Development and evaluation of the Clinician Suicide Risk Assessment Checklist

This paper describes the development and evaluation of a new instrument – the Clinician Suicide Risk Assessment Checklist (CSRAC). The instrument assesses the clinician’s competency in three areas: clinical interviewing, assessment of specific suicide risk factors, and formulating a management plan. A draft checklist was constructed by integrating information from 1) literature review 2) expert clinician focus group and 3) consultation with experts. It was utilised in a simulated clinical scenario with clinician trainees and a trained actor in order to test for inter-rater agreement. Agreement was calculated and the checklist was re-drafted with the aim of maximising agreement. A second phase of simulated clinical scenarios was then conducted and inter-rater agreement was calculated for the revised checklist. In the first phase of the study, 18 of 35 items had inadequate inter-rater agreement (60%>), while in the second phase, using the revised version, only 3 of 39 items failed to achieve adequate inter-rater agreement. Further evidence of reliability and validity are required. Continued development of the CSRAC will be necessary before it can be utilised to assess the effectiveness of risk assessment training programs.

Reflections on the development and implementation of an early warning system for ecstasy and related drug markets in Australia

Regular and systematic monitoring of drug markets provides the basis for evidence-based policy. In Australia, trends in ecstasy and related drug (ERD) markets have been monitored in selected jurisdictions since 2000 and nationally since 2003, by the Party Drugs Initiative (PDI). The PDI maximises the validity of conclusions by triangulating information from (a) interviews with regular ecstasy users (REU), (b) interviews with key experts and (c) indicator data. There is currently no other system in Australia for monitoring these markets systematically; however, the value of the PDI has been constrained by the quality of available data. Difficulties in recruiting and interviewing appropriate consumers (REU) and key experts have been experienced, but largely overcome. Limitations of available indicator data from both health and law enforcement continue to present challenges and there remains considerable scope for enhancing existing routine data collection systems, to facilitate monitoring of ERD markets. With an expanding market for ecstasy and related drugs in Australia, and in the context of indicator data that continue to be limited in scope and detail, there is a strong argument for the continued collection of annual, comparable data from a sentinel group of REU, such as those recruited for the PDI.

Measurement and management of genotype-environment interaction (GxE) for the improvement of rainfed lowland rice yield in Cambodia

The magnitude and nature of genotype-by-environment interactions (G×E) for grain yield (GY) and days to flower (DTF) in Cambodia were examined using a random population of 34 genotypes taken from the Cambodian rice improvement program. These genotypes were evaluated in multi-environment trials (MET) conducted across three years (2000 to 2002) and eight locations in the rainfed lowlands. The G×E interaction was partitioned into components attributed to genotype-by-location (G×L), genotype-by-year (G×Y) and genotype-by-location-by-year (G×L×Y) interactions. The G×L×Y interaction was the largest component of variance for GY. The G×L interaction was also significant and comparable in size to the genotypic component (G). The G×Y interaction was small and non significant. A major factor contributing to the large G×L×Y interactions for GY was the genotypic variation for DTF in combination with environmental variation for the timing and intensity of drought. Some of the interactions for GY associated with timing of plant development and exposure to drought were repeatable across the environments enabling the identification of three-target populations of environments (TPE) for consideration in the breeding program. Four genotypes were selected for wide adaptation in the rainfed lowlands in Cambodia.