Priorities and Public Safety II: Adopting Effective Probation Practices

Outlines the structural problems of Massachusetts' corrections, the role of probation in public safety, best practices in community supervision in other states, and the elements of an evidence-based probation system, including inter-agency collaboration

Alcohol management plans and related alcohol reforms

Abstract Indigenous Justice Clearinghouse Research Brief 16 provides an analysis of Alcohol Management Plans (AMPs); a relatively new instrument joining the extensive range of regulations relating to alcohol supply and consumption. AMPs vary in design and implementation across Australia, and include strategies designed to reduce harms resulting from alcohol misuse. The authors chart the background and development of these instruments in Australia, as well as providing a comparison to international alcohol supply and control reforms. The authors find that evaluations in the public domain are limited. These evaluations appear to indicate that where AMPs are locally driven and owned, there are stronger and more sustainable outcomes. There is a good evidence base for the individual components that make up an AMP. Success has been achieved through alcohol restrictions, and both harm and demand reduction strategies have an evidence base as targeted interventions. The authors conclude that as more AMPs are implemented across Australia, there is a greater need for further research to better understand the process of implementation and how communities can work together with governments to design, implement and evaluate AMPs

The Contribution Of Outer HI Disks To The Merging Binary Black Hole Population

We investigate the contribution of outer HI disks to the observable population of merging black hole binaries. Like dwarf galaxies, the outer HI disks of spirals have low star formation rates and lower metallicities than the inner disks of spirals. Since low-metallicity star formation can produce more detectable compact binaries than typical star formation, the environments in the outskirts of spiral galaxies may be conducive to producing a rich population of massive binary black holes. We consider here both detailed controlled simulations of spirals and cosmological simulations, as well as the current range of observed values for metallicity and star formation in outer disks. We find that outer HI disks contribute at least as much as dwarf galaxies do to the observed LIGO/Virgo detection rates. Identifying the host galaxies of merging massive black holes should provide constraints on cosmological parameters and insights into the formation channels of binary mergers.Comment: accepted to ApJL, 5 pages, 2 figure

Cumulo: A Dataset for Learning Cloud Classes

One of the greatest sources of uncertainty in future climate projections comes from limitations in modelling clouds and in understanding how different cloud types interact with the climate system. A key first step in reducing this uncertainty is to accurately classify cloud types at high spatial and temporal resolution. In this paper, we introduce Cumulo, a benchmark dataset for training and evaluating global cloud classification models. It consists of one year of 1km resolution MODIS hyperspectral imagery merged with pixel-width 'tracks' of CloudSat cloud labels. Bringing these complementary datasets together is a crucial first step, enabling the Machine-Learning community to develop innovative new techniques which could greatly benefit the Climate community. To showcase Cumulo, we provide baseline performance analysis using an invertible flow generative model (IResNet), which further allows us to discover new sub-classes for a given cloud class by exploring the latent space. To compare methods, we introduce a set of evaluation criteria, to identify models that are not only accurate, but also physically-realistic. CUMULO can be download from https://www.dropbox.com/sh/6gca7f0mb3b0ikz/AADq2lk4u7k961Qa31FwIDEpa?dl=0

Which features of primary care affect unscheduled secondary care use?:A systematic review

OBJECTIVES: To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. SETTING: Observational studies at primary care practice level. PARTICIPANTS: Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. RESULTS: 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. CONCLUSIONS: The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions

Законодательные барьеры для многоцелевого лесопользования

© 2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). Background/objectives There are some older patients who are at the decision margin' of admission. This systematic review sought to explore this issue with the following objective: What admission alternatives are there for older patients and are they safe, effective and cost-effective? A secondary objective was to identify the characteristics of those older patients for whom the decision to admit to hospital may be unclear. Design Systematic review of controlled studies (April 2005-December 2016) with searches in Medline, Embase, Cinahl and CENTRAL databases. The protocol is registered at PROSPERO (CRD42015020371). Studies were assessed using Cochrane risk of bias criteria, and relevant reviews were assessed with the AMSTAR tool. The results are presented narratively and discussed. Setting Primary and secondary healthcare interface. Participants People aged over 65 years at risk of an unplanned admission. Interventions Any community-based intervention offered as an alternative to admission to an acute hospital. Primary and secondary outcomes measures Reduction in secondary care use, patient-related outcomes, safety and costs. Results Nineteen studies and seven systematic reviews were identified. These recruited patients with both specific conditions and mixed chronic and acute conditions. The interventions involved paramedic/emergency care practitioners (n=3), emergency department-based interventions (n=3), community hospitals (n=2) and hospital-at-home services (n=11). Data suggest that alternatives to admission appear safe with potential to reduce secondary care use and length of time receiving care. There is a lack of patient-related outcomes and cost data. The important features of older patients for whom the decision to admit is uncertain are: Age over 75 years, comorbidities/multi-morbidities, dementia, home situation, social support and individual coping abilities. Conclusions This systematic review describes and assesses evidence on alternatives to acute care for older patients and shows that many of the options available are safe and appear to reduce resource use. However, cost analyses and patient preference data are lacking

Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice

Objectives: To describe how processes of primary care access influence decisions to seek help at the emergency department (ED).Design: Ethnographic case study combining non-participant observation, informal and formal interviewing.Setting: Six general practitioner (GP) practices located in three commissioning organisations in England.Participants and methods: Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29).Results: Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like ‘urgent’ and ‘emergency’ was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use.Conclusions: This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups

Single center experience on dosing and adverse events of recombinant factor seven use for bleeding after congenital heart surgery

There are limited data on the relationship between the administered dose of recombinant factor seven (rFVIIa) and the development of adverse clinical outcomes after congenital heart surgery. This single institution case series reports on dosing, adverse events, and blood product usage after the administration of rFVIIa in the congenital heart surgery patient population. A retrospective review identified 16 consecutive pediatric patients at an academic, free-standing, children’s hospital who received rFVIIa to curtail bleeding following congenital heart surgery between April 2004 and June 2012. Patients were assessed for survival to hospital discharge versus in-hospital mortality and the presence or absence of a major neurological event during inpatient hospitalization. The median age at surgery was 6.8 months (range: 3 days–42 years). Seven patients (44%) survived to hospital discharge and nine patients (56%) died. The cause of mortality included major neurological events (44%), uncontrolled bleeding (33%), and sepsis (23%). Eight patients (50%) required extracorporeal membrane oxygenation support following congenital heart surgery. The median cumulative rFVIIa dose administered was 97 mcg/kg, and the median cumulative amount of blood products administered was 452 ml/kg. In conclusion, this case series underscores the need to prospectively evaluate the effect that rFVIIa has on patient survival and the incidence of adverse events, including thrombotic and major neurological events, in congenital heart surgery patients. Ideally, a randomized, multicenter study would provide the sufficient numbers of patients and events to test these relationships