over time, emphasizing deliberate practice and reflection on real-world challenges and experiences. The dispositional domain illuminates the dichotomy between collectivist and individualist perspectives, unveiling the diverse manners in which students engage with critical thinking within the framework of group dynamics or as autonomous thinkers. In the spoken discourse domain, two discernible approaches emerge: the product-oriented and the process-oriented. The product-oriented stance accentuates tangible outcomes of critical thinking, such as persuasive arguments, articulate and coherent written expression, and adept problem-solving. In contrast, the process-oriented approach underscores the intricate cognitive and metacognitive processes intrinsic to critical thinking, encompassing activities like information analysis, evaluation, idea integration, and the cultivation of innovative insights. This study's findings underscore the necessity of customizing pedagogical instruction to harmonize with the diverse perspectives and methodologies embraced by students in their approach to critical thinking skills. [ABSTRACT FROM AUTHOR]

Objectives: To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.Methods: Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.Results: Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.Conclusions: Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss. [ABSTRACT FROM AUTHOR]

We consider multi-input single-output (MISO) fractional systems of commensurate fractional orders with different input or output delays. We derive explicit expressions of left and right coprime factorizations over H ∞ and of the associated Bézout factors of the transfer matrix of the systems. These factors allow the construction of the Youla–Kučera parametrization of the set of stabilizing controllers which guarantee the internal stability of the closed-loop systems. [ABSTRACT FROM AUTHOR]

Host-pathogen interactions (HPIs) are complex processes that require tight regulation. A common regulatory mechanism of HPIs is through glycans of either host cells or pathogens. Due to their diverse sequences, complex structures, and conformations, studies of glycans require highly sensitive and powerful tools. Recent improvements in technology have enabled the application of many bioanalytical techniques and modeling methods to investigate glycans and their mechanisms in HPIs. This mini-review highlights how these advances have been used to understand the role glycans play in HPIs in the past 2 years. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Behavioral interventions show potential for promoting increased fruit and vegetable consumption in the general population. However, little is known about their effectiveness or cost-effectiveness among socioeconomically disadvantaged groups, who are less likely to consume adequate fruit and vegetables. Objective: This study investigated the effects and costs of a behavior change intervention for increasing fruit and vegetable purchasing and consumption among socioeconomically disadvantaged women. Design: ShopSmart 4 Health was a randomized controlled trial involving a 3-mo retrospective baseline data collection phase [time (T) 0], a 6-mo intervention (T1-T2), and a 6-mo no-intervention follow-up (T3). Socioeconomically disadvantaged women who were primary household shoppers in Melbourne, Australia, were randomly assigned to either a behavior change intervention arm (n = 124) or a control arm (n = 124). Supermarket transaction (sales) data and surveys measured the main outcomes: fruit and vegetable purchases and self-reported fruit and vegetable consumption. Results: An analysis of supermarket transaction data showed no significant intervention effects on vegetable or fruit purchasing at T2 or T3. Participants in the behavior change intervention arm reported consumption of significantly more vegetables during the intervention (T2) than did controls, with smaller intervention effects sustained at 6 mo postintervention (T3). Relative to controls, vegetable consumption increased by ~0.5 serving · participant-1 · d-1 from baseline to T2 and remained 0.28 servings/d higher than baseline at T3 among those who received the intervention. There was no intervention effect on reported fruit consumption. The behavior change intervention cost A$3.10 (in Australian dollars) · increased serving of vegetables-1 · d-1. Conclusions: This behavioral intervention increased vegetable consumption among socioeconomically disadvantaged women. However, the lack of observed effects on fruit consumption and on both fruit and vegetable purchasing at intervention stores suggests that further investigation of effective nutrition promotion approaches for this key target group is required. The Shop- Smart 4 Health trial was registered at www.isrctn.com as ISRCTN48771770. [ABSTRACT FROM AUTHOR]

Objective Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Design and methods Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. Results At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. Conclusions A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901. [ABSTRACT FROM AUTHOR]

Background Activation of the hypothalamic-pituitary-adrenal (HPA) axis has been associated with higher levels of cardiovascular (CVD) risk factors in adults. This study aimed to assess the relation between measures of HPA axis activity under resting conditions and CVD risk factors in a general population of adolescents at 17 years. Methods A total of 1134 adolescents from the Western Australian Pregnancy Cohort (Raine) Study had phenotypic and socio-demographic data. The associations between HPA axis measures (plasma ACTH, total cortisol, calculated free cortisol, corticosteroid binding globulin (CBG), and salivary cortisol) and a range of cardiovascular risk factors were examined using multivariable linear regression models, with adjustment for gender, adiposity, birth weight, gestational age, and socio-behavioural factors. Results Plasma total cortisol was positively associated with systolic blood pressure (SBP) ( p = 0.011), total cholesterol, HDL-cholesterol, and triglycerides (all p < 0.001), and hs-CRP ( p = 0.047). Salivary cortisol was associated positively with HDL-C ( p = 0.033) and negatively with LDL-cholesterol ( p = 0.016); plasma calculated free cortisol was positively associated with triglycerides ( p = 0.006); plasma CBG was positively associated with total cholesterol and HDL-cholesterol (both p < 0.001), LDL-cholesterol ( p = 0.022), and hs-CRP ( p = 0.001). After correction for multiple comparisons, significant associations remained for total cortisol with total cholesterol, HDL-C, and triglycerides; for calculated free cortisol with triglycerides; and for CBG with HDL-C, total cholesterol, and hs-CRP. Plasma ACTH was not associated with any cardiovascular risk factor. There was no association between BMI and any measure of HPA axis activity. Conclusion In an adolescent population, HPA axis measures under resting conditions are associated with a range of CVD risk factors. Clarification of the mechanisms underlying these associations in adolescence would be an important step in understanding the evolution of adult CVD. [ABSTRACT FROM AUTHOR]

This paper is an effort towards presenting a new mix design method for self-compacting high performance concrete (SCHPC) containing various mineral admixtures (MA). In the proposed method, the constituent materials were calculated by using the absolute volume method. The packing theory of Funk and Dinger with the exponent q = 0.25 was adopted to determine the grading of aggregate. The primary paste volume for filling capacity was computed from the void content of compacted aggregate. The superplasticizer dosage for the concrete was set on the basis of the superplasticizer saturation dosage of the corresponding mortar. Efficiency factors were used to express the effect of MAs on compressive strength of concrete. The results show that the method was adequate to proportion SCHPC mixtures containing ternary binders, i.e. cement and two different MAs (rice husk ash (RHA), silica fume, fly ash, and lime stone powder), satisfying the self-compactability requirements and compressive strength class in the range of C60/75–C90/105. With 5–20 wt.% cement replacement, RHA was very effective in improving compressive strength of SCHPC. The efficiency factor for RHA, i.e., 2.7–1.8, which is the first time applied, is only marginally lower as compared to that of silica fume. [ABSTRACT FROM AUTHOR]

It is believed that together with critical thinking, critical reading has emerged as a fundamental skill that university graduates are expected to possess in an increasingly modern and digitally connected world (Bråten & Braasch, 2017). With the advancement of technology, young adults have been increasingly submerged in a sea of information available at their fingertips. Hence, they must learn how to select, analyze, evaluate, and assess the information they encounter in their academic or professional lives (Siemens, 2004). However, it is observed that critical reading skills in higher education seem to be neglected in the research field compared to an interest in critical thinking studies. This study systematically evaluates 75 papers published between 2001 and 2021 and indexed in the Web of Science and Education Resources Information Center (ERIC) databases. The findings indicate that scholars in Turkey and the United States place a higher premium on critical research than researchers in other parts of the world. Most papers focus on investigating feasible approaches to develop critical reading skills amongst undergraduates and proposing critical reading pedagogy in higher education institutions. However, there has been a deficiency in research of critical reading in STEM education, especially in the Asian tertiary context. This study highlights the significance of conducting additional in-depth research into the effects of integrating critical reading classrooms and teaching-and-learning activities into STEM education, as well as the impact of using science topics with the goal of cultivating this crucial skill for young people's academic and professional development in the era of the digital revolution. Moreover, research on a conceptual framework to develop critical reading abilities amongst Asian undergraduates could be considered as a potential topic for novice researchers. [ABSTRACT FROM AUTHOR]

