Psychological screening of adults and young people following the Manchester Arena incident

Background: Terrorist attacks have increased globally since the late 1990s with clear evidence of psychological distress across both adults and children and young people (CYP). After the Manchester Arena terrorist attack, the Resilience Hub was established to identify people in need of psychological and psychosocial support. Aims: To examine the severity of symptoms and impact of the programme. Method: The hub offers outreach, screening, clinical telephone triage and facilitation to access evidenced treatments. People were screened for trauma, depression, generalised anxiety and functioning who registered at 3, 6 and 9 months post-incident. Baseline scores were compared between screening groups (first screen at 3, 6 or 9 months) in each cohort (adult, CYP), and within groups to compare scores at 9 months. Results: There were significant differences in adults' baseline scores across screening groups on trauma, depression, anxiety and functioning. There were significant differences in the baseline scores of CYP across screening groups on trauma, depression, generalised anxiety and separation anxiety. Paired samples t-tests demonstrated significant differences between baseline and follow-up scores on all measures for adults in the 3-month screening group, and only depression and functioning measures for adults in the 6-month screening group. Data about CYP in the 3-month screening group, demonstrated significant differences between baseline and follow-up scores on trauma, generalised anxiety and separation anxiety. Conclusions: These findings suggest people who register earlier are less symptomatic and demonstrate greater improvement across a range of psychological measures. Further longitudinal research is necessary to understand changes over time

Responding to mental health needs after terror attacks

Mental health responses for people caught up in terror attacks are often inadequate. Internationally, existing services repeatedly fail to identify those with short and long term needs, resulting in an increased prevalence of post-traumatic stress disorder, depression, and anxiety disorders compared with the general population.1 Health services should plan for short and longer term psychosocial care and mental health treatment for the substantial minority who need interventions.2 But the UK has been slow to learn. Many shortcomings in the response to the 2005 London bombings remained at the time of the 2017 Manchester Arena bombing, despite proposals for a new approach. Here, we discuss how services have evolved since 2005 and what still needs to be don

A systematic review and meta-analysis of adjuncts to minimally invasive treatment of urethral stricture in men

Context Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates. Objective To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD. Evidence acquisition A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist. Evidence synthesis A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C-N-acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27–0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11–0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02–0.61; p = 0.01). Urinary tract infection (2.9–14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen. Conclusions Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence. Patient summary We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality

The Arctic Summer Cloud-Ocean Study (ASCOS): Overview and experimental design

The climate in the Arctic is changing faster than anywhere else on Earth. Poorly un-derstood feedback processes relating to Arctic clouds and aerosol-cloud interactionscontribute to a poor understanding of the present changes in the Arctic climate system,and also to a large spread in projections of future climate in the Arctic. The problem is exacerbated by the paucity of research-quality observations in the central Arctic. Im-proved formulations in climate models require such observations, which can only comefrom measurements in-situ in this difficult to reach region with logistically demandingenvironmental conditions.The Arctic Summer Cloud-Ocean Study (ASCOS) was the most extensive central Arctic Ocean expedition with an atmospheric focus during the International Polar Year(IPY) 2007–2008. ASCOS focused on the study of the formation and life cycle of low-level Arctic clouds. ASCOS departed from Longyearbyen on Svalbard on 2 August andreturned on 9 September 2008. In transit into and out of the pack ice, four short re-search stations were undertaken in the Fram Strait; two in open water and two in the marginal ice zone. After traversing the pack-ice northward an ice camp was set up on12 August at 87◦21′N 01◦29′W and remained in operation through 1 September, drift-ing with the ice. During this time extensive measurements were taken of atmosphericgas and particle chemistry and physics, mesoscale and boundary-layer meteorology,marine biology and chemistry, and upper ocean physics. ASCOS provides a unique interdisciplinary data set for development and testing ofnew hypotheses on cloud processes, their interactions with the sea ice and ocean andassociated physical, chemical, and biological processes and interactions. For exam-ple, the first ever quantitative observation of bubbles in Arctic leads, combined withthe unique discovery of marine organic material, polymer gels with an origin in the ocean, inside cloud droplets suggest the possibility of primary marine organically de-rived cloud condensation nuclei in Arctic stratocumulus clouds. Direct observations ofsurface fluxes of aerosols could, however, not explain observed variability in aerosol concentrations and the balance between local and remote aerosols sources remainsopen. Lack of CCN was at times a controlling factor in low-level cloud formation, andhence for the impact of clouds on the surface energy budget. ASCOS provided de-tailed measurements of the surface energy balance from late summer melt into theinitial autumn freeze-up, and documented the effects of clouds and storms on the surface energy balance during this transition. In addition to such process-level studies, theunique, independent ASCOS data set can and is being used for validation of satelliteretrievals, operational models, and reanalysis data sets.ISSN:1680-7375ISSN:1680-736

Thermal substitution and aerobic efficiency: measuring and predicting effects of heat balance on endotherm diving energetics

For diving endotherms, modelling costs of locomotion as a function of prey dispersion requires estimates of the costs of diving to different depths. One approach is to estimate the physical costs of locomotion (Pmech) with biomechanical models and to convert those estimates to chemical energy needs by an aerobic efficiency (η=Pmech/Vo2) based on oxygen consumption (Vo2) in captive animals. Variations in η with temperature depend partly on thermal substitution, whereby heat from the inefficiency of exercising muscles or the heat increment of feeding (HIF) can substitute for thermogenesis. However, measurements of substitution have ranged from lack of detection to nearly complete use of exercise heat or HIF. This inconsistency may reflect (i) problems in methods of calculating substitution, (ii) confounding mechanisms of thermoregulatory control, or (iii) varying conditions that affect heat balance and allow substitution to be expressed. At present, understanding of how heat generation is regulated, and how heat is transported among tissues during exercise, digestion, thermal challenge and breath holding, is inadequate for predicting substitution and aerobic efficiencies without direct measurements for conditions of interest. Confirming that work rates during exercise are generally conserved, and identifying temperatures at those work rates below which shivering begins, may allow better prediction of aerobic efficiencies for ecological models