Administering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homes

Background: In the United Kingdom, an approach to improving end-of-life care has been the introduction of ‘just in case’ or ‘anticipatory’ medications. Nurses are often responsible for deciding when to use anticipatory medications, but little is known about their experiences. Aim: To examine nurses’ decisions, aims and concerns when using anticipatory medications. Design: An ethnographic study in two UK regions, using observations and interviews with nurses working in community and nursing home teams (n = 8). Findings: Observations (n = 83) and interviews (n = 61) with community nurses. Nurses identified four ‘conditions’ that needed to be established before they implemented anticipatory medications: (1) irreversibility; (2) inability to take oral medication; (3) where the patient was able, they should consent and (4) decision had to be independent of demands or requests from patient’s relatives. By using anticipation medications, nurses sought to enable patients to be ‘comfortable and settled’ by provision of gradual relief of symptoms at the lowest dose possible. They aimed to respond quickly to needs, seeking to avoid hospital admission or medical call-out, while adhering to local prescribing policies. Worries included distinguishing between pain and agitation, balancing risks of under- and over-medication and the possibility of hastening death. Conclusion: Nurses take a leading role in the administration of anticipatory medications. Nurses apply consideration and caution to the administration of anticipatory medications but some experience emotional burden. Education, training and experience played a role in the nurses’ confidence and should continue to be central to efforts to improving the quality of palliative care in the community and nursing homes

Implementing a Low-Threshold Analysis with the Askaryan Radio Array (ARA)

The Askaryan Radio Array (ARA) is a ground-based radio detector at the South Pole designed to capture Askaryan emission from ultra-high energy neutrinos interacting within the Antarctic ice. The newest ARA station has been equipped with a phased array trigger, in which radio signals in multiple antennas are summed in predetermined directions prior to the trigger. In this way, impulsive signals add coherently, while noise likely does not, allowing the trigger threshold to be lower than a traditional ARA station. Early results on just a fraction of available data from this new system prove the feasibility of a low-threshold analysis

Review and Evaluation of the J100â 10 Risk and Resilience Management Standard for Water and Wastewater Systems

Risk analysis standards are often employed to protect critical infrastructures, which are vital to a nation’s security, economy, and safety of its citizens. We present an analysis framework for evaluating such standards and apply it to the J100â 10 risk analysis standard for water and wastewater systems. In doing so, we identify gaps between practices recommended in the standard and the state of the art. While individual processes found within infrastructure risk analysis standards have been evaluated in the past, we present a foundational review and focus specifically on water systems. By highlighting both the conceptual shortcomings and practical limitations, we aim to prioritize the shortcomings needed to be addressed. Key findings from this study include (1) risk definitions fail to address notions of uncertainty, (2) the sole use of â worst reasonable caseâ assumptions can lead to mischaracterizations of risk, (3) analysis of risk and resilience at the threatâ asset resolution ignores dependencies within the system, and (4) stakeholder values need to be assessed when balancing the tradeoffs between risk reduction and resilience enhancement.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/1/risa13421_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/2/risa13421.pd

A neural network based UHE neutrino reconstruction method for the Askaryan Radio Array (ARA)

The Askaryan Radio Array (ARA) is an ultra-high energy (UHE) neutrino (Eν > 1017 eV) detector at South Pole. ARA aims to utilize radio signals detected from UHE neutrino interactions in the glacial ice to infer properties about the interaction vertex as well as the incident neutrino. To retrieve these properties from experiment data, the first step is to extract timing, amplitude and frequency information from waveforms of different antennas buried in the deep ice. These features can then be utilized in a neural network to reconstruct the neutrino interaction vertex position, incoming neutrino direction and shower energy. So far, vertex can be reconstructed through interferometry while neutrino reconstruction is still under investigation. Here I will present a solution based on multi-task deep neural networks which can perform reconstruction of both vertex and incoming neutrinos with a reasonable precision. After training, this solution is capable of rapid reconstructions (e.g. 0.1 ms/event compared to 10000 ms/event in a conventional routine) useful for trigger and filter decisions, and can be easily generalized to different station configurations for both design and analysis purposes

The Calibration of the Geometry and Antenna delay in Askaryan Radio Array Station 4 and 5

The Askaryan Radio Array (ARA) experiment at the South Pole is designed to detect the radio signals produced by ultra high energy cosmic neutrino interactions in the ice. There are 5 independent ARA stations, one of which (A5) includes a low-threshold phased array trigger string. Each ARA station is designed to work as an autonomous detector. The Data Acquisition System in all ARA stations is equipped with the Ice Ray Sampler second-generation (IRS2) chip, a custom-made, application-specific integrated circuit (ASIC) for high-speed sampling and digitization. In this contribution, we describe the methodology used to calibrate the IRS2 digitizer chip and the station geometry, namely the relative timing between each pair of ARA antennas, deployed at 200 m below the Antarctic ice surface, and their geometrical positions in the ice, for ARA stations 4 and 5. Our calibration allows for proper timing correlations between incoming signals, which is crucial for radio vertex reconstruction and thus detection of ultra high energy neutrinos through the Askaryan effect. We achieve a signal timing precision on a sub-nanosecond level and an antenna position precision within 10 cm