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The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care.
To explore the experiences and career development opportunities for trainee nursing associates based in primary care.
This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically.
Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a ‘valuable opportunity for career progression’. Trainees were frustrated by the ‘emphasis on secondary care’ in both academic content and placement portfolio requirements. They also experienced ‘inconsistency in support’ from their managers and assessors and noted a number of ‘constraints to their learning opportunities’, including the opportunity to progress to become registered nurses.
This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.
To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England.
Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this.
This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach.
Three themes were developed: ‘Understanding the trainee role and requirements’, ‘Trainee support in primary care’ and ‘Skills and scope of practice’. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.
Social jetlag (SJ) occurs when sleep-timing irregularities from social or occupational demands conflict with endogenous sleep–wake rhythms. SJ is associated with evening chronotype and poor mental health, but mechanisms supporting this link remain unknown. Impaired ability to retrieve extinction memory is an emotion regulatory deficit observed in some psychiatric illnesses. Thus, SJ-dependent extinction memory deficits may provide a mechanism for poor mental health. To test this, healthy male college students completed 7–9 nights of actigraphy, sleep questionnaires, and a fear conditioning and extinction protocol. As expected, greater SJ, but not total sleep time discrepancy, was associated with poorer extinction memory. Unexpectedly, greater SJ was associated with a tendency toward morning rather than evening chronotype. These findings suggest that deficient extinction memory represents a potential mechanism linking SJ to psychopathology and that SJ is particularly problematic for college students with a greater tendency toward a morning chronotype.
Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted.
This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI).
There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI.
Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
Global policy places emphasis on the implementation and usage of advance care planning (ACP) to inform decision making at the end of life. For people with dementia, where its use is encouraged at the point of diagnosis, utilisation of ACP is relatively poor, particularly in parts of Europe. Using a constructivist grounded theory methodology, this study explores the ways in which co-residing couples considered ACP. Specifically, it seeks to understand the ways in which people with dementia and their long-term co-residing partners consider and plan, or do not plan, for future medical and social care. Sixteen participants were interviewed. They identified the importance of relationships in the process of planning alongside an absence of formal service support and as a result few engaged in ACP. The study recognises the fundamental challenges for couples in being obliged to consider end-of-life issues whilst making efforts to ‘live well’. Importantly, the paper identifies features of the ACP experience of a relational and biographical nature. The paper challenges the relevance of current global policy and practice, concluding that what is evident is a process of ‘emergent planning’ through which couples build upon their knowledge of dementia, their networks and relationships, and a number of ‘tipping points’ leading them to ACP. The relational and collective nature of future planning is also emphasised.
Recent advances in the additive manufacturing technology now enable fused filament fabrication of polyetheretherketone (PEEK). A standardized lumbar fusion cage design was 3D printed with different speeds of the printhead nozzle to investigate whether 3D-printed PEEK cages exhibit sufficient material properties for lumbar fusion applications. It was observed that the compressive and shear strength of the 3D-printed cages were 63–71% of the machined cages, whereas the torsion strength was 92%. The printing speed is an important printing parameter for 3D-printed PEEK, which resulted in up to 20% porosity at the highest speed of 3000 mm/min, leading to reduced cage strength. Printing speeds below 1500 mm/min can be chosen as the optimal printing speed for this printer to reduce the printing time while maintaining strength. The crystallinity of printed PEEK did not differ significantly from the as-machined PEEK cages from extruded rods, indicating that the processing provides similar microstructure.
The primary goal of this study was to compare paramedic first pass success rate between two different video laryngoscopes and direct laryngoscopy (DL) under simulated prehospital conditions in a cadaveric model.
This was a non-randomized, group-controlled trial in which five non-embalmed, non-frozen cadavers were intubated under prehospital spinal immobilization conditions using DL and with both the GlideScope Ranger (GL; Verathon Inc, Bothell, Washington USA) and the VividTrac VT-A100 (VT; Vivid Medical, Palo Alto, California USA). Participants had to intubate each cadaver with each of the three devices (DL, GL, or VT) in a randomly assigned order. Paramedics were given 31 seconds for an intubation attempt and a maximum of three attempts per device to successfully intubate each cadaver. Confirmation of successful endotracheal intubation (ETI) was confirmed by one of the six on-site physicians.
