Large-scale mutational analysis identifies UNC93B1 variants that drive TLR-mediated autoimmunity in mice and humans.

Nucleic acid-sensing Toll-like receptors (TLR) 3, 7/8, and 9 are key innate immune sensors whose activities must be tightly regulated to prevent systemic autoimmune or autoinflammatory disease or virus-associated immunopathology. Here, we report a systematic scanning-alanine mutagenesis screen of all cytosolic and luminal residues of the TLR chaperone protein UNC93B1, which identified both negative and positive regulatory regions affecting TLR3, TLR7, and TLR9 responses. We subsequently identified two families harboring heterozygous coding mutations in UNC93B1, UNC93B1+/T93I and UNC93B1+/R336C, both in key negative regulatory regions identified in our screen. These patients presented with cutaneous tumid lupus and juvenile idiopathic arthritis plus neuroinflammatory disease, respectively. Disruption of UNC93B1-mediated regulation by these mutations led to enhanced TLR7/8 responses, and both variants resulted in systemic autoimmune or inflammatory disease when introduced into mice via genome editing. Altogether, our results implicate the UNC93B1-TLR7/8 axis in human monogenic autoimmune diseases and provide a functional resource to assess the impact of yet-to-be-reported UNC93B1 mutations.

Revolutions in Lipid Isomer Resolution: Application of Ultrahigh-Resolution Ion Mobility to Reveal Lipid Diversity.

Many families of lipid isomers remain unresolved by contemporary liquid chromatography-mass spectrometry approaches, leading to a significant underestimation of the structural diversity within the lipidome. While ion mobility coupled to mass spectrometry has provided an additional dimension of lipid isomer resolution, some isomers require a resolving power beyond the capabilities of conventional platforms. Here, we present the application of high-resolution traveling-wave ion mobility for the separation of lipid isomers that differ in (i) the location of a single carbon-carbon double bond, (ii) the stereochemistry of the double bond (cis or trans), or, for glycerolipids, (iii) the relative substitution of acyl chains on the glycerol backbone (sn-position). Collisional activation following mobility separation allowed identification of the carbon-carbon double-bond position and sn-position, enabling confident interpretation of variations in mobility peak abundance. To demonstrate the applicability of this method, double-bond and sn-position isomers of an abundant phosphatidylcholine composition were resolved in extracts from a prostate cancer cell line and identified by comparison to pure isomer reference standards, revealing the presence of up to six isomers. These findings suggest that ultrahigh-resolution ion mobility has broad potential for isomer-resolved lipidomics and is attractive to consider for future integration with other modes of ion activation, thereby bringing together advanced orthogonal separations and structure elucidation to provide a more complete picture of the lipidome.

Subdural hemorrhage, macrocephaly, rash, and developmental delay in an infant: A pathogenic variant in NLRP3 causes CINCA/NOMID.

Subdural hemorrhages (SDHs) in children are most often observed in abusive head trauma (AHT), a distinct form of traumatic brain injury, but they may occur in other conditions as well, typically with clear signs and symptoms of an alternative diagnosis. We present a case of an infant whose SDH initially raised the question of AHT, but multidisciplinary evaluation identified multiple abnormalities, including rash, macrocephaly, growth failure, and elevated inflammatory markers, which were all atypical for trauma. These, along with significant cerebral atrophy, ventriculomegaly, and an absence of other injuries, raised concerns for a genetic disorder, prompting genetic consultation. Clinical trio exome sequencing identified a de novo likely pathogenic variant in NLRP3, which is associated with chronic infantile neurological, cutaneous, and articular (CINCA) syndrome, also known as neonatal-onset multisystem inflammatory disease (NOMID). He was successfully treated with interleukin-1 blockade, highlighting the importance of prompt treatment in CINCA/NOMID patients. This case also illustrates how atraumatic cases of SDH can be readily distinguished from AHT with multidisciplinary collaboration and careful consideration of the clinical history and exam findings.

Assessing dynamic violence risk: Common language risk levels and recidivism rates for the Violence Risk Scale.

