Background: In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the risk of infections, metabolic and hemodynamic complications or even of malignancy, but may expose patients to episodes of acute rejection. New drugs are being developed to improve graft survival at the lowest risk of side effects. Belatacept has recently been introduced in kidney transplantation to inhibit the co-ligand signal of T cell stimulation. It is a drug with a safe profile, is well-tolerated and appears to improve long-term survival of kidney grafts. However, there may be an increase in opportunistic infections which may be facilitated by T cell depression, as Aspergillus sp.,  Cryptococcus neoformans or tuberculosis.Case Presentation: We describe a 59-year-old female who developed fever, clinical wasting and a mediastinal mass 31 months after receiving a living non-related kidney transplant while on belatacept therapy. A mediastinal node biopsy disclosed the presence of Histoplasma capsulatum. Infection successfully resolved after appropriate antifungal treatment.Conclusions: To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapy Histoplasma capsulatum.In kidney transplantation, there is an increased risk of infections. Belatacept is a novel and effective immunosuppressant with no nephrotoxic effects. We describe the first reported patient on belatacept therapy with an opportunistic infection due to Histoplasma capsulatum infection in a living non-related kidney graft 31 months post-transplantation and discuss the potential association between histoplasmosis and belatacept.Immunosuppressive drugs with specific targets are being developed in order to manipulate the immune system in a step-wise manner. In this respect, CD4 T-cells can be mainly activated by three different signals upon stimuli triggered by antigen presenting cells or cytokines, in order to amplify the immune response . In kidnHistoplasma capsulatum were reported in Giemsa stain in tissue samples  scan disclosed enlarged mediastinal nodes. A bronchoalveolar lavage was macroscopically non-contributory, and both smears and cultures were initially negative. A mediastinoscopy was performed and a node biopsied for histological and microbiological assessment. After 24 hours small intracellular yeast compatible with  samples . Fungal  samples . The patHistoplasma capsulatum and belatacept therapy in kidney transplantation. The incidence of histoplasmosis infection in renal transplant patients ranges from <0.5% to 1.1% (To our knowledge, this is the first reported case of  to 1.1% ,11 as to to 1.1% . The dis to 1.1% . In our Pulmonary involvement presents with common airway symptoms associated with diffuse lung infiltrates and/or mediastinal adenopathies . In thisBelatacept has been employed to prevent acute rejection in kidney transplantation . BelatacWe employed belatacept in our patient due to its advantages: Lower risk o cardiovascular disease, hypertension, it is a non-diabetogenic agent and presents lower risk of bacterial infections. The risk of early acute rejection episodes may be higher when compared to cyclosporine, but the long-term survival is higher when belatacept is employed .In conclusion, we believe belatacept is a safe, efficient, non-nephrotoxic immunosuppressant to be employed in kidney transplantation that may present an apparently higher risk of fungal and mycobacterial infections, probably due to its mechanism of action. Despite the microbiologic background profile of the recipient is critical at the time of tailoring the immunosuppression protocol, many times infectious complications cannot be foretold.Primary draft by HT, TR, JA and MP. AI and IL contributed to the histologic and microbiologic study and figures. FL, VP, MF, MF, RI and JM participated in the case discussion and assisted the patient. Manuscript edited by HT. All authors read the final version.Hernán Trimarchi is a consultant to Brystol-Myers-Squibb for the product Belatacept.No funding was obtained for the preparation of this manuscript.


Poor executive function (EF) has been linked to attention-deficit/hyperactivity disorder (ADHD). Children born at extremely low birth weight  have been found to show both poor EF, as well as elevated levels of symptoms of ADHD. In the present study, we examined whether fluid intelligence moderates the link between birth weight and later ADHD symptoms by prospectively following a cohort of 179 survivors who were born at ELBW. When participants were 8 years-old, they were matched with 145 normal birth weight  control participants. At age 8, fluid intelligence was measured, and during young adulthood (ages 22–26), participants' self-reported levels of ADHD symptoms were examined. We found that ELBW survivors, who also showed poor fluid intelligence, had the highest rates of ADHD symptoms, and particularly, symptoms of inattention. These findings point to the importance of examining developmental trajectories that contribute to risk for psychopathology in those exposed to intrauterine adversity. Extremely low birth weight  survivors are among the tiniest and most vulnerable babies. Compared to individuals born at normal birth weight , those born at very low birth weight  and smaller have been found to be at increased risk for later psychopathology, including Attention Deficit/Hyperactivity Disorder  birth, (2) middle childhood (age 8), and (3) young adulthood (ages 22–26). This allowed us to examine a developmental trajectory leading to developmental outcomes. We were interested in predicting from birth into young adulthood, which was our endpoint visit.The cohort of ELBW survivors was followed-up at age 8 and again at 22–26 years of age. A control sample matched on age, sex, and SES was recruited at 8 years of age. During the 8 years visit, participants completed Raven's Colored Progressive Matrices Test  between 1977 and 1982 to residents of a geographically defined region in central-west Ontario, Canada. Follow-up assessments were conducted when participants were 8- (childhood) and 22–26- (young adulthood) years old. Of the original 397 infants, 179 (45%) survived to hospital discharge from the NICU. There were 13 late deaths, and 166 survived to young adulthood.N = 9) and refusal (N = 8). An additional seven participants had neurosensory impairments  and could not complete the assessments. Of these 142, a total of 125 had complete data on the measures collected at the 8-years visit.During the young adult visit, data were collected on 142 of the 166 (86%) survivors. Reasons for missing data include loss to follow-up (N = 5) and refusal (N = 7). All 133 participants had complete data on the measures collected at the 8-years visit.The NBW control group was identified and recruited when they and the ELBW cohort were 8 years old. This group comprised a sample of 145 children born at term according to maternal report, between 1977 and 1981. The control sample was selected from class lists provided by local school boards and group-matched with the ELBW cohort on child age, sex, and socioeconomic status  for children at this age  to 3  , as well as the main moderator and outcome variables . Mother's highest level of education was measured according to the following rating scale: 1 = No schooling, 2 = Some primary schooling, 3 = Completed primary school, 4 = Some secondary schooling, 5 = Completed secondary school, 6 = Some community college, 7 = Completed community college, 8 = Some university, 9 = Completed university. Young adult's highest level of education was measured according to the following rating scale: 1 = Less than 7th grade, 2 = Junior high school (9th grade), 3 = Partial high school (10 or 11th grade), 4 = High school graduate, 5 = Partial college , 6 = Standard college or university graduation, 7 = Graduate professional training . Descriptive statistics are presented in Table In order to examine associations between birth weight group and the variables in the study, a series of ps > 0.09. Significant differences were observed between the two groups on birth weight, , fluid intelligence, , general intelligence, , and all WISC-R subtests, all ps < 0.005, with NBWs scoring higher on all of these measures. However, ELBW and NBW participants did not significantly differ on ADHD total score, ADHD inattentive score, ADHD hyperactivity/impulsivity score, or YASR attention problems, all ps> 0.09. Finally, Pearson correlations revealed that the main variables of interest—fluid intelligence and the various ADHD scores—were not related to one another, all ps < 0.59. This result suggests that fluid intelligence at age 8 is not simply an early presentation of later ADHD.No significant differences were found between the ELBW and NBW groups on sex, mother's highest level of education, and young adult's highest level of education, all SD. Follow-up statistical tests from these probes are reported below.In order to examine the moderating role of fluid intelligence in understanding the relation between birth weight group and ADHD symptoms, four separate hierarchical multiple regression analyses were carried out. Each regression included the following outcome variables: ADHD total score, ADHD inattentive score, ADHD hyperactivity/impulsivity score, and YASR attention problems. To reduce multi-collinearity and aid in interpretation, mean centered predictors were used. Next, the interaction terms were computed as the product between birth weight group and the mean-centered measure of fluid intelligence. Given links between fluid intelligence and general intelligence  = 4.54, p < 0.05] (see Table t(244) = 2.10, p < 0.05], such that participants who were at greatest risk at birth , had the highest ADHD score. However, no such relation emerged in participants with high fluid intelligence, β = −0.09, .For ADHD total score, the interaction between birth weight group and fluid intelligence significantly improved the fit of the model, Δ  0.02,  (see Table t(244) = 2.58, p < 0.01], such that participants who were at greatest risk at birth , had the highest ADHD inattentive score. However, no such relation emerged in participants with high fluid intelligence, β = −0.07, .For ADHD inattentive score, the interaction between birth weight group and fluid intelligence significantly improved the fit of the model, Δ R2 = 0.01,  (see Table t(244) = 2.24, p < 0.05], such that participants who were at greatest risk at birth , had the most YASR attention problems. However, no such relation emerged in participants with high fluid intelligence, β = −0.04, .When predicting YASR attention problems a trend was found for the interaction between birth weight group and fluid intelligence, Δ R2 = 0.01, .Finally, the regression model was not significant for ADHD hyperactivity/impulsivity score, Δ This longitudinal study prospectively followed a cohort of ELBW survivors and a matched NBW control sample at age 8 and again during young adulthood (22–26). During the 8-year visit, participants completed measures of fluid and general intelligence. Approximately 15 years later, as young adults, participants provided self-report of ADHD symptoms. As predicted, fluid intelligence moderated the link between birth weight and ADHD symptoms. In particular, ELBW survivors with poor fluid intelligence were at the greatest risk for later ADHD symptoms, particularly symptoms pertaining to the inattentive sub type of ADHD. These findings suggest that fluid intelligence is an important mechanism involved in developmental trajectories that lead ELBW survivors to develop later symptoms of ADHD.Importantly, our analyses for ADHD total score and ADHD inattentive score were statistically significant even when general intelligence was included in the models as a covariate. This result suggests that fluid intelligence plays a specific role in the association between birth weight group and ADHD above and beyond the role of general intelligence. This finding is important given the presence of substantial correlations between fluid intelligence and measures of general intelligence (e.g., Embretson, Our findings are also consistent with work on VLBW participants, suggesting that links between extreme preterm birth and inattention was mediated by working memory, a specific type of EF (Nadeau et al., The present study also extends previous work by Boyle et al.  who founSeveral authors have proposed that symptoms of ADHD arise from a primary deficit in EF (Pennington and Ozonoff, both being born at ELBW and having poor fluid intelligence that together contribute to the prediction of later ADHD symptoms, and particularly symptoms of inattention.In the present study, fluid intelligence moderated ADHD symptoms using the total ADHD score on the ADHD Rating Scale (Barkley and Murphy, It is important to note that the RCPM is only one of many fluid intelligence measures. In addition, although fluid intelligence and EF involve the same underlying processes Blair, , there iIn summary, the present study followed prospectively the oldest known cohort of ELBW survivors and a matched control sample over a period of 26 years. Fluid intelligence was assessed at 8 years of age, and ADHD symptoms were assessed at 22 to 26 years of age. Our findings indicate that among individuals with poor fluid intelligence measured at age 8, ELBW survivors had the highest level of ADHD symptoms as young adults. These findings point to the importance of examining possible moderating mechanisms that contribute to developmental outcomes and risk for psychopathology.