Successful ETI within three attempts across all devices occurred 99.5% of the time overall and individually 98.5% of the time for VT, 100.0% of the time for GL, and 100.0% of the time for DL. First pass success overall was 64.4%. Individually, first pass success was 60.0% for VT, 68.8% for GL, and 64.5% for DL. A chi-square test revealed no statistically significant difference amongst the three devices for first pass success rates (P=.583). Average time to successful intubation was 42.2 seconds for VT, 38.0 seconds for GL, and 33.7 for seconds for DL. The average number of intubation attempts for each device were as follows: 1.48 for VT, 1.40 for GL, and 1.42 for DL.
The was no statistically significant difference in first pass or overall successful ETI rates between DL and video laryngoscopy (VL) with either the GL or VT (adult).
HodnickR, ZitekT, GalsterK, JohnsonS, BledsoeB, EbbsD. A Comparison of Paramedic First Pass Endotracheal Intubation Success Rate of the VividTrac VT-A 100, GlideScope Ranger, and Direct Laryngoscopy Under Simulated Prehospital Cervical Spinal Immobilization Conditions in a Cadaveric Model. Prehosp Disaster Med. 2017;32(6):621–624.
Inadequate corn stands due to extreme weather conditions may require producers to replant their corn fields. The use of GR corn, however, can result in difficulty in managing replanted corn without experiencing yield loss. Therefore, the objectives of this research were to evaluate the herbicide options for control of GR corn in a corn replant situation and to determine the effect of corn replanted into various initial corn stands on grain yield. Two field studies were conducted to accomplish the objectives. The first experiment was designed to identify the most efficacious herbicide treatment for GR corn removal in a corn replant situation. Clethodim (51 g ai ha−1) applied 6 d prior to replanting, paraquat (700 g ai ha−1) plus metribuzin (160 g ai ha−1) applied at replanting, and glufosinate (450 g ai ha−1) applied at replanting along with a sequential treatment 3 wk later provided 96 to 100% control of the initial corn stand and resulted in the highest yield. If corn from the first planting remains, the interaction between different sized plants can reduce yield of corn. Thus, a second field experiment was conducted to evaluate the influence on grain yield of corn replanted into various initial corn stands. Corn stands of 0, 20,000, 40,000, 60,000, 80,000, and 100,000 plants ha−1 were established and either followed by a corn replant at 80,000 seeds ha−1 or not replanted. Initial stands ≥ 60,000 plants ha−1 did not require a replant to maximize yield. Initial corn stands ≤ 40,000 plants ha−1 required a replant with initial stand control to maximize grain yield. The percent yield contribution from an initial stand of 20,000 plants ha−1 was 20% greater than the same population replanted a few weeks later, which showed the competitive advantage to earlier planting even at the lowest initial corn stand. Because of this competitive advantage, an initial stand must be removed to maximize corn yield in a replant situation.
Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services.
To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services.
A total of 433 participants (aged 18–64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up.
The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group.
This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.
To describe the clinical and demographic characteristics of all in-patients experiencing delayed discharge over 3 months in an English urban mental health National Health Service trust. We carried out a cross-sectional case record study with care coordinator questionnaire.
Overall, 67 in-patients with delayed discharge occupied 18.6% of acute beds. Older in-patients were White, diagnosed with dementia and experienced relatively short admissions. Younger in-patients were often of Black and minority ethnic background with a psychotic diagnosis and long service contact, and sometimes experienced very long admissions. They were similar to a long-stay comparison group. The whole cohort was socially isolated and marginalised, and frequently misused alcohol.
People with complex mental health problems can experience long stays in acute care settings. This particularly affects people with psychosis who are isolated in the community. Alcohol misuse is the most common complicating factor. There are insufficient community-oriented rehabilitation services to meet these patients' diverse needs.
