Advance care planning in England: is there an association with place of death? Secondary analysