Newborn Length of Stay and Risk of Readmission.

BACKGROUND: Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14. METHODS: The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day). RESULTS: Of 4 667 827 babies, 5.2% were readmitted within 30 days. Aggregated data showed hospitals with longer mean LOS were not associated with lower readmission rates for vaginal (adjusted risk ratio (aRR) 0.87, 95% confidence interval (CI) 0.66, 1.13), or caesarean (aRR 0.89, 95% CI 0.72, 1.12) births. LOS fell by an average 2.0% per year for vaginal births and 3.4% for caesarean births, while readmission rates increased by 4.4 and 5.1% per year respectively. Approaches (iii) and (iv) indicated that longer LOS was associated with a reduced risk of readmission, but only for late preterm, vaginal births (34-36 completed weeks' gestation). CONCLUSIONS: Longer newborn LOS may benefit late preterm babies, possibly due to increased medical or psychosocial support for those at greater risk of potentially preventable readmissions after birth. Research based on observational data to evaluate relationships between LOS and readmission should use methods to reduce the impact of unmeasured confounding

How We Choose One over Another: Predicting Trial-by-Trial Preference Decision

Preference formation is a complex problem as it is subjective, involves emotion, is led by implicit processes, and changes depending on the context even within the same individual. Thus, scientific attempts to predict preference are challenging, yet quite important for basic understanding of human decision making mechanisms, but prediction in a group-average sense has only a limited significance. In this study, we predicted preferential decisions on a trial by trial basis based on brain responses occurring before the individuals made their decisions explicit. Participants made a binary preference decision of approachability based on faces while their electrophysiological responses were recorded. An artificial neural network based pattern-classifier was used with time-frequency resolved patterns of a functional connectivity measure as features for the classifier. We were able to predict preference decisions with a mean accuracy of 74.3±2.79% at participant-independent level and of 91.4±3.8% at participant-dependent level. Further, we revealed a causal role of the first impression on final decision and demonstrated the temporal trajectory of preference decision formation

Transport and instability in driven two-dimensional magnetohydrodynamic flows

This paper concerns the generation of large scale flows in forced two-dimensional systems. A Kolmogorov flow with a sinusoidal profile in one direction (driven by a body force) is known to become unstable to a large scale flow in the perpendicular direction at a critical Reynolds number. This can occur in the presence of a beta-effect and has important implications for flows observed in geophysical and astrophysical systems. It has recently been termed ‘zonostrophic instability’ and studied in a variety of settings, both numerically and analytically. The goal of the present paper is to determine the effect of magnetic field on such instabilities using the quasi-linear approximation, in which the full fluid system is decoupled into a mean flow and waves of one scale. The waves are driven externally by a given, random body force and move on a fast time scale, while their stress on the mean flow causes this to evolve on a slow time scale. Spatial scale separation between waves and mean flow is also assumed, to allow analytical progress. The paper first discusses purely hydrodynamic transport of vorticity including zonostrophic instability, the effect of uniform background shear, and calculation of equilibrium profiles in which the effective viscosity varies spatially, through the mean flow. After brief consideration of passive scalar transport or equivalently kinematic magnetic field evolution, the paper then proceeds to study the full MHD system and to determine effective diffusivities and other transport coefficients using a mixture of analytical and numerical methods. This leads to results on the effect of magnetic field, background shear and beta-effect on zonostrophic instability and magnetically driven instabilitiesWe are grateful to the EPSRC for funding SD via a DTG research studentship

International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England.

OBJECTIVES: To compare emergency hospital use for infants in Ontario (Canada) and England. METHODS: We conducted a population-based data linkage study in infants born ≥34 weeks' gestation between 2010 and 2013 in Ontario (n=253 930) and England (n=1 361 128). Outcomes within 12 months of postnatal discharge were captured in hospital records. The primary outcome was all-cause unplanned admissions. Secondary outcomes included emergency department (ED) visits, any unplanned hospital contact (either ED or admission) and mortality. Multivariable regression was used to evaluate risk factors for infant admission. RESULTS: The percentage of infants with ≥1 unplanned admission was substantially lower in Ontario (7.9% vs 19.6% in England) while the percentage attending ED but not admitted was higher (39.8% vs 29.9% in England). The percentage of infants with any unplanned hospital contact was similar between countries (42.9% in Ontario, 41.6% in England) as was mortality (0.05% in Ontario, 0.06% in England). Infants attending ED were less likely to be admitted in Ontario (7.3% vs 26.2%), but those who were admitted were more likely to stay for ≥1 night (94.0% vs 55.2%). The strongest risk factors for admission were completed weeks of gestation (adjusted OR for 34-36 weeks vs 39+ weeks: 2.44; 95% CI 2.29 to 2.61 in Ontario and 1.66; 95% CI 1.62 to 1.70 in England) and young maternal age. CONCLUSIONS: Children attending ED in England were much more likely to be admitted than those in Ontario. The tendency towards more frequent, shorter admissions in England could be due to more pressure to admit within waiting time targets, or less availability of paediatric expertise in ED. Further evaluations should consider where best to focus resources, including in-hospital, primary care and paediatric care in the community

