Assessing changes in the internal worlds of early- and late-adopted children using the Story Stem Assessment Profile (SSAP)

A growing body of literature has consistently shown how adopted children often have previous history of trauma and neglect, and in turn develop negative representations of the self and others. This study assesses the internal representations of three groups of children, as measured by the Story Stem Assessment Profile (SSAP). These were: (1) a maltreated, late-adopted (MLA) sample (n = 63); (2) a non-maltreated, early-adopted (EA) sample (n = 48); and (3) a non-maltreated community sample (COMM) (n = 80). In addition, it examined whether MLA and EA adopted children’s attachment and internal representations changed over time. Results showed that children in the MLA sample significantly displayed more disorganised, avoidant and negative representations and fewer representations characteristic of ‘secure’ attachment when compared with EA and, especially, COMM children. Longitudinal follow-up of both MLA and EA samples demonstrated significant changes over a two-year period in SSAP representation; secure representations increased while the avoidant and disorganised ones diminished. These findings are discussed and the limitations and implications of the study presented

It is feasible to flag 'near end-of-life' status in older patients from routine general practice data.

METHOD:A retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75-84 and ≥85 years using a case-control design matching by practice. RESULTS:The strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke. DISCUSSION:Consideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions

The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study

Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients.We conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis.We studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14-3.53; 60-day mortality HR 2.45, 95% CI 1.94-3.10; 90-day mortality HR 2.31, 95% CI 1.85-2.87; 1-year mortality HR 1.71, 95% CI 1.46-2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56-7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45-2.89; very severe vs normal HR 2.17, 95% CI 1.49-3.17) were the only other significant independent predictors of increased 1-year mortality.Among elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.Lixin Ou, Jack Chen, Ken Hillman, Arthas Flabouris, Michael Parr, Hassan Assareh and Rinaldo Bellom

“We can all just get on a bus and go” : Rethinking independent mobility in the context of the universal provision of free bus travel to young Londoners

This paper uses qualitative data from interviews with 118 young Londoners (age 12-18) to examine how the universal provision of free bus travel has affected young people’s independent mobility. Drawing on Sen’s ‘capabilities approach’, we argue that free bus travel enhanced young Londoners’ capability to shape their daily mobility, both directly by increasing financial access and indirectly by facilitating the acquisition of the necessary skills, travelling companions and confidence. These capabilities in turn extended both opportunity freedoms (e.g. facilitating non-“necessary” recreational and social trips) and process freedoms (e.g. feeling more independent by decreasing reliance on parents). Moreover, the universal nature of the entitlement rendered buses a socially inclusive way for groups to travel and spend time together, thereby enhancing group-level capabilities. We believe this attention to individual and group capabilities for self-determination provides the basis for a broader and more child-centred view of ‘independent mobility’ than the typical research focus upon ‘travelling without an adult’ and acquiring parental permissions.Peer reviewe

In acute lung injury, inhaled nitric oxide improves ventilation-perfusion matching, pulmonary vascular mechanics, and transpulmonary vascular efficiency

AbstractAcute respiratory distress syndrome continues to be associated with significant morbidity and mortality related to ventilation-perfusion mismatch, pulmonary hypertension, and right ventricular failure. It has been suggested that inhaled nitric oxide, which is a selective pulmonary vasodilator, may be effective in the treatment of acute respiratory distress syndrome; however, the effects of nitric oxide on cardiopulmonary interactions are poorly understood. We therefore developed a model of acute lung injury that mimics the clinical syndrome of acute respiratory distress syndrome. In our model, inhaled nitric oxide significantly reduced pulmonary artery pressure, pulmonary vascular resistance, and pulmonary vascular impedance. In addition, inhaled nitric oxide improved transpulmonary vascular efficiency and ventilation-perfusion matching, which resulted in increased arterial oxygen tension. Although arterial oxygen tension increased, oxygen delivery did not improve significantly. These data suggest that by improving ventilation-perfusion matching and arterial oxygen tension while lowering pulmonary vascular resistance and impedance, nitric oxide may be beneficial in patients with acute respiratory distress syndrome. However, additional measures to enhance cardiac performance may be required. ( J THORAC CARDIOVASC SURG 1995;110: 593-600