The present study features the development of new risk categories and recidivism estimates for the Violence Risk Scale (VRS), a violence risk assessment and treatment planning tool. We employed a combined North American multisite sample (k = 6, N = 1,338) of adult mostly male offenders, many with violent criminal histories, from correctional or forensic mental health settings that had complete VRS scores from archival or field ratings and outcome data from police records (N = 1,100). There were two key objectives: (a) to identify the rates of violent recidivism associated with VRS scores and (b) to generate updated evidence-based VRS violence risk categories with external validation. To achieve the first objective, logistic regression was applied using VRS pretreatment and change scores on treated samples with a minimum 5-year follow-up (k = 5, N = 472) to model 2-, 3-, and 5-year violent and general recidivism estimates, with the resulting logistic regression algorithms retained to generate a VRS recidivism rates calculator. To achieve the second objective, the Council of State Governments' guidelines were applied to generate five risk levels using the common language framework using percentiles, risk ratios (from Cox regression), and absolute violent and general recidivism estimates (from logistic regression). Construct validity of the five risk levels was examined through group comparisons on measures of risk, need, protection, and psychopathy obtained from the constituent samples. VRS applications to enhance risk communication, treatment planning, and violence prevention in light of the updated recidivism estimates and risk categories are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Allergen Immunotherapy Extract Shortages and Their Effects on Clinical Care: A Work Group Report of the AAAAI Immunotherapy, Allergen Standardization, and Allergy Diagnostics Committee.

Allergen immunotherapy (AIT) is the only disease-modifying therapy indicated for treatment of allergic asthma, rhinitis, conjunctivitis, and Hymenoptera hypersensitivity. Manufacturing of the extracts used in AIT involve multistep complex processes as well as regulatory oversight. Furthermore, some source materials are vulnerable to unexpected events of nature. Given these circumstances, allergen extract supply can be disrupted with a potential to adversely impact patient care. A group of members from the American Academy of Allergy, Asthma, and Immunology (AAAAI) Immunotherapy, Allergy Standardization and Allergy Diagnostic Committee formed a workgroup to assess the frequency and effects of allergen extract shortages and associated factors. This workgroup developed a survey that was distributed to a random 20% of the AAAAI membership. In addition, the group also performed a review of the scientific literature on allergen extract supply and shortage. Based on the findings of the survey study and literature review, the workgroup reports frequency and extent of shortages, potential ways to improve communication with suppliers, and need for further guidance in patient care during times of shortage.

Multisite evaluation of fire ant venom immunotherapy safety and efficacy.

Background: Imported fire ant (IFA) venom immunotherapy (VIT) is the only disease-modifying treatment reported to be effective at decreasing the risk of systemic reactions (SRs) to IFA stings. Objective: Our aims were to determine the baseline rates of IFA sensitization in subjects, describe IFA VIT prescribing patterns across the military health system (MHS), and retrospectively evaluate the safety and efficacy of IFA VIT. Methods: We prospectively compared IFA sensitization in participants with and without an SR to flying Hymenoptera venom. Separately, IFA VIT prescription records were extracted from a centralized repository, and rates were described across the MHS. Additionally, we retrospectively reviewed the clinical course of patients being treated with IFA VIT at 11 military treatment facilities. Results: The in vitro IFA sensitization rates in our prospective cohort ranged from 19.1% to 24.1%. Sensitization rates did not differ statistically between the subjects with or without an SR to flying Hymenoptera venom. We found that 60.9% of all MHS IFA VIT prescriptions (491 of 806) were from the 11 facilities in this study. We retrospectively identified 137 subjects actively undergoing IFA VIT. Among the subjects actively undergoing IFA VIT, 28 reported an SR to IFA venom and repeat stings by IFAs after reaching VIT maintenance, and 85.7% (24 of 28) of the subjects noted symptoms no worse than a large swelling reaction after a repeat IFA sting. Notably, only 2.9% of the subjects (4 of 137) had an SR due to VIT. Conclusion: This study's results align with those of prior IFA sensitization reports. A substantial proportion of patients undergoing IFA VIT experienced protection against anaphylaxis with reexposure, with relatively few adverse events.

Welcoming Healthcare Into Our Virtual Meeting Rooms: Perspective and Perseverance in Pediatric Rheumatology.

Purpose of Review: We highlight practice changes adopted to increased use of telemedicine, look at precision, and accuracy in using a virtual visit to evaluate and treat rheumatic disease, and describe our shift in engaging patients and their families in supporting our research aims. Recent Findings: Telemedicine visits increased substantially with the start of the SARS-CoV-2 pandemic. With this change came the need for significant advances to our telemedicine practices to allow for quality patient visits and continued research collection. Summary: Telemedicine will continue to be an area of increasing importance and has been found to be especially useful for regions like ours which cover many patients in remote areas across Washington, Wyoming, Idaho, Montana, and Alaska. Through the development of new techniques and the use of new technologies, we have been able to improve both the visit quality for patients and our ability to collect research data.

