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

Physical, Chemical, and biotic influences on Zooplankton Composition in Zaranik Lagoon, Egypt

EnZaranik Protected Area encompasses the eastern end of Lake Bardawil: the Zaranik Lagoon. The lagoon is shallow, with numerous small islets scattered throughout it, most of which are covered with dense saltmarsh vegetation. Nitrogenous and phosphorus forms (ammonia, nitrite, nitrate, orthophosphate and total phosphorus) were studied as a basic nutrient salts affected different flora and fauna of the studied area. Nitrite was depleted completely during the study period except for winter. The nitrate values were fluctuated in a relatively narrow range (23.5 – 60 µg/l). Ammonia was detected in a normal range varied between 89-172 µg/l. Both orthophosphate and total phosphorus exhibit similar distribution dynamics. A total of 45 zooplankton species belonging to 9 main groups (Protista, Copepoda, Rotifera, Cladocera, Pteropoda, Cheatognatha, Cnidaria, Appendiculariae, and meroplankton) were recorded. Copepoda were the most abundant and ubiquitous zooplankton organisms in Zaranik protectorate, forming the 63 % of total zooplankton density. Salinity showed a negative correlation with total Protista (r = - 0.77) while NH3 showed a positive correlation with total zooplankton (r = 0.68)

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

Membandingkan Algoritma D'satur dengan Algoritma Vertex Merge dalam Pewarnaan Graf Tak Berarah

This article provides an undirected graph vertex coloring. Graph vertex coloring can be done by using the coloring algorithm, including d'satur algorithm and vertex merge algorithm. Of the two algorithms, a more efficient algorithm is determined that generates chromatic number χ(G) which is the minimum or produces fewercolors. This article is a review of the work of Handrizal et. al [Journal of Computer Science 7(5):664-670]

Morphology and anatomical structure of the larval salt gland of Artemia tunisiana under different salinities

Brine shrimps of the genus Artemia is characterized by its high adaptability to adverse environmental conditions. To elucidate the effect of salinity on the neck organ (salt gland) of Artemia tunisiana nauplii, the morphology and fine structure of the ion transporting epithelium were examined following culturing under different salinities (25, 40, 70, 140 and 180 g/L). The expression of APH-1 mRNA, using semiquantitative reverse transcription-polymerase chain reaction (RT-PCR), was also determined. The morphology and anatomical structure of the salt gland varied according to the salinity degree. At low salinities, salt gland was small, thin and flat having many shallow canals, while at high salinities, it was more elongated with deeper canals and grooves. Ultrastructure examination showed low amplification of the plasma membrane at 25 g/L with no tubular tufts, while at 40 and 70 g/L salinities, the apical and central zones showed a large amplification of the surface area of the plasma membrane. At 140 g/L salinity, the epithelial cells were more elongated and the cuticle appeared to be composed of many layers. The general structure of the salt gland of nauplii cultured at 180 g/L disappeared. Semiquantitative APH-1 mRNA analysis indicated that the gene was expressed in all tested salinities. The expression did not change remarkably between 25 and 40 g/L salinities. As salinity increased, the gene was up regulated at 70 g/L and reached the highest level at 140 g/L, while the expression level reduced significantly at 180 g/L. This coincides with the histological results and highlights the possible role of APH-1 in salinity protection in Artemia.Keywords: Artemia, nauplii, salt gland, salinity, APH-1 gene expressionAfrican Journal of Biotechnology Vol. 12(41), pp. 6032-604

Chicory abrogates oxidative stress, inflammation and caspase-dependent apoptosis in acute hepatic injury model induced by acetaminophen in rats

In this study the protective effect of chicory leaves hydroalcoholic extract (CIE) against acute liver injury induced by a single dose of acetaminophen (700 mg/kg, i.p.) was investigated in rats. The CIE and silymarin treatment (standard reference) were given in a dose of (100 mg/kg, p.o.) for 3 days before and at 1 and 12 h following acetaminophen administration. Treatment with CIE significantly reduced the levels of serum ALT, AST, alkaline phosphatase, bilirubin, total cholesterol, triglycerides, urea, creatinine, TNF-α and hepatic contents of malondialdehyde (MDA), nitric oxide, caspase-3 and hydroxyproline, with significant increases in serum total protein, albumin, HDL- cholesterol and hepatic activities of reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) as compared with the acetaminophen group. The histopathological alterations mediated by acetaminophen were ameliorated by CIE. It was concluded that CIE protects rat liver against acetaminophen hepatotoxicity, most probably through abrogation of oxidative stress, inflammation and caspase-3 dependent apoptosis