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Hugo Chávez dominated the Venezuelan electoral landscape since his first presidential victory in 1998 until his death in 2013. Nobody doubts that he always received considerable voter support in the numerous elections held during his mandate. However, the integrity of the electoral system has come into question since the 2004 Presidential Recall Referendum. From then on, different sectors of society have systematically alleged electoral irregularities or biases in favor of the incumbent party. We have carried out a thorough forensic analysis of the national-level Venezuelan electoral processes held during the 1998–2012 period to assess these complaints. The second-digit Benford's law and two statistical models of vote distributions, recently introduced in the literature, are reviewed and used in our case study. In addition, we discuss a new method to detect irregular variations in the electoral roll. The outputs obtained from these election forensic tools are examined taking into account the substantive context of the elections and referenda under study. Thus, we reach two main conclusions. Firstly, all the tools uncover anomalous statistical patterns, which are consistent with election fraud from 2004 onwards. Although our results are not a concluding proof of fraud, they signal the Recall Referendum as a turning point in the integrity of the Venezuelan elections. Secondly, our analysis calls into question the reliability of the electoral register since 2004. In particular, we found irregular variations in the electoral roll that were decisive in winning the 50% majority in the 2004 Referendum and in the 2012 Presidential Elections. Hugo Chávez was elected President of Venezuela in 1998 and ruled the country until his death in 2013. He won four consecutive presidential elections  and a recall referendum (2004), convened against him by opposition forces. He also proposed several major reforms that were approved in national referenda . In addition, his party won an overall majority in the National Assembly in three parliamentary elections that took place during his presidency , and in all regional and local elections. His sole election defeat came in the 2007 constitutional referendum, when he attempted a radical socio-political reform. This electoral record could be overshadowed, however, by the allegations of fraud made by opposition sectors since the 2004 Recall Referendum The electoral law, approved in Venezuela in 1997, established the automation of the vote count. In the period between 1998 and 2000, the vote count was carried out both manually and automatically. However, since 2004 the results come exclusively from a computer center, where the data from the voting machines distributed throughout the country are centralized. Another important characteristic that differentiates the electoral processes before and after 2004 is the composition of the governing body of the elections, the National Electoral Council (CNE in Spanish). The National Assembly, which was controlled by the ruling coalition, appointed an openly pro-government management body. Four out of the five current CNE's rectors lean strongly towards the ruling party and only one to the opposition forces. Although the CNE has improved the transparency and reliability of the electoral system, particularly since 2006, the fact is that the Venezuelan electoral authority has taken controversial decisions that have only ever favored the government and never the opposition Chavismo can be found in http://www.americasquarterly.org/electoral-irregularities-under-chavismo-tally. Links to several dozens of documents about them are available at http://esdata.info and http://www.sumate.org.Despite the frequent use of the term, there is ambiguity regarding what is and what is not electoral fraud. What may constitute fraud in one country, or at a particular moment, may not be considered as such in another. Nonetheless, any irregular action that is performed with the intention of altering the development of an election or election-related materials, with the aim of affecting its results, may be considered a fraud outliers) are usually interpreted as statistical evidence regarding the fairness of an election. Benford's test outcome-determinative fraud, “where the fraud affects the outcome of the election such that the winners and losers are different from what they would have been had the fraud not be committed” Some electoral irregularities may leave traces in the form of numerical anomalies. If this is the case, they can be detected by appropriate statistical methods. The main idea underlying these methods is the comparison between observed values of statistics based on the vote count and their expected values. When we say expected value, we usually mean the regular value in a free and fair election. Therefore, large discrepancies between observed values and expected ones  has been downloaded and stored in spreadsheets in http://esdata.info/, where the reader can also find additional information on each election.Therefore, we took into account every year of national-level elections since Chávez first won the presidency of Venezuela until his death. However, for the 2000 general elections, known as ‘Mega-elections’ because every single official was re-elected, we only considered data from the presidential elections. In 1999 there were two referenda, one in April and one in December, and one election in July for the seats of the National Constituent Assembly (NCA). During the April referendum, two queries were made: about the convening of the NCA to draft a new constitution and about the approval of the basis for this constituent process. In December, the new constitution was adopted by national referendum. We only considered the April referendum due to the lack of available data for the July elections and the December referendum at the level of breakdown we require for our analysis. The official data , and for the endorsed candidates by the ruling party (in parliamentary elections)Number of valid votesNumber of registered votersPolling center to which the electoral unit belongshttp://elecionforensincs.com.es/. For each election, we consolidated these data in one set, labeled with the year of the election, except for the 1999 and 2007 referenda and the 2010 Parliamentary elections, for which there are two data sets. 1999a, 1999b, 2007a and 2007b are the abbreviations to refer to the data associated to the two questions considered in the referenda of 1999 and 2007. The 2010 Parliamentary elections were preceded by an electoral reform. Under the approved system, 70% of the 165 deputies of the National Assembly were elected on a first-past-the post system and 30% on a party list. The results are considered in two separate sets, labeled 2010a and 2010b, respectively. Each polling center is identified by a code. The numbers were re-labeled. We used the old labels for elections and referenda previous to 2005 and the new ones for elections and referenda from 2005 onwards. The conversion table and the election data under consideration are available at The Benford test for the second significant digit is one of the most commonly-used tools in election forensics. It has been previously used to analyze the 2000 Presidential Elections and the 2004 Recall Referendum d. The restriction of 10 or more votes is required only for the existence of the second significant digit. If the election is fair, the frequency distribution From polling places that collect election data with 10 or more votes favoring Chávez, consider the proportion Discrepancies between the frequency distribution and the law may be interpreted as evidence of fraud of various kinds.The most accepted discrepancy measure between the frequencies distribution and the law is the Pearson's chi-square statistic0H: The data is consistent with the Benford's law for the second significant digit. If the chi-squared p-value  =  0H. Here and elsewhere, p-value is drastically affected by the sample size . For a correction of p-values, Pericchi and Torres Bayesian posterior probability with Uniform priors. This measure, denoted by P(0H |data), can be understood as the probability of being right when we assert the hypothesis 0H is true.The statistics is the basis of an uncritical practice to test the null hypothesis false positives) and, conversely, that they might not occur in fraudulent elections . Mebane Despite its widespread use, the application of Benford's test has been severely criticized p-values and the Bayesian posterior probabilities proposed by Pericchi and Torres are negligible at this aggregation level, except for the 2000 elections.Firstly, let us consider the electoral units with 10 or more votes favoring Chávez. p-values are still almost zero, the Bayesian posterior probabilities change abruptly when we consider only electoral units with 100 or more votes favoring Chávez. According to this measure, we should reject 0H exclusively from 2004 onwards  larger only in 2000. The natural way to span these data to higher orders of magnitude is to consider outcomes per polling center. Polling centers may combine multiple electoral units in the same voting place with a number of votes for Chávez above 8000. 