What are the experiences and perceptions of unplanned readmissions to hospital within 30 days of discharge from the perspective of older people and their families within an English NHS context?

Background: Older people continue to have a higher risk of unplanned readmission. The current landscape on unplanned readmissions is dominated by quantitative research exploring associations, patient characteristics and unplanned readmissions and little attention has been given to the experiences of older people and their families. There is a gap in understanding the patient perspective and viewing unplanned readmissions in a more holistic manner and a clinical need to further understand the patient and family experience of unplanned readmissions. Methodology and method: An interpretivist paradigm and constructivist approach were adopted. A collective case study informed by Stake (1995, 2006) was conducted. A case was defined as an adult aged 65 years or over and who has had an unplanned readmission to the study site hospital Trust within 30 days of discharge. Each case was viewed from the perspective of the patient, in addition to that of a family member if available, alongside documents, observations, and reflections. This is a case of experiences and perceptions of unplanned readmissions to hospital within 30 days of discharge situated within this context. 14 cases were included in this study. Data were collected via interviews; observations and a reflective diary was used. Case descriptions were written, and multiple case study analysis was conducted following the ethos of Stake (2006) combined with the tools of framework analysis as described by Ritchie and Spence (1994). Findings: Unplanned readmissions were experienced as a disrupter by patients and families, with disruptions to their existential condition, with emotional and practical impacts. Within this case study unplanned readmissions were a phenomenon characterised by misaligned expectation and need in both communication and expectations. Unplanned readmissions were also a catalyst for change and viewed as lifesaving and key to unlocking care and/or support. Finally, they were perceived as symptoms of perceived organisational pressures. Unique contributions: 1. The findings from this study present a deeper and richer understanding of experiences and perceptions of unplanned readmissions to hospital among older people and their families. This study has presented the magnitude of the disruption and illustrated how the impacts of these unplanned readmissions can ripple out across time and wider society. 2. Nuance around the experiences and perceptions of unplanned readmissions have captured the fact that as a catalyst for change they can be viewed as key to unlocking care and support. This suggests older people and their families are reaching a type of crisis point before things change for them. 3. This study’s findings involving the experiences and perceptions older people have of their unplanned readmission offer contextually bound first-hand accounts of the lived experience of being older and accessing healthcare, which contributes to diversifying the narrative around older age and supports combatting ageism. Conclusion: The experiences and perceptions of unplanned readmissions are based on experiences that transcend the specific moment of unplanned readmission incorporating instances before, during and after the unplanned readmission. The unplanned readmission has ripple effects with waves that touch on wide personal and professional networks which have deep and varied impacts on peoples’ lives. This study confirms the misalignment between how unplanned readmissions are conceptualised by organisations, health care professionals, patients, and families. It is imperative nurses appreciate and understand the experiences and perceptions older people and their families have of unplanned readmission so they can provide responsive, holistic care and support patients and families appropriately

Student nurses’ competence in sexual health care: A literature review

Aims and objectives. To explore the way in which sexual health care is perceived and experienced by students in clinical practice. Background. Student nurses understand the need to learn about sexual health but report a variety of learning needs and experience challenges acquiring skills to deliver such care in part due to varied clinical experience. Furthermore, there is a paucity of data exploring clinical competence of sexual health care among student nurses. Design and methods. A literature review of the published literature was conducted following a search of online databases. Articles were selected for analysis according to inclusion and exclusion criteria. Eight articles were critically appraised and thematically analysed. Results. The following themes were identified: student nurses report having a positive attitude towards sexual health care; however, many felt uncomfortable about addressing sexual health and are reluctant to initiate a conversation; many student nurses lack knowledge about sexual health; they also lack role models at university and on clinical placement. Student nurse caregiving in relation to sexual health was also noted. Conclusions. It is encouraging that student nurses have some knowledge, but their knowledge assessed is narrow. Their attitude is generally positive although many feel uncomfortable discussing issues of sexual health and sexuality. Very few student nurses report delivering sexual health care. There is a lack of positive role models both on clinical placement and at university

Making the Executive ‘Function’ for the Foundations of Mathematics: the Need for Explicit Theories of Change for Early Interventions

