Die extrakorporale Membranoxygenierung ist ein seit Jahrzehnten etabliertes Verfahren, Patienten trotz kardialem und/oder pulmonalem Versagen ein zeitbegrenztes Überleben zu ermöglichen. Obgleich sich an den Grundzügen der Herangehensweise bis heute wenig verändert hat, konnte diese Hochrisikotherapie mithilfe der Entwicklung blutschonenderer Materialien und der Verwendung verbesserter Pumpen und Oxygenatoren zunehmend effizienter gestaltet werden. Durch eine Überlebensanalyse aller ECMO-Patienten der Datenbank der Klinik für Tho-rax-, Herz- und Thorakale Gefäßchirurgie des Universitätsklinikums Würzburg zwischen 2015 und 2018 (172 Fälle) sollten unabhängige Risikofaktoren für ein negatives Outcome der Therapie identifiziert werden. Insbesondere den Laborparametern während der ersten 72 Stunden am System galt hierbei ein besonderes Augenmerk, aber auch Vorerkrankun-gen, Komplikationen, Substitutionen während der Therapie und weitere Parameter wurden für jeden Patienten individuell ermittelt und tabellarisch festgehalten. Insgesamt verstarben davon 125 Patienten (72,7%), 47 Patienten (27,3%) überlebten und konnten entlassen werden. Bei 24 der 125 verstorbenen Patienten (14%) konnte zwar ein Weaning vom System erfolgreich durchgeführt werden (>24h), sie verstarben jedoch während des anschließenden stationären Aufenthaltes. Bei den präinsertionell erhobenen Parametern waren der BMI und der Euroscore II bei verstorbenen Patienten signifikant höher, ebenso wie die Cross-Clamp-Zeit und der SO-FA-Score. Für die Laborwerte an ECMO ergaben sich für den Serumlaktatspiegel und die Throm-bozytenanzahl der Patienten die signifikantesten Unterschiede. Auch andere Laborparame-ter erwiesen sich in beiden Gruppen als signifikant unterschiedlich: Insbesondere der Quick Wert der überlebenden Patienten war zu Beginn signifikant höher. Auch der Fibri-nogenspiegel der Gruppe der überlebenden Patienten lag ab der 12 Stunden Marke signi-fikant höher. Verstorbene Patienten erhielten mehr Blutpräparate als Überlebende. Außerdem führte ein dialysepflichtiges Nierenversagen im Laufe der Therapie zu signifikant schlechterem Out-come. Wider Erwarten waren während der Therapie auftretende Blutungskomplikationen nicht mit schlechterem Outcome assoziiert. Jedoch konnte bei Auftritt von Thromben im Sys-tem, die einen Austausch des Oxygenators/ECMO-Systems nötig machten, sowie Magen-Darm-Ischämien und Kompartmentsyndrom ein klarer Überlebensnachteil erfasst werden. Abschließend ließ sich mittels multivariater logistischer Regression zeigen, dass der SO-FA-Score, der Serumlaktatspiegel und die Thrombozytenanzahl sowie eine adjuvante I-ABP Implantation und der Bedarf einer Nierenersatztherapie den größten Einfluss auf das Überleben der Patienten hatten. / Extracorporeal Life Support is a well established therapy for high risk patients with heart and/or lung failure. Although ECMO has increased a lot in number of cases, as well as in centres worldwide within the past few years, mortality still remains high. The aim was to identify risk factors which led to a negative outcome on ECMO. This retro-perspective study includes all patients from 01.01.2015 - 31.12.2018 that received va-ECMO support after cardiac surgery at the "Heart and thoracal surgery centre" (HTC) of the University-hospital in Würzburg (UKW). Out of those 172 patients, 47 patients (27,3%) survived and 125 patients (72,7%) died during the therapy. Regarding all parameters before ECMO-Insertion, high Body-Mass-Index (BMI), long "Cross-Clamp" time of the aorta during the operation (X-Clamp), as well as high SOFA-Score and high Euroscore II, were associated with significant higher mortality. SOFA-Score, in comparison with Euroscore II, turned out to be more reliable, concerning outcome prediction. During the first 72 hours on ECMO, non-survivors had significant higher lactate-levels and lower platelet count than survivers. Additional usage of intraaortic balloon pump (IABP) was associated with better survival, whereas renal failure leading to dialysis was mostly identified among non-survivors. "Bleeding" was the most frequently occuring complication, even though it didn't have any impact on the patient's outcome. Non-survivors showed overall more clotting events, especially in the oxygentor and the extracorporeal system itself and needed significant more substitution of blood preserves than patients that survived the therapy.

The goal of this study was to examine differential effects of amount and pattern of prenatal alcohol exposure on child outcome. Alcohol use was assessed at each prenatal visit, and IQ and behavior were measured at age 7 years. After control for confounders, the amount of exposure was unrelated to IQ score and behavior for >500 black 7-year-old children. However, children who were exposed to binge drinking were 1.7 times more likely to have IQ scores in the mentally retarded range and 2.5 times more likely to have clinically significant levels of delinquent behavior. During prenatal care, clinicians should attend not only to amount but also to the pattern of alcohol intake, because of the elevated risk for cognitive deficits and long-term behavioral abnormality.

