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Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

Using data from the Survey of Income and Program Participation (SIPP) matched to administrative records, we examine mortality risk and participation in the Disability Insurance (DI) and Supplemental Security Income (SSI) disability programs from a long-term perspective. Over a period of 14 years, we analyze the effect of self-reported health and disability on the probability of death and disability program entry among individuals aged 18–48 in 1984. We also assess DI and SSI programs from a life-cycle perspective. Self-reported poor health and severe disability at baseline are strongly correlated with death over the 14-year follow-up period. These variables also are strong predictors of disability program participation over the follow-up period among non-participants at baseline or before, with increasing marginal probabilities in the out-years. Our cross-sectional models are consistent with recent studies that find that the work-prevented measure is useful in modeling DI entry. However, once self-reported health and functional limitations are accounted for, the longitudinal entry models provide conflicting DI results for the work-prevented measure, suggesting that, contrary to claims based on cross-sectional or short-time horizon application models, the work-prevented measure is an unreliable indicator of severity. The risk of SSI and DI participation is significantly greater for individuals who die, suggesting that future mortality captures the effect of case severity and deterioration of health during the follow-up period. From a life-cycle perspective, a substantially greater proportion of individuals participate in SSI or DI at some point in their lives compared to typical cross-sectional estimates of participation, especially among minorities, people with less than a high school education, and those with early onset of poor health and/or disabilities. Cross-sectional estimates for the Social Security area population indicate SSI and DI participation rates of no more than 5% combined in 2000. In contrast, for individuals aged 43–48 in 1984, we observe a cumulative lifetime SSI and/or DI participation rate of 14%. The corresponding figure is 32% for individuals in that age group who did not graduate from high school, suggesting the need for human capital investments and/or improved work incentives.

In recent years, a wide range of psychosocial health interventions have been implemented among military service members and their families. However, there are questions over the evaluative rigor of these interventions. We conducted a systematic review of this literature, rating each relevant study (k = 111) on five evaluative rigor scales (type of control group, approach to participant assignment, outcome quality, number of measurement time points, and follow-up distality). The most frequently coded values on three of the five scales (control group type, participant assignment, and follow-up distality) were those indicating the lowest level of operationally defined rigor. Logistic regression results indicate that the evaluative rigor of intervention studies has largely remained consistent over time, with exceptions indicating that rigor has decreased. Analyses among seven military sub-populations indicate that interventions conducted among soldiers completing basic training, soldiers returning from combat deployment, and combat veterans have had, on average, the greatest evaluative rigor. However, variability in mean scores across evaluative rigor scales within sub-populations highlights the unique methodological hurdles common to different military settings. Recommendations for better standardizing the intervention evaluation process are discussed.

Florida Partners in Education and Research for Kindergarten Success (PERKS) was an effective, large-scale professional development initiative to move Florida's early childhood workforce toward increased education and improved practices. This 7-month professional development intervention succeeded in increasing teacher knowledge, enhancing quality of the classroom literacy environment, and notably improving language development of children in high-need communities. These changes were generally sustained as seen in positive ratings of the classroom literacy environment a year later and children's maintenance of learning across the summer months prior to kindergarten entry. In addition, Florida PERKS provided preliminary answers regarding intensity of technical assistance needed to create positive change. Technical assistance delivered onsite was best, with no notable advantage found for weekly over monthly visits. To fully sustain change, however, may require continued support of teachers beyond a single school year when working with teachers who lack college degrees.

Employment has been identified as a significant goal for many homeless persons with mental illness. However, treatment plans for this population typically focus on housing and mental health needs, and neglect to assess individuals’ desires and abilities to achieve and maintain paid employment. This chapter describes the work experiences of the Chicago cohort of the Access to Community Care and Effective Services and Supports (ACCESS) project.

Social sustainability is of increasing importance in societal development, which will affect the implementation of construction projects. The social responsibilities for both construction clients and suppliers will be an increasingly relevant part of their business processes. The objective of this study is to evaluate how the procurement process functions today with respect to social considerations.

The empirical data is based on interviews with procurement officials for each studied contract, together with official guidelines concerning social considerations and tender documents for each studied contract. Furthermore, the interviews addressed the level of knowledge that exists with procurement officials concerning social considerations in the procurement of road and railroad projects.

The results showed that there was a positive attitude towards social considerations in the procurement process and that there is a need in the construction sector to consider social issues to a higher degree.

This study is based on six road and five railroad contracts within the Swedish Transport Administration as the client organization.

It was evident that the level of knowledge with individual procurement officials concerning social issues is relatively low and needs to be increased. There is a perception that the management social considerations in construction procurement need to be clarified.

Further research is needed to develop procedures, guidelines, routines and strategies for social considerations in procurement. Another important issue for further research is the development of routines to follow up social terms of contract during the implementation of the project.

In the International Classification of Functioning, Disability and Health (ICF) 2001, the World Health Organization (WHO) defines disability as: ‘an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors)’, with environmental factors including assistance from other people, from equipment and from formal sources. WHO previously defined disability, in the context of health experience, as “any restriction or lack (resulting from impairment) of ability to perform an action in the manner or within the range considered normal for a human being” (World Health Organization, 1980, p. 28).

The global financial crisis has magnified the role of Financial Sector Surveillance (FSS) in the International Monetary Fund's activities. This chapter surveys the various steps and initiatives through which the Fund has increasingly deepened its involvement in FSS. Overall, this process can be characterised by a preliminary stage and two main phases. The preliminary stage dates back to the 1980s and early 1990s, and was mainly related to the Fund's research and technical assistance activities within the process of monetary and financial deregulation embraced by several member countries. The first ‘official’ phase of the Fund's involvement in FSS started in the aftermath of the Mexican crisis, and relates to the international call to include financial sector issues among the core areas of Fund surveillance. The second phase focuses on the objectives of bringing the coverage of financial sector issues ‘up-to-par’ with the coverage of other traditional core areas of surveillance, and of integrating financial analysis into the Fund's analytical macroeconomic framework. By urging the Fund to give greater attention to its member countries' financial systems, the international community's response to the global crisis may mark the beginning of a new phase of FSS. The Fund's financial sector surveillance, particularly on advanced economies, is of paramount importance for emerging market and developing countries, as they are vulnerable to spillover effects from crises originated in advanced economies. Emerging market and developing economies, which constitute the majority of the Fund's 187 members, are currently the recipients of over 50 programmes of financial support from the Fund (including those of a precautionary nature), totalling over $250 billion.

Findings are presented from a cohort program between a university and local school districts to prepare special-education personnel. Participants (N=164), who were from 15 different cohorts, responded to an online survey. Follow-up face-to-face interviews were conducted with a representative sample of 29 participants. Perceived benefits included improved social-emotional and academic support; improved pedagogical skills, including academic and behavioral strategies, collaboration, and feeling more acculturated to the school climate; and improved logistical and financial supports. Implications for use of cohorts in the preparation of special-education personnel are discussed.