Breaking bad news revisited: the push for negotiated disclosure and changing practice implications.

This article revisits the ethical, legal, professional and emotional issues involved with disclosing bad news. The authors examine the push for disclosure that has come from a number of quarters in the UK, including ethical and legal challenges, in particular the Bristol Royal Inquiry Report, professional codes of conduct, health policy and the expectations of the public. The contribution of nurses to breaking bad news is not widely discussed in the literature. With the development of new nursing roles and evidence-based practice it is timely to consider the role of nurses in this process. The article highlights some limitations with current guidelines for breaking bad news, in particular, that these guidelines tend to be constructed from a professional standpoint and lack patient-centred evidence. The issue of emotional labour and how it relates to giving bad news is discussed with respect to professional staff and patients. The article concludes by raising some practice implications, including: the importance of context and continuity; the significance of information and support; the desirable qualities of the professional; and issues to consider in determining patient preferences

The triggering of MHD instabilities through photospheric footpoint motions

The results of 3D numerical simulations modelling the twisting of a coronal loop due to photospheric vortex motions are presented. The simulations are carried out using an initial purely axial field and an initial equilibrium configuration with twist, . The non-linear and resistive evolutions of the instability are followed. The magnetic field is twisted by the boundary motions into a loop which initially has boundary layers near the photospheric boundaries as has been suggested by previous work. The boundary motions increase the twist in the loop until it becomes unstable. For both cases the boundary twisting triggers the kink instability. In both cases a helical current structure wraps itself around the kinked central current. This current scales linearly with grid resolution indicating current sheet formation. For the cases studied 35-40% of the free magnetic energy is released. This is sufficient to explain the energy released in a compact loop flare

Caring for a loved one with a malignant fungating wound

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Purpose: Caring for a loved one with a malignant fungating wound is very challenging and causes extreme physical and psychological distress. The aim of this study was to explore the experiences of carers who care for a loved one with a fungating breast wound. Method: To explore the lived experiences of carers, a methodological framework using Heideggerian hermeneutic phenomenology and semi-structured interviews was used. Seven carers were interviewed from January until November 2009. Results: Having to deal with a situation of a loved one with a visible cancer was hard for all the carers. The visibility of the cancer was one of the most shocking aspects to deal with from the perspective of the patient and the carer. The presence of the visible wound and a cancer at an advanced stage contributed to a change in the relationship and extreme suffering for both the patient and the carer. Despite many problems such as wound odour and copious discharge from the wound, which was difficult to control, carers did their best to help their loved one with the wound. Gradually, the wound became the centre of the patient and carer’s life, and a great deal of time was spent trying to control the wound symptoms. All carers managed the wound on their own without help and advice from health care practitioners. For all of them, it was a major burden and they felt isolated. Conclusion: This study contributes to an understanding that the care of women and their carers needs strategies that are integrated in palliative wound care that takes a holistic and empathic approach that responds to patients’ and carers’ psychosocial and emotional needs and a practical need for information to help carers assist in managing the wound-related symptoms

On the Synanthy in the Genus Lonicera.

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Managing sleep and wakefulness in a 24 hour world

This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work–social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns

Acoustic oscillations in solar and stellar flaring loops

Evolution of a coronal loop in response to an impulsive energy release is numerically modelled. It is shown that the loop density evolution curves exhibit quasi-periodic perturbations with the periods given approximately by the ratio of the loop length to the average sound speed, associated with the second standing harmonics of an acoustic wave. The density perturbations have a maximum near the loop apex. The corresponding field-aligned flows have a node near the apex. We suggest that the quasi-periodic pulsations with periods in the range 10-300 s, frequently observed in flaring coronal loops in the radio, visible light and X-ray bands, may be produced by the second standing harmonic of the acoustic mode

Surveillance des comportements face au VIH/sida chez les hommes ayant des rapports sexuels avec des hommes — Suisse, 1992-2004

Abstract.: Surveillance of HIV/AIDS — related behaviors among men who have sex with men — Switzerland, 1992-2004 Objective:: To update (1992-2004, Switzerland) trends in behaviors and opinions relative to HIV prevention among men who have sex with men. Methods:: A cross sectional survey, repeated five times since 1992, among readers of the gay press and members of gay associations. Results:: An increase was observed in the median number of partners (1994: 5; 2004: 7, p < 0.05), in the proportion of participants who practiced anal penetration with their stable partner (1992: 71%; 2004: 80%, p < 0.05) or with casual partners (1994: 59% 2004: 73% ; p < 0.05). Non systematic use of condoms with casual partners during anal penetration increased between 1994 and 2004 (9% to 20%; p < 0.05). Combination therapies gave rise to growing pessimism among participants regarding the decrease in preventive behaviors among homosexuals. Conclusions:: The slow trend towards a reduction of safer sex practices continues among men who have sex with men. It is necessary to strengthen prevention interventions in this populatio

Numerical simulations of kink instability in line-tied coronal loops

The results from numerical simulations carried out using a new shock-capturing, Lagrangian-remap, 3D MHD code, Lare3d are presented. We study the evolution of the m=1 kink mode instability in a photospherically line-tied coronal loop that has no net axial current. During the non-linear evolution of the kink instability, large current concentrations develop in the neighbourhood of the infinite length mode rational surface. We investigate whether this strong current saturates at a finite value or whether scaling indicates current sheet formation. In particular, we consider the effect of the shear, defined by where is the fieldline twist of the loop, on the current concentration. We also include a non-uniform resistivity in the simulations and observe the amount of free magnetic energy released by magnetic reconnection

Unstable coronal loops : numerical simulations with predicted observational signatures

We present numerical studies of the nonlinear, resistive magnetohydrodynamic (MHD) evolution of coronal loops. For these simulations we assume that the loops carry no net current, as might be expected if the loop had evolved due to vortex flows. Furthermore the initial equilibrium is taken to be a cylindrical flux tube with line-tied ends. For a given amount of twist in the magnetic field it is well known that once such a loop exceeds a critical length it becomes unstableto ideal MHD instabilities. The early evolution of these instabilities generates large current concentrations. Firstly we show that these current concentrations are consistent with the formation of a current sheet. Magnetic reconnection can only occur in the vicinity of these current concentrations and we therefore couple the resistivity to the local current density. This has the advantage of avoiding resistive diffusion in regions where it should be negligible. We demonstrate the importance of this procedure by comparison with simulations based on a uniform resistivity. From our numerical experiments we are able to estimate some observational signatures for unstable coronal loops. These signatures include: the timescale of the loop brightening; the temperature increase; the energy released and the predicted observable flow speeds. Finally we discuss to what extent these observational signatures are consistent with the properties of transient brightening loops.Comment: 13 pages, 9 figure