The social climate of correctional (forensic) settings is likely to have a significant impact on the outcome of treatment and the overall functioning of these units. The Essen Climate Evaluation Schema (EssenCES) provides an objective way of measuring social climate that overcomes the content, length and psychometric limitations of other measures. But, the English translation of the EssenCES has yet to be sufficiently validated for use in forensic settings in the United Kingdom (UK). The current study presents psychometric properties (factor structure and internal consistency) and an examination of construct validity with the English EssenCES. Satisfactory internal consistency was found for all EssenCES scales and the expected three-factor structure was confirmed with both staff and residents and in prison and secure hospital settings using confirmatory factor analysis (CFA). Evidence to support construct validity was established using multi-level models, which showed statistically significant associations between scores on the EssenCES and scores on the Working Environment Scale (WES-10), institutional aggression, and site security. Future validation work and potential practical applications of the EssenCES are discussed.

Biomarker studies for early detection of acute kidney injury (AKI) have been limited by non-selective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), Interleukin-18 (IL-18), and Kidney Injury Moledule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category free net reclassification index improved with urine L-FABP [total net reclassification index for non-events 31.0%] and urine NGAL [total net reclassification index for events 33.3%]. However, only urine L-FABP significantly improved the integrated discriminative index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP providing independent and additive prognostic information when combined with clinical predictors.

These data support the feasibility of a larger trial where a sample of 72 (36 participants in each arm) would be required to confirm or refute these findings.

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