Evaluation of the new ward housekeeper role in UK NHS Trusts

In the year 2000, the UK government promoted the concept that hospital services be shaped around the needs of the patient to make their stay in hospital as comfortable as possible and advocated the introduction of a ward housekeeper role in at least 50 per cent of hospitals by 2004. This is a ward-based non-clinical role centred on cleaning, food service and maintenance to ensure that the basics of care are right for the patient. In 2002 the Facilities Management Graduate Centre at Sheffield Hallam University completed a series of six case studies looking at the role within different NHS Trusts. These were developed through interviews and observations with the facilities manager, ward housekeepers and nursing staff and also by collecting documentary evidence such as job descriptions, financial details and training information. Common themes were identified, relating to experiences of developing and implementing the ward housekeeper role. This paper suggests models of best practice relating to role, recruitment, induction, training, integration and management.</p

Using queuing theory to analyse completion times in accident and emergency departments in the light of the government 4-hour target

This paper uses a queuing model to evaluate completion times in accident and emergency (A&E) departments in the light of the Government target of completing and discharging 98% of patients inside 4 hours. It illustrates how flows though an A&E can be very accurately represented as a queuing process, how the outputs of a queuing model can be used to visualise and interpret the 4-hour hours Government target in a simple way and how queuing models can be used to assess the practical achievability of A&E targets in the future. The paper finds that A&E targets have resulted in significant improvements in completion times and thus deal with a major source of complaint by users of the National Health Service. It finds that whilst some of this improvement is attributable to better management, some is also due to the way some patients in A&E are designated and therefore counted. It finds for example that the current target would not have been possible without some form of patient re-designation or re-labelling taking place. Further it finds that the current target is so demanding that the integrity of reported performance is open to question and that a different approach is needed. Related incentives and demand management issues resulting from this Government target are also briefly discussed

Gender convergence in human survival and the postponement of death

It has been a long accepted demographic maxim that females outlive males. Using data for England and Wales, we show that life expectancy at age 30 is converging and continuation of this long-term trend suggests it could reach parity in 2030. Key among the reasons identified for the narrowing of the gap are differences in smoking prevalence between males and females which have narrowed considerably. Using data from 30 comparator countries gender differences in smoking prevalence are found to explain over 75% of the variance in the life expectancy gap, but other factors such as female emancipation and better health care are also considered. The paper presents a model which considers differences in male and female longevity in greater detail using novel methods for analysing life tables. It considers the ages from which death is being postponed to the ages at which people now die; the relative speed at which these changes are taking place between genders; how the changes observed are affecting survival prospects at different ages up to 2030. It finds that as life expectancy continues to rise there is evidence for convergence in the oldest ages to which either gender will live

The 100-year family Longer lives, fewer children

This paper investigates how the role and resilience of the family in the UK has changed over time, and explores how it is coming under increasing pressure from external demographic and economic forces. We investigate these effects using a novel approach based on survivorship. We also propose a new way to define ‘family,’ using a framework flexible enough to model a range of family structures and situations: by centring analysis on the ‘focal woman.’ Survivorship is the probability of living to a given age (see section 2 for more detail); we take this data from the UK Office for National Statistics (ONS) life tables for England and Wales. These are constructed using mortality data and are available from the mid-nineteenth century onwards. We construct the joint survivorship of typical families based on the number of births. We also employ novel ‘family accounting’ methods to quantify and analyse the potential overlapping of care responsibilities that face today’s families. Our work is informed by the effects of two broad transitions, widely recognised by demographers as occurring across many societies: The first is the progression from high to low mortality and from high to low fertility rates (the average number of children born to each woman in any given population). These two changes combine to produce a surge in population and economic growth, accompanied by rapid increases in life expectancy. In the UK this period lasted from around the mid-nineteenth to the mid-twentieth century or later. The nature of the second transition is not universally accepted among demographers, but broadly it refers to the societal changes in any given population that have taken place since the 1970s; these include changes in family structures, and a shift towards women choosing to have fewer children, later in life. The arrival of protected rights and wider access to education for women during this period have been key factors in driving these shifts. We posit that the economic benefits of the first transition are in danger of being reversed by the second, and that our social, political and economic structures are not aligned to support the families in which we now live. We explore this possibility through analysis of family structures in a context of increasingly stretched welfare systems, widening inequalities and ageing populations. This context raises questions: Whether our population can continue to replace itself given that families are having fewer children, later in life: our analysis indicates that, at a family level, our increased longevity does not offset the decline in fertility rates. How to address the additional strain on our underfunded social, health and state pension systems, with more older people living alone, and a greater need within today’s smaller, older families for external support. How to address the likelihood that the tendency towards older families leads to each family’s main carer being responsible for multiple generations at once. Whether the additional burdens of juggling work and caring responsibilities will have a further stagnating effect on the wider economy. How to address the inheritance gap that delays the passing of wealth to the next generation as we all live longer. We believe that society must adjust itself to the new reality, by taking steps to move into a third transition. This will require action to enable more of us to spend our additional years in good health and in decent housing, with the capacity to undertake paid work, to care for our families, or to do both. We suggest that as part of this transition there may be a need for: Reformulated personal financial services to address the current gaps in provision at the family level. A new approach to social protection that focuses on families as well as individuals. Our analysis shows that the changes occurring during the second transition have put society on a demographic escalator to economic stagnation, and that matters can only get worse. We believe it will take conscious action by the UK’s decision-makers to make a third transition reality and step off the escalator

