Reducing Observation Unit Length of Stay Hours: A Quality Improvement Project

An acute care observation unit provides care for patients admitted via Emergency Center (EC) or direct admission from a healthcare provider’s office who do not yet require inpatient status. The goal length of stay (LOS) for these patients should be less than or equal to 24-48 hours. This project is being developed for a 22-bed observation unit in the Southeastern United States to decrease current LOS hours. Currently, the goal LOS for this unit is 24 hours, not to exceed 48 hours, and for patients admitted with a chest pain diagnosis, no longer than 19 hours. A plan to expand current exclusion criteria will involve excluding the geriatric population over 80 years of age and patients with post-hospitalization placement issues from observation status. Expanded exclusion criteria will decrease LOS within the unit by increasing appropriate observation admissions. In addition, an after-hours discharge procedure will be implemented to allow for discharges after 1900 each day. This project will be conducted over a 6-month trial period. Post completion of the 6-week trial period, monthly LOS hours, revenue, and patient satisfaction scores will be compared to the previous year. It is hypothesized that by expanding exclusion criteria and implementing the after-hours discharge process, LOS hours will decrease, and patient satisfaction will increase

Teaching Data Carving Using The Real World Problem of Text Message Extraction From Unstructured Mobile Device Data Dumps

Data carving is a technique used in data recovery to isolate and extract files based on file content without any file system guidance. It is an important part of data recovery and digital forensics, but it is also useful in teaching computer science students about file structure and binary encoding of information especially within a digital forensics program. This work demonstrates how the authors teach data carving using a real world problem they encounter in digital forensics evidence processing involving the extracting of text messages from unstructured small device binary extractions. The authors have used this problem for instruction in digital forensics courses and in other computer science courses

Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions : an evidence map and realist synthesis

Background In 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice. Objectives To map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions. Methods For the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA). Results A total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights. Limitations The research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders. Conclusions Overall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services. Future work Research should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme

Recognition of risk and prevention in safeguarding of children and young people : a mapping review and component analysis of interventions aimed at health and social care professionals.

Background: The term ‘safeguarding’ refers to measures designed to protect health, wellbeing and human rights, allowing people (especially children, young people and vulnerable adults) to live without fear of abuse, harm or neglect. The Children Act 2004 placed a responsibility on key agencies, including those in health and social care, to have regard to the need to safeguard children and promote their welfare. Objectives: To address the question ‘What interventions are feasible/acceptable, effective and cost effective in: • improving health and social care practitioners' recognition of children or young people who are at risk of abuse? • improving recognition of co-occurring forms of abuse where relevant? • preventing abuse in these groups?‘ Data sources: Fourteen health and social care databases were searched from 2004 (date of Children Act) to October 2019. Methods: This mapping review included an extensive literature search, independent study selection, extraction of study data and quality assessment of study design features. The research was carried out in two stages. We systematically retrieved and coded UK research and policy documents to gain a contemporary picture of safeguarding issues and practice. We also identified systematic reviews or narrative reviews that reported safeguarding practice from other high-income countries. Studies were summarised using narrative synthesis in four pre-defined groupings. A further grouping of policy/guidance documents was added based on examination of the evidence retrieved. Results: The review included 179 papers (Strategies=15; Policy/Guidance=36; Cultural/Organisational=31; Initiatives=69 and Reviews=28). There were four empirical evaluations of strategies (‘what to do’) and 54 of initiatives (‘how to do it’). Most initiatives fell into three categories: training, service development and use of data. Promising initiatives included liaison nurses; assessment clinics; secondment; joint protocols; and a ‘hub and spoke’ model. Approaches using routinely collected data also appeared promising. However, the evidence base comprised mainly cross-sectional or before/after studies with no control group, providing little hard evidence of effectiveness. Barriers to effective implementation of safeguarding strategies were identified at all levels of the health and care system. Limitations: We used a number of methods to abbreviate the review process. Limitations of the evidence base included lack of long-term follow-up, control groups and data on service relevant outcomes. Conclusions: The UK and international literature documents increased awareness and activity in relation to safeguarding. A limited number of types of interventions have been reported and generally these lack rigorous evaluation. In particular, the user voice is muted in relation to experience of different interventions or services. Taken as a whole the topic of child safeguarding seems to be lacking a whole system approach which would facilitate a more joined-up approach. Future work: Future research questions centre on the need to balance multi-agency training and development initiatives with the specific needs of individual health and social care professional groups

Varying Instructional Approaches to Physical Extraction of Mobile Device Memory

Digital forensics is a multidisciplinary field encompassing both computer science and criminal justice. This action research compared demonstrated skill levels of university students enrolled in a semester course in small device forensics with 54 hours of instruction in mobile forensics with an emphasis on physical techniques such as JTAG and Chip-Off extraction against the skill levels of industry professionals who have completed an accelerated 40 hour advanced mobile forensics training covering much of the same material to include JTAG and Chip-Off extraction. Participant backgrounds were also examined to determine if those participants with a background in computer science had an advantage over participants with a criminal justice background. Study participants were volunteers ranging in age from 20 to over 60 and had a variety of backgrounds and prior work experience. Volunteers completed a timed trial comprised of four timed subtasks. Results were compared for both quality and speed in task. Qualitative, quantitative and observational data were gathered throughout the course of this study. Data gathered by this research study indicated that while students in the campus cohort were able to complete the subject trial within a 10% variance of those in the workshop cohort, the quality of the tasks completed was not within the 10% variance

The 7Q10 in South Carolina Water-Quality Regulation: Nearly Fifty Years Later

2010 S.C. Water Resources Conference - Science and Policy Challenges for a Sustainable Futur

Highlights of OH, H2SO4, and methane sulfonic acid measurements made aboard the NASA P-3B during Transport and Chemical Evolution over the Pacific

Measurements of hydroxyl radical (OH), sulfuric acid (H2SO4), and methane sulfonic acid (MSA) were performed aboard the NASA P-3B using the selected ion chemical ionization mass spectrometry technique during the Transport and Chemical Evolution over the Pacific (TRACE-P) study. Photochemical box model calculations of OH concentrations yielded generally good agreement with an overall tendency to overestimate the measured OH by ∼20%. Further analysis reveals that this overestimation is present only at altitudes greater than ∼1.5 km, with the model underestimating OH measurements at lower altitudes. Boundary layer H2SO4 measurements, performed in a volcanic plume off the southern coast of Japan, revealed some of the largest marine boundary layer H2SO4 concentrations ever observed and were accompanied by new particle formation. Nighttime measurements of OH, H2SO4, and MSA in the remote pacific off Midway Island revealed significant boundary layer concentrations of H2SO4 and MSA, indicating evidence of nighttime boundary layer oxidation processes but in the absence of OH. A cursory exploration of the sources of production of the H2SO4 and MSA observed at night is presented