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William Gesztes1,2, Cara Schafer1,2, Denise Young1,2, Jesse Fox1,2, Yongmei Chen1,2, Huai-Ching Kuo1,2, Kuwong B. Mwamukonda4, Albert Dobi1,2, Gyorgy Petrovics1,2, Allen Burke3, Judd W. Moul1,4, David G. McLeod1,4÷, Inger L. Rosner1,4, Shyh-Han Tan1,2, Jennifer Cullen1,2, Shiv Srivastava1,5, Isabell A. Sesterhenn3 1Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, 20817, USA; 2Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, 20817 USA; 3Joint Pathology Center; Silver Spring, Maryland 20906, USA; 4Urology Service, Walter Reed National Military Medical Center, Bethesda, Maryland 20852, USA Background Summary & Conclusions Methods Results Prostate cancer incidence is the highest and is the second deadliest of cancers among American men. Although availability of several tests based on the detection of PSA, kallikrein proteins, or mRNA has improved the management of localized prostate cancer, the is an urgent need to identify early molecular biomarkers that would predict disease progression following treatment. Given the high representation of men in the US military, identification of early molecular biomarkers within a military cohort supports mission readiness and return to duty across all uniformed services. TP53 is one of the most frequently altered genes in primary prostate cancer. The precise assessment of its focal alterations in localized primary tumors by using immunohistochemistry (IHC) assay has significantly aided the prognosis of prostate cancer. Here, we evaluated the p53 protein expression as a surrogate for the detection of TP53 mutations and prostate lymphatic vessel invasion (LVI) for predicting metastatic progression. • p53 expression of >5% strongly correlates with positive LVI status. • Multivariate analysis suggests p53 expression and LVI status confers additive risk for DM. • Tumo, RITM0027793, Prostate cancer incidence is the highest and is the second deadliest of cancers among American men. Although availability of several tests based on the detection of PSA, kallikrein proteins, or mRNA has improved the management of localized prostate cancer, the is an urgent need to identify early molecular biomarkers that would predict disease progression following treatment. Given the high representation of men in the US military, identification of early molecular biomarkers within a military cohort supports mission readiness and return to duty across all uniformed services. TP53 is one of the most frequently altered genes in primary prostate cancer. The precise assessment of its focal alterations in localized primary tumors by using immunohistochemistry (IHC) assay has significantly aided the prognosis of prostate cancer. Here, we evaluated the p53 protein expression as a surrogate for the detection of TP53 mutations and prostate lymphatic vessel invasion (LVI) for predicting metastatic progression.

Objective: The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods: Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive sample of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results: Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care; consumer-focused service; knowledge improvement; early assessment; the development of models, systems and processes; and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions: Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic?: There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses; however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add?: For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of serv

Introduction More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. Objectives To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. Methods We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. Results The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. Conclusions The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.

People brought in by police (BIBP) to the ED are a potentially vulnerable group. This narrative scoping review aimed to identify, evaluate and summarise current literature regarding the frequency of presentation, demographic and clinical profile of patients (including reason for presentation), care delivery, and outcomes for people BIBP to the ED, and identify current gaps in knowledge. The review involved searching EMBASE, CINAHL and PubMed using a combination of terms: emergency/ED coupled with police custody/watch house or police presentation, for papers published in English language from January 2006 to November 2017. A total of 20 studies met the inclusion criteria. These included 17 observational (non-randomised controlled trials) quantitative studies and three descriptive case reports. The proportion of presentations to ED that were BIBP varied depending on the study design and sampling frame. People BIBP often presented with mental health problems, substance use problems, aggressive behaviour and injury caused by self or others. Of studies focused specifically on patients arriving to the ED in mental health crisis (i.e. suicidal ideation or self-harm), 18–27% were BIBP. ED presentations BIBP were mostly male and typically younger than people arriving by other means. The nature of care provided in the ED and outcomes of the acute episode of care were typically not well described. Limited research regarding people BIBP to the ED limits the ability to comprehensively understand their demographic and clinical profile and outcomes of emergency care. Further research is required to inform if and where in the patient’s journey further improvements may be targeted.

The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence-based, best-practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person-centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED.

