Objective. To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. Study Setting. Six hospitals and clinics and a liability insurer in Washington State. Study Design. Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed. Data Collection Methods. Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members. Principal Findings. Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust. Conclusions. Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions. Key Words. Medical liability, malpractice, patient safety, communication, medical error Early adopters of communication-and-resolution programs (CRPs), in which health care organizations communicate with patients about adverse events and their causes, use investigation findings to improve patient safety, and they proactively offer compensation where substandard care caused harm, have
We studied the contribution of phasic left atrial (LA) function to left ventricular (LV) filling during exercise. We hypothesized that reduced LV filling time at moderate-intensity exercise limits LA passive emptying and increases LA active emptying. Twenty endurance-trained males (55 ± 6 yr) were studied at rest and during light- (∼100 beats/min) and moderate-intensity (∼130 beats/min) exercise. Two-dimensional and Doppler echocardiography were used to assess phasic volumes and diastolic function. LV end-diastolic volume increased from rest to light exercise (54 ± 6 to 58 ± 5 ml/m(2), P < 0.01) and from light to moderate exercise (58 ± 5 to 62 ± 6 ml/m(2), P < 0.01). LA maximal volume increased from rest to light exercise (26 ± 4 to 30 ± 5 ml/m(2), P < 0.01) related to atrioventricular plane displacement (r = 0.55, P < 0.005), without further change at moderate exercise. LA passive emptying increased at light exercise (9 ± 2 to 13 ± 3 ml/m(2), P < 0.01) and then returned to baseline at moderate exercise, whereas LA active emptying increased appreciably only at moderate exercise (6 ± 2 to 14 ± 3 ml/m(2), P < 0.01). Thus, the total atrial emptying volume did not increase beyond light exercise, and the increase in LV filling at moderate exercise could be attributed primarily to an increase in the conduit flow volume (19 ± 3 to 25 ± 5 ml/m(2), P < 0.01). LA filling increases during exercise in relation to augmented LV longitudinal contraction. Conduit flow increases progressively with exercise in athletes, although this is driven by LV properties rather than intrinsic LA function. The pump function of the LA augments only at moderate exercise due to a reduced diastolic filling time and the Frank-Starling mechanism.
This article reports on research into the experiences of people serving short sentences in prison. It is part of a larger qualitative study of experiences of punishment in the community and in prison (Armstrong and Weaver 2010; Weaver and Armstrong 2011). The location of the research was Scotland, where the use of prison for people who will not stay very long is a characteristic feature of sentencing practice -nearly threequarters of people sent to prison in Scotland in 2008/09 (the year before sentence reform legislation was passed) were sentenced to serve six months or less (Scottish Government 2010a). Although courts make frequent use of short prison sentences, this does not appear to be driven by evidence of their effectiveness. In Scotland, only about one-quarter of people released from a custodial sentence of six months or less manage to avoid reconviction within two years of being released (Scottish Government 2010b).Since the 19th Century, courts have complained that short periods of detention offer too brief a time to work with and change an 'offender' and are more likely to provide schooling in crime than in law-abiding behaviour (Killias et al. 2010). These concerns resonate in the current reform bs_bs_banner
Imprisonment is the exemplary symbol of waiting, of being stuck in a space and for a time not of our choosing. This concept of waiting is perfectly represented by the image of the prison cell. In this paper, I contrast the cell with the less familiar imagery of the corridor, a space of prison that evokes and involves mobility. Through this juxtaposition, I aim to show that prisons are as much places of movement as stillness with associated implications for penal power and purpose. I argue that the incomplete imaginary of prison as a cell (and waiting as still) may operate as a necessary fiction that both sustains and undermines its legitimacy. By incorporating the corridor into the penal imaginary, key premises about how prisons do and should work, specifically by keeping prisoners busy, and how prison time flows and is experienced, are disrupted.
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