A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Challenging the Logics of Reformism and Humanism in Juvenile Justice Rhetoric

This article draws on contemporary policy discourse in order to advance claims about the intractable figure of the “bad” child in contemporary juvenile justice reforms in the United States (US). The article focuses in particular on the discourses of trauma and “brain science” to point to a form of neo-positivism that has arguably emerged and which challenges efforts to engage in systematic decarceration. The article also focuses on the idea of the “bad child” that persists in the commitment of some reformers to the necessity of confinement for some children. The article questions the extent to which new forms of positivism challenge our ability to leverage structural claims

Proceedings of the National Security Affairs Conference, July 17-19, 1978, National Defense University : equivalence, sufficiency, and the international balance /

Cover title: Equivalence, sufficiency, and the international balance.Includes bibliographical references.Mode of access: Internet

The extent of restrictions on the service of active-component military women /

Despite a historical increase in the role of women in the U.S. military, including in operations in Iraq and Afghanistan, gender-based policies continue to affect the positions they can fill. The National Defense Authorization Act for Fiscal Year 2011 mandated a review of laws, policies, and regulations that may restrict the service of military women to determine whether changes are needed to ensure equitable opportunity to compete and excel in the armed forces; in response, the U.S. Department of Defense established the Women in the Services Review. To support this effort, RAND researchers analyzed service data to describe and quantify the military occupations that are closed to women, as well as occupations that are open but have some positions that are closed to women. The study also examined a few of the open occupations in greater depth to further characterize the nature of the restrictions and to illuminate the potential career implications of assignment policies. Most positions that are closed to women are located in Army and Marine Corps units and occupations that have a primary mission of engaging in direct ground combat.Despite a historical increase in the role of women in the U.S. military, including in operations in Iraq and Afghanistan, gender-based policies continue to affect the positions they can fill. The National Defense Authorization Act for Fiscal Year 2011 mandated a review of laws, policies, and regulations that may restrict the service of military women to determine whether changes are needed to ensure equitable opportunity to compete and excel in the armed forces; in response, the U.S. Department of Defense established the Women in the Services Review. To support this effort, RAND researchers analyzed service data to describe and quantify the military occupations that are closed to women, as well as occupations that are open but have some positions that are closed to women. The study also examined a few of the open occupations in greater depth to further characterize the nature of the restrictions and to illuminate the potential career implications of assignment policies. Most positions that are closed to women are located in Army and Marine Corps units and occupations that have a primary mission of engaging in direct ground combat.Includes bibliographical references (pages 121-126).Introduction -- Terms, data, and methods -- Overview of results -- Air Force positions closed to women -- Army positions closed to women -- Marine Corps positions closed to women -- Navy positions closed to women -- Conclusions and recommendations.Online resource; title from PDF title page (RAND, viewed on May 22, 2012).JSTO

Dilemmas of intervention : social science for stabilization and reconstruction /

Governments intervening in post-conflict states find themselves beset with numerous challenges and profound dilemmas: it is often unclear how best to proceed because measures that may improve conditions in one respect may undermine them in another. This volume reviews and integrates the scholarly social-science literature relevant to stabilization and reconstruction (S & R), with the goal of informing strategic planning at the whole-of-government level. The authors assert that S & R success depends on success in each of four component domains -- political, social, security, and economic. The authors discuss each domain separately but emphasize their interactions and the idea that the failure of any component can doom S & R as a whole. The authors also focus on a number of dilemmas that intervenors in post-conflict states face -- such as between short- and long-term goals and whether to work through or around the state's central government -- and suggest how these dilemmas can be confronted depending on context."Prepared for the Office of the Secretary of Defense.""National Defense Research Institute."Governments intervening in post-conflict states find themselves beset with numerous challenges and profound dilemmas: it is often unclear how best to proceed because measures that may improve conditions in one respect may undermine them in another. This volume reviews and integrates the scholarly social-science literature relevant to stabilization and reconstruction (S & R), with the goal of informing strategic planning at the whole-of-government level. The authors assert that S & R success depends on success in each of four component domains -- political, social, security, and economic. The authors discuss each domain separately but emphasize their interactions and the idea that the failure of any component can doom S & R as a whole. The authors also focus on a number of dilemmas that intervenors in post-conflict states face -- such as between short- and long-term goals and whether to work through or around the state's central government -- and suggest how these dilemmas can be confronted depending on context.Includes bibliographical references.Introduction / Paul K. Davis -- Establishing security / Christopher S. Chivvis and Paul K. Davis -- Establishing favorable political conditions / Julie E. Taylor -- Political dilemmas of stabilization and reconstruction / Stephen Watts -- Establishing social conditions of trust and cooperation / Elizabeth Wilke, Paul K. Davis, and Christopher S. Chivvis -- Dilemmas of foreign aid in post-conflict areas / Claude Berrebi and Veronique Thelen -- Final observations / Paul K. Davis.Online resource; title from PDF title page (RAND, viewed on October 12, 2011).JSTO

EU civilian crisis management : the record so far /

"The European Union has been deploying civilians in conflict and postconflict stabilization missions since 2003, and the scope of civilian missions is likely to increase in the future. This volume offers a general overview and assessment of the EU's civilian operations to date, as well as a more in-depth look at the two missions in which the EU has worked alongside NATO: the EU police-training mission in Afghanistan and the integrated rule of law mission in Kosovo. The author concludes with a discussion of the main policy implications for the United States and Europe."--Rand web site.Includes bibliographical references (pages 49-52)."The European Union has been deploying civilians in conflict and postconflict stabilization missions since 2003, and the scope of civilian missions is likely to increase in the future. This volume offers a general overview and assessment of the EU's civilian operations to date, as well as a more in-depth look at the two missions in which the EU has worked alongside NATO: the EU police-training mission in Afghanistan and the integrated rule of law mission in Kosovo. The author concludes with a discussion of the main policy implications for the United States and Europe."--Rand web site.Prepared for the Office of the Secretary of DefenseIntroduction -- The European Union's civilian military capabilities -- EUPOL Afghanistan -- EULEX Kosovo -- Conclusions.Print version record.Electronic reproduction.Master and use copy. Digital master created according to Benchmark for Faithful Digital Reproductions of Monographs and Serials, Version 1. Digital Library Federation, December 2002.digitizedJSTO