Uncharted waters: mesenchymal stem cell treatment for pediatric refractory rheumatic diseases; a single center case series.

BACKGROUND: With the advent of innovative therapies including biologics and Janus kinase inhibitors, children with rheumatic diseases are more likely to have improved outcomes. Despite these advances, some children do not respond, or they, or their parents fear adverse events and seek other alternatives. Increasingly, private companies are offering mesenchymal stem cells (MSC) as an alternative, which are described as natural therapies for rheumatic diseases, often insinuating them as a cure. MSC have immunomodulatory properties, and transplantation of these stem cells have been used to successfully treat immunologic conditions like graft-versus-host disease. Lately, MSC research in adult lupus has been encouraging, but the clinical trials are still underway and in most, MSC therapy is not a standalone treatment. This retrospective case series will highlight three cases of pediatric refractory autoimmune disease whose parents sought out and received MSC therapy as a self-decision without first seeking medical advice from our specialty. The three families felt that their children were improved and in two believed that their child was cured. MSC have the potential of beneficial immunomodulation and may be a powerful tool in the therapy of rheumatic disease, but well controlled clinical trials are necessary and should be designed and monitored by experts in childhood rheumatic disease. CASE PRESENTATION: Three children with three different rheumatic diseases; systemic lupus erythematosus, mixed connective tissue disease and juvenile idiopathic arthritis were under the care of pediatric rheumatology at a large, tertiary-care, teaching institution. Multiple non-biologic and biologic disease-modifying anti-rheumatic drugs failed to significantly decrease disease activity, and as a result, the families chose to undergo MSC therapy. After transplantation, all children improved per patient and parent report and tapered off conventional immunosuppressive drugs. No serious adverse events occurred in these three patients. CONCLUSION: The three cases presented in this report reflect comparable beneficial outcomes and minimal risks published in adult studies. These were not controlled studies, however, and benefit was reported rather than documented. These cases suggest that MSC transplantation may prove a promising adjunctive treatment option; however, further research, development of standardized infusion therapy protocols, and well-designed monitored clinical trials are essential.

Predictive Properties of the Violence Risk Scale-Sexual Offense Version as a Function of Age.

The present study examined the discrimination and calibration properties of Violence Risk Scale-Sexual Offense version (VRS-SO) risk and change scores for sexual and violent recidivism as a function of age at release, on a combined sample of 1,287 men who had attended sexual offense-specific treatment services. The key aim was to examine to what extent VRS-SO scores can accurately discriminate recidivists from nonrecidivists among older cohorts, and if the existing age-related adjustments in the instrument adequately correct for increasing age. VRS-SO risk and change scores showed consistent properties of discrimination for sexual recidivism across the age cohorts, via area under the curve and Cox regression survival analysis, as demonstrated through fixed effects meta-analysis. Calibration analyses, employing logistic regression, demonstrated that age at release was consistently incrementally predictive of violent, but not sexual, recidivism after controlling for individual differences on static and dynamic risk factors. E/O index analyses demonstrated that predicted rates of sexual recidivism from VRS-SO scores, particularly when employed with Static-99R, were not significantly different from those observed among age cohorts; however, calibration was weaker for general violence. Implications for use of the VRS-SO in sexual recidivism risk assessment with older offenders are discussed.

A prospective multisite examination of dynamic sexual violence risk: Extension and update to Olver, Nicholaichuk, Kingston, and Wong (2014).

OBJECTIVE: The present study is an extension and update of Olver, Nicholaichuk, Kingston, and Wong's (2014) prospective multisite examination of sexual violence risk and treatment change on a large federal Canadian sample of 570 treated sexual offenders rated pretreatment and posttreatment on the Violence Risk Scale-Sexual Offense version (VRS-SO). METHOD: The present study featured the clinical application of a risk assessment and treatment planning tool, the VRS-SO, with recidivism outcome data updated by 4 years to a total of 10.2 years. VRS-SO change scores, representing reductions in sexual violence risk from treatment or other change agents (e.g., aging), were reanalyzed in terms of their associations with community sexual, violent, and general recidivism postrelease. RESULTS: Recidivism base rates increased with the concordant increase in follow-up time. VRS-SO risk scores significantly predicted all recidivism outcomes, whereas change scores were consistently associated with decreases in sexual and violent recidivism after controlling for baseline risk through bivariate (d = -.24 to -.61) and Cox regression survival analyses (eB = .878 to .938). CONCLUSIONS: The results affirm the dynamic nature of sexual violence risk and demonstrate that structured assessments of change, linked to participation in sexual offense specific treatment, to be associated with decreases in future sexual offending as well as other recidivism outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Assessing the Risk of Australian Indigenous Sexual Offenders Reoffending: A Review of the Research Literature and Court Decisions.