The present study investigated the relationship between mothers', fathers', and parents' employment stability and five child cognitive and social outcome measures. A total of 179 children who attended Head Start between 1991 and 1995 participated in the study with their parents. Child outcomes were examined to determine if they varied as a function of employment stability categories. Children of parents possessing stable employment histories had significantly higher Woodcock-Johnson broad knowledge cluster scores than children of parents possessing unstable employment histories. Child outcomes generally did not vary as a function of employment stability categories. Number of employment changes was used to predict child outcomes after controlling moderating variables. Number of changes in mothers' and parents' employment accounted for statistically significant amounts of Woodcock- Johnson broad knowledge cluster score variance. Number of employment changes was generally a poor predictor of child outcomes.

Leaders in the field of home visiting and family support research have indicated that the inclusion of home visiting in comprehensive services for low-income families with young children can play a key role in improving a wide variety of outcomes for at-risk children and their families. These recommendations have been based in part on selected empirical findings from the home visiting literature. However, synthesis of empirical findings has proven difficult, due to the heterogeneity of this population and the diverse applications of home visiting as a service delivery strategy. The present meta-analysis examined a representative sample of the peer-reviewed literature to provide a comprehensive, quantified description of the features and findings of this literature. The four research questions addressed by the meta-analysis provide a framework for this description. The first research question concerned a description of research designs and methodological features found in the literature. The second and third research questions concerned, respectively, descriptions of the samples and interventions employed in primary studies. The final research question concerned the examination of those domains in which primary studies measured outcomes, and the quantification of outcomes in terms of standardized mean difference effect sizes. Summarization of primary studies' methodological features illustrated specific issues that may be addressed in the design of future home visiting research, and laid a basis for the examination of meta-analysis findings. The composition of primary studies' samples reflected the heterogeneity expected from a population defined by a parameter as broad as "low-income," yet included lacunae that may represent subgroups among the poor that are not being studied. Data providing an assessment of several types of intervention features have implications for questions of treatment efficacy, and for future home visiting research. Mean effect sizes in several domains were found to have a magnitude of practical significance for child and family outcomes. Findings of this project provide a structure for continued meta-analysis of this body of literature, and highlight potential areas for further primary research. Meta-analysis data lend support to previous recommendations, as well as point out gaps in our knowledge.

Thesis (M.M. (Security))--University of the Witwatersrand, Faculty of Commerce, Law and Management, Graduate School of Business Administration, 2013. / The first key to wisdom is this - constant and frequent questioning, for by doubting, we are led to question and by questioning we arrive at the truth (Pierre Peter Aberlard). lll The purpose of this study is, to investigate possible contributory factors to poor learner1 performance at the School of Military Justice (SoMJ) on Advanced Military Law Course, the trend that was noticed after the implementation of Outcome-Based Education (OBE) in 2009. The determination of the nature of challenges that might contribute negatively to learner performance at SoMJ will be concluded. My hypothesis is that since the accreditation of SoMJ as a service provider and implementation of OBE, a trend of poor learner performance has been noticed. This might impact negatively on the South African National Defence Force (SANDF) and ultimately poor performance at the workplace. A qualitative method was used, the reason being qualitative method will describe social reality from the point of vlew of participants within the system studied as well as supported by the relevant data collected. A qualitative phenomenological method to prove the hypothesis of this study was conducted. One-on-one semi-structured interviews corroborated by analysis of document relevant to the research questions and the concept of study was used. The study explored the perceptions and experiences of twenty seven volunteer learners who attended the Advanced Military Law Course during 2010, 2011, 2012, the specialists from the management group and facilitators in terms of the research questions. As demonstrated by data collection and data analysis processes, five themes emerged, namely global view of changing approaches to education, South African view of changing education approaches, Military Education, traditional learning versus OBE and contributory factors to learner performance (adult learning) .The findings of the study revealed that there is actually a high rate of incompetence after the first assessment attempt. A lot of factors that might contribute to poor learner performance were identified and investigated. Recommendations based on the findings of the study will guide the Defence Legal Services Division (DLSD) on measures to improve the current learner performance at SoMJ.

Prior research in individual therapy has provided evidence that therapists are poor predictors of client outcome without the aid of objective measures and often misjudge clients' perceptions of the therapeutic relationship. The focus of the current research was to conduct a similar study in a group setting. Therapists from a university counseling center and a state psychiatric hospital were recruited to test their accuracy in predicting client outcome, quality of therapeutic relationship and their own use of empirically supported group interventions. Results indicated that therapists are poor predictors of all three, providing support for the implementation of measure-based feedback systems to inform therapists about key information that may affect the effectiveness of group psychotherapy.

