Materialising memories: exploring the stories of people with dementia through dress

In this article, we use clothes as a tool for exploring the life stories and narratives of people with dementia, eliciting memories through the sensory and material dimensions of dress. The article draws on an Economic and Social Research Councilfunded study, ‘Dementia and Dress’, which explored everyday experiences of clothing for carers, care workers and people with dementia, using qualitative and ethnographic methods including: ‘wardrobe interviews’, observations, and visual and sensory approaches. In our analysis, we use three dimensions of dress as a device for exploring the experiences of people with dementia: kept clothes, as a way of retaining connections to memories and identity; discarded clothes, and their implications for understanding change and loss in relation to the ‘dementia journey’; and absent clothes, invoked through the sensory imagination, recalling images of former selves, and carrying identity forward into the context of care. The article contributes to understandings of narrative, identity and dementia, drawing attention to the potential ofmaterial objects for evoking narratives, and maintaining biographical continuity for both men and women. The paper has larger implications for understandings of ageing and care practice; as well as contributing to the wider Material Turn in gerontology, showing how cultural analyses can be applied even to frail older groups who are often excluded from such approaches

Clinically practising nurses\u27 perceptions of professionalism

This study describes clinically practising nurses’ perceptions of professionalism and compares these with reports of nurses’ perceptions of professionalism in the published literature. A phenomenological approach was chosen to identify and interpret the phenomena (professionalism). Ten Registered Nurses representing a range of clinical nursing positions were interviewed on the subject. Data were analysed using an interpretive methodology which identified themes and meanings. Credibility of results was established through participant validation of the identified themes and meanings and by researcher and data triangulation. The study identified six themes common to all participants’ descriptions: expertise based upon a sound education, continued learning, and clinical skill; caring which involved communication skills, mutual trust and respect, and holistic nondiscriminatory care; an image which portrayed a professional persona, expertise and commitment; recognition of expertise by the public and other health workers; unity promoted through professional organisations; and finally autonomy. These themes were in agreement with the concept of professionalism as published in the literature

Having a greater proportion of registered nurses in a respiratory care centre is associated with fewer urinary infections and increased successful ventilator weaning

This study explored the impact of skill mix model changes on patient outcomes in a critical care environment, specifically, a respiratory care centre based in a southern Taiwan medical centre. It identified that the cost of ventilator-dependent patients in Taiwan in 1999 was 3.5 billion New Taiwan dollars, equivalent to US$ 121 million. In this context, controlling the costs of healthcare while maintaining quality care became critical. This research examined two skill mix staffing models, a mixed registered nurse (RN) and nursing aid model and a 100% RN model, and their impact on patient outcomes. Patient outcomes were pressure ulcers, respiratory and urinary tract infections, blood stream infections, days of hospitalisation and ventilator weaning

Production of hydrogen by unmixed steam reforming of methane

Unmixed steam reforming is an alternative method of catalytic steam reforming that uses separate air and fuel–steam feeds, producing a reformate high in H2 content using a single reactor and a variety of fuels. It claims insensitivity to carbon formation and can operate autothermally. The high H2 content is achieved by in situ N2 separation from the air using an oxygen transfer material (OTM), and by CO2 capture using a solid sorbent. The OTM and CO2 sorbent are regenerated during the fuel–steam feed and the air feed, respectively, within the same reactor. This paper describes the steps taken to choose a suitable CO2-sorbent material for this process when using methane fuel with the help of microreactor tests, and the study of the carbonation efficiency and regeneration ability of the materials tested. Elemental balances from bench scale experiments using the best OTM in the absence of the CO2 sorbent allow identifying the sequence of the chemical reaction mechanism. The effect of reactor temperature between 600 and on the process outputs is investigated. Temperatures of 600 and under the fuel–steam feed were each found to offer a different set of desirable outputs. Two stages during the fuel–steam feed were characterised by a different set of global reactions, an initial stage where the OTM is reduced directly by methane, and indirectly by hydrogen produced by methane thermal decomposition, in the second stage, steam reforming takes over once sufficient OTM has been reduced. The implications of these stages on the process desirable outputs such as efficiency of reactants conversion, reformate gas quality, and transient effects are discussed

Looking out of place: analysing the spatial and symbolic meanings of dementia care setting through dress