Abstract: In this work the synthesis of a nickel doped cubic manganese spinel has been studied for application as cathode material in secondary lithium batteries. Six different experimental approaches have been tested in order to carry out a screening of the various possible synthetic routes. The used synthetic strategies were wet chemistry (WC), solid state (SS), combustion synthesis (CS), cellulose-based sol–gel synthesis (SG-C), ascorbic acid-based sol–gel synthesis (SG-AA) and resorcinol/formaldehyde-based sol–gel synthesis (SG-RF). The goal of our study is to obtain insights about how the synthesis conditions can be modified in order to achieve a material with improved electrochemical performances in such devices, especially in high current operating regimes. The synthesized materials have been characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), atomic absorption, inductively coupled plasma (ICP-MS) atomic emission spectroscopy, surface area measurements and tested as high voltage cathodes in Li-ion electrochemical devices. [Copyright &y& Elsevier]

Abstract: This article is about the struggles to sustain identity as writers while accommodating the demands of the university experienced by Arianto and his thesis supervisor, myself. It shows how critical EAP was the on-going conversation between us about how to negotiate norms, voice and creativity in our writing and in the negotiations Arianto had to make when writing his own essays and thesis in English and assessing his students'' written works. The article also discusses how my positioning as a writer of two languages and having a passion for my own voice and identity in writing has influenced the ways I have analysed and interpreted Arianto''s tensions, contradictions and justifications in his negotiation processes. The findings showcase the ways in which power is shared and shifted among EAP teachers, supervisors and students and the tendency to recognise and respect different ways of practising EAP among readers, such as journal reviewers and thesis examiners. They also reveal how Arianto''s readiness and confidence to share the ownership of and appropriate English as an international language has been exercised in the negotiation processes involving my support, encouragement as well as critical comments and high expectation of his writing. [Copyright &y& Elsevier]

Abstract: One critical task in any wind power interconnection study involves the modelling of wind turbines. This paper provides the most basic yet comprehensive time–domain wind turbine model upon which more sophisticated models along with their power and speed control mechanisms, can be developed. For this reason, this paper concentrates on the modelling of a fixed-speed wind turbine. The model includes turbine''s aerodynamic, mechanical, and electrical components. Data for the rotor, drive-train, and electrical generator are given to allow replication of the model in its entirety. Each of the component-blocks of the wind turbine is modelled separately so that one can easily expand the model to simulate variable-speed wind turbines or customise the model to suit their needs. Then, an aggregate wind turbine model, or wind farm, is developed. This is followed by four case studies to demonstrate how the models can be used to study wind turbine operation and power grid integration issues. Results obtained from the case studies show that the models perform as expected. [Copyright &y& Elsevier]

• This study examines the linkages between on-the-job training and employee benefits in terms of wages as well as non-monetary gains. • The study used a uniquely matched employer-employee panel dataset for the 2011–2015 period in Vietnam. • We find that on-the-job training has a positive but insignificant effect on wages. However, wage returns for on-the-job training are recorded for young workers only. • Also, our results reveal that on-the-job training improves employee working conditions. • These findings suggest that on-the-job training plays an important role in employee benefits, especially for young employees. This study examines the linkages between on-the-job training and employee benefits in terms of wages as well as non-monetary gains. Based on a uniquely matched employer-employee panel dataset for the 2011–2015 period in Vietnam, we find that on-the-job training has a positive but insignificant effect on wages. However, wage returns for on-the-job training are recorded for young workers only. Also, our results reveal that on-the-job training improves employee working conditions. These findings suggest that on-the-job training plays an important role in employee benefits, especially for young employees. [ABSTRACT FROM AUTHOR]

• RHA particles (micro-reactive aggregates) react with alkali hydroxide to generate ASR products. • Pozzolanic reaction and ASR take place successively from the exterior to interior of RHA particles. • The C-S-H phases of RHA contain sodium and potassium, and its ASR products contain calcium. The aim of this study is to investigate alkali silica reactivity of rice husk ash (RHA) in cement paste. Scanning electron microscope in combination with Energy-dispersive X-ray spectroscopy was used to analyse the mechanism of alkali silica reactivity of RHA. The results indicate that RHA has paradoxical effect on alkali silica reaction (ASR) in cement paste, especially with coarse RHA particles and at high temperatures. RHA particles indeed act as micro-reactive aggregates and react with alkali hydroxide to generate expansive ASR products even when particle size of RHA is in range of 5.7–22.6 µm. The pozzolanic reaction and ASR take place successively from the exterior to interior of RHA particles. The mechanism for the successive reactions of RHA is proposed. The C-S-H phases as pozzolanic products of RHA contain an amount of sodium and potassium, whereas the ASR products of RHA contain an amount of calcium. The Ca/Si and (Na + K)/Si ratios of pozzolanic products are much higher and lower than those of ASR products, respectively. To mitigate ASR, RHA should be ground to very fine particles, at least finer than 5 µm. [ABSTRACT FROM AUTHOR]

• Examine the impact of financial inclusion on CO2 emissions in Asia from 2004 to 2014. • Three proxies of financial inclusion are built based on principal component analysis. • Estimate the model by Hoechle (2007) procedure for Driscoll-Kraay standard errors. • Financial inclusion appears to have led to higher emissions of CO2 in the region. • No policy synergies were found between financial inclusion and mitigating emissions. This study examines the impact of financial inclusion on CO 2 emissions using a sample of 31 Asian countries during the period 2004–2014. Three composite indicators for financial inclusion are constructed using principal component analysis (PCA) based on normalized variables. To estimate the model, we adopted the Hoechle (2007) procedure which produces Driscoll-Kraay standard errors for linear panel models that are not only heteroskedasticity consistent but also robust to general forms of cross-sectional dependence. We find that income, energy consumption, industrialization, urbanization, FDI and financial inclusion appear to have led to higher emissions of CO 2 in the region. Meanwhile, increased openness to trade seems to have reduced CO 2 emissions. The findings are qualitatively robust to different proxies of financial inclusions and reasonable modifications to specification of the model. The empirical results imply that there are currently no policy synergies between growing financial inclusion and mitigating CO 2 emissions. Thus, financial inclusion should be integrated into climate change adaptation strategies at local, national and regional levels, especially to address the side effect of higher CO 2 emissions associated with improved financial inclusion. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. This study aims to systematically synthesize the literature on service utilization and costs for children with ADHD. The search included 9 databases for peer-reviewed primary studies in English from 2007 to 2023. Two independent reviewers conducted title/abstract and full-text screenings and quality assessment. Meta-analysis was conducted on direct medical costs. Thirty-two studies were included. Children with ADHD have used more pharmaceuticals, mental health, and special education services than children without ADHD (counterparts). Nevertheless, one study found that children with ADHD were twice as likely to have unmet health needs than their counterparts. Annual health system costs per patient were highly varied and higher in children with ADHD ($722-$11 555) than their counterparts ($179-$3646). From a societal perspective, children with ADHD were associated with higher costs ($162-$18 340) than their counterparts ($0-2540). The overall weighted mean direct medical cost was $5319 for children with ADHD compared with $1152 for their counterparts when all studies with different sample sizes were considered together, with the difference being $4167. Limited literature on productivity losses associated with ADHD reported them as a substantial cost. ADHD in children had a "large" effect on the increment of direct medical costs. ADHD was associated with increased service utilization and costs. However, unmet health needs or underuse among children with ADHD was also evident. Governments should endeavor to improve access to effective services for children with ADHD to mitigate the impact of ADHD. • Attention-deficit/hyperactivity disorder (ADHD) was associated with substantial healthcare and societal costs. • There is evidence of unmet needs and underuse of services among children with ADHD. • Strategies to improve service access and utilization are needed to reduce inequity across different sociodemographic groups and to mitigate the long-term adverse outcomes of ADHD. [ABSTRACT FROM AUTHOR]