Our Space: Being a Responsible Citizen of the Digital World

Our Space is a set of curricular materials designed to encourage high school students to reflect on the ethical dimensions of their participation in new media environments. Through role-playing activities and reflective exercises, students are asked to consider the ethical responsibilities of other people, and whether and how they behave ethically themselves online. These issues are raised in relation to five core themes that are highly relevant online: identity, privacy, authorship and ownership, credibility, and participation.Our Space was co-developed by The Good Play Project and Project New Media Literacies (established at MIT and now housed at University of Southern California's Annenberg School for Communications and Journalism). The Our Space collaboration grew out of a shared interest in fostering ethical thinking and conduct among young people when exercising new media skills

Access or Exclusion? An Analysis of State Reproductive Rights and Comprehensive Sex Education

In 2009, Colorado successfully decreased their abortion rate among minors and at-risk teenagers through a privately-funded trial. This outcome was realized by offering affordable, accessible, and comprehensive reproductive healthcare options, specifically long-acting reversible contraception, to young women. Reproductive rights is an issue at the forefront of political discussion, often a determining factor for party identification. The controversy of reproductive rights--in particular, abortion--leads to a higher reliance on hear-say, instead of peer-reviewed literature, statistics, and legislation. In order to gain a well-balanced understanding of abortion politics, I compare three Midwestern states--Illinois, Indiana, and Minnesota--to determine their respective policy successes and shortcomings. I examine each state\u27 s abortion related policies including sex education and contraception access in order to determine how these factors affect the abortion rate. Determining what factors work in each state, and whether that is a pattern among the states, guides my proposed policy reforms. The purpose of this exploration is to encourage and promote the significance of women\u27s health education--specifically, reproductive rights. Considering the majority of information portrayed regarding sexual health occurs at a high school level age, there is a more structured focus on the abortion rate of minors. Access to information and birth control, coupled with mandated comprehensive sex education in schools, are key to re-shaping America\u27s current, complex state of healthcare. Change needs to be inspired, and that is the purpose of this thesis: to improve women\u27s reproductive healthcare system; lower abortion rates would simply be an added benefit

Mandated data archiving greatly improves access to research data

The data underlying scientific papers should be accessible to researchers both now and in the future, but how best can we ensure that these data are available? Here we examine the effectiveness of four approaches to data archiving: no stated archiving policy, recommending (but not requiring) archiving, and two versions of mandating data deposition at acceptance. We control for differences between data types by trying to obtain data from papers that use a single, widespread population genetic analysis, STRUCTURE. At one extreme, we found that mandated data archiving policies that require the inclusion of a data availability statement in the manuscript improve the odds of finding the data online almost a thousand-fold compared to having no policy. However, archiving rates at journals with less stringent policies were only very slightly higher than those with no policy at all. At one extreme, we found that mandated data archiving policies that require the inclusion of a data availability statement in the manuscript improve the odds of finding the data online almost a thousand fold compared to having no policy. However, archiving rates at journals with less stringent policies were only very slightly higher than those with no policy at all. We also assessed the effectiveness of asking for data directly from authors and obtained over half of the requested datasets, albeit with about 8 days delay and some disagreement with authors. Given the long term benefits of data accessibility to the academic community, we believe that journal based mandatory data archiving policies and mandatory data availability statements should be more widely adopted

Fostering compassionate care for persons with Alzheimer\u27s disease in nursing facilities.

