Supported: supporting, enabling, and sustaining homecare workers to deliver end-of-life care: a qualitative study protocol

Background Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. Aim To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. Methods In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner’s Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). Contribution We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers

Applications of electrified dust and dust devil electrodynamics to Martian atmospheric electricity

Atmospheric transport and suspension of dust frequently brings electrification, which may be substantial. Electric fields of 10 kVm-1 to 100 kVm-1 have been observed at the surface beneath suspended dust in the terrestrial atmosphere, and some electrification has been observed to persist in dust at levels to 5 km, as well as in volcanic plumes. The interaction between individual particles which causes the electrification is incompletely understood, and multiple processes are thought to be acting. A variation in particle charge with particle size, and the effect of gravitational separation explains to, some extent, the charge structures observed in terrestrial dust storms. More extensive flow-based modelling demonstrates that bulk electric fields in excess of 10 kV m-1 can be obtained rapidly (in less than 10 s) from rotating dust systems (dust devils) and that terrestrial breakdown fields can be obtained. Modelled profiles of electrical conductivity in the Martian atmosphere suggest the possibility of dust electrification, and dust devils have been suggested as a mechanism of charge separation able to maintain current flow between one region of the atmosphere and another, through a global circuit. Fundamental new understanding of Martian atmospheric electricity will result from the ExoMars mission, which carries the DREAMS (Dust characterization, Risk Assessment, and Environment Analyser on the Martian Surface)-MicroARES (Atmospheric Radiation and Electricity Sensor) instrumentation to Mars in 2016 for the first in situ measurements

Measurement of 3D forces at the foot-shoe interface during locomotor activity

The origin of this project was the problem of foot ulceration in the diabetic patient. Whilst the principal cause of the susceptibility to foot ulceration in patients with this pathology, and others such as leprosy, is abnormal physiology, there is no doubt the mechanical forces that are applied to the foot surface are a major factor. Currently several devices are available to measure the perpendicular forces at the foot-shoe interface (ie. the "pressure" distribution). However the full assessment of tri-axial forces at this interface has largely eluded quantification despite the fact that it has been demonstrated that shear forces may be of equal significance to those of direct pressure. The purpose of this study was to develop a transducer for the assessment of the three dimensional forces experienced, over a very localised area, at the foot-shoe interface during normal functional locomotor activity. The application of such a device in the clinical setting will provide valuable information for the medical and orthotic professions and thereby assist them in the treatment of many patients who are at risk of foot ulceration. The principle for a transducer to be embedded in an insole and utilising electromagnetic induction between air-cored coils was proposed. Coil winding techniques were developed to enable manufacture of coils within constrained sizes. Examination of the inductive coupling possible between the coils and its variation with displacement in space was carried out using a purpose built testing rig. Transducer electronics were designed and manufactured and a data logging system implemented. Various approaches to the derivation of 3D interpretation from the system were implemented in software. An examination of the accuracy of the approach was made. A prototype design and manufacturing method was suggested utilising a specific grade of silicone rubber. The results indicated that the design proposed could be implemented effectively in a size suited to in-shoe application. The design offers a relatively low cost method which could be adapted for use in many applications requiring three dimensional displacement or force measurements