Readmission to intensive care: development of a nomogram for individualising risk

Background: Readmission to intensive care during the same hospital stay has been associated with a greater risk of in-hospital mortality and has been suggested as a marker ofquality of care. There is lack of published research attempting to develop clinical prediction tools that individualise the risk of readmission to the intensive care unit during the same hospital stay. Objective: To develop a prediction model using an inception cohort of patients surviving an initial ICU stay. Design, setting and participants: The study was conducted at Liverpool Hospital, Sydney. An inception cohort of 14 952 patients aged 15 years or more surviving an initial ICU stay and transferred to general wards in the study hospital between 1 January 1997 and 31 December 2007 was used to develop the model. Binary logistic regression was used to develop the prediction model and anomogram was derived to individualise the risk of readmission to the ICU during the same hospital stay. Main outcome measure: Readmission to the ICU during the same hospital stay.Results: Among members of the study cohort there were 987 readmissions to ICU during the study period. Compared with patients not readmitted to the ICU, patients who were readmitted were more likely to have had ICU stays of at least 7 days (odds ratio [OR], 2.2 [95% CI, 1.85-2.56]); non-elective initial admission to the ICU (OR, 1.7[95% CI, 1.44-2.08]); and acute renal failure (OR, 1.6 [95%CI, 0.97-2.47]). Patients admitted to the ICU from the operating theatre or recovery ward had a lower risk of readmission to ICU than those admitted from general wards, the emergency department or other hospitals. The maximum error between observed frequencies and predicted probabilities of readmission to ICU was estimatedto be 3%. The area under the receiver operating characteristic curve of the final model was 0.66.Conclusion: We have developed a practical clinical tool toindividualise the risk of readmission to the ICU during the same hospital stay in patients who survive an initial episodeof intensive care

USING TIME SERIES TO STUDY DYNAMICS OF SWEAT RATES OF HOLSTEIN COWS EXPOSED TO INITIAL AND PROLONGED SOLAR HEAT STRESS

Sweating is a very important way for cows to cope with heat stress. We are interested in the ability of Holstein cows to sustain high sweat or evaporation rates when exposed to solar radiation. There were two solar heat stress treatments: onset and prolonged. The onset data provided an opportunity to examine the impact of sudden exposure to a solar thermal load. The prolonged data allowed us to examine the impact of exposure to solar heat stress for an expended period (5 hr). Two questions of interest were: Do cows sweat at a constant or cyclic rate? Is there a difference in the dynamics of the two treatments: onset and prolonged solar heat stress? The data were examined for stationarity. In the time domain, we fit ARIMA models and estimated the parameters. In the frequency domain, we used nonparametric spectral estimation to identify cyclic patterns in the sweat rates. The usefulness of each technique for analyzing the dynamics of sweat rates is discussed

A COMPARISON OF ANALYTIC AND BAYESIAN APPROACHES FOR CHARACTERIZING THERMAL HYSTERESIS IN CATTLE USING ALGEBRAIC AND GEOMETRIC DISTANCES

A high ambient temperature poses a serious threat to cattle. Above a certain threshold, an animal’s body temperature (Tb) appears to be driven by the hot cyclic air temperature (Ta) and hysteresis occurs. Elliptical hysteresis describes the output of a process in response to a simple harmonic input, and the trajectory forms a closed loop. The hysteresis loop shows a rotated elliptical pattern which depends on the lag between Tb and Ta. The objectives of this study are 1) to characterize hysteresis using bootstrapped ellipse specific nonlinear least squares 2) to reformulate models using the Bayesian method, and 3) to assess the contribution of the Bayesian approach by comparing the risks using two metrics: algebraic and geometric. Comparisons and illustrations are made using simulations over three levels of signal strength. For each method; bootstrap and Bayes, both algebraic and geometric distances are compared based on the root mean square distance (RMSE) from fitting the hysteresis loop. Data from a heat stressed steer in a field experiment was analyzed to illustrate and compare the results from each method