010a see . It comeBeyond the controversies concerning the application of Second-Digit Benford's law for fraud detection, we can extract at least one conclusion from our analyses: 2004 appears to be an inflection point in which the Venezuelan elections begin to move away from the law. A recent study based on authentic and synthetic election data reports that the non compliance of the law is associated with fraud at least in 50% of cases election fingerprint. Their fingerprints are the 3D-histograms of the number of electoral units for a given voter turnout and the percentage of votes for the winner (for Chávez in our case). From these figures they make inference on possible processes and mechanisms that lead to the overall election results. We show the election fingerprints of the presidential elections 1998 and the recall referendum 2004 . We selected this method because it relies on the Gaussianity hypothesis of Klimek et al. The classifier provides a simple rule to determine when an electoral unit is an observation that most likely corresponds to the 1998 model rather than to the 2004 model. The results allow for the elections to be grouped into four categories, according to the shape of their fingerprints and the percentage of electoral units classified into the 1998 model, which we will denote by [%] Mod.98.incremental and/or extreme fraud. Incremental fraud means that ballots for one candidate are added or votes for other candidates are taken away. Extreme fraud corresponds to reporting a complete turnout and almost all votes for a single candidate. The 2007 Constitutional Referendum and the 2010 Parliamentary Elections deserve a special category. Although their shapes are very similar to the second category . However, some irregularities may generate large values of Z, out of any normal confidence interval. Examples of these irregularities are ad hoc decisions on the final allocation of voters, taken on the election-day to solve fails on touch-screen machines. We will call non-fraudulent irregularity any unforeseen action that affects the vote distribution of the electoral units in a polling center without affecting significantly the vote distribution at the center. Non-fraudulent irregularities may occur with high probability due to the complexity of the electoral processes. Therefore, the distribution of the Z-scores should have heavier tails than the normal distribution. In fact, the Z-scores of the elections collapse on a t-student. With the possible exception of the 2000 elections, the goodness of fit is extremely good for a t-student with 3 degrees of freedom (t(3). As we commented, 2000 was a mega-election, where every elected office in the country was elected. Thus, we expect more non-fraudulent irregularities in these elections than in any other and, consequently, heavier tail distribution for their Z-scores. But, leaving aside some minor loss of accuracy for the 2000 case, we can assume that the Z-scores of any election are approximately distributed according to a t(3). This fit will be used to simulate Z-scores for a bootstrap model, which is employed only for illustrating the asymptotic normality of the test statistics that we discuss below. These statistics, that we will name standardized differences, are based on the Z-scores but their asymptotic distribution does not depend on the goodness of the fit of the t(3)-distribution. freedom , hereaftZ-scores farther from zero should be product of chance. This covers extreme Z values generated by non-fraudulent irregularities on a random set of electoral units. Hence we consider:If an election is fair, including that election resources are distributed with equity among the polling centers, k electoral units with Z-score farther from zero, which we will denote by kM.The set of the 1H: all the electoral units have the same probability to be in kM.The null hypothesis 1H based on one developed for the study of the 2004 Recall Referendum We propose a test for kM. Denote by R the same proportion but computed on all the electoral units under study. Let iT be the total valid votes at the electoral unit i, iV the number of votes for Chávez, andLet K the total number of electoral units, and by Denote by k is large, K-k is much larger than k, and 1H is true, the standardized differenceN 1H by computing the k. Values far away from normal confidence intervals, for a wide range of large values of k, are considered strong presumptions against 1H. In estimating proportions, standard large sample sizes  are above 1000. We consider values of k between 500 and 1500, thus we are covering, from below and from above, standard large sample sizes. For all the cases, K-k is large enough. We also illustrate the asymptotic normality of 1H from a model of fair elections based on a hierarchical bootstrap. Specifically, we generate random samples of size K of Z-scores from a t(3) distribution. Then we assign the k Z-scores farther from zero to a random sample of units. Thus, p, m, n and iT, per electoral unit and polling center in each election or referendum.Then, if 1H. Although some of them go outside of the confidence interval, they are mainly embedded within it. The curves based on official results of k, are well embedded within/in the confidence interval at large sample sizes. The standardized difference series from official results of 1H for elections of this group. Except for 2005, we firmly reject 1H from 2004 onwards.1H does not imply necessarily that there were fraudulent irregularities in the units with outlier values of Z; only that the extreme results occurred on a non-random set of electoral units. On this set, the vote counting has a significant bias in favor of Chávez. It is possible that there are non-fraudulent mechanisms that can explain this phenomenon. In fact, it is not unreasonable to think that some electoral districts have a greater chance of presenting non-fraudulent irregularities than others. But it is suspicious that it is only observed from 2004 onwards, with the sole exception of the 2005 parliamentary election. Inevitably, this points again to the 2004 Recall Referendum as a watershed regarding the integrity of the Venezuelan electoral processes.The alternative hypothesis to Although we cannot discard that some of the anomalous patterns observed in elections since 2004 can be the result of non-fraudulent mechanisms that could affect the vote distribution, we have not found a convincing explanation of why the irregularities on the vote distribution were mainly observed in electoral units that favored Chávez. But, if there were election irregularities in those units, we have not estimated how they could affect the overall results. In light of the data collected over time, we tried a new approach to address this problem, which requires some preliminaries.Electoral units in polling centers can be different from one election to the next. The number is determined by the electoral referee, who considers the number of registered voters in polling centers, among other control variables. Nevertheless, many polling centers are common in two consecutive elections. Thus, we will henceforth consider only results by polling center.per se but here we are only interested on how the growth is correlated with votes for Chávez.As mentioned earlier, one concern of the opposition is the possible fraudulent manipulation of the electoral register, which has grown dramatically over the last few years. In the twelve years between the presidential elections of 2000 and 2012, it increased by roughly 60% whereas the Venezuelan population grew significantly less between 2001 and 2011 (around 16% according to the projections of the Venezuelan census bureau). This is a controversial demographical problem m(t) the number of registered voters in a polling center in the electoral year t. Let us denote by inter-annual growth in the center at year t, defined byDenote by G(t) should be, the highest inter-annual population growth reported in Venezuela was 4%, in the 60 s. The current level is 1.5%. However, G(t) may take values 20 times larger. Another claim of the opposition is the unauthorized relocation of registered voters from one center to another. This irregularity may generate negative values of G(t) farther than the expected. We consider the absolute value |G(t)| as the measure of the inter-annual variation in the center for the election year t. Thus, irregular variation can involve irregular growth or irregular relocations. We point out that, for any year and any center, the inter-annual variation is measured in the same units.This indicator corresponds to the standard measure of inter-annual population growth. To get an idea of what the range of G(t)|: for each value |G(t)|, we compute the percentage of votes for Chávez  from centers with this value or lower. In order to compare the results for the different elections on the same scale, we centered the curves by subtracting the overall percentage of votes obtained by Chávez that year, denoted by R (G(t)| | . The ploFor the 2004 Recall Referendum, tight results in centers with variation of less than 1%. We note that these centers represent up to 69% of the total valid votes.For the 2012 Presidential Election, adverse results in centers with variation of less than 4%. These centers represent up to 79% of total valid votes.G(t)|.A strong increase close to extreme values of |misión identidad: a Chávez program to provide ID cards, throughout the length and breadth of the country, which involved voter inclusion on the electoral roll. The new voters mostly came from excluded sectors: poor, rural and indigenous areas where the population had no access to many rights. According to conventional wisdom, they could have tenaciously supported Chávez Until the 2000 Presidential Elections, the historical growth rate of the electoral roll was 11% every five years. The growth rate for the 2004 Recall Referendum was more than twice larger. This notable increment was a direct consequence of Since the establishment of democracy in 1958, Venezuelan elections were considered free and fair until the 1993 Presidential Elections. Although the electoral outcome was accepted, and the winner did not face any legitimacy problem kino (a type of bingo card). After a year and a half of far-reaching sociopolitical transformations, including the promulgation of a new constitution, criticism towards Chavez's government increased in many sectors of society. In this context, as the 2000 elections approached, doubts were raised about the reliability of elections in great part because of the appointment of a biased CNE, disregarding constitutional procedures, and the changes introduced to the electoral system after the deadline set in the 1999 Constitution. Though the elections were flawed due to important organizational deficiencies and multiple complaints over irregularities, international observers validated the electoral results: Chávez was elected to his second term with 59.76% of valid votes The 1999 and 2000 electoral processes were carried out with roughly the same voting system used in 1998 The recall referendum of 2004 has been widely analyzed From 2006, the CNE introduced important improvements. These included better infrastructure, more guarantees for the secrecy of the ballot, and an increase of the audits carried out on the system. In particular, the post-election audits now involve more than 54% of the electoral units. During this period, the electoral council also continued with the campaign initiated in 2004, aimed at the inclusion of new voters. The improvements have led to a growing confidence in elections as a tool for political change morochas). In addition, there were modifications in the electoral districts which indicated gerrymandering as was rendered evident by the double strategy employed: isolating and/or concentrating zones that had voted against Chávez and his supporters in the past, and uniting areas with an electoral behavior favorable to the Government with others that historically opposed him. In the end, the government party, The United Socialist Party of Venezuela (PSUV in Spanish), and its allies, had the most votes, but they obtained less than 50% of valid votes. Nevertheless, the changes clearly favored the PSUV in the National Assembly . The opposition criticized the reform but accepted the results of the vote count The 2010 Parliamentary Elections were preceded by a new electoral reform. Under the approved system, the percentage of deputies of the National Assembly elected by nominal election increased from 60% to 70%. Furthermore, the reform legalized a practice with which the government's party had been clearly overrepresented since the 2004 regional elections  started before the 2004 referendum. According to official figures (http://www.ine.gov.ve), the coverage of the electoral register went from approximately 75% in 2000 to 97% in 2012, involving a growth of 60% in the number of voters. The consistency of these changes is controversial. Some scholars think that they are out of proportion Chavista vote, particularly in 2004 and 2012.Firstly, both international observers and the opposition have recommended for years a full audit of the electoral register. This has undergone tremendous changes with the voter inclusion program  occurs systematically. We also strongly recommend a full audit of the register. Without it, there is no certainty of the validity of post-election audits. These are considered the main guarantor of an electronic voting system, recently recognized by former president Jimmy Carter as “the best in the world” In sum, we have found anomalous statistical patterns consistent with a hypothetical electoral fraud in the 2004 recall referendum and all elections and referenda held between 2006 and 2012. Although this does not mean that we provide concluding evidence of fraud, specifically of outcome-determinative fraud, this raises serious doubts regarding the impartiality of the current electoral authority and supports the allegations of fraud claimed by important sectors of the Venezuelan society. Our study calls into question the reliability of the electoral register, a major concern since 2004. In particular, we detected irregular variations in the electoral roll that could have overturned the results for the 2004 referendum and the 2012 elections. As a corollary to our analysis, we recommend monitoring polling centers where atypical support (extreme


