‘Through the patient’s eyes’: shadowing patients at the end of life

Background The priority given to patient-centred care in recent years has included a requirement for healthcare organisations to collect patient experience data, and to improve patients’ experience of care. Shadowing is an experiential technique intended to enable healthcare staff to collect information in a way which will aid them to understand the experience of care from the patient’s perspective. It has been introduced recently to quality improvement projects, but accounts of healthcare staff who undertake shadowing have not hitherto been explored. Aim To explore the experience for healthcare staff of shadowing their patients and their motivation to make improvements. Method An exploratory qualitative study with a diverse sample of 20 clinical and non-clinical healthcare staff in different end of life settings, including acute hospitals, community and mental health, and care and nursing homes. Data were analysed using Thematic Analysis (Braun and Clarke, 2006). Results Participants’ accounts of shadowing revealed that their initial anxieties about aspects of shadowing did not materialise, although for some it was an ‘unusual’ experience, placing them in a novel relationship with patients. For some participants, shadowing had a powerful personal impact, intensified by being with patients who were at end of life. Shadowing promoted better insights into the experience of patients and their families, thus motivating participants to focus their improvement efforts. However, most participants were unaware that they were bringing their personal and professional lens to what they observed, which may influence their interpretation of the patients’ experience. Conclusion The challenge to taking up shadowing is not primarily logistical but emotional. Healthcare staff need to be supported to be aware of how shadowing may affect them. It may involve the need to manage their emotion, and to be reflexive so that appropriate service changes are made for patients and families

On the Complexity of List Ranking in the Parallel External Memory Model

We study the problem of list ranking in the parallel external memory (PEM) model. We observe an interesting dual nature for the hardness of the problem due to limited information exchange among the processors about the structure of the list, on the one hand, and its close relationship to the problem of permuting data, which is known to be hard for the external memory models, on the other hand. By carefully defining the power of the computational model, we prove a permuting lower bound in the PEM model. Furthermore, we present a stronger \Omega(log^2 N) lower bound for a special variant of the problem and for a specific range of the model parameters, which takes us a step closer toward proving a non-trivial lower bound for the list ranking problem in the bulk-synchronous parallel (BSP) and MapReduce models. Finally, we also present an algorithm that is tight for a larger range of parameters of the model than in prior work

Locking device for turbine rotor blades Patent

Locking device for retaining turbine rotor blades on turbine whee

Shuttle orbiter boundary layer transition at flight and wind tunnel conditions

Hypersonic boundary layer transition data obtained on the windward centerline of the Shuttle orbiter during entry for the first five flights are presented and analyzed. Because the orbiter surface is composed of a large number of thermal protection tiles, the transition data include the effects of distributed roughness arising from tile misalignment and gaps. These data are used as a benchmark for assessing and improving the accuracy of boundary layer transition predictions based on correlations of wind tunnel data taken on both aerodynamically rough and smooth orbiter surfaces. By comparing these two data bases, the relative importance of tunnel free stream noise and surface roughness on orbiter boundary layer transition correlation parameters can be assessed. This assessment indicates that accurate predications of transition times can be made for the orbiter at hypersonic flight conditions by using roughness dominated wind tunnel data. Specifically, times of transition onset and completion is accurately predicted using a correlation based on critical and effective values of a roughness Reynolds number previously derived from wind tunnel data

Stability of jammed packings I: the rigidity length scale

In 2005, Wyart et al. (Europhys. Lett., 72 (2005) 486) showed that the low frequency vibrational properties of jammed amorphous sphere packings can be understood in terms of a length scale, called l*, that diverges as the system becomes marginally unstable. Despite the tremendous success of this theory, it has been difficult to connect the counting argument that defines l* to other length scales that diverge near the jamming transition. We present an alternate derivation of l* based on the onset of rigidity. This phenomenological approach reveals the physical mechanism underlying the length scale and is relevant to a range of systems for which the original argument breaks down. It also allows us to present the first direct numerical measurement of l*.Comment: 8 pages, 5 figure