The assessment of offenders' risk of reoffending, particularly sexual reoffending, is a core activity of forensic mental health practitioners. The purpose of these assessments is to reduce the risk of harm to the public, but they are controversial and become more contentious when Australian practitioners who want to undertake such assessments in an ethically responsible way must use reliable validated instruments, disclose the limitations of their assessment methods, instruments and data to judicial decision-makers and understand how decision-makers might use their reports. The purpose of this systematic literature review was to explore the practices of Australian practitioners and courts in respect of the assessment of Australian Indigenous male sexual offenders' risk of reoffending. We could not identify an instrument that has been developed for the assessment of this population group. Australian courts differ in whether they admit and give weight to practitioners' evidence and opinions based on data obtained with non-validated instruments. We could only identify three possible predictor variables with enough quantitative support to justify including them in an instrument that could be used to assess Indigenous sexual offenders. There is a need for research regarding the validity of the instruments that practitioners use.

Using the Violence Risk Scale-Sexual Offense version in sexual violence risk assessments: Updated risk categories and recidivism estimates from a multisite sample of treated sexual offenders.

The present study sought to develop updated risk categories and recidivism estimates for the Violence Risk Scale-Sexual Offense version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003-2017), a sexual offender risk assessment and treatment planning tool. The overarching purpose was to increase the clarity and accuracy of communicating risk assessment information that includes a systematic incorporation of new information (i.e., change) to modify risk estimates. Four treated samples of sexual offenders with VRS-SO pretreatment, posttreatment, and Static-99R ratings were combined with a minimum follow-up period of 10-years postrelease (N = 913). Logistic regression was used to model 5- and 10-year sexual and violent (including sexual) recidivism estimates across 6 different regression models employing specific risk and change score information from the VRS-SO and/or Static-99R. A rationale is presented for clinical applications of select models and the necessity of controlling for baseline risk when utilizing change information across repeated assessments. Information concerning relative risk (percentiles) and absolute risk (recidivism estimates) is integrated with common risk assessment language guidelines to generate new risk categories for the VRS-SO. Guidelines for model selection and forensic clinical application of the risk estimates are discussed. (PsycINFO Database Record

A comprehensive examination of the psychometric properties of the Hare Psychopathy Checklist-Revised in a Canadian multisite sample of indigenous and non-indigenous offenders.

The present study examined the psychometric properties of Hare Psychopathy Checklist-Revised (PCL-R; Hare, 2003) scores in a multisite sample of 1,163 federally incarcerated Canadian indigenous and non-indigenous offenders from the Prairie Region of the Correctional Service of Canada. The research occurred against the backdrop of the Ewert v. Canada (2015) matter, in which the PCL-R was originally impugned in Federal Court for use with indigenous persons (later overturned in Canada v. Ewert, 2016). Indigenous men scored higher than non-indigenous men on most components of the PCL-R and had higher rates of recidivism, irrespective of follow-up. Discrimination analyses, however, supported the predictive efficacy of PCL-R total, factor, and facet scores for violent and general recidivism across both ancestral groups, with most group differences in area under the curve (AUC) magnitudes being small and nonsignificant. Calibration analyses demonstrated that higher PCL-R scores were associated with higher rates of general and violent recidivism for both ancestral groups, although higher recidivism rates were observed and estimated for indigenous men at specific PCL-R score thresholds. Confirmatory factor analyses supported the 4-factor model of psychopathy and hence, structural invariance, of PCL-R scores across ancestral groups. Structural equation modeling affirmed the predictive efficacy of the 4-factor model for recidivism. We discuss these findings in terms of clinical applications of the PCL-R and the psychopathy construct in general, with male offenders of indigenous ancestry. (PsycINFO Database Record

Construct Validity of the Violence Risk Scale-Sexual Offender Version Instrument in a Multisite Sample of Treated Sexual Offenders.