Reliability of self-report outcome assessment is often called into question with the severely mentally ill population. In the context of inpatient care, demand characteristics may further complicate self-report measures. Although clinician-completed outcome measures, such as the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E), have become industry standard with this population, self-report assessment may be useful under certain conditions. This study sought to explore the relationship between a clinician-completed, the BPRS-E, and a self-completed measure, the SOQ, within the SMI inpatient population. A total of 357 adult participants with a minimum of three assessment iterations were analyzed. The results of the analysis indicated both measures correlated at all assessment iterations (admission, 90-, 180-, 270-, 360+ days), but when divided into SOQ admission clinical and subclinical groups only the clinical group maintained the correlation at all points. A logistical regression analysis indicated that membership in the subclinical group can be predicted by one subscale (Mood Disturbance) and three items (Hallucinations, Uncooperativeness, and Conceptual Disorganization) from the BPRS-E. The change trajectories of both measures were essentially identical; however, when divided into SOQ admission clinical and subclinical scores the SOQ and BPRS-E change trajectories were significantly different from each other and clinical versus subclinical on the same measure were significantly different. Further examination of the subclinical SOQ group revealed two distinct groups, scores that eventually had reliable change and exceeded the cutoff score and those that never did. A logistical regression analyses revealed that membership in these two groups can be reliably predicted by two BPRS-E items (Somatic Concerns and Suspiciousness), in that as each item increases the likelihood of membership in the group that never exceeds the cutoff score also increases. These results suggest that although the SMI inpatient population present with profound limitations, it may be possible to predict those who will eventually provide reliable self-report outcome assessments and those who will not. Although further research is necessary, these results are promising and may provide decision points for clinicians on when and when not to trust self-report outcome assessment with the SMI inpatient population.

The purpose of this project was to summarize psychotherapy outcomes for eating disorders using meta-analysis. Psychotherapy was defined as any psychosocial treatment including face-to-face therapy, self-help, and Internet approaches. All primary studies, meeting inclusion/exclusion criteria from 1980 to 2010, were included. Results suggested that individuals treated with active treatments demonstrate better outcomes than those in control conditions (d= 0.33, p <.01, 95% CI [0.19-0.46]). CBT was the most often occurring treatment in the primary studies and a small effect, favoring CBT, was found when the treatment was compared to all other active treatments (d = 0.16, p = .02, 95% CI [0.03-0.28]). Internet and self-help approaches continue to show promise with Internet treatments demonstrating superior outcomes to control conditions (d = 0.54, p <.01, 95% CI [0.19-0.90]). More research is needed to determine whether these approaches can suffice as stand-alone treatments or if they are best used in addition to already well-established approaches (i.e., individual CBT). The meta-analysis also explored whether treatment type, outcome measure, diagnosis, attrition, and diagnostic severity moderate treatment effect. Finally, the meta-analysis updated and improved upon previous meta-analyses by focusing on randomized controlled trials, including all diagnoses of eating disorder, only combining effect sizes from similar conditions, including all possible studies that meet inclusion criteria, computing and comparing effect sizes for outcome measures beyond those considered primary to eating disorder treatment, and also addressing outcomes for all brands of psychotherapy including traditional talk therapy, self-help, and Internet approaches.

OBJECTIVE: Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. There is a paucity of studies addressing factors associated with diverticular re-bleeding, especially in the United States. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital. METHODS: We conducted a retrospective case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis in the same period. We collected data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in the hospital, and re-bleeding rate within 2 years of the first bleeding episode. RESULTS: Factors such as cerebrovascular accident (p=0.009), coronary artery disease (p=0.037), diabetes mellitus (p=0.046), obstructive sleep apnea (p=0.033), NSAIDs (p=0.038), use of anti-thrombotics (p=0.001), anticoagulants (p=0.002) or calcium channel blockers (p=0.009), and bilateral diverticulosis (p=0.001) were significantly associated with diverticular bleeding as compared to diverticulitis. Recurrence of bleeding was noted in 26 out of 93 patients (28%) within 2 years of the first bleeding episode (p=0.001). Bilateral colonic involvement, anticoagulants, and elderly age (≥65 years) were found to have a closer relationship to diverticular re-bleeding, although it was not statistically significant. CONCLUSION: This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, the use of anti-thrombotics, anticoagulants or calcium channel blockers, and obstructive sleep apnea are factors that are significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age, and anticoagulants have a closer relationship to diverticular re-bleeding. More prospective studies in patients with diverticular bleeding should be conducted to shed light on the causality of these factors and the prevalence of diverticulitis.

This study examines how substance-abusing women and their partners perceive their relationship and how these perceptions are related to women's treatment completion. The participant pool came from a larger study comparing the effects of adding couples therapy to traditional substance abuse treatment. All couples were in a committed relationship of at least six months duration. The sample was 166 mostly white and lower income women and their partners. The primary drugs of choice were opiates, alcohol, and cocaine. Relationship perceptions were assessed prior to treatment by using the Kansas Marital Satisfaction Scale, the Dyadic Formation Inventory, and the Family Assessment Device. These scales all measure relationship quality as perceived by the subjects. Perceptions of the women with substance abuse problems who completed treatment did not differ significantly from those who dropped out. The partners' perceptions did differ significantly. Partners of women who dropped out reported more couple commitment and more couple interaction as measured by the DFI, and higher overall general functioning, as measured by the FAD, than the partners of those who completed. These findings suggest the importance of partners' involvement in, and support for, the woman's drug treatment. / Master of Science