The ‘regulated death’: a documentary analysis of the regulation and inspection of dying and death in English care homes for older people.

In England, processes of regulation and inspection have been established to ensure that older people living in long-term care settings receive quality care. This paper describes how dying and death in care homes for older people is regulated and inspected. A documentary analysis was undertaken of the standard that addresses dying and death in the 2001 Care Homes for Older People: National Minimum Standards. Present in the standard is a ‘good death’ template drawn from constructions of best practice in palliative care. The way in which this national standard is enacted in the inspection process is described using a content analysis of the inspection reports from 226 care homes for older people. These present a narrow focus on dying and death, one that emphasises the older person's wishes and the degree of adherence to policies and procedures concerned with the dying and death event. A regulated death attenuates the ‘good death’ template and reflects both the inspection process and capabilities of the residents of care homes. If the regulation and inspection process is to integrate dying with living, a broader conception and regime of inspection is required. Only then will end-of-life care be provided that meets the diverse needs of older people who live in care homes

Implementation of the Multiple Point Principle in the Two-Higgs Doublet Model of type II

The multiple point principle (MPP) is applied to the non--supersymmetric two-Higgs doublet extension of the Standard Model (SM). The existence of a large set of degenerate vacua at some high energy scale caused by the MPP results in a few relations between Higgs self-coupling constants which can be examined at future colliders. The numerical analysis reveals that these MPP conditions constrain the mass of the SM--like Higgs boson to lie below 180 GeV for a wide set of MPP scales $\Lambda$ and $\tan\beta$.Comment: 26 pages, 3 figures, some minor changes to the tex

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

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