The present study examined the construct validity of the Violence Risk Scale-Sexual Offender version (VRS-SO) through an examination of its factor structure and convergence with psychological measures assessing conceptually relevant constructs in a sample of 732 treated incarcerated adult male sex offenders. The VRS-SO was rated prospectively pre- and posttreatment by service providers, and several of the men had completed a psychometric battery at each time point. Prospective Stable 2000 ratings were examined for comparison purposes. Results of exploratory longitudinal factor analysis, performed on VRS-SO pre- and posttreatment dynamic item scores, supported a three-factor model (comparative fit index = .990) and the measurement invariance of the loadings over time. A stringent longitudinal confirmatory factor analysis of the VRS-SO items also supported the three-factor structure. Scores from the three factors (Sexual Deviance, Criminality, and Treatment Responsivity) were correlated in conceptually meaningful ways with scores from the Stable 2000 and selected psychometric measures. The results provide evidence for the construct validity of VRS-SO test scores as providing an index of sex offender risk and, more specifically, that its item content and factor domains measure psychological constructs pertinent to sex offender risk and need.

Predictive Accuracy of Violence Risk Scale-Sexual Offender Version Risk and Change Scores in Treated Canadian Aboriginal and Non-Aboriginal Sexual Offenders.

The present study examined the predictive properties of Violence Risk Scale-Sexual Offender version (VRS-SO) risk and change scores among Aboriginal and non-Aboriginal sexual offenders in a combined sample of 1,063 Canadian federally incarcerated men. All men participated in sexual offender treatment programming through the Correctional Service of Canada (CSC) at sites across its five regions. The Static-99R was also examined for comparison purposes. In total, 393 of the men were identified as Aboriginal (i.e., First Nations, Métis, Circumpolar) while 670 were non-Aboriginal and primarily White. Aboriginal men scored significantly higher on the Static-99R and VRS-SO and had higher rates of sexual and violent recidivism; however, there were no significant differences between Aboriginal and non-Aboriginal groups on treatment change with both groups demonstrating close to a half-standard deviation of change pre and post treatment. VRS-SO risk and change scores significantly predicted sexual and violent recidivism over fixed 5- and 10-year follow-ups for both racial/ancestral groups. Cox regression survival analyses also demonstrated positive treatment changes to be significantly associated with reductions in sexual and violent recidivism among Aboriginal and non-Aboriginal men after controlling baseline risk. A series of follow-up Cox regression analyses demonstrated that risk and change score information accounted for much of the observed differences between Aboriginal and non-Aboriginal men in rates of sexual recidivism; however, marked group differences persisted in rates of general violent recidivism even after controlling for these covariates. The results support the predictive properties of VRS-SO risk and change scores with treated Canadian Aboriginal sexual offenders.

Characteristics of alleged homicide offenders with and without schizophrenia in Sichuan, China.

BACKGROUND: Little is known about the characteristics of people with and without schizophrenia who have been charged with homicide in China. AIMS AND RESEARCH QUESTION: Our research question was what differences are there between alleged homicide offenders with and without psychosis? METHOD: All archival records of alleged homicide cases referred for assessment to the West China Forensic Central Medical Service during 1998-2006 were retrieved. The centre serves a large catchment area in the mainly rural province of Sichuan. A random 20% of cases with schizophrenia and all cases without psychosis were selected for comparison. Demographic, criminological and mental health data were extracted from the records, and violence was rated by using the Violence Risk Scale (Chinese version). RESULTS: The two groups differed significantly in age, education, occupation, marital status and relationships to victim. The estimated risk of reoffending was higher in the schizophrenia group than the non-psychotic group, even after controlling for demographic differences. Despite many individuals reporting long histories of mental illness, about 40% of those with schizophrenia had never had any psychiatric treatment and less than 4% were in treatment at the time of the alleged homicide. CONCLUSIONS: The tendency for homicidal people with schizophrenia to be older, less educated and more socially isolated than their non-psychotic peers is similar to experience in Western countries, but the apparently higher risk scale scores of the Chinese schizophrenia group and their greater tendency to attack strangers are different. The lack of reported previous engagement with mental health services by a clearly ill and risky group of people is a likely explanation. Similar rural problems compared with better served urban areas have been reported in the Chuvash Republic. The case for better rural mental health services seems strong. Copyright © 2017 John Wiley & Sons, Ltd.

