Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II)

Background Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder, seen in 20–30% of young adult prisoners. Pharmacoepidemiological studies, a small randomised controlled trial and open trial data of methylphenidate suggest clinically significant reductions in ADHD symptoms, emotional dysregulation, disruptive behaviour and increased engagement with educational activities. Yet, routine treatment of ADHD in offenders is not yet established clinical practice. There is continued uncertainty about the clinical response to methylphenidate (MPH), a first-line treatment for ADHD, in offenders, who often present with an array of complex mental health problems that may be better explained by states of inattentive, overactive, restless and impulsive behaviours. To address this problem, we will conduct an efficacy trial to establish the short-term effects of osmotic-controlled release oral delivery system (OROS)-methylphenidate (Concerta XL), an extended release formulation of MPH, on ADHD symptoms, emotional dysregulation and behaviour. Methods This study is a parallel-arm, randomised, placebo-controlled trial of OROS-MPH on ADHD symptoms, behaviour and functional outcomes in young male prisoners aged 16–25, meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for ADHD. Participants are randomised to 8 weeks of treatment with OROS-MPH or placebo, titrated over 5 weeks to balance ADHD symptom improvement against side effects. Two hundred participants will be recruited with a 1:1 ratio of drug to placebo. The primary outcome is change in level of ADHD symptoms after 8 weeks of trial medication. Discussion Potential benefits include improvement in ADHD symptoms, emotional dysregulation, attitudes towards violence and critical incidents and increased engagement with educational and rehabilitation programmes. Demonstrating the efficacy and safety of MPH on ADHD symptoms and associated impairments may provide the data needed to develop effective healthcare pathways for a significant group of young offenders. Establishing efficacy of MPH in this population will provide the foundation needed to establish long-term effectiveness studies with the potential for demonstrating significant reductions in criminal behaviour and improved health-economic outcomes

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Treatments for Dangerous and Severe Personality Disorder (DSPD)in UK units

Four units established in England for individuals with dangerous severepersonality disorder differ significantly in their treatment regimes. Theirdistribution and relationship to risk are unknown. In this study, amodified Delphi process identified the treatments and allocated them to11 mutually exclusive categories. Attendance at treatments was obtainedfrom records, and these were compared to annual assessments of risk. Of150 proposed treatments, 50 were allocated to the 11 categories. Onlytwo treatment categories were provided in all units. Specifiedpsychological treatment programmes occupied an average of less than2 h a week, and 10% of patients had no treatment in each year.Reduction in risk was significantly associated with total hours oftreatment received. A rigorous rationalisation of the treatments isneeded to permit a robust evaluation of their effectiveness. Furtherresearch is needed to determine whether reductions in risk reflectreoffending rates

Dataset Supporting "Observation of diffuse scattering in scanning helium microscopy"

A set of 4 SHeM measurements that are used in the quantative analysis in the linked journal publication.Sam M Lambrick acknowledges funding from Mathworks Ltd.

Dangerous Severe Personality Disordered (DSPD) patients: characteristics and comparison with other high-risk offenders

England and Wales introduced the administrative category of Dangerous Severe Personality Disorder (DSPD) and established special units in prisons and high-secure psychiatric hospitals for their treatment. To examine their characteristics, we approached 202 patients admitted to DSPD units; 174 consented to participate in research. All were male, and the median age was 38 years. Most were white and born in the UK. Most patients (75%) met full DSPD criteria as suffering from severe personality disorder that caused them to be dangerous. With respect to personality disorder, most had elevated psychopathic traits and 40% met criteria for psychopathy on the Psychopathy Checklist-Revised (Hare, 2003). With respect to dangerousness, 25% of patients had a history of homicide; 28%, sexual offenses; and 41%, other violent offenses. Median time spent in prison was more than 12 years. According to standardized measures of violence risk, those admitted to DSPD units resembled other groups of high risk offenders described in the international literature. There were some significant differences between those admitted to prison- versus hospital-based units. The findings confirmed that DSPD units contain dangerous offenders with no evidence of preemptive incarceratio

Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries

Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) remains a significant surgical challenge. Despite claims to the contrary, the incidence of bile duct injury has remained elevated since the introduction of LC. Several issues regarding the surgical management of BDI are controversial, including: (i) identification of the surgeon and centre most capable of managing the injury, (ii) timing of surgical repair, (iii) incidence and significance of associated vascular injury and (iv) identification of patient factors which significantly impact outcome after repair. Variability in timing of referral of BDI to tertiary centres has been noted in the literature. The impact of timing of referral upon post-operative outcomes after definitive surgery has yet to be clearly investigated. We report our experience with 44 patients who required reconstructive surgery after BDI. In contrast to the many studies available in the literature, patients in the current study were classified according to a modern injury classification system. Additionally, we examined the impact of delayed referral to our centre on short- and long-term outcomes after surgical repair of BDI

Baseline sputum eosinophil + neutrophil subgroups’ clinical characteristics and longitudinal trajectories for NHLBI Severe Asthma Research Program (SARP 3) cohort

Combined elevated sputum eosinophils+neutrophils in asthma associated with lowest lung function, greater healthcare utilization, and longitudinally, further spirometric loss, implicating cell-cell interactions or overlapping inflammatory pathways while increased eosinophils or neutrophils alone show less effect