Globally, there is good evidence that people in prison are distinguished by their poor health profile and by entrenched socio-economic disadvantage. Mental disorders, especially severe mental illness, are overrepresented among people in prison. People released from prison are at particularly high risk of poor health outcomes and this risk is higher among people with pre-existing mental disorders compared to those without mental disorders. However, beyond drug-related outcomes, infectious disease epidemiology, and mortality, substantial gaps in evidence exist, limiting the capacity to respond to the often multiple and complex needs of people with mental disorders released from prison. This thesis fills this internationally recognised gap in the literature. It comprises a review of the literature and six discrete studies. The studies included in this thesis generate previously unavailable evidence on gaps in transitional service provision for people with intellectual disability released from prison; patterns of health service utilisation, and health outcomes for people with and without pre-existing mental disorders released from prison; and the determinants of findings of unfitness and unsoundness for people with cognitive disability referred to a Mental Health Court in Australia. The findings reported in this thesis indicate that people with pre-existing mental disorders experience gaps in transitional service provision; and are at increased risk of poor health and related outcomes compared to those without a mental disorder after release from prison. Given their poor outcomes and inherent vulnerabilities in the criminal justice system, people with mental disorders should be considered for diversion from incarceration into therapeutic environments where appropriate. Furthermore, the findings in this thesis provide new evidence that injury is a key target for prevention among people released from prison, especially among those with co-occurring mental illness and subs

Diverse disciplines investigate how muscular tissue (i.e. ‘meat’) responds to being cut and deformed, however, large-scale, empirically robust investigations into these matters are often impractical and expensive. Previous research has used clay as an alternative to meat. To establish whether clay is a reliable proxy for meat, we directly compare the two materials via a series of cutting and projectile tests. Results confirm that the two materials display distinct cutting mechanics, resistance to penetration and are not comparable. Under certain conditions clay can be used as an alternative to meat, although distinctions between the two may lead to experimental limitations.

Objective: The identification of khat dependence and the association between khat dependence, use patterns, and related health problems have not been quantitatively described in Australia. The current study aimed to describe khat dependence, use patterns, and khatrelated health problems in Australian migrant communities. Method: A 48-item questionnaire was administered to a convenience sample of 52 participants from African migrant communities who self-reported using khat in four Australian state capital cities between April 1 and June 1, 2012. Associations between Severity of Dependence Scale for khat use (SDS-khat) screening status, use patterns, and khat-related psychological and physical health problems were assessed using multivariate loglinked Poisson regression controlling for potential sociodemographic confounders. Results: Overall, 44.2% (n = 23) of the study participants screened positive on the SDS-khat, indicating probable khat dependence. Screening positive for khat dependence was associated with increased risk for khat use frequency in the last 30 days (adjusted prevalence risk ratio [APRR] = 2.26, 95% CI [1.23, 4.15], p =.009), experiencing three or more psychological health problems (APRR = 1.87, 95% CI [1.04, 3.36], p =.037), and experiencing two or more physical health problems (APRR = 1.92, 95% CI [1.13, 3.27], p =.016) after using khat. Conclusions: Screening positive on the SDS-khat is associated with increased recent khat use frequency and elevated physical and psychological health problems, providing preliminary evidence that probable khat use dependence may be associated with an increased risk of harm in Australia. Furthermore, these preliminary results support the potential utility of the SDS-khat to healthcare providers to identify those at risk for khatrelated harms. Further investigation into the relationship between khat dependence, use patterns, and related health outcomes is warranted.

INTRODUCTION: Ex-prisoners with a history of injecting drug use (IDU) experience disproportionate drug-related harm. Rapid resumption of substance use following prison release is common and evidenced in high rates of overdose mortality. However, few studies have documented the rate of IDU resumption following prison release or identified risk factors for relapse. METHODS: Structured interviews were conducted with 533 adults with a history of IDU in Queensland, Australia prior to release from prison and approximately 1, 3 and 6 months post-release. Incidence of self-reported IDU resumption was calculated overall and for each follow-up interval. Risk factors associated with time to resumption of IDU were estimated using discrete-time survival analysis. RESULTS: IDU resumption was reported by 41% of participants during a median of 98days of follow-up (IQR=94-121), an overall crude incidence of 1.06 per person-year. The highest rate was observed in the first month (23%; crude incidence 2.24 per person-year). In adjusted discrete-time survival analyses, being unemployed at the previous interview (AHR=1.59; 95%CI:1.10-2.30), shorter incarceration (=90days vs. >365days; AHR=2.20; 95%CI:1.33-3.65), and IDU during the index incarceration (AHR=2.80; 95%CI:1.92-4.09) were significantly associated with time to IDU resumption; parole was protective (AHR=0.66; 95%CI:0.47-0.92). CONCLUSIONS: Evidence-based efforts to prevent IDU in prison and IDU resumption after release are important for both prisoner and public health. Enhancing opportunities for employment and capitalising on the short-term benefits of parole for ex-prisoners may delay resumption of IDU after release from prison. These strategies should complement rather than replace harm reduction efforts for this high-risk population.