Eidolon dupreanum) and tree-roosting Madagascan flying foxes (Pteropus rufus) in four single-species roosts within a sympatric geographic foraging range for these species in central Madagascar. We describe infection with novel Bartonella spp. in sampled Eidolon dupreanum and associated bat flies (Cyclopodia dubia), which nest close to or within major known Bartonella lineages; simultaneously, we report the absence of Bartonella spp. in Thaumapsylla sp. fleas collected from these same bats. This represents the first documented finding of Bartonella infection in these species of bat and bat fly, as well as a new geographic record for Thaumapsylla sp. We further relate the absence of both Bartonella spp. and ectoparasites in sympatrically sampled Pteropus rufus, thus suggestive of a potential role for bat flies in Bartonella spp. transmission. These findings shed light on transmission ecology of bat-borne Bartonella spp., recently demonstrated as a potentially zoonotic pathogen.We captured, ectoparasite-combed, and blood-sampled cave-roosting Madagascan fruit bats , trench fever (Bartonella quintana), and cat scratch fever (Bartonella henselae), all of which are transmitted via arthropod vectors—respectively sand flies, lice, and fleas. Bats are known to host multiple Bartonella spp., including some capable of infecting humans. Some bat species are also known to host obligate ectoparasites known as bat flies (Diptera: Hippoboscoidea), which also sometimes support Bartonella spp. infections. The role of bat flies and other bat ectoparasites as vectors for Bartonella spp. transmission has been suggested, but not fully explored. We demonstrate Bartonella spp. infection in one species of Madagascar fruit bat, which hosts bat flies, simultaneously with the absence of Bartonella in a fruit bat species of overlapping range that appears not to support these ectoparasites. In light of ongoing trends of zoonotic emergence of human diseases from bat reservoirs, further understanding of the transmission dynamics of bat-borne pathogens is paramount. Bartonella bacteria in localities as wide-ranging as the United Kingdom . Al. AlBartoBartonella mayotimonensis [Bartonella spp. in Chiropteran reservoirs. In Madagascar, insectivorous bats are known to roost in human residences, and both P. rufus and E. dupreanum are widely consumed as bushmeat, highlighting the extent of human-wildlife interface in the region [The recent identification of bats as reservoirs for human pathogenic monensis  validatee region .Bartonella elsewhere [Bartonella spp. prevalence (57.4%) in a long-lived, cave-roosting E. dupreanum host . We corroosting  and cavedagascar , althougast Asia  and AustBartonella spp. infection in bat flies (Cyclopodia dubia) of E. dupreanum, simultaneous with Bartonella DNA absence in flea ectoparasites (Thaumapsylla sp.) of those same bats. Fleas are the confirmed vector for Bartonella henselae, the causative agent in cat scratch fever [Bartonella DNA [Bartonella spp., suggesting that the mechanisms by which arthropods host and transmit pathogens vary and impact their functionality as vectors. Sampling of flea ectoparasites was not extensive enough to assess the true extent of their ability, or lack of ability, to transmit Bartonella spp., and further experimental studies of the vector potential of both bat flies and fleas for Bartonella is warranted.In addition to pathogen prevalence in the host, we report ch fever , and fleella DNA ,22. In oE. dupreanum indicated significantly higher rates of ectoparasite infection with both flies and fleas in Angavokely vs. Angavobe. These differences could result from ecological variation in both host density and/or climate between the two cave roosts. More extensive spatial sampling, in conjunction with climactic monitoring, in other E. dupreanum roost sites of varying size, temperature, and humidity across Madagascar will help elucidate habitat thresholds for ectoparasite invasion. In particular, sampling of E. dupreanum in reported tree roosts in central Madagascar will shed light on the extent to which roosting behavior limits bats’ abilities to support ectoparasites in this system [Bartonella spp. are, indeed, transmitted by bat fly vectors, such findings will have important implications for our understanding of the distribution, prevalence, and transmission dynamics of a potentially zoonotic pathogen.Finally, observed differences in the frequency of ectoparasite burden between sample sites for s system . If Bart


Attention deficit hyperactivity disorder (ADHD) is a condition that begins in childhood but can continue into adulthood, and may be the cause of many disadaptive behaviors, as in the case of homeless people, who often display a high incidence of personality disorders. The goal of this study is to analyze the comorbidity of ADHD with axis II disorders in a Spanish homeless population.The outcomes show high comorbidity between these two kinds of disorders, and that the prevalence of axis II disorders is higher among people with ADHD than among the general population.From these results we can draw the conclusion that in homeless people ADHD in childhood continues into adulthood, when it is very often observed together with personality disorders. Finally, the implications of this study both for clinical practice and for future lines of research are discussed. In recent years 2005–2012) the homeless population has increased 132% in Spain and died in our country a homeless person every five days [2 the homAttention deficit hyperactivity disorder (ADHD) is a development disorder with its origin in childhood but which can persist in adulthood , 5. The It is estimated that about 3-5% of children and nearly 4% of adults present ADHD , 8. A meSymptoms of ADHD in childhood are consistent with those showed by homeless people, who display social, emotional and personal instabilities which influence both their diagnosis and prognosis. Moreover, the prevalence of organic and mental disorders is much higher in this population than in the population at large , 19. In The goal of this study is to analyze the comorbidity of ADHD and personality disorders in homeless people.Most homeless people in Spain receive assistance from various public-funded municipal bodies, and it is very difficult to determine the percentage of this population relative to the general population. Our study was carried out in a city of 700.000 inhabitants. The sample consisted of homeless people (N = 196) taking part in a process of psychosocial insertion at a special centre of Zaragoza (Spain), where they received psychological and social support and occupational training. The participants in the study were selected from among 203 people involved in the insertion process and were chosen according to the following criteria: a) condition of homelessness; b) having stayed for more than two months in the centre; c) voluntary participation in the study; and d) a long enough stay for the completion of the study. All the participants provided written informed consent prior to participating in the study. This study was approved by the ethics committee of Department of Psychology and Sociology at the University of Zaragoza, which complied with the ethical requirements of the Declaration of Helsinki.Given the aim of our study a clinical psychologist carried out the assessment process to evaluate the ADHD-related clinical profile of each participant, where they self-reported the existence of ADHD in childhood or a current profile of ADHD in adulthood .Initial assessment interview. To begin with, a structured clinical individual interview was conducted in order to establish a diagnosis. At this interview the salient data were collected: age, marital status, educational level, age at which the subject began a transient life, the causes that led her/him to this kind of life, incidence of alcohol or drug abuse.MCMI II. Millon Multiaxial Clinical Inventory II . This isASRS. Adult Self-Report Scale Version 1.1 (ASRS v.1.1) . This isWURS. Wender-Utah Rating Scale . For assThe participants’ profile up to the present was analyzed using an initial structured interview, reflecting mainly sociodemographic data and personal history as a homeless person. The statistical analysis of the data was carried out using the statistical program SPSS version 21.0. A descriptive analysis was performed  for each of the variables. In all cases the significance level used was 5%. Crossed variables and bilateral correlation analyses were also carried out. All the tests were applied and corrected by the clinical psychologist in charge of the research.This section evidences the high proportion of young homeless people included in the integration process Table . 64.79% According to the results obtained from the Millon Multiaxial Clinical Inventory (MCMI-II), 154 of the subjects (78.57% of the sample) showed one or more personality disorders Table . AntisocThe number of personality disorders present in each subject was analyzed. Some subjects receiving the homeless insertion treatment showed no personality disorders , while others in the sample displayed one , two  or even three or more .Results showed that 14.28% of the sample (n = 28) could be diagnosed as suffering from ADHD in childhood, whereas 8.16% of the participants (n = 16) would have a current diagnosis of ADHD. This would imply that 57.14% of the subjects would maintain this diagnosis throughout their lives.Furthermore, comorbidity of personality disorders and ADHD was studied Table , taking Finally, we sought to determine whether suffering from ADHD could lead to the presentation of a personality disorder in adulthood Table . The outPrevious studies show a 4% occurrence of ADHD in adults, although some authors consider that this disorder is underdiagnosed and consequently wrongly treated . In commIn our research strong correlations between the outcomes obtained both with ASRS and MCMI-II were observed, although the first measures axis I disorders such as inattention, hyperactivity and impulsivity , and theNot every personality disorder showed a positive correlation with ADHD. The correlations observed with both the dependent and the compulsive disorders were negative. The correlation was stronger with the more severe disorders, both impulsive spectrum disorders with "fight response"  and schizophreniform spectrum disorders with "flight response” . These results coincide with those obtained in previous studies .According to the results of this study where the study population demonstrate an early beginning of transient living, the homeless people examined displayed more significant psychopathological symptoms, both in ADHD and the personality disorders, than the general population, in addition to the correlation between psychological and personality disorders , 34. HomThese findings have useful clinical implications due to determine a better comprehension of specific clinical profile in homeless people for setting adjusted intervention programs. However, the sample size was relatively small from a statistical perspective. Moreover, other limitation could be related with the fact that we did not include a control group in the sampling process. This methodological approach could give more consistency to the empirical evidence showed in our study. Future studies will overcome these limitations, and are required in order to identify the specific profiles and evolution of attention deficit hyperactivity and personality disorders in homeless population.In future lines of investigation, the presence of other clinical manifestations in conjunction with ADHD should be studied, since this causes confusion in the therapeutic approach and makes treatment of these patients more difficult. Furthermore, it is possible that the comorbidity of ADHD with other disorders has different clinical subtypes, phenotypes or other phenotype expressions that should be studied to achieve a better understanding of this pathology.


