Providing nursing support within residential care homes

This study examines a joint NHS-Local Authority initiative providing a dedicated nursing and physiotherapy team to three residential care homes in Bath and North East Somerset. The initiative aims to meet the nursing needs of residents where they live and to train care home staff in basic nursing. * Hospital admissions and nursing home transfers were prevented. Care home staff and managers preferred residents to be able to stay in their home when they were ill, as did residents themselves. * Enhancing health-orientated education and training of care home staff was challenging at first but relationships improved, and the confidence and professionalism of care staff grew. * Residents’ nursing needs cannot simply be equated with their level of dependency. For example, a resident with dementia can be functionally independent yet have major, often un-communicated health needs. * The early detection of illness and resulting opportunity for early intervention was a major part of the team’s work. Residents were likely to benefit from improved quality of life. * Overall, estimates of costs and savings ranged from a 'worst case' scenario of £2.70 extra to a more likely scenario of £36.90 saved per resident per week. Savings were mainly in reduced use of NHS services, while the Primary Care Trust and Adult Social Services both funded the intervention, highlighting the need for partnership working to sustain funding. * The researchers conclude that any increase in cost should be measured against the benefits of promoting long-term quality of life, quality of care and providing a firm foundation for future workforce development

Dynamics of Chainlike Molecules on Surfaces

We consider the diffusion and spreading of chainlike molecules on solid surfaces. We first show that the steep spherical cap shape density profiles, observed in some submonolayer experiments on spreading polymer films, imply that the collective diffusion coefficient $D_C(\theta)$ must be an increasing function of the surface coverage $\theta$ for small and intermediate coverages. Through simulations of a discrete model of interacting chainlike molecules, we demonstrate that this is caused by an entropy-induced repulsive interaction. Excellent agreement is found between experimental and numerically obtained density profiles in this case, demonstrating that steep submonolayer film edges naturally arise due to the diffusive properties of chainlike molecules. When the entropic repulsion dominates over interchain attractions, $D_C(\theta)$ first increases as a function of $\theta$ but then eventually approaches zero for $\theta \to 1$. The maximum value of $D_C(\theta)$ decreases for increasing attractive interactions, leading to density profiles that are in between spherical cap and Gaussian shapes. We also develop an analytic mean field approach to explain the diffusive behavior of chainlike molecules. The thermodynamic factor in $D_C(\theta)$ is evaluated using effective free energy arguments, and the chain mobility is calculated numerically using the recently developed dynamic mean field theory. Good agreement is obtained between theory and simulations.Comment: 16 pages, 13 Postscript figure

Interface Equations for Capillary Rise in Random Environment

We consider the influence of quenched noise upon interface dynamics in 2D and 3D capillary rise with rough walls by using phase-field approach, where the local conservation of mass in the bulk is explicitly included. In the 2D case the disorder is assumed to be in the effective mobility coefficient, while in the 3D case we explicitly consider the influence of locally fluctuating geometry along a solid wall using a generalized curvilinear coordinate transformation. To obtain the equations of motion for meniscus and contact lines, we develop a systematic projection formalism which allows inclusion of disorder. Using this formalism, we derive linearized equations of motion for the meniscus and contact line variables, which become local in the Fourier space representation. These dispersion relations contain effective noise that is linearly proportional to the velocity. The deterministic parts of our dispersion relations agree with results obtained from other similar studies in the proper limits. However, the forms of the noise terms derived here are quantitatively different from the other studies

Equilibrium Shape and Size of Supported Heteroepitaxial Nanoislands

We study the equilibrium shape, shape transitions and optimal size of strained heteroepitaxial nanoislands with a two-dimensional atomistic model using simply adjustable interatomic pair potentials. We map out the global phase diagram as a function of substrate-adsorbate misfit and interaction. This phase diagram reveals all the phases corresponding to different well-known growth modes. In particular, for large enough misfits and attractive substrate there is a Stranski-Krastanow regime, where nano-sized islands grow on top of wetting films. We analyze the various terms contributing to the total island energy in detail, and show how the competition between them leads to the optimal shape and size of the islands. Finally, we also develop an analytic interpolation formula for the various contributions to the total energy of strained nanoislands.Comment: 9 pages, 7 figure

Low Complexity Blind Equalization for OFDM Systems with General Constellations

This paper proposes a low-complexity algorithm for blind equalization of data in OFDM-based wireless systems with general constellations. The proposed algorithm is able to recover data even when the channel changes on a symbol-by-symbol basis, making it suitable for fast fading channels. The proposed algorithm does not require any statistical information of the channel and thus does not suffer from latency normally associated with blind methods. We also demonstrate how to reduce the complexity of the algorithm, which becomes especially low at high SNR. Specifically, we show that in the high SNR regime, the number of operations is of the order O(LN), where L is the cyclic prefix length and N is the total number of subcarriers. Simulation results confirm the favorable performance of our algorithm

