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Lawrence (Chelsea and Westminster Hospital) were the syphilis specialists who reviewed the cases, and we thank them for their speedy turn round of case reports. We acknowledge the diligence of individual specialists in genitourinary medicine and paediatricians in returning cards and data.Contributors: A-KH undertook the analysis of the data and drafted the paper. AN designed and oversaw the running of the surveys and completed the paper. CC led and coordinated the British Cooperative Clinical Group survey and contributed to the writing of the paper, as did TL, who was the lead clinician for the survey of paediatricians. NC contributed to writing the paper and applying the findings to syphilis screening policy. JW and LR administered the two surveys. AN is the guarantor.Funding: The British Paediatric Surveillance Unit (BPSU) is part of the Research Division of the Royal College of Paediatricians and Child Health (RCPCH) and was supported at the time of the survey by a grant from Children Nationwide. Administration of the surveys was supported by the PHLS through core funding from the Department of Health.Competing interests: None declared. AbstractObjective To determine the prevalence of severe psychological trauma-that is, post-traumatic stress disorder-in children involved in everyday road traffic accidents. Design 12 month prospective study. Setting Accident and emergency department, Royal United Hospital, Bath.

The limitations of Kidcope are discussed and the need to develop more complex ways of assessing childhood coping within a developmental framework highlighted.

Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

Genome duplication causes phenotypic shifts and contributes directly to prezygotic isolation for some barriers (gametic isolation) but cannot account for the cumulative isolation from diploids observed in natural tetraploids. Therefore, conditions for species formation through genome duplication are not necessarily instantaneous and selection to strengthen prezygotic barriers in young polyploids is critical for the establishment of polyploid species in sympatry.