Today’s ready access to electronic devices and the internet often substitute for social interaction. Such situation, if it starts in early childhood, in certain vulnerable individuals, who crave immediate rewards, can decrease the ability to maintain prolonged attention  and tolein utero drug exposure, low birth weight, premature delivery, endocrine deregulation, early developmental neglect, environmental toxins, head trauma, and genetic vulnerability, we can understand the vulnerability and deregulation of these networks (On the other hand, neuroscientists focus primarily on the relationship between the symptoms and brain structures such as the dorsal lateral prefrontal cortex, ventral lateral prefrontal cortex, insula, anterior cingulate, and default networks and functions linked to neurotransmitter systems -10. Theynetworks .Quantitative EEG has helped define ADHD’s physiological underpinnings by clearly identifying electrical patterns such as increased frontal slowing and excessive frontal theta  that corThen we should ask what happens to the child as they become an adult? To answer this question, we need to understand the adult presentation of attention deficit disorder ,19. GeneNevertheless, our current data support the idea that, in many cases, ADHD persists throughout one’s life: when untreated, ADHD can have significant psychiatric comorbidities that include anxiety, depression, substance abuse, conduct disorder, and bipolar disorder . Therefo


The principal aims of this study are to identify risk factors associated with police arrest and false confessions and to investigate whether the severity of the ADHD condition/symptoms increases the risk.22,226 young persons in Iceland anonymously completed self-report questionnaires screening for conduct disorder and ADHD. In addition, they stated whether they had a diagnosis of ADHD and had received ADHD medication, and their history of offending, police interrogation and false confession. Participants were stratified into two age groups, 14–16 and 17–24 years.The older group was significantly more likely to have been interrogated by the police but the younger group were much more vulnerable to false confession during interrogation. Males were more likely to be at risk for both than females. The severity of the ADHD condition increased the risk of both interrogation and false confession. Negative binomial regressions showed that age, gender, conduct disorder, offending, and ADHD symptoms were all significant predictors of both interrogations and number of false confessions. Conduct disorder was the single best predictor of police interrogation, but the findings were more mixed regarding false confessions. Young people presenting with a combination of severe ADHD and comorbid conduct disorder had the worst outcome for both interrogation and false confessions.The findings endorse the need for support of persons with ADHD to be put in place to ensure fair due process and to prevent miscarriages of justice. It is important to identify risk factors associated with police interrogation and false confessions in order that appropriate safeguards may be applied. Age is an important predictor of outcome. A review of the literature revealed that juveniles are more vulnerable to giving a false confession during interrogation than adults –5. The eGiven the high rates of ADHD reported in the prison population of 26 % for adults and 30 % for youths , it is oPrevious work has not attempted to tease out the relationship between predictors of arrests and false confessions. Frequency of arrests has been predicted by both an ADHD diagnosis and childhood CD symptoms, the latter being the more powerful predictor than the former . Loeber,So far as false confessions are concerned, Gudjonsson, Sigurdsson, Bragason, Einarsson, & Valdimarsdottir  found thWhat has not been systematically investigated for age, gender, ADHD, CD and OB is whether different factors pose a risk for being arrested for the purpose of interrogation and false confessions. The present study aimed to address this gap in knowledge by conducting a study with definitive power to investigate whether the pattern of risk for juveniles and young persons to be arrested and interrogated by the police for suspected crimes is similar to the risk that they will give a false confession. The literature reviewed suggests that the severity of ADHD symptoms is likely to be an important mediator of outcome, thus the present study included measures of severity.CD and OB are likely to be salient triggers for arrest and interrogation, whereas ADHD symptoms per se are probably less important at the point of arrest. In contrast, once arrested and interrogated ADHD symptoms are likely to become more relevant to how they cope with interrogation in terms of the risk of giving a false confession .The current sample was stratified into two age groups, 14–16 and 17–24 years. This categorisation is based on the UK Police and Criminal Evidence Act 1984 (PACE) Code of Practice where those below the age of 17 are classified as ‘juveniles’ and require the services of an ‘Appropriate Adult’ during police interviews. The role of an ‘Appropriate Adult’ is to provide support and advice to people with intellectual disability and other mental health difficulties and is the main protection for juveniles and ‘mentally vulnerable’ detainees during interviews by police .Hypothesis 1 is that older youth (17–24) are more likely to be interrogated by police than juveniles (14–16), whereas the younger group is likely to report more instances of false confessions during interrogation. Hypothesis 2 is that males are more likely to be interrogated than females and when interrogated they are more likely to give false confessions. Hypothesis 3 is that CD and OB are better predictors of interrogation than false confessions, whereas ADHD is a better predictor of false confessions than CD and OB. Hypothesis 4 is that the severity of the ADHD condition/symptoms increases the risk for police interrogation and false confession.n = 13,933) and 17–24 (n = 7797).The sample was comprised of 22,226 young persons in Iceland; 10,838 (48.8 %) were in the final 3 years of mandatory education and 11,388 (51.2 %) were in further education at college. The mean age for the total sample (496 did not give their age) was 16.4 years . There were 10,778 males (49 %) and 11,211 females (237 did not give their gender). For the purpose of analysis, the participants were categorised into two age groups, those aged 14–16  [le (BCS) . This scle (BCS) , 24, 27.Questions about ADHD diagnosis and medication. Participants were specifically asked ‘Have you been diagnosed with ADHD?’ and ‘Are you currently taking medication for ADHD?’. Both answers were endorsed as either ‘Yes’ or ‘No’.Severity of ADHD. Two measures of severity were obtained from (a) categorising the symptomatic group into predominantly inattentive, predominantly hyperactive/impulsive, and combined type; the combined type represents greatest severity Severity 1: not on medication and not meeting screening diagnosis on BCS Severity 2: not on medication but meeting screening diagnosis on BCS Severity 3: currently on medication but not meeting screening diagnosis on BCS Severity 4: currently on medication and meeting screening diagnosis on BCS (The oregon adolescent depression project conduct disorder screen (OADP-CDS) [ADP-CDS) . This 6-ADP-CDS) . A cutofOffending behaviour(OB) [iour(OB) . This fiPolice interrogationand confessions questionnaire [ionnaire . Partici‘How often have you been interrogated at a police station as a suspect in a criminal offence?’ and ‘Have you ever confessed during police interrogation to a criminal offence that you did not commit (i.e. you had nothing to do with the offence and are completely innocent)?’ Replies were rated on the five-point scale: ‘Never’, ‘Once’, ‘Twice’, ‘3–5 times’, ‘6 or more times’.Because in the authors’ previous experience participants have been reluctant to specify a precise number for these variables, thereby leaving a great deal of missing data, these otherwise count variables were coded in ordered categories.The participants were approached by teachers in scheduled classes and invited to participate in the survey. The participants were assured that their answers would be anonymous. The questionnaire took up to 80 min to complete and upon completion the students sealed them in a blank envelope and left it by the exit of the classroom.Frequencies were reported for all categorical variables, and means with their standard deviations for continuous descriptive variables.2) tests. For all these binary association tests, odds ratios (OR) with 95 % confidence intervals were calculated as a measurement of their effect size.To establish independence in the proportions of the observations of all binary and categorical variables, we used Chi-square  models. A Poisson distribution is appropriate in accounting for observed heterogeneity when using count data but is not when there is overdispersion, as observed in both these response variables. And although there was a high proportion of zero responses on both variables, a zero-inflated model presupposes the existence of two zero processes (i.e. two plausible reasons why there are zero responses) . In our α < 0.05 was adopted throughout. All analyses were performed using Stata version 13 [Model beta coefficients were exponentiated, with odds ratios (OR) as indicators of the magnitude of associations in binary outcome models, and incidence rate ratios (IRR) in negative binomial regressions. A significance level of rsion 13 .χ2 = 542.2, df = 1, p < 0.001, OR = 2.6, 95 % CI 2.4–2.8), as well as those in the older age group .Out of 21,260 participants where data were available, 2987 (14.0 %) reported having been interrogated at a police station. Of those, 1739 (58.2 %) had been interrogated only once, 586 (19.6 %) twice, 408 (13.7 %) three to five times, and 254 (8.5 %) six or more times. Males were significantly more likely to report having been ever interrogated than females, 19.8 and 8.7 %, respectively . Those in the younger age group (20.0 %) were more likely than those in the older group (10.3 %) to report having given a false confession .As far as the reporting of false confessions is concerned, of those 2947 participants interrogated where data on false confessions were available, 434 (14.7 %) reported having made a false confession; out of those, 264 (60.8 %) had made a false confession once, 82 (18.9 %) made a false confession twice, 40 (9.2 %) three to five times, and 48 (11.1 %) six or more times. Males were significantly more likely to report having made a false confession than females, 16.2 and 11.4 %, respectively  met screening criteria for self-reported ADHD symptoms, of whom 469 (2.1 %) were predominantly inattentive type, 273 (1.2 %) hyperactive/impulsive type, and 353 (1.6 %) were combined type. 2288 (10.8 %) reported having received a diagnosis of ADHD and 946 (4.5 %) reported to be currently taking medication for ADHD. The great majority (76.8 %) of those of the comorbid type reported not being currently on ADHD medication. Of the total sample, 3098 (14.3 %) met screening criteria for CD and 4207 (20 %) reported having committed one or more offences.χ2 = 6.9, df = 1, p < 0.05, OR = 1.3, 95 % CI 1.1–1.6); currently taking ADHD medication, 6.2 and 2.9 % ; reported having received a diagnosis of ADHD, 13.7 % and 8.2 ; classified as CD, 19.4 and 9.5 % ; and had committed offences, 25.2 and 15.2 % .Significantly more males than females were ADHD combined type, 1.8 and 1.4 %, respectively . Only 12.4 % of those who were not symptomatic and not on medication reported having been interrogated in contrast to 48.5 % of those who were medicated and symptomatic. With regard to false confession, the respective percentages were 10.8 and 40.2 %.The ADHD status of the 21,330 participants (where complete data were available—data were missing for 896 participants or 4 %) was categorised using the hierarchy of presentation according to severity of symptoms. Table To aid interpretation, the proportions of interrogations and false confessions in relation to severity are depicted graphically in Fig. χ2 = 1595.12, p < 0.001, Cramer’s V = 0.275), with CD being most common among the severity group 4 (64.8 %) and lowest among severity group 1 (11.4 %). There was a significant difference between those who were medicated and symptomatic versus those medicated and non-symptomatic with the former being more likely to have CD .There was a strong relationship (large effect size) between the severity group classification and CD , with the OB being most common among the severity group 4 (50.0 %) and lowest among severity group 1 (18.4 %). There was a significant difference between those who were medicated and symptomatic versus those medicated and non-symptomatic with the former being more likely to have offended .A similar pattern was found with respect to OB during the previous 12 months (medium effect size) . These findings add substantially to the literature and reinforce the preliminary findings of Gudjonsson et al. by clearMales were more likely than females to report an interrogation and a false confession. The effect size was larger with regard to interrogations than false confessions . This suggests that gender is good predictor of whom the police bring in for interrogation; this most likely relates to the higher level of CD and OB. Gender was a less powerful predictor of false confessions than interrogation, but the current study demonstrated that there was some relationship with the susceptibility to give false confessions. This merits further research, particularly as miscarriages of justice due to unreliable confessions predominantly involve males .As hypothesised, there were differences in the relative contribution of CD and ADHD in relation to interrogation and false confessions and the severity of ADHD was a further contributory vulnerability factor. A screening diagnosis of CD increased the likelihood of having been interrogated 5.9 times and the likelihood of a false confession 2.6 times. The corresponding ORs for ADHD-combined were 4.3 and 3.7, respectively. The ORs for ADHD were lower (i.e. 3.1 and 2.6) when including the larger group of participants who met the screening criteria for ADHD-symptomatic. This suggests that the severity of ADHD in terms meeting screening criteria for both inattention and hyperactivity/impulsivity, referred to as the combined type, substantially increases the risk of being brought to a police station for interrogation and giving a false confession. The great majority of these comorbid young persons (76.8 %) were not being medicated for their condition at the time of the data collection.NBR regressions showed that age, gender, conduct disorder, offending, and ADHD-symptomatic were all significant predictors of number of interrogations and false confessions. CD made the largest single contribution to the variance in police interrogations and CD and ADHD-symptomatic to false confessions. The findings suggest that CD is likely to bring young people to the attention of the police, but when interrogated their ADHD symptoms presents an additional vulnerability to giving a false confessions. This is consistent with research into false confessions among adult prisoners with ADHD . The relV = 0.22) than interrogation (Cramer’s V = 0.15) and was more linearly related to the four group classification  being most commonly interrogated (48.5 %) and reporting a history of a false confession (40.2 %). This vulnerability group, whose medication may be ineffective in reducing their ADHD symptoms, had the highest co-comorbidity with CD (64.8 %) and OB (50.0 %). They resembled the ADHD participants followed up by Satterfield et al.  and LangTaken together, the two different measures of ADHD severity used in the current study, which only overlapped in a minority of cases, provide evidence that the severity of ADHD is an important risk factor in relation to both interrogation and false confession in addition to young persons being merely symptomatic in accordance with diagnostic screening criteria.The strength of the study is its representative sample of a large national population; there were approximately similar number of participants in both groups and for the two genders. This made it possible to calculate and control for both age and gender differences in relation to interrogation experience and false confessions. In addition, the large sample size enabled the researchers to investigate the relationship of the combination of ADHD symptoms and medication status to both interrogation and false confessions, which has never been done before. The study was limited from its reliance on self-reported data as corroboration of responses was not obtained. Second, the current findings do not provide a complete explanation of factors related to false confession as this is likely to be complex. The false confession or false denial of an offence much depends on the situational context  , as wellIn summary, this large national epidemiological study adds to our understanding about the relative importance of ADHD, CD and OB with regard to police interrogation and false confessions. Fourteen percent of the participants reported having been subject to police interrogation and the study highlighted the important contribution of the severity of the ADHD condition and need for effective treatment, together with the need for support to be put in place to ensure fair due process and prevent miscarriages of justice.


Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms . For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms of inattention, hyperactivity, and impulsivity that present in multiple settings . InitialAlthough symptoms of ADHD have been extended developmentally upward to adults and the diagnostic criteria of ADHD have been revised in the DSM-5 to reflect more accurately the experience of affected adults, adult ADHD research is in an early stage , 7, 8. MData on prevalence of adult ADHD are limited, but estimates based on international studies using multistage household probability samples range from 1.2 to 7.3% with an average of 3.4% . No popuCurrent research suggests that gender differences in the prevalence of adult ADHD may differ from prevalence patterns reported in children. Studies of ADHD in children find that boys are much more affected than girls, with clinically referred studies having gender differences closer to 9 : 1 and epidemiological studies closer to 3 : 1 . Among aClinical studies of adolescents and adults with ADHD have found higher rates of psychopathology, such as mood, anxiety, childhood disruptive, antisocial personality, and substance use disorders compared with control groups , 15, 17.Those with ADHD are also less likely to enter college and to graduate and generally have 2 years less schooling . They arThe purpose of this study was to examine prevalence of ADHD symptoms and their relationship with comorbidities and social outcomes and to explore differences by gender, in a large population-based survey of adults in Ontario, Canada.The data are based on telephone interviews (landlines and cell phones) with 4,014 Ontario adults (ages 18 or older) over 24 months between January 2011 and December 2012. The data are from the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing cross-sectional, computer-assisted telephone survey administered by the Institute for Social Research at York University, Canada  Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) was developed by Kessler et al.  as part (1) General Health Questionnaire (GHQ12) is a 12-item, 4-point widely used screening instrument for current psychiatric distress that captures depression/anxiety and problems with social functioning –29 with (1) Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview (MINI-APD), a 12-item, dichotomous scale, was designed to provide a short clinical screening tool to assess delinquencies  before and after age 15. We excluded one item of the MINI-APD (forced someone to have sex before age 15), as required by the ethics review board. A score of three or more on the latter six MINI-APD questions indicated a positive APD screen .(1) Lifetime cannabis and cocaine use ; (2) Alcohol Use Disorders Identification Test (AUDIT) is a validated screening instrument developed by the WHO, to detect individuals at the less severe end of the spectrum of alcohol problems, with a score greater than seven indicating hazardous alcohol use –33. The These were self-report items: (1) vehicle crash involvement in past year and (2) ever in lifetime arrested for a criminal offence.(1) Gender, (2) age, (3) marital status, (4) educational status, (5) employment status, and (6) income were included.All analyses used linearized methods based on sample design and weighted by probability of selection. The percentages reported are considered representative for the population surveyed. We used logistic regression analysis to estimate odds ratios for ADHD positive symptoms associated with sociodemographics, previous ADHD diagnosis, medication use, comorbidities, substance use and abuse, and social problems. We conducted separate regression analyses for men and women. We adjusted for age, marital status, education, and employment. Results are based on “valid” responses; responses such as “do not know” and refusals were considered missing data and excluded from analyses.Overall, 3.30%  of the sample screened above the cutoff for positive ADHD symptoms. Examination of sociodemographics by gender indicates  that forDifferent patterns emerged between men and women on education and employment. Among men, those who reported not completing postsecondary education showed higher odds of screening positively for ADHD symptoms than those with only a high school education. For women, those who reported achieving a postsecondary diploma or degree showed significantly lower odds of screening positively for ADHD symptoms than those who did not complete a postsecondary degree. For employment no significant differences were observed among men between those who reported being unemployed and those who reported working either full or part time. Among women, however, those who reported being employed full time showed significantly lower odds of screening positively for ADHD symptoms.The adjusted logistic regression  shows vaGender differences also emerged for social problems. While women who reported a collision in the last year showed significantly higher odds of screening positively for ADHD symptoms, no significant relationship was found between arrest for criminal offence and ADHD symptoms. However, the findings were reversed for men.This first population-based Canadian study of adult ADHD symptoms found prevalence of 3.3% screening positively for ADHD symptoms and no differences between men and women. This is congruent with M. D. Weiss and J. R. Weiss's  suggestiOur study found few differences in the clinical phenotypes of men and women who screened positively for ADHD symptoms. Although diagnosis of ADHD among those who screened positively was low at 22.7%, women reporting ADHD diagnosis and medication treatment had more than two times higher adjusted odds of screening positively for ADHD symptoms compared to men. Given that girls with ADHD tend to be underidentified because of their less disruptive behaviours , it may Psychiatric comorbidities are commonly found among adult ADHD patients, in particular, mood, anxiety, substance use, and antisocial personality disorders , 37. TheADHD patients are also at significant risk for substance use, particularly for cannabis and cocaine, with 40% prevalence of lifetime diagnosis of substance use disorders . A recenThe results of this study are subject to important limitations. These data are based on self-report screeners and do not reflect the breadth of information needed for clinical diagnoses. This is a key issue because the current study only reflects self-reported symptoms and does not examine impaired functioning and other issues related to specific diagnoses. Indeed, Gambino  cautionsThere are several clinical implications. Higher reports of ADHD symptoms are associated with more difficulties, further validating the ADHD self-report construct in a community sample. The relationships between the variables in this study also provide insights into better operationalizing self-reported adult ADHD symptoms. ADHD is typically regarded as an externalizing condition, but it has been acknowledged in the literature that internalizing symptoms are comorbid in adolescence and adulthood . It is u