Automation literature: A brief review and analysis

Current thought and research positions which may allow for an improved capability to understand the impact of introducing automation to an existing system are established. The orientation was toward the type of studies which may provide some general insight into automation; specifically, the impact of automation in human performance and the resulting system performance. While an extensive number of articles were reviewed, only those that addressed the issue of automation and human performance were selected to be discussed. The literature is organized along two dimensions: time, Pre-1970, Post-1970; and type of approach, Engineering or Behavioral Science. The conclusions reached are not definitive, but do provide the initial stepping stones in an attempt to begin to bridge the concept of automation in a systematic progression

A rocket-borne airglow photometer

The design of a rocket-borne photometer to measure the airglow emission of ionized molecular nitrogen in the 391.4 nm band is presented. This airglow is a well known and often observed phenomenon of auroras, where the principal source of ionization is energetic electrons. It is believed that at some midlatitude locations energetic electrons are also a source of nighttime ionization in the E region of the ionosphere. If this is so, then significant levels of 391.4 nm airglow should be present. The intensity of this airglow will be measured in a rocket payload which also contains instrumentation to measured in a rocket payload which also contains instrumentation to measure energetic electron differential flux and the ambient electron density. An intercomparison of the 3 experiments in a nightime launch will allow a test of the importance of energetic electrons as a nighttime source of ionization in the upper E region

An improved rocket-borne electric field meter for the middle atmosphere

Improvements in a rocketborne electric field meter designed to measure the atmosphere's electric field and conductivity in the middle atmosphere are described. The general background of the experiment is given as well as changes in the instrument and data processing schemes. Calibration and testing procedures are documented together with suggestions for future work

Carrier transport coefficients across GaAs-GaAIAs (100) interfaces

We present calculations of reflection and transmission coefficients for electrons and holes at (100) interfaces for the GaAs–Ga_(1–x)Al_xAs system. We consider semi‐infinite crystals of the two semiconductors joined at an abrupt or compositionally graded interface. The calculations are performed using the empirical tight binding approximation. The transport coefficients were computed as a function of the components of the incident carrier wavevector normal and parallel to the interface. We have investigated the transport coefficients for incident states near various band minima into different final state channels. The transmission into states with qualitatively similar character to the incident state is found to be much greater than transmission into states of different character. For example, an electron near the X minimum normal to the interface in Ga_(1–xAl_xAs transmits into the X valley of GaAs with much greater probability than it transmits into the Γ minimum of GaAs. We have investigated the dependence of the transport coefficients on alloy composition. The effect of compositional grading of the interface on the transport coefficients has also been investigated

Applications of inverse simulation to a nonlinear model of an underwater vehicle

Inverse simulation provides an important alternative to conventional simulation and to more formal mathematical techniques of model inversion. The application of inverse simulation methods to a nonlinear dynamic model of an unmanned underwater vehicle with actuator limits is found to give rise to a number of challenging problems. It is shown that this particular problem requires, in common with other applications that include hard nonlinearities in the model or discontinuities in the required trajectory, can best be approached using a search-based optimization algorithm for inverse simulation in place of the more conventional Newton- Raphson approach. Results show that meaningful inverse simulation results can be obtained but that multi-solution responses exist. Although the inverse solutions are not unique they are shown to generate the required trajectories when tested using conventional forward simulation methods

Whither human survival and longevity or the shape of things to come

With the continuing increases in life expectancy, populations are ageing rapidly. Governments are concerned for the future of pensions and health care for which population forecasts are an important component for planning purposes. In this paper we focus on human survival rather than mortality rates which are the more usual starting point when estimating future populations. Using a simple model we link basic measures of life expectancy to the shape of the human survival function and consider its various forms. We then use the simple model as the basis for investigating actual survival in England and Wales from 1841 onwards and investigate the concept of a ‘maximum age’. We show how the model can be used in a predictive sense and demonstrate in two tests that show our model would have given more accurate results than comparable government forecasts using the same base information. We then go on to show that, based on trends in life expectancy, official population forecasts could undershoot the population at age 50+ by 0.6m, with consequent financial implications for pensions, health and social care