The conversation: developing confidence to provide end of life care in Salford nursing homes

The study was funded by the Burdett Trust for Nursing and partly by Salford Primary Care Trust. A realistic evaluation design was used to collect data using a range of approaches, from before and after surveys of confidence in delivering end of life care, to participant observation and interviews. A total of 43 people were interviewed involving both staff, residents and relatives. Key Messages a) Significant resources are needed to engage staff, residents and relatives/carers with the idea of advance care planning b) Care home staff are optimistic about involving residents and relatives in planning care at the end of life and some relatives become very involved in care c) Clearly registered nurses and other care home workers such as care assistants have different roles, but the overlap between these and the appropriate boundaries would benefit from further work d) Talking to residents and relatives about their feelings and wishes for care at the end of life remains especially difficult, but education and training in key skills and knowledge can engender both ability and motivation e) Care homes need strong and well-informed leadership in order to implement the Gold Standards Framework f) Placing a relative in a care home involves strain and an ability to compromise ‘there’s no perfect place’ g) Advance care planning can reduce the distress and the number of inappropriate hospital admissions, but is challenging in the face of staff rotation and out of hours medical staff being unpredictable h) The principles of the Gold Standards Framework are widely seen as sensible, but clinical challenges include diagnosing and predicting dying trajectories, especially in heart failure, chronic pulmonary disease and dementia i) A particular concern of staff is how to approach nutrition and hydration as frailty and death approach j) Communicating about diagnosis and especially prognosis with residents who lack capacity is an increasing problem k) Natural justice suggests that resources should be allocated to the general standardisation of a good quality of care at the end of life in ALL care homes whatever their Care Quality Commission ratin

Noncoherent Space-Time Coding: An Algebraic Perspective

Cataloged from PDF version of article.The design of space–time signals for noncoherent block-fading channels where the channel state information is not known a priori at the transmitter and the receiver is considered. In particular, a new algebraic formulation for the diversity advantage design criterion is developed. The new criterion encompasses, as a special case, the well-known diversity advantage for unitary space–time signals and, more importantly, applies to arbitrary signaling schemes and arbitrary channel distributions. This criterion is used to establish the optimal diversity-versus-rate tradeoff for training based schemes in block-fading channels. Our results are then specialized to the class of affine space–time signals which allows for a low complexity decoder. Within this class, space–time constellations based on the threaded algebraic space–time (TAST) architecture are considered. These constellations achieve the optimal diversity-versus-rate tradeoff over noncoherent block-fading channels and outperform previously proposed codes in the considered scenarios as demonstrated by the numerical results. Using the analytical and numerical results developed in this paper, nonunitary space–time codes are argued to offer certain advantages in block-fading channels where the appropriate use of coherent space–time codes is shown to offer a very efficient solution to the noncoherent space–time communication paradigm

Energy and angular momentum of general 4-dimensional stationary axi-symmetric spacetime in teleparallel geometry

We derive an exact general axi-symmetric solution of the coupled gravitational and electromagnetic fields in the tetrad theory of gravitation. The solution is characterized by four parameters $M$ (mass), $Q$ (charge), $a$ (rotation) and $L$ (NUT). We then, calculate the total exterior energy using the energy-momentum complex given by M{\o}ller in the framework of Weitzenb$\ddot{o}$ck geometry. We show that the energy contained in a sphere is shared by its interior as well as exterior. We also calculate the components of the spatial momentum to evaluate the angular momentum distribution. We show that the only non-vanishing components of the angular momentum is in the Z direction.Comment: Latex. Will appear in IJMP

Numerical investigation of high-pressure combustion in rocket engines using Flamelet/Progress-variable models

The present paper deals with the numerical study of high pressure LOx/H2 or LOx/hydrocarbon combustion for propulsion systems. The present research effort is driven by the continued interest in achieving low cost, reliable access to space and more recently, by the renewed interest in hypersonic transportation systems capable of reducing time-to-destination. Moreover, combustion at high pressure has been assumed as a key issue to achieve better propulsive performance and lower environmental impact, as long as the replacement of hydrogen with a hydrocarbon, to reduce the costs related to ground operations and increase flexibility. The current work provides a model for the numerical simulation of high- pressure turbulent combustion employing detailed chemistry description, embedded in a RANS equations solver with a Low Reynolds number k-omega turbulence model. The model used to study such a combustion phenomenon is an extension of the standard flamelet-progress-variable (FPV) turbulent combustion model combined with a Reynolds Averaged Navier-Stokes equation Solver (RANS). In the FPV model, all of the thermo-chemical quantities are evaluated by evolving the mixture fraction Z and a progress variable C. When using a turbulence model in conjunction with FPV model, a probability density function (PDF) is required to evaluate statistical averages of chemical quantities. The choice of such PDF must be a compromise between computational costs and accuracy level. State- of-the-art FPV models are built presuming the functional shape of the joint PDF of Z and C in order to evaluate Favre-averages of thermodynamic quantities. The model here proposed evaluates the most probable joint distribution of Z and C without any assumption on their behavior.Comment: presented at AIAA Scitech 201