A vast body of work highlights executive functions (EFs) as robust correlates of mathematics achievement over the primary and preschool years. Yet, despite such correlational evidence, there is limited evidence that EF interventions yield improvements in early years mathematics. As intervention studies are a powerful tool to move beyond correlation to causality, failures of transfer from executive functions interventions are, we argue, highly problematic for both applied and theoretical reasons. We review the existing correlational and intervention literature at complementary neuroscientific, cognitive, developmental and educational levels. We appraise distinct theories of change underpinning the correlations between EF and early mathematics, as well as explicit or implicit theories of change for different types of EF interventions. We find that isolated EF interventions are less likely to transfer to improvements in mathematics than integrated interventions. Via this conceptual piece, we highlight that the field of EF development is in need of (1) a clearer framework for the mechanisms underpinning the relationships between early EF and other developing domains, such as mathematical cognition; (2) clearer putative theories of change for how interventions of different kinds operate in the context of EF and such domains; (3) and greater clarity on the developmental and educational contexts that influence these causal associations. Our synthesis of the evidence emphasises the need to consider the dynamic development of EFs with co-developing cognitive functions, such as early math skills, when designing education environments

Measuring exposure to bullying and harassment in health professional students in a clinical workplace environment : Evaluating the psychometric properties of the clinical workplace learning NAQ-R scale

Acknowledgments: The authors would like to thank all of the Associate Deans of Medical Education for Otago Medical School who assisted with the data collection for this questionnaire, as well as Faculty in The School of Nursing at Otago Polytechnic. We would also like to thank Dr Ella Iosua and Michel de Lange for their initial advice on the analysis of this paper. We would also like to thank the students for their time and effort in completing this questionnaire.Peer reviewedPostprin

Temporal Binding, Causation, and Agency: Developing a New Theoretical Framework

In temporal binding, the temporal interval between one event and another, occurring some time later, is subjectively compressed. We discuss two ways in which temporal binding has been conceptualized. In studies showing temporal binding between a voluntary action and its causal consequences, such binding is typically interpreted as providing a measure of an implicit or pre-reflective “sense of agency.” However, temporal binding has also been observed in contexts not involving voluntary action, but only the passive observation of a cause–effect sequence. In those contexts, it has been interpreted as a top-down effect on perception reflecting a belief in causality. These two views need not be in conflict with one another, if one thinks of them as concerning two separate mechanisms through which temporal binding can occur. In this paper, we explore an alternative possibility: that there is a unitary way of explaining temporal binding both within and outside the context of voluntary action as a top-down effect on perception reflecting a belief in causality. Any such explanation needs to account for ways in which agency, and factors connected with agency, has been shown to affect the strength of temporal binding. We show that principles of causal inference and causal selection already familiar from the literature on causal learning have the potential to explain why the strength of people's causal beliefs can be affected by the extent to which they are themselves actively involved in bringing about events, thus in turn affecting binding

The developmental profile of temporal binding: From childhood to adulthood.

Temporal binding refers to a phenomenon whereby the time interval between a cause and its effect is perceived as shorter than the same interval separating two unrelated events. We examined the developmental profile of this phenomenon by comparing the performance of groups of children (aged 6–7, 7–8, and 9–10 years) and adults on a novel interval estimation task. In Experiment 1, participants made judgements about the time interval between (a) their button press and a rocket launch, and (b) a non-causal predictive signal and rocket launch. In Experiment 2, an additional causal condition was included in which participants made judgements about the interval between an experimenter’s button press and the launch of a rocket. Temporal binding was demonstrated consistently and did not change in magnitude with age: estimates of delay were shorter in causal contexts for both adults and children. In addition, the magnitude of the binding effect was greater when participants themselves were the cause of an outcome compared with when they were mere spectators. This suggests that although causality underlies the binding effect, intentional action may modulate its magnitude. Again, this was true of both adults and children. Taken together, these results are the first to suggest that the binding effect is present and developmentally constant from childhood into adulthood

Conversion of Amides into Esters by the Nickel-Catalyzed Activation of Amide C-N Bonds

The amide function is ubiquitous in natural compounds as well as in man-made molecules and materials. It is generally very stable and poorly reactive owing to its resonance-stabilized C–N group that imparts a planar geometry to amides. In contrast, carboxylic esters are generally reactive under a variety of mild conditions; therefore, it is not surprising that a number of direct methods are available to the chemist for converting esters into amides (amino-de-alkoxylation reaction) but very few for achieving the opposite transformation. Recently, Professors Neil Garg and Ken Houk from the University of California, Los Angeles (UCLA, USA) reported in Nature a groundbreaking method for converting amides into esters with a high degree of efficiency

Two randomized trials of effect of live attenuated influenza vaccine on pneumococcal colonization

The human nasopharynx is frequently colonized by Streptococcus pneumoniae (the pneumococcus), serving as the reservoir for transmission, a state which necessarily precedes invasive pneumococcal infection. Influenza infection increases pneumococcal colonization density and dysregulates host immune responses, increasing the risk of secondary bacterial pneumonia and death

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research