Depression and apathy are associated with decreased functional capacity in Huntington's disease (HD) but frequency of depression and apathy in HD is largely unknown. Systematic literature searching was conducted across 21 databases until 30 June 2021. Inclusion criteria was limited to clinician-rated assessments of depression and apathy and adult-onset HD. Inverse-variance heterogeneity meta-analyses were conducted exploring depression and apathy frequency within individuals from families affected by HD, and within individuals with confirmed HD gene-positive status. Screening identified 289 articles for full-text review; nine remained for meta-analysis. Depression frequency in the lifetime in adults affected by or at-risk for HD was 38%, I2 = 99%. Apathy frequency in the lifetime in adults affected by or at-risk for HD was 40%, I2 = 96%. The robustness of the findings improved when limiting the analysis to gene-positive individuals only where apathy was found to be slightly more common than depression, 48% and 43% respectively. Future studies may consider reporting results from juvenile-onset HD and adult-onset HD cohorts separately to further explore phenotypic profiles. • First meta-analysis of depression and apathy frequency in Huntington's disease. • Apathy appears to be slightly more common than depression. • Discusses the use of psychiatric assessment tools in Huntington's disease. • Calls for separate reviews and reporting of juvenile and adult-onset HD phenotypes. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of PD-1-directed antibody-based therapy in patients with symptomatic melanoma brain metastases (MBM) and concurrent treatment with corticosteroids. This retrospective cohort study included patients with cutaneous melanoma with symptomatic MBM and concurrent treatment with corticosteroids who received PD-1-directed antibody-based treatment at the Royal Marsden Hospital London between 2016 and 2021. The primary outcome was overall survival (OS), secondary outcomes were intracranial response rate (ORR) and duration of response (DOR). We used the Kaplan-Meier method to describe survival. Between 2016 and 2021, 256 patients presented with metastatic melanoma, of whom 29 were eligible with symptomatic MBM requiring corticosteroids and receiving ipilimumab plus nivolumab. Median age was 54 (interquartile range 44, 66). Median OS was 5.45 months (95% confidence interval (CI) 2.89, 29.40), with 21% of patients (95% CI 9%, 47%) alive after 3 years. ORR was 28% (8/29) and DOR was 7.85 months (95% CI 7.85, not estimably [NE]). Responding patients had a median OS of 56.4 months (95% CI 46.03, NE). Elevated lactate dehydrogenase and Eastern Cooperative Oncology Group PS> 2 were associated with poorer outcomes (median OS 29.4 versus 3.12 months and 6.44 versus 5.13 months), no such association was observed for corticosteroid dose, number of lesions, or line of treatment. Patients with symptomatic MBM derive only modest benefit from combination immunotherapy treatment. Nevertheless, those with disease response have the potential to derive long-term benefit, justifying ipilimumab plus nivolumab in this group in the absence of other more effective treatment options. • Metastatic melanoma frequently presents with symptomatic brain metastasis. • Ipilimumab plus nivolumab has modest efficacy in those patients. • Responding patients to ipilimumab plus nivolumab may derive long-term benefit. • Even patients with high-dose corticosteroids may respond to ipilimumab & nivolumab. [ABSTRACT FROM AUTHOR]