Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant

Objective
Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.

Methods
Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial Po2 to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours.

Results
Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%).

Conclusions
Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5–6-year-old and 188 10–12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, children's BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5–6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10–12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Influence of stocking rate and mixed grazing of Angora goats and Merino sheep on animal and pasture production in southern Australia : 2 : liveweight, body condition score, carcass yield and mortality

The effects of animal species (AS; Angora goats, Merino sheep, mixed-grazed goats and sheep at the ratio of 1:1) and stocking rate (SR; 7.5, 10 and 12.5 animals/ha) on the liveweight, body condition score, carcass yield and mortality of goats and sheep were determined in a replicated experiment on improved annual temperate pastures in southern Australia from 1981 to 1984. The pattern of liveweight change was similar for both species with growth from pasture germination in autumn until maturation in late spring followed by weight loss. In winter, sheep grew faster than goats (65 versus 10 g/day, P < 0.05). In mixed-grazed treatments between November and December goats either grew when sheep were losing weight or goats lost less weight than sheep (P < 0.01). Both AS (P < 0.001) and SR (P < 0.001) affected liveweight of sheep and an AS SR interaction (P <  0.05) affected liveweight of goats. Mixed-grazed sheep were heavier than separately grazed sheep at all SR with a mean difference at 10 and 12.5/ha of 4.6 kg. Mixed-grazed goats at 10/ha were heavier than separately grazed goats from the end of the second year of the experiment, but at 12.5/ha, separately grazed goats maintained an advantage over mixed-grazed goats, with a 9.4-kg mean difference in December (P < 0.05). Body condition scores of goats and sheep declined with increasing SR; they were highest in late spring and were highly correlated with liveweight (r² > 0.8). Both AS and SR affected (P < 0.001) carcass weight and GR tissue depth as a direct result of differences in liveweight. Adjusting for differences in carcass weight negated AS effects on GR tissue depth. The carcass weights of sheep and goats increased by similar amounts for each 1-kg increase in liveweight. Mortality of sheep (3.1% p.a.) was unaffected by AS or SR. An AS SR interaction indicated mortality of separately grazed goats at 12.5/ha and mixed-grazed goats at 10 and 12.5/ha were higher (P < 0.05) than all other goat (29 versus 9%) and sheep treatments, primarily because of increased susceptibility to cold stress. Disease prevalence differed between sheep and goats. Mixed grazing of Merino sheep and Angora goats produced complementary and competitive effects depending upon the SR. Goats used summer pasture better but winter pasture less well for liveweight gain than sheep. Angora goats should not be grazed alone or mixed grazed with sheep on annual temperate pastures at SR greater than that recommended for Merino sheep and the evidence indicates a lower SR will reduce risks associated with mortality.

A descriptive model of the offense process for female sexual offenders

Although considerable efforts have been made to develop and validate etiological models of male sexual offending, no theory is available to guide research or practice with female sexual offenders (FSOs). In this study, the authors developed a descriptive, offense process model of female sexual offending. Systematic qualitative analyses (i.e., grounded theory) of 22 FSOs' offense interviews were used to develop a temporal model documenting the contributory roles of cognitive, behavioral, affective, and contextual factors in female sexual abuse. The model highlights notable similarities and divergences between male and female sexual offenders' vulnerability factors and offense styles. In particular, the model incorporates male co-offender and group co-offender influences and describes how these interact with vulnerability factors to generate female sexual offending. The gender-specific research and clinical implications of the model are discussed.

Study on student score based on data mining

Education is a complex systematic engineering, which is the guarantee of training high-quality talent, helping society make full use of educational outcomes and promote the healthy development of education. In the education, the students' score is a very important quantitative evaluation indicator, which can objectively reflect the effects of educational system and is an important basis to make lots of scientific decisions. This paper uses clustering algorithm and decision tree to comprehensively analyze the students' score, and obtains useful results. It can be observed that the results are valuable for the teaching and management.

