Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England

Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of 'key' external advocates and leverage of additional resources by adoption of care pathway tools

Public Involvement in research within care homes: Benefits and challenges in the APPROACH Study

Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health care services achieve integrated working to promote older people’s health, PIR was integrated throughout the research processes. Objectives This paper aims to present one way in which PIR has been integrated into the design and delivery of a multi-site research study based in care homes. Design A prospective case study design, with an embedded qualitative evaluation of PIR activity. Setting and Participants Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Data Collection Qualitative data collection involved discussion groups, and site-specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. Results PIR members supported: recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimised distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Discussion and Conclusions Clearly defined roles with identified training and support facilitated involvement in different aspectsPublic Involvement in Research members of the research team: Gail Capstick, Marion Cowie, Derek Hope, Rita Hewitt, Alex Mendoza, John Willmott. Also the involvement of Steven Iliffe and Heather Gag

UV Exposed Optical Fibers with Frequency Domain Reflectometry for Device Tracking in Intra-Arterial Procedures

Shape tracking of medical devices using strain sensing properties in optical fibers has seen increased attention in recent years. In this paper, we propose a novel guidance system for intra-arterial procedures using a distributed strain sensing device based on optical frequency domain reflectometry (OFDR) to track the shape of a catheter. Tracking enhancement is provided by exposing a fiber triplet to a focused ultraviolet beam, producing high scattering properties. Contrary to typical quasi-distributed strain sensors, we propose a truly distributed strain sensing approach, which allows to reconstruct a fiber triplet in real-time. A 3D roadmap of the hepatic anatomy integrated with a 4D MR imaging sequence allows to navigate the catheter within the pre-interventional anatomy, and map the blood flow velocities in the arterial tree. We employed Riemannian anisotropic heat kernels to map the sensed data to the pre-interventional model. Experiments in synthetic phantoms and an in vivo model are presented. Results show that the tracking accuracy is suitable for interventional tracking applications, with a mean 3D shape reconstruction errors of 1.6 +/- 0.3 mm. This study demonstrates the promising potential of MR-compatible UV-exposed OFDR optical fibers for non-ionizing device guidance in intra-arterial procedures

A General Analysis of Corrections to the Standard See-saw Formula in Grand Unified Models

In realistic grand unified models there are typically extra vectorlike matter multiplets at the GUT scale that are needed to explain the family hierarchy. These contain neutrinos that, when integrated out, can modify the usual neutrino see-saw formula. A general analysis is given. It is noted that such modifications can explain why the neutrinos do not exhibit a strong family hierarchy like the other types of fermions.Comment: 30 page

On the I=2 channel pi-pi interaction in the chiral limit

An approximate local potential for the residual pi+ pi+ interaction is computed. We use an O(a**2) improved action on a coarse 9x9x9x13 lattice with approximately a=0.4fm. The results present a continuation of previous work: Increasing the number of gauge configurations and quark propagators we attempt extrapolation of the pi+ pi+ potential to the chiral limit.Comment: LATTICE98(spectrum) LaTeX2e, 3 pages, 3 eps figure

Phase transition in gauge theories, monopoles and the Multiple Point Principle

This review is devoted to the Multiple Point Principle (MPP), according to which several vacuum states with the same energy density exist in Nature. The MPP is implemented to the Standard Model (SM), Family replicated gauge group model (FRGGM) and phase transitions in gauge theories with/without monopoles. Lattice gauge theories are reviewed. The lattice results for critical coupling constants are compared with those of the Higgs Monopole Model (HMM), in which the lattice artifact monopoles are replaced by the point-like Higgs scalar particles with a magnetic charge. Considering our (3+1)-dimensional space-time as discrete, for example, as a lattice with a parameter a=\lambda_P, equal to the Planck length, we have investigated the additional contributions of monopoles to beta-functions of renormalization group equations in the FRGGM extended beyond the SM at high (the Planck scale) energies. We have reviewed that, in contrast to the Anti-grand unified theory (AGUT), there exists a possibility of unification of all gauge interactions (including gravity) near the Planck scale due to monopoles. The unifications [SU(5)]^3 and [SO(10)]^3 at the GUT-scale \sim 10^{18} GeV are briefly discussed.Comment: 100 pages, 25 figures, typos correcte

Seesaw Neutrino Masses with Large Mixings from Dimensional Deconstruction

We demonstrate a dynamical origin for the dimension-five seesaw operator in dimensional deconstruction models. Light neutrino masses arise from the seesaw scale which corresponds to the inverse lattice spacing. It is shown that the deconstructing limit naturally prefers maximal leptonic mixing. Higher-order corrections which are allowed by gauge invariance can transform the bi-maximal into a bi-large mixing. These terms may appear to be non-renormalizable at scales smaller than the deconstruction scale.Comment: Revised version published in PR

An astronomical search for evidence of new physics: Limits on gravity-induced birefringence from the magnetic white dwarf RE J0317-853

The coupling of the electromagnetic field directly with gravitational gauge fields leads to new physical effects that can be tested using astronomical data. Here we consider a particular case for closer scrutiny, a specific nonminimal coupling of torsion to electromagnetism, which enters into a metric-affine geometry of space-time. We show that under the assumption of this nonminimal coupling, spacetime is birefringent in the presence of such a gravitational field. This leads to the depolarization of light emitted from extended astrophysical sources. We use polarimetric data of the magnetic white dwarf ${RE J0317-853}$ to set strong constraints on the essential coupling constant for this effect, giving k^2 \lsim (19 {m})^2 .Comment: Statements about Moffat's NGT modified. Accepted for publication in Phys.Rev.

Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review

© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe