Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT).

BACKGROUND: Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies. METHODS: Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively. RESULTS: 2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51). CONCLUSION: The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.

OLIVER: an online library of images for veterinary education and research.

As part of a strategic move by the University of Sydney toward increased flexibility in learning, the Faculty of Veterinary Science undertook a number of developments involving Web-based teaching and assessment. OLIVER underpins them by providing a rich, durable repository for learning objects. To integrate Web-based learning, case studies, and didactic presentations for veterinary and animal science students, we established an online library of images and other learning objects for use by academics in the Faculties of Veterinary Science and Agriculture. The objectives of OLIVER were to maximize the use of the faculty's teaching resources by providing a stable archiving facility for graphic images and other multimedia learning objects that allows flexible and precise searching, integrating indexing standards, thesauri, pull-down lists of preferred terms, and linking of objects within cases. OLIVER offers a portable and expandable Web-based shell that facilitates ongoing storage of learning objects in a range of media. Learning objects can be downloaded in common, standardized formats so that they can be easily imported for use in a range of applications, including Microsoft PowerPoint, WebCT, and Microsoft Word. OLIVER now contains more than 9,000 images relating to many facets of veterinary science; these are annotated and supported by search engines that allow rapid access to both images and relevant information. The Web site is easily updated and adapted as required.