Clinical Leadership in Jordanian Hospitals: The Clinicians' Perspective

The main aim of this study is to explore the nature of leadership in Jordanian hospitals. This study consists of four objectives; the first objective is to identify the extent to which clinicians perform their role of managing and leading Jordanian hospitals .The second objective for this study is to explore the source of power and authority being adopted in Jordanian hospitals. Then the third objective is to differentiate between doctors and other clinicians from nurses and AHPS in practicing leadership. While the fourth objective to explore the obstacles in developing CL in Jordanian hospitals. The methodology of a qualitative approach was adopted through analyzing the contents, thus, semi-structured interview was conducted with 38 participants from managers who have a clinical mission besides managerial and supervising ones. The study has found out that there is a lack of administrative qualifications for clinicians, and seems difficult to apply the transformational style in Jordanian hospitals due the fear of responsibility and bad distribution of power and authority among clinicians and doctors in particular. Furthermore, there is a lack cultural diversity and this weakens the provided medical services in matching globalization and international criteria. Communication channels in Jordanian hospitals are acceptable; because both technical and personal settings among clinicians are emerged. Unfortunately, there was no specific and clear agenda for both quality and ethical considerations .Doctors are dominated by the concept of bureaucracy and centralism. Accordingly, some obstacles have been revealed in Jordanian hospitals; doctors are the biggest obstacle because they are holding the whole power. Also, communication channels with other departments and among colleagues are weak. Furthermore, the clinical culture did not reach the creation of cultural system .This is due to the weak coordination among academic faculties and governmental departments to shape the meaningful concept of health care management and leadership. The researcher recommends that both quality and ethical considerations should be involved in more practical sense and doctors need to be trained to carry out the administrative responsibilities by involving nurses and AHPS to ensure the distribution of power and diversity. This study has added the academic contribution by presenting a new mass of knowledge, and considering clinical team members in Jordanian hospitals as a uniform by creating the comprehensiveness of work culture. Finally, the study proved that both experience and knowledge are additional authorities beside position, law and work that may enrich performance

The short future of public broadcasting: Replacing digital terrestrial television with internet protocol?

According to recent European estimates, the life expectancy of broadcasting as a free-to-air television platform is not more than 15 years. BBC, Yle and the UK regulator Ofcom have reached this conclusion in their reports about the future of news, media distribution and digital terrestrial television (DTT). Although broadcasting is seen as necessary until 2030, all three assume that DTT can – under certain conditions – be replaced with delivery using internet protocol (IP). However, it seems that the idea of IPTV taking over DTT is just a sophisticated version of “black box fallacy”, driven by the expected growth of the new media ecosystem. The problems in replacing a socio-technological system have largely been neglected

Models for providing improved care in residential care homes: a thematic literature review

This Annotated Bibliography is one output from a review of the available research evidence to support improved care in residential care homes as the needs of older people intensify. Key findings The review identified extremely little published evidence on residential care homes; the research base is almost exclusively related to provision of care in nursing homes. Much of this research is from the US or other non-UK sources. Although it could be argued that some findings are generalisable to the UK residential care context, a systematic process is required to identify which. The literature often makes no distinction between nursing and residential homes; use of generic terms such as ‘care home’ should be avoided. There is considerable international debate in the quality improvement literature about the relationship between quality of care and quality of life in nursing and residential homes. Measures of social care, as well as clinical care, are needed. The centrality of the resident’s voice in measuring quality of life must be recognised. Ethnic minority residents are almost entirely absent from the quality improvement literature. Some clinical areas, internationally identified as key in terms of quality e.g. palliative care, are absent in the general nursing and residential home quality improvement literature. Others such as mental health (dementia and depression), diabetes, and nutrition are present but not fully integrated. Considerable evidence points to a need for better management of medication in nursing homes. Pharmacist medication reviews have shown a positive effect in nursing homes. It is unclear how this evidence might relate to residential care. There is evidence that medical cover for nursing and residential care home residents is suboptimal. Care could be restructured to give a greater scope for proactive and preventive interventions. General practitioners' workload in care homes may be considered against quality-of-care measures. There is US literature on the relationship between nurse staffing and nursing care home quality, with quality measured through clinical-based outcomes for residents and organisational outcomes. Conclusions are difficult to draw however due to inconsistencies in the evidencebase. Hospital admission and early discharge to nursing homes research may not be generalisable to residential care. The quality of inter-institutional transfers and ensuring patient safety across settings is important. To date research has not considered transfer from residential to nursing home care. The literature on district nurse and therapist roles in care homes includes very little research on residential care. Partnership working between district nurses and care home staff appears largely to occur by default at present. There is even less research evidence on therapist input to care homes. Set against the context outlined above, the international literature provides evidence of a number of approaches to care improvement, primarily in nursing homes. These include little discussion of cost-effectiveness other than in telecare. Research is needed in the UK on care improvement in residential homes

Comment on: `Pipe Network Model for Scaling of Dynamic Interfaces in Porous Media'

We argue that a proposed exponent identity [Phys. Rev. Lett 85, 1238 (2000)] for interface roughening in spontaneous imbibition is wrong. It rests on the assumption that the fluctuations are controlled by a single time scale, but liquid conservation imposes two distinct time scales.Comment: 1 page, to appear in Phys. Rev. Let