Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach

BACKGROUND: Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings. OBJECTIVE: To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice. METHOD: A Participatory Action Research approach, guided by the Promoting Action Research in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long‐term actions (Action Cycle Three). RESULTS: Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information. CONCLUSION: Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task‐focused, target and policy‐driven care that was not person‐centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice

Using Quantum Computers for Quantum Simulation

Numerical simulation of quantum systems is crucial to further our understanding of natural phenomena. Many systems of key interest and importance, in areas such as superconducting materials and quantum chemistry, are thought to be described by models which we cannot solve with sufficient accuracy, neither analytically nor numerically with classical computers. Using a quantum computer to simulate such quantum systems has been viewed as a key application of quantum computation from the very beginning of the field in the 1980s. Moreover, useful results beyond the reach of classical computation are expected to be accessible with fewer than a hundred qubits, making quantum simulation potentially one of the earliest practical applications of quantum computers. In this paper we survey the theoretical and experimental development of quantum simulation using quantum computers, from the first ideas to the intense research efforts currently underway.Comment: 43 pages, 136 references, review article, v2 major revisions in response to referee comments, v3 significant revisions, identical to published version apart from format, ArXiv version has table of contents and references in alphabetical orde

Ancilla-based quantum simulation

We consider simulating the BCS Hamiltonian, a model of low temperature superconductivity, on a quantum computer. In particular we consider conducting the simulation on the qubus quantum computer, which uses a continuous variable ancilla to generate interactions between qubits. We demonstrate an O(N^3) improvement over previous work conducted on an NMR computer [PRL 89 057904 (2002) & PRL 97 050504 (2006)] for the nearest neighbour and completely general cases. We then go on to show methods to minimise the number of operations needed per time step using the qubus in three cases; a completely general case, a case of exponentially decaying interactions and the case of fixed range interactions. We make these results controlled on an ancilla qubit so that we can apply the phase estimation algorithm, and hence show that when N \geq 5, our qubus simulation requires significantly less operations that a similar simulation conducted on an NMR computer.Comment: 20 pages, 10 figures: V2 added section on phase estimation and performing controlled unitaries, V3 corrected minor typo

Publishing patterns within the UK accounting and finance academic community

This study reports on publishing patterns in the UK and Irish accounting and finance academic community for the 2-year period 1998-1999 using the data contained in the BAR Research Register. It is found that the community has been growing modestly since 1991, with a doubling in the number of PhD-qualified staff (to 30%) and a reduction in the number with a professional qualification (from 81 to 58%). Nearly half of all outputs appear in other than academic journals. The mean number of publications is 1.76 per capita, with significantly more staff active in publishing than in 1991 (44% compared to 35%). However, only 17% publish in a subset of 60 'top' journals. Just over half of all articles are published in the core discipline journals, the rest appearing mainly in management, economics, sociology, education and IT journals. This may indicate a growing maturity in the disciplines, whereby applied research findings are flowing back into related foundation and business disciplines. Nearly two-thirds of academic articles are co-authored, with 25% of contributions coming from outside the community, indicating an openness to interdisciplinary collaboration, collaboration with overseas academics and collaboration with individuals in practice. The findings of this study will be of assistance to those making career decisions (either their own career or decisions involving other people's careers). They also raise awareness of the way in which the accounting and finance disciplines are developing

Rapid death of duck cells infected with influenza: a potential mechanism for host resistance to H5N1

Aquatic birds are the natural reservoir for most subtypes of influenza A, and a source of novel viruses with the potential to cause human pandemics, fatal zoonotic disease or devastating epizootics in poultry. It is well recognised that waterfowl typically show few clinical signs following influenza A infection, in contrast, terrestrial poultry such as chickens may develop severe disease with rapid death following infection with highly pathogenic avian influenza. This study examined the cellular response to influenza infection in primary cells derived from resistant (duck) and susceptible (chicken) avian hosts. Paradoxically, we observed that duck cells underwent rapid cell death following infection with low pathogenic avian H2N3, classical swine H1N1 and ‘classical' highly pathogenic H5N1 viruses. Dying cells showed morphological features of apoptosis, increased DNA fragmentation and activation of caspase 3/7. Following infection of chicken cells, cell death occurred less rapidly, accompanied by reduced DNA fragmentation and caspase activation. Duck cells produced similar levels of viral RNA but less infectious virus, in comparison with chicken cells. Such rapid cell death was not observed in duck cells infected with a contemporary Eurasian lineage H5N1 fatal to ducks. The induction of rapid death in duck cells may be part of a mechanism of host resistance to influenza A, with the loss of this response leading to increased susceptibility to emergent strains of H5N1. These studies provide novel insights that should help resolve the long-standing enigma of host–pathogen relationships for highly pathogenic and zoonotic avian influenza

A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder.

A total of 105 patients with post-traumatic stress disorder (PTSD) were randomly allocated to eye-movement desensitization and reprocessing (EMDR) (n = 39) versus exposure plus cognitive restructuring (E + CR) (n = 37) versus waiting list (WL) (n = 29) in a primary care setting. EMDR and E + CR patients received a maximum of 10 treatment sessions over a 10-week period. All patients were assessed by blind raters prior to randomization and at end of the 10-week treatment or waiting list period. EMDR and E + CR patients were also assessed by therapists at the mid-point of the 10-week treatment period and on average at 15 months follow-up. Patients were assessed on a variety of assessor-rated and self-report measures of PTSD symptomatology including the Clinician Administered PTSD Scale (CAPS), the Impact of Events Scale (IOE) and a self-report version of the SI-PTSD Checklist. Measures of anxiety and depression included the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Scale (HAM-A) and the Hospital Anxiety and Depression Scale (HADS). A measure of social function, the Sheehan Disability Scale was also used. Drop-out rates between the three groups were 12 EMDR, 16 E + CR and five WL. Treatment end-point analyses were conducted on the remaining 72 patients. Repeated measures analysis of variance of treatment outcome at 10 weeks revealed significant time, interaction and group effects for all the above measures. In general there were significant and substantial pre–post reductions for EMDR and E + CR groups but no change for the WL patients. Both treatments were effective over WL. The only indication of superiority of either active treatment, in relation to measures of clinically significant change, was a greater reduction in patient self-reported depression ratings and improved social functioning for EMDR in comparison to E + CR at the end of the treatment period and for fewer number of treatment sessions for EMDR (mean 4.2) than E +... [ABSTRACT FROM AUTHOR