Objective: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

OBJECTIVE: Australia's prison population is growing at a rate well in excess of population growth. Indigenous Australians are over-represented by a factor of 13. Prisoners are a profoundly marginalised group characterised by complex health and social needs. Despite improvements in health during incarceration, poor health outcomes after release are common, and the net effect of incarceration is usually health depleting. Given the need for effective care coordination, primary care plays a pivotal role in meeting the health needs of this population. In this paper we review what is known about patterns of primary care utilisation in ex-prisoners, identify evidence-based strategies for increasing access to primary care in ex-prisoners, and consider how such contact may shape subsequent health service outcomes. CONCLUSIONS: Primary care is a necessary but not sufficient condition for effective post-release support. Positive outcomes may depend more on the quality than the quantity of care received. Given massive over-representation of Indigenous people in Australia's prisons, and compelling evidence of preventable morbidity and mortality after release from prison, effective models of care for this population are an important component of closing the gap in Indigenous life expectancy.

Introduction and Aims - Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. Design and Methods - A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. Results - Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19–2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21–3.45) and amphetamine (OR = 1.96; 95% CI: 1.26–3.06) as well as significantly increased risk of moderate (3–4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. Discussion and Conclusions - The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.

© 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd. Background: Reliable ascertainment of intellectual disability (ID) is important to identify those with special needs, in order for those needs to be met in the criminal justice system. Although the Hayes Ability Screening Index (HASI) is valid and widely used for the identification of possible ID, the risk of inter-rater bias between researchers when scoring the HASI has not yet been established. The current paper estimates the inter-rater reliability of the HASI in a sample of Indigenous and non-Indigenous prisoners in Western Australia. Methods: We estimated intra-class correlation coefficients (ICC) for the consistency of agreement among three blinded raters using a two-way random-effects model assessing the inter-rater agreement of the HASI. Kappa was also estimated for the dichotomous HASI screening threshold outcome between the raters. Results: The HASI exhibited very good within-subject consistency of agreement for Section B (ICC=0.95; 95%CI:0.94-0.96), Section C (ICC=0.97; 95%CI: 0.96-0.98) and Section D (ICC=0.90; 95%CI: 0.87-0.92) subscales and for the total scaled score (ICC=0.97; 95%CI: 0.96-0.98). The inter-rater reliability of the dichotomous adult ID screening threshold (<85) was also very good (Kappa=0.95). Conclusions: The current study provides new evidence that the HASI has a low risk of bias from between-rater scoring and can be reliably scored by both non-clinicians and clinicians with little training, when administered in prison settings. Pre-scoring training should focus on the more subjective 'clock-drawing' section, in order to maximise inter-rater reliability.

Objective: To describe the association between ex-prisoner primary care physician contact within 1 month of prison release and health service utilisation in the 6 months following release. Design: A cohort from the Passports study with a mean follow-up of 219 (±44) days postrelease. Associations were assessed using a multivariate Andersen-Gill model, controlling for a range of other factors. Setting: Face-to-face, baseline interviews were conducted in a sample of prisoners within 6 weeks of expected release from seven prisons in Queensland, Australia, from 2008 to 2010, with telephone follow-up interviews 1, 3 and 6 months postrelease. Participants: From an original population-based sample of 1325 sentenced adult (≥18 years) prisoners, 478 participants were excluded due to not being released from prison during follow-up (n=7, 0.5%), loss to follow-up (n=257, 19.4%), or lacking exposure data (n=214, 16.2%). A total of 847 (63.9%) participants were included in the analyses. Exposure: Primary care physician contact within 1 month of follow-up as a dichotomous measure. Main outcome measures: Adjusted time-to-event hazard rates for hospital, mental health, alcohol and other drug and subsequent primary care physician service utilisations assessed as multiple failure time-interval data. Results: Primary care physician contact prevalence within 1 month of follow-up was 46.5%. One-month primary care physician contact was positively associated with hospital (adjusted HR (AHR)=2.07; 95% CI 1.39 to 3.09), mental health (AHR=1.65; 95% CI 1.24 to 2.19), alcohol and other drug (AHR=1.48; 95% CI 1.15 to 1.90) and subsequent primary care physician service utilisation (AHR=1.47; 95% CI 1.26 to 1.72) over 6 months of follow-up. Conclusions: Engagement with primary care physician services soon after prison release increases health service utilisation during the critical community transition period for ex-prisoners.

Jesse Bowman Young discusses Republican politics in Ohio and newspaper reports on the opponents of President Roosevelt. Young details reports against Representative Foraker in recent newspaper articles.

Borschmann, R., Tibble, H., Spittal, M. J., Preen, D., Pirkis, J., Larney, S., ... Kinner, S. A. (2020). The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. International Journal of Population Data Science. https://doi.org/10.23889/ijpds.v5i1.1145