The article explores how clothing exposes – and troubles – the ambiguous location of care homes on the boundaries of public/private, home/institutional space. It deploys a material analysis of the symbolic uses and meanings of dress, extending the remit of the new cultural gerontology to encompass the “fourth age,” and the lives of older people with dementia. The article draws on an ESRC-funded study “Dementia and Dress,” conducted in the United Kingdom (UK), which explored everyday experiences of clothing for people with dementia, carers and careworkers, using ethnographic and qualitative methods. Careworkers and managers were keen to emphasise the “homely” nature of care homes, yet this was sometimes at odds with the desire to maintain presentable and orderly bodies, and with institutional routines of bodywork. Residents’ use of clothing could disrupt boundaries of public/private space, materialising a sense of not being “at home,” and a desire to return there

Hardness of Exact Distance Queries in Sparse Graphs Through Hub Labeling

A distance labeling scheme is an assignment of bit-labels to the vertices of an undirected, unweighted graph such that the distance between any pair of vertices can be decoded solely from their labels. An important class of distance labeling schemes is that of hub labelings, where a node $v \in G$ stores its distance to the so-called hubs $S_v \subseteq V$, chosen so that for any $u,v \in V$ there is $w \in S_u \cap S_v$ belonging to some shortest $uv$ path. Notice that for most existing graph classes, the best distance labelling constructions existing use at some point a hub labeling scheme at least as a key building block. Our interest lies in hub labelings of sparse graphs, i.e., those with $|E(G)| = O(n)$, for which we show a lowerbound of $\frac{n}{2^{O(\sqrt{\log n})}}$ for the average size of the hubsets. Additionally, we show a hub-labeling construction for sparse graphs of average size $O(\frac{n}{RS(n)^{c}})$ for some $0 < c < 1$, where $RS(n)$ is the so-called Ruzsa-Szemer{\'e}di function, linked to structure of induced matchings in dense graphs. This implies that further improving the lower bound on hub labeling size to $\frac{n}{2^{(\log n)^{o(1)}}}$ would require a breakthrough in the study of lower bounds on $RS(n)$, which have resisted substantial improvement in the last 70 years. For general distance labeling of sparse graphs, we show a lowerbound of $\frac{1}{2^{O(\sqrt{\log n})}} SumIndex(n)$, where $SumIndex(n)$ is the communication complexity of the Sum-Index problem over $Z_n$. Our results suggest that the best achievable hub-label size and distance-label size in sparse graphs may be $\Theta(\frac{n}{2^{(\log n)^c}})$ for some $0<c < 1$

Foliar wheat diseases and cereal smuts.

Chemical control of leaf spots of wheat, 86BA41, 86MT49. Semi-natural inoculum for plant breeders plots, 86MD2. Chemical control of soil-borne flag smut, 86ME73, 86M032. Chemical control of barley loose smut, 86AL50, 86KA59, 86MT47. Chemical control of loose smut in barley with different levels of seed infections, 86MT48. Disease characterisation of cereal variety trial stage 4 sites

Variation in compulsory psychiatric inpatient admission in England:a cross-sectional, multilevel analysis

Background: Rates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes. Objectives: To quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places. Design: Cross-sectional analysis using multilevel statistical modelling. Setting: England, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services. Participants: 1,287,730 patients. Main outcome measure: The study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period. Data sources: The Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers. Results: A total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models. Conclusions: This was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Nurse staffing and workload drivers in small rural hospitals: An imperative for evidence

Purpose: The aim of this study was to explore staffing issues and the workload drivers influencing nursing activities in designated small rural hospitals of Western Australia. A problem for small rural hospitals is an imbalance between nurse staffing resources and work activity. Sample: A purposive sample of 17 nurse leaders employed at designated small rural hospitals in Western Australia. Method: A qualitative research design was used. Data were collected by focus group and semi-structured interviews and review of Western Australian Country Health Service records. Thematic analysis was used to interpret data. Findings: A minimum nurse staffing model is in use. Staff workload is generated from multiple activities involving 24-hour emergency services, inpatient care, and other duties associated with a lack of clinical and administrative services. These factors together impact on nursing staff resources and the skill mix required to ensure the safety and quality of patient care. Conclusion: Nurse staffing for small rural hospitals needs site-specific recording techniques for workload measurement, staff utilisation and patient outcomes. It is imperative that evidence guide nurse staffing decisions and that the workload driving nursing activity is reviewed