The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use

Objective The Clinical Global Impression Scale (CGI) is established as a core metric in psychiatric research. This study aims to test the validity of CGI as a clinical outcome measure suitable for routine use in a private inpatient setting.

Methods The CGI was added to a standard battery of routine outcome measures in a private psychiatric hospital. Data were collected on consecutive admissions over a period of 24 months, which included clinical diagnosis, demographics, service utilization and four routine measures (CGI, HoNOS, MHQ-14 and DASS-21) at both admission and discharge. Descriptive and comparative data analyses were performed.

Results Of 786 admissions in total, there were 624 and 614 CGI-S ratings completed at the point of admission and discharge, respectively, and 610 completed CGI-I ratings. The admission and discharge CGI-S scores were correlated (r = 0.40), and the indirect improvement measures obtained from their differences were highly correlated with the direct CGI-I scores (r = 0.71). The CGI results reflected similar trends seen in the other three outcome measures.

Conclusions The CGI is a valid clinical outcome measure suitable for routine use in an inpatient setting. It offers a number of advantages, including its established utility in psychiatric research, sensitivity to change, quick and simple administration, utility across diagnostic groupings, and reliability in the hands of skilled clinicians.

Can the Severity of Dependence Scale be usefully applied for 'ecstasy'?

Background/Aims: Although use of 'ecstasy' (drugs sold as containing 3,4-methylenedioxymethamphetamine) is prevalent, it is typically infrequent, and treatment presentations involving ecstasy as a principal problem drug are relatively rare. Human case reports and animal literature suggest dependence potential, although there may be some unique aspects to this syndrome for ecstasy in comparison to other substances. The Severity of Dependence Scale (SDS) was examined to determine whether this could usefully identify 'dependent' ecstasy consumers.

Methods: We conducted a cross-sectional survey of 1,658 frequent (at least monthly) ecstasy consumers across Australia, assessing drug use, associated harms and risk behaviours. Dependence was evaluated with the SDS, using a cut-off of ≥4 to identify potential 'dependence'. Results: One fifth of the participants were screened as potentially dependent. These individuals used ecstasy more frequently, in greater amounts, engaged more extensively in risk behaviours and reported greater role interference than other participants. These findings were independent of methamphetamine use or dependence. The underlying structure of the ecstasy SDS was bifactorial.

Conclusions: The SDS has demonstrated construct validity as a screening tool to identify ecstasy users at elevated risk of experiencing adverse consequences, including features of dependence. The underlying structure of dependence symptoms differs for ecstasy compared to other drug classes, and some dependent consumers use the drug infrequently. The unique neurotoxic potential and entactogenic effects of ecstasy may require a distinct nosological classification for the experience of dependence associated with the drug.

Oral language competence in incarcerated young offenders : links with offending severity

Previous research in Australia and overseas has shown that young offenders serving community-based orders are at high-risk for undetected but clinically significant oral language difficulties. However, this phenomenon has received little attention in incarcerated samples, and links with offending severity, mental health, and other markers of early risk have not previously been systemically examined. A cross-sectional examination of 100 young offenders (mean age 19.03 years) completing custodial sentences in Victoria, Australia was conducted. A range of standardized oral language, IQ, mental health, and offending severity measures was employed. Forty-six per cent of participants were classified as language impaired (LI), and these were compared with the non-LI sub-group on background and offending variables. When the sub-group with high scores on a measure of offending severity was compared with those with (relatively) lower offending scores, significant differences on a range of language measures were identified. A range of early risk indicators (such as placement in Out of Home Care) was also examined with respect to language impairment in this high-risk group. Results are discussed with respect to policy and practice pertaining to early intervention for vulnerable children, and implications for service delivery within the justice system. In particular, emphasis is placed on the need to closely examine the oral language skills of children who struggle with the transition to literacy and then display behavioural difficulties in the classroom. Once a young person is engaged with youth justice services, a high index of suspicion should be maintained with respect to their oral language skills; for example, in relation to forensic interviewing and the ability to benefit from verbally mediated interventions.