Global Profiling of Metabolite and Lipid Soluble Microbial Products in Anaerobic Wastewater Reactor Supernatant Using UPLC-MSE.

Identification of soluble microbial products (SMPs) released during bacterial metabolism in mixed cultures in bioreactors is essential to understanding fundamental mechanisms of their biological production. SMPs constitute one of the main foulants (together with colloids and bacterial flocs) in membrane bioreactors widely used to treat and ultimately recycle wastewater. More importantly, the composition and origin of potentially toxic, carcinogenic, or mutagenic SMPs in renewable/reused water supplies must be determined and controlled. Certain classes of SMPs have previously been studied by GC-MS, LC-MS, and MALDI-ToF MS; however, a more comprehensive LC-MS-based method for SMP identification is currently lacking. Here we develop a UPLC-MS approach to profile and identify metabolite SMPs in the supernatant of an anaerobic batch bioreactor. The small biomolecules were extracted into two fractions based on their polarity, and separate methods were then used for the polar and nonpolar metabolites in the aqueous and lipid fractions, respectively. SMPs that increased in the supernatant after feed addition were identified primarily as phospholipids, ceramides, with cardiolipins in the highest relative abundance, and these lipids have not been previously reported in wastewater effluent.

Risk reduction treatment of psychopathy and applications to mentally disordered offenders.

Therapeutic nihilism on treating psychopathy is widespread and is largely based on many outdated and poorly designed studies. Important recent advances have been made in assessing psychopathy and recidivism risks, as well as in offender rehabilitation to reduce reoffending, all of which are now well supported by a considerable literature based on credible empirical research. A 2-component model to guide risk reduction treatment of psychopathy has been proposed based on the integration of key points from the 3 bodies of literature. Treatment programs in line with the model have been in operation, and the results of early outcome evaluations are encouraging. Important advances also have been made in understanding the possible etiology of mentally disordered offenders with schizophrenia and history of criminality and violence, some with significant features of psychopathy. This article presents a review of recent research on risk reduction treatment of psychopathy with the additional aim to extend the research to the treatment of mentally disordered offenders with schizophrenia, violence, and psychopathy.

A cluster analytic examination and external validation of psychopathic offender subtypes in a multisite sample of Canadian federal offenders.

The present study is a cluster analytic examination and validation of psychopathic offender subtypes from 4 combined samples of Canadian federally incarcerated offenders, most of whom were serving sentences for violent offenses. The men were rated on the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003) on the basis of comprehensive file information and 314 cases were extracted using a PCL-R total cut score of 25. Cluster analysis of the 4 PCL-R facets converged at a 2-cluster solution: a primary subtype characterized by prominent interpersonal and affective features of psychopathy and a secondary subtype characterized by comparatively few interpersonal features and high scores on the remaining facets. Validation analyses found that the vast majority of primary psychopathic offenders (74.1%) were White or of non-Aboriginal descent in contrast to the secondary subtype (47.6%). Secondary psychopathic offenders tended to be actuarially higher risk, have greater criminogenic needs, and to make greater amounts of treatment change on criminogenic targets; however, contrary to expectations, within-treatment changes from a violence reduction program were significantly associated with reductions in violent recidivism for primary, but not secondary, variants. There were few differences in rates of recidivism between the groups overall; secondary variants had higher rates of sexual violence which was largely accounted for by individual differences in baseline static risk. Implications for risk assessment, treatment planning, and the classification and etiology of primary and secondary psychopathy are discussed.

Evaluation and applications of the clinically significant change method with the Violence Risk Scale-Sexual Offender version: implications for risk-change communication.

We examined the use of the clinically significant change (CSC) method with the Violence Risk Scale-Sexual Offender version (VRS-SO), and its implications for risk communication, in a combined sample of 945 treated sexual offenders from three international settings, followed up for a minimum 5 years post-release. The reliable change (RC) index was used to identify thresholds of clinically meaningful change and to create four CSC groups (already okay, recovered, improved, unchanged) based on VRS-SO dynamic scores and amount of change made. Outcome analyses demonstrated important CSC-group differences in 5-year rates of sexual and violent recidivism. However, when baseline risk was controlled via Cox regression survival analysis, the pattern and magnitude of CSC-group differences in sexual and violent recidivism changed to suggest that observed variation in recidivism base rates could be at least partly explained by pre-existing group differences in risk level. Implications for communication of risk-change information and applications to clinical practice are discussed.