FBI Remedial Measures Produce ~98% Query Compliance Rate

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Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study

BACKGROUND: Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge. METHODS: Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD. RESULTS: Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0–13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases. CONCLUSION: Technology-dependency is common among children discharged from a children's hospital

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

Disrupting colonial discourses in the Geography curriculum during the introduction of British Values policy in schools

The main purpose of this article is to expose and disrupt discourses dominating global development in an English school geography textbook chapter. The study was prompted by a teacher’s encounter with cultural difference in a geography lesson in South Korea. I investigate the issues raised through the lens of a new curriculum policy in English schools called ‘Promoting Fundamental British Values’ which forms part of England’s education-securitisation agenda, a topic of international attention. Following contextualisation across research fields and in recent curriculum and assessment policy reform, I bring together theoretical perspectives from curriculum studies and Continental philosophy that do not usually speak to each other, to construct a new analytical approach. I identify three key themes, each informed by colonial logic: ‘development’, ‘numerical indicators’ and ‘learning to divide the world’. The inquiry appears to expose a tension between the knowledge of the textbook chapter and the purported aims of the British Values curriculum policy, but further investigation reveals the two to be connected through common colonial values. The findings are relevant to teachers, publishers, textbook authors, policy makers and curriculum researchers. I recommend a refreshed curriculum agenda with the politics of knowledge and ethical global relations at its centre

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

Background: Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay. Objectives: To (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay. Design: A mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4). Setting: All three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England. Participants: Information was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4). Results: Approximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain. Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group. Limitations: We did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients. Conclusions: The number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain. Future work: To compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients. Study registration: The National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376. Funding: The NIHR Health Services and Delivery Research programm

Mitigating humanitarian crises during non-international armed conflicts:the role of human rights and ceasefire agreements

Situations of humanitarian crisis are often caused by armed conflicts. Given the prevalence of non-international armed conflicts today, ways of ameliorating these situations are at the forefront of concerns. The international humanitarian law rules governing non-international armed conflict remain much less developed than those for international armed conflicts. This is exacerbated by the lack of direct human rights obligations for non-state armed groups, which makes governing the behaviour of non-state parties to non-international armed conflicts (non-state armed groups) even more challenging. Although several initiatives have been taken to encourage non-state actors to mitigate situations of humanitarian crisis, the role of human rights law is in need of further clarification. The paper aims to assess what role human rights may have in improving humanitarian crises, suggesting one specific way: The paper will first discuss the international laws applicable to situations of non-international armed conflict, before critically analysing some of the initiatives that have already been taken to govern the behaviour of non-state armed groups. Part 3 will assess the possibility of using cease-fire agreements to impose specific human rights obligations on all parties to a non-international armed conflict. Finally, a conclusion will be drawn in Part 4 as to the role that human rights and ceasefire agreements could have during humanitarian crises