Thin-film piezoelectric lead zirconate titanate (PZT) is one of the most efficient electromechanical coupling transducer materials currently available for microelectromechanical systems (MEMS). This article reviews piezoelectric MEMS (piezo MEMS) technologies using PZT thin films in radio frequency (RF) devices for communications and radar applications and in the emerging field of millimeter-scale robotics. The electromechanical material properties of thin-film PZT uniquely enable insect-inspired and insect-scale autonomous robots. Recent progress on large force and displacement actuators for robotic leg joints, compact and high torque ultrasonic motors, and bioinspired millimeter-scale flapping wing platforms will be presented. The use of thin-film PZT to achieve high performance and low-voltage RF MEMS switches, ultralow power consumption nanomechanical logic circuits, and high coupling and low loss resonators, filters, and transformers are also reviewed.
Camera traps are standard tools for assessing populations of medium–large terrestrial mammals, particularly for rare, elusive or cryptic species, yet few researchers have attempted to employ camera traps to document rare primates in arboreal settings. We examined different arboreal camera-trap techniques to document the Critically Endangered greater bamboo lemur Prolemur simus in Madagascar. We documented P. simus at two sites, confirming presence at one site. Most species, including 86% of all lemur occurrences, were documented in low light conditions (c. < 105 lux). Our study suggests that camera traps can be effective in validating unconfirmed sightings of rare or secretive primate species. We recommend that future work with cameras in arboreal settings considers seasonal activity patterns, targets sites with high food densities, uses local knowledge, and utilizes available techniques (e.g. traditional trapping techniques) and landscape topography to concentrate animal movement (e.g. steep slopes or ridge lines).
This article examines a series of Schelling-like models of residential segregation, in which agents prefer to be in the minority. We demonstrate that as long as agents care about the characteristics of their wider community, they tend to end up in a segregated state. We then investigate the process that causes this and conclude that the result hinges on the similarity of informational states among agents of the same type. This is quite different from Schelling-like behavior and suggests (in his terms) that segregation is an instance of macrobehavior that can arise from a wide variety of micromotives.
All societies require energy services to meet basic human needs (e.g., lighting, cooking, space comfort, mobility, communication) and to serve productive processes. For development to be sustainable, delivery of energy services needs to be secure and have low environmental impacts. Sustainable social and economic development requires assured and affordable access to the energy resources necessary to provide essential and sustainable energy services. This may mean the application of different strategies at different stages of economic development. To be environmentally benign, energy services must be provided with low environmental impacts and low greenhouse gas (GHG) emissions. However, 85% of current primary energy driving global economies comes from the combustion of fossil fuels and consumption of fossil fuels accounts for 56.6% of all anthropogenic GHG emissions.
Renewable energy sources play a role in providing energy services in a sustainable manner and, in particular, in mitigating climate change. This Special Report on Renewable Energy Sources and Climate Change Mitigation explores the current contribution and potential of renewable energy (RE) sources to provide energy services for a sustainable social and economic development path. It includes assessments of available RE resources and technologies, costs and co-benefits, barriers to up-scaling and integration requirements, future scenarios and policy options.
GHG emissions associated with the provision of energy services are a major cause of climate change. The IPCC Fourth Assessment Report (AR4) concluded that “Most of the observed increase in global average temperature since the mid-20th century is very likely due to the observed increase in anthropogenic greenhouse gas concentrations.”
People with learning difficulties are now surviving into old age and more and more of them are being resettled from long-stay hospitals. The main purpose of this article is to examine some of the key barriers facing, and dilemmas involved in, the provision of community-based services to this newly emerging user group. The findings of some recent field research on older people with learning difficulties who have been resettled into the community are used to illustrate the challenges facing service providers. Particular reference is made to the impact of age discrimination and traditional differences between service specialisms. The article shows that both official definitions of need in old age and the aspirations of the service responses to those needs have been artificially constructed in very narrow terms, especially when compared with the principled approach to service provision for younger people with learning difficulties. In conclusion, therefore, it is argued that the principles underpinning services for people with learning difficulties, such as normalisation, should be applied to older people as well.
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