The aim of this dissertation study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). More specifically, this dissertation used Kirkpatrick’s model of evaluation to assess the reactions, learning, and behavior change of the CNAs exposed to the curriculum, and ultimately the impact of the curriculum on the stress levels of residents with AD. To accomplish this, we had two studies that aligned with the Kirkpatrick model of evaluation. For Study #1, the evaluation of the compassionate care curriculum (Kirkpatrick Levels One, Two, and Three), the following hypotheses guided the study: Hypothesis 1: After completion of the compassionate care curriculum by the CNA experimental group, CNAs will show a significantly higher increase in knowledge, caregiving self-efficacy, caregiving satisfaction and a significantly higher reduction in feelings of affiliate stigma than the CNAs who completed the current standard curriculum (control group). For Study #2, Evaluation of the Compassionate Care Curriculum (Kirkpatrick Level Four), the following hypotheses were used to guide the study: Hypothesis 1a: Residents with AD from the experimental nursing facility will have a different 12-week agitation change trajectory from the residents with AD from the control nursing facility. Hypothesis 1b: Residents with AD from the experimental nursing facility will have a different 12-week salivary cortisol change trajectory from the residents with AD from the control nursing facility. Hypothesis 2a: Differences in change in CNAs knowledge, confidence, satisfaction and affiliate stigma will have a differential effect on the 12-week agitation trajectories of residents with AD in the experimental and control nursing facilities. Hypothesis 2b: Differences in change in CNAs knowledge, confidence, satisfaction and stigma and differences in residents with AD agitation will have a differential effect on the 12-week salivary cortisol trajectories of residents with AD in the experimental and control nursing facilities. Methods: The study included an experimental and control nursing facility. The sample of residents with AD from the two facilities, including a convenient sample of 25 residents from the experimental group and 27 from the control group. All the CNAs who took care of the residents with AD that took part in the study were also included in the study for a total of 99 CNAs, 48 in the experimental group and 51 in the control group. At baseline, prior to the implementation of the curriculum, data were collected on the demographics of the CNAs along with their pre-test on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma for both the experimental and control groups. At the 12-week period, after the curriculum and care groups were implemented, data on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma were collected again for both groups. After equivalency between the two groups was tested, a two-way mixed method MANOVA was utilized to examine how scores changed for all of the dependent variables. For this study, the focus of the analysis was to examine whether there was a significant difference over time (within-subjects), whether there were differences between the control and experimental groups (between-subjects), and whether there was an interaction effect between time and group, indicating if the groups change differently over time. The second study examined the final element of the Kirkpatrick model, namely stress levels of residents with AD. This study was conducted by testing a hybrid multilevel growth model. Results: CNAs changes in terms of their knowledge of AD, self-efficacy, caregiving satisfaction and affiliate stigma were analyzed to understand the impact the compassionate care curriculum had on the CNAs, using levels 1, 2 and 3 of the Kirkpatrick Evaluation Model. For AD knowledge, we saw a significant increase in scores from baseline to 12 weeks for the experimental group while the control group remained the same over the 12-week period. Self-efficacy for the experimental group improved between baseline and 12-weeks but deteriorated slightly for the control group. Caregiver satisfaction showed a slight improvement at 12-weeks for both groups, yet the experimental group showed a trend of greater improvement than the control group. For the experimental group, feelings of affiliate stigma declined between baseline and 12- weeks, while the control group remained similar at the 12-week period. From the Kirkpatrick model, level 4 examined outcomes. This study focused on the stress outcomes of the residents with AD, specifically agitation and salivary cortisol levels. All models built showed that the experimental group performed better in reducing agitation and reducing salivary cortisol levels. The final models were able to show how the changes in the CNAs specifically affected these positive outcomes. CNA knowledge and self-efficacy had the most impact on changing agitation levels, and CNA knowledge and agitation levels had the most impact on salivary cortisol levels. Conclusions: The results of this study showed that integrating a compassionate care curriculum into the work that CNAs perform with persons with AD can lead to positive outcomes on CNAs knowledge, self-efficacy, caregiving satisfaction, affiliate stigma and a reduction of agitation and cortisol levels in persons with AD. This has implications for the way we conceptualize the type of care that is provided by CNAs to persons with AD in nursing facilities. Currently, CNAs are trained to only provide traditional basic nursing care focuses primarily on the basic needs of the person such as attending to activities of daily living. While traditional basic nursing care is important, it should be supplemented with compassionate care for persons with AD. Compassionate care (CC) emphasizes the bond between the caregiver (the CNA) and the care receiver (the person with AD) and their journey together. CC can also provide CNAs with skills to respond to the changes that the person with AD experiences as they decline

Can people guess what happened to others from their reactions?

Are we able to infer what happened to a person from a brief sample of his/her behaviour? It has been proposed that mentalising skills can be used to retrodict as well as predict behaviour, that is, to determine what mental states of a target have already occurred. The current study aimed to develop a paradigm to explore these processes, which takes into account the intricacies of real-life situations in which reasoning about mental states, as embodied in behaviour, may be utilised. A novel task was devised which involved observing subtle and naturalistic reactions of others in order to determine the event that had previously taken place. Thirty-five participants viewed videos of real individuals reacting to the researcher behaving in one of four possible ways, and were asked to judge which of the four ‘scenarios’ they thought the individual was responding to. Their eye movements were recorded to establish the visual strategies used. Participants were able to deduce successfully from a small sample of behaviour which scenario had previously occurred. Surprisingly, looking at the eye region was associated with poorer identification of the scenarios, and eye movement strategy varied depending on the event experienced by the person in the video. This suggests people flexibly deploy their attention using a retrodictive mindreading process to infer events