The removal rate of this novel fluid is extremely low compared with the value of conventional one even though the spot of the former is much bigger. This surprising phenomenon is generated due to the small size and low saturation magnetization (Ms) of Fe3O4 and corresponding weak shear stress under external magnetic field according to material removal rate model of magnetorheological finishing (MRF). Different from conventional D-shaped finishing spot, the low Ms also results in a shuttle-like spot because the magnetic controllability is weak and particles in the fringe of spot are loose. The surface texture as well as figure accuracy and PSD1 (power spectrum density) of potassium dihydrogen phosphate (KDP) is greatly improved after MRF, which clearly prove the feasibility of substituting CIP and abrasive with Fe3O4 in our novel MRF design.The cubic Fe Potassium dihydrogen phosphate (KDP) is the unique nonlinear single crystal that is large enough as optical frequency conversion and electro-optical switch in high-fluence environment such as inertial confinement fusion (ICF) laser system. However, this crystal presents a great challenge to the ultra-precision manufacturing due to its low hardness, temperature sensitivity, and water solubility –3. TodayMagnetorheological finishing (MRF) is an advanced sub-aperture polishing technology that contains magnetic sensitive carbonyl iron powders (CIPs) and nonmagnetic abrasive incorporated in aqueous medium. The choice of abrasive is directed by the interaction with workpiece such as the physical properties  and chemical properties . It is considered to be an excellent, deterministic process for finishing optics to high precision with few subsurface defects –11. For Arrasmith et al. has reported that nonaqueous magnetorheological fluid which was composed of CIPs, nanodiamonds, and dicarboxylic ester could successfully polish a previously diamond-turned KDP to remove all turning grooves without deteriorating the roughness . Menapac3O4 is a common magnetic functional material that has been widely researched in recent years for its outstanding properties and potential applications in various fields, such as ferrofluids, catalysts, colored pigments, microwave absorber, high-density magnetic recording media, and medical diagnostics [3O4 nanoparticles to substitute conventional CIP and abrasive simultaneously, which means Fe3O4 plays the role of a magnetic sensitive particle as well as an abrasive. The idea is based on the understanding that small, narrow size distribution, low hardness, and weak magnetic particle with low removal rate are beneficial for the finishing of the ultra-precise surface.Fegnostics –22. In agnostics –25. In t3O4 nanoparticles were obtained from Aipurui Reagent Co. Ltd.  without any further surface modification. Other chemical reagents were purchased from Aladdin Chemical Co., Ltd. without purification. The typical magnetorheological fluid consists of basic liquid, functional particles , and some additives. The dispersion of particles to avoid scratch during finishing was achieved via high-shear emulsification and ultrasonic fragmentation.The CIPs were purchased from BASF Co., Ltd. (Germany), and FeThe microstructure and morphology were characterization by scanning electron microscopy  and transmission electron microscopy . The magnetic studies were carried out on a Lake Shore 7410 vibrating sample magnetometer (VSM). The finishing spot was taken on a KDP with the ribbon immersion depth of 0.5 mm. The 3D surface morphology of the finished surface was characterized by Taylor Hobson CCI lite with 20× objective of full resolution. After finishing the experiment on a 100 mm × 100 mm KDP via self-developed MRF apparatus and cleaning, the surface figure accuracy was examined and analyzed by Zygo interferometer.3O4 nanoparticles, from which we can see that the size distribution is 100–200 nm with cubic shape, and the edge is clear and four horns of every particle are sharp. Though the particles apparently agglomerate together due to intrinsic static magnetic absorption force, it should be noted that these incompact agglomerations may not greatly influence the subsequently finishing quality because the slurry is stirred online in the delivery system and the soft agglomerations would be dispersed.Spherical CIP particles with sizes between 0.5–3 μm are shown in Fig. 3O4 particles and CIPs are shown in Fig. 3O4 particles are typical soft magnetic materials. We can see that the Ms of Fe3O4 is 84.06 emu/g and the value of CIPs is 194.61 emu/g. It is reported that the existence of non-collinear spin structure which originated from the pinning of surface spins would result in the reduction of magnetic moment. The low Ms means Fe3O4 will be promptly saturated under an external magnetic field and the corresponding shear force induced by the field would not be as large as that of CIP which has higher Ms.The magnetization hysteresis loops of Fe3O4 nanoparticles to substitute both the CIP and abrasive as shown in Fig. Based on the above analysis, we deduce that the small particle size and low shear stress may be beneficial to improve the surface quality in soft KDP finishing. Different from conventional magnetorheological finishing fluid that contains CIP and abrasive to generate a smooth surface, we design a novel finishing fluid by choosing the Fe2/diamond finishing fluid containing CIPs [3/min, which are evidently lower than the value of commercial fluid between 4 and 30 λ/min [3O4 and CIP.The morphology and profile of finishing spot are exhibited in Fig. ing CIPs . However30 λ/min . This stKordonski et al. have proposed the particle force model via taking the form ofK is the dimensionless coefficient, ρp is the density, dp is the diameter, and γ is the shear rate [3O4 (5.18 g/cm3) is obviously lower than that of CIP (7.845 g/cm3). Secondly, the diameter of nanosized Fe3O4 (100 nm) is much smaller than the microsized CIP (1 μm). So, according to Equation , HV is related to Vickers hardness (resistance to plastic deformation), and Kc is fracture toughness (resistance to fracture/crack growth). The Ms of Fe3O4 is much lower than that of CIP as shown in Fig. 3O4 nanoparticles rather than the smaller or spherical ones for the sake of utilizing spiculate friction of horns to maintain relative mechanical removal ability. Otherwise, too low removal rate would result in unacceptable finishing period. It should be noted that the shuttle-like spot is evidently different from conventional spot with D-shaped framework [Ms of Fe3O4. The controllability of Fe3O4 under an external magnetic field is weak compared with CIP, especially in the area that is far from the center of the spot. So, the Fe3O4 nanoparticles in the fringe of the spot are loose and the spot is enlarged.where MRR is the material removal rate, entclass1pt{minimaramework , 14. Thi3O4 nanoparticles with much bigger and deeper spot is inversely lower than the value of conventional finishing fluid containing CIPs and CeO2/diamond abrasives. In order to validate our assumption that low removal rate may be in favor of the improvement of surface quality, we explore the surface texture of the finished KDP as shown in Fig. 3O4 is introduced as shown in Fig. Through the above discussion, it is easy to understand why the removal rate of the fluid containing Fe3O4 nanoparticles instead of conventional CIPs and abrasives. The initial low-frequency figure accuracy PV is 0.646 λ (1 λ = 632 nm) as shown in Fig. 3O4 nanoparticles as a magnetic sensitive medium and an abrasive simultaneously. Continuous exploration to further improve surface quality on large-aperture KDP is under work.With the spot and removal function as discussed above, we take an experiment on a 100 mm × 100 mm KDP to display the finishing effectiveness of Fe3O4 nanoparticles with sharp edges and horns is determined by TEM within 100–200 nm. A novel magnetorheological finishing fluid is designed by substituting conventional CIP and abrasive simultaneously with Fe3O4. The removal rate is extremely low compared with the value of conventional fluid though the finishing spot is much bigger, and the shuttle-like spot is different from the conventional D-shaped configuration. These strange phenomena are arising from the small size and inherently weak Ms of Fe3O4 by theoretical analysis. The finishing experiment exhibits nice surface texture and obvious convergence of figure accuracy PV and PSD1, validating the feasibility of our novel Fe3O4 design in MRF.The size distribution of cubic Fe


The vast majority of Attention-deficit/hyperactivity disorder (ADHD) patients have other associated pathologies, with depressive symptoms as one of the most prevalent. Among the mediators that may participate in ADHD, melatonin is thought to regulate circadian rhythms, neurological function and stress response. To determine (1) the serum baseline daily variations and nocturnal excretion of melatonin in ADHD subtypes and (2) the effect of chronic administration of methylphenidate, as well as the effects on symptomatology, 136 children with ADHD  were divided into subgroups using the “Children’s Depression Inventory” (CDI). Blood samples were drawn at 20:00 and 09:00 h, and urine was collected between 21:00 and 09:00 h, at inclusion and after 4.61 ± 2.29 months of treatment. Melatonin and its urine metabolite were measured by radioimmunoassay RIA. Factorial analysis was performed using STATA 12.0. Melatonin was higher predominantly in hyperactive-impulsive/conduct disordered children (PHI/CD) of the ADHD subtype, without the influence of comorbid depressive symptoms. Methylphenidate ameliorated this comorbidity without induction of any changes in the serum melatonin profile, but treatment with it was associated with a decrease in 6-s-melatonin excretion in both ADHD subtypes. Conclusions: In untreated children, partial homeostatic restoration of disrupted neuroendocrine equilibrium most likely led to an increased serum melatonin in PHI/CD children. A differential cerebral melatonin metabolization after methylphenidate may underlie some of the clinical benefit. In addition to genetic factors , environructures  and the ructures . As a neructures  that parructures ,10.Melatonin is a critical circadian synchronizer with a pleiotropic biological signal that exerts multiple effects , includiThe key features of ADHD include the presence of the core problems of inattention, hyperactivity and impulsivity. In addition, the vast majority of ADHD patients have at least one comorbid condition, e.g., conduct disorders, depressive symptoms or sleep disorders . A hypotThe aim of this study was to examine the relationship between serum levels of melatonin, as well as its daily fluctuations in ADHD children in addition to the urinary nocturnal excretion of 6-sulphatoxy-melatonin, prior to and after chronic methylphenidate treatment. In addition, another aim was to explore the relationship of these melatonin values to clinical symptomatology to determine whether this neuroendocrine mediator actively participates in the pathophysiology of ADHD or the response to ADHD treatment.All of the clinical course data , d2 attention test and Children’s Depression Inventory (CDI) scores) for the ADHD group, separated for diagnostic subtypes and subgroups, displayed an improvement . After tAt inclusion in the study, 23% of the ADHD sample showed a sleep onset delay, defined by a delay in the hour for going to bed and/or a prolongation of time needed for sleep induction, which were referred to by parents as of low/moderate intensity; with 12% of them showing nocturnal enuresis and no other sleep problems. Approximately a similar percentage (a quarter) of the parents of these subgroups of patients referred to worsening or ameliorations, respectively, of this symptom, with the other 50% of the patients experiencing no changes in their sleep patterns. The amelioration of sleep pattern refers mostly to the decrease of the resistance of children to go to sleep. On the other hand, one of five children without previous sleep disruption referred to a slight increase in the duration time needed to achieve sleep after methylphenidate treatment. Methylphenidate induced no changes in the rate of nocturnal enuresis.In the predominantly attention disorder (PAD) ADHD subtype children subgroup without depressive symptoms, the morning melatonin concentration was 22.59 ± 11.97 pg/mL at baseline and 18.58 ± 16.42 pg/mL after treatment A. In chiIn the hyperactive-impulsive/conduct disordered children (PHI/CD) subtype  subgroupvs. 18.62 ± 21.24 pg/mL; z = 2.28, p = 0.02), with significant day/night fluctuations . There was no differences by time (z = 0 and p = 0.97) nor depressive symptoms  before or after methylphenidate.The factorial analysis, adjusted by age and sex, with subtype, subgroup, time and hour, as factors, displayed significant differences between ADHD subtypes with higher values in the PHI/CD children , respectively, and 0.72 ± 0.43 and 0.48 ± 1.6 (p < 0.001) for the PHI/CD subtype, respectively . In the PAD subtype, the values were 0.75 ± 0.34 and 0.24 ± 0.35 before and after treatment  was very similar in both subtypes. The treatment with PRMPH induced a very significant decrease in excretion of 6-subtypes , which wi.e., PRMPH induced a very significant increase in the concentration of allopregnanolone, only in PAD patients without comorbid depressive symptoms.In another report, we demonstrated that neurosteroids and other neuroendocrine mediators are also influenced by PRMPH treatment. Dehydroepiandrosterone and allopregnanolone displays a trend toward lower baseline concentrations in ADHD children . Methylpvs. the PAD-ADHD subtype. The PHI-CD subtype is more related with externalizing symptoms and higher melatonin levels that of the PAD-ADHD subtype, which is more related to internalizing symptoms. In a control group without ADHD, the serum melatonin levels concentration were intermediate between PAD and PHI/CD subtypes, without differences in comparisons with both ADHD subtypes [p = 0.054), PHI/CD: (13.44 ± 6.24)/(12.33 ± 7.80) (p < 0.001), before/after treatment, respectively  and fewer depressive symptoms (CDI) after methylphenidate may be related, in part, to the neuroendocrine changes documented in this study. In addition, subtle changes in the daily fluctuations of both melatonin and serotonin  may contThe serum melatonin values of the PAD subtype are more correlated with the decrease observed in other mediators, for example for adrenocorticotropic Hormone (ACTH), β-endorphin and melatonin in affective deprived children  and for Untreated children with ADHD have a high rate of sleep onset disorder , which mN(1)-acetyl-N(2)-formyl-5-methoxykynuramine (AFMK) and N(1)-acetyl-5-methoxy-kynuramine (AMK), melatonin was usually believed to be almost exclusively metabolized to 6-hydroxymelatonin and its excretion product, 6-sulphatoxy-melatonin. AFMK and AMK now are known as major brain metabolites of melatonin [The reduced excretion of the 6-sulphatoxy-melatonin in nocturnal collected urine after PRMPH prompt us to suggest that the stimulant treatment may induce an alternative route for melatonin metabolism/utilization. Until the discovery of two 5-methoxylated kynuramines, named elatonin , with acelatonin . These pIn vitro studies have demonstrated that amphetamine increases inducible NOS mRNA, which may be prevented by melatonin [Psychostimulants, such as methylphenidate, produce differential lasting behavioral alterations, depending on the time of the day that they are administered, and correlate with diurnal changes in the system of transcription factors, termed clock genes, and with changes in the availability of subtypes of dopamine receptors . The molelatonin ,43.The PAD and PHI-CD ADHD subtypes may be separate disorders. Attention and impulsivity are sexually dimorphic in healthy populations. These gender differences may be related to dehydroepiandrosterone . SimilarMelatonin production, which is related to free radical production , reducesIn terms of the limitations of our study, our study had an open design and lack of randomization, with reporting of objective neuroendocrine measures of response after chronic treatment. Other limitations include (1) a low number of females, adolescents and patients belonging to the PAD subtype and (2) a large proportion of ADHD children with comorbid CD. Similar studies involving homogeneous groups of patients in terms of age, gender and co-morbidities, along with a more precise estimation of the adherence to treatment, are warranted for defining the serum biomarkers of the disorder and its comorbidities, in addition to the neurophysiological biomarkers that recently have been proposed .A total of 148 children  between the ages of 5 and 14 years old (mean: 9.61 ± 2.54 year) were included in a prospective, quasi-experimental open clinical study in a hospital-based sample, primarily reporting objective neuroendocrine measures of response.The sample included a total of 136 children who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision/9th International Classification of Diseases (DSM-IV-TR/ICD-9) criteria for ADHD , after cAfter the initial clinical interview with parents, completion of a personal medical history and physical examination of the child, we delivered to parents the following documents: (1) the DSM-IV-TR criteria assessment, which was completed by the child’s teacher; (2) EDAH scale , in The d2 attention test  is a meaThe CDI  is a selAll children were evaluated with an abbreviated intelligence test as a screening cognitive ability Kaufman (KBIT)  and alsoWritten informed consent was obtained from all parents and from children aged ≥12 years, and informed assent was obtained from all participants. The study design and outcome variables were approved by the Hospital Ethics Committee and the Health Research Fund of Spanish Ministry of Science and Innovation.The exclusion criteria were as follows: (1) KBIT < 85; (2) preexisting or actual treatment for epilepsy; (3) other treatments for ADHD or other conditions and (4) revocation of previous informed consent.The only drug used in the study was prolonged release methylphenidate , initially at 0.5 mg/kg/day. The dosage was adjusted as a function of response and tolerance to treatment (absence of adverse symptomatology). The mean initial dose of methylphenidate was 25.81 ± 10.35 mg, and the final dose at the time of the second evaluation was 31.85 ± 10.68 mg. At inclusion, all patients were naive of any medication, and no other treatment  was administered before conclusion of the protocol.Previously, at inclusion and during the study duration time, none of the patients of our sample were treated with melatonin or other sleep medications.None of the samples were obtained in the presence of an acute or severe illness. Blood samples were taken at 20:00 and at 09:00 the following day. In the ADHD group, after 4.61 ± 2.29 months of daily methylphenidate administered early in the morning, the identical study protocol was repeated. Serum was separated into 0.5-mL aliquots for freezing at −30 °C until analysis.Serum melatonin was measured using melatonin direct RIA . The intra- and inter-assay CV were 3.9%–6.9% in the range of 28.8 to 266 pg/mL and 6.2%–15.9% in the range of 3.5 to 281 pg/mL, respectively. The mean recovery of melatonin was 102%, and the sensitivity was 0.9 pg/mL.r = 0.96.In addition, 6-sulphatoxy-melatonin (6-S-aMT) in urine was measured by ELISA (IBL–Hamburg). The detection limit was 1 ng/mL, with an intra-assay range of 5.2% to 12.2%, and the inter-assay range was 5.1%–14.9%. Recovery ranged from 91% to 122%, and the correlation with RIA techniques was t” as expected, because we used “z”, the normal approximations for “t’s”, because of global sample sizes. The analyses reported were crude analyses, and adjusted analyses by age and gender were performed using the ANCOVA methodology. In all cases, the interactions were studied for levels below 0.15, and the latest comparisons were considered significant at p < 0.05 after applying the penalty provided by the correction. When analyzing the variances in different groups, homogeneous transformations were conducted for data using natural logarithm to achieve uniformity. We used the statistical package STATA 12.0  for all analyses.To achieve the objectives of the study, factorial analyses were conducted as described below. For comparisons between EDAH and CDI scores , Wilcoxon signed-rank tests (paired samples) were used for inferential statistics. For comparisons between patients (cases) and each variable in the study, the factors in the factorial models were as follows: (1) subtype with two categories: PAD and PHI/CD subtypes; (2) patients, nested in subtypes and subgroups (CDI); (3) hour, with two categories, day and night, and crossed with subtype; and (4) time, with two levels before and after treatment; this factor was a crossed factor with subtype and hour. Subtype, hour and time were fixed effects factors, and patients were considered as a random effects factor. Comparisons between cases were performed. The factorial model had the following three factors: (1) group with two categories (PAD and PHI/CD subtypes); (2) patients nested in CDI subgroups; and (3) hour, with two categories, day and night, that was crossed with group. Group and hour were fixed effects factors, and subjects was a random effects factor. For both types of comparisons, an ANOVA table was built, and higher interactions were determined. If these were significant, multiple pairwise comparisons were made using Bonferroni’s correction, and if not, these corrections were applied to the principal effects in the table. The experimental quantities for these comparisons were not “In summary, our study indicates that the presence of depressive symptoms is not responsible for the observed higher melatonin levels in the PHI-CD subtype of ADHD children, although the pineal hormone may participate in the pathophysiology of ADHD, as, in addition to melatonin alleviating sleep onset disorders, clinically effective methylphenidate treatment is related to a decrease of 6-sulphatoxy-melatonin excretion, most likely indicating a differential cerebral metabolism, which may generate end products that finally result in a clinically favorable outcome. Methylphenidate appears to induce changes in several others neuroendocrine mediators that globally act by adjusting physiological functions that collaborate to achieve the high efficacy of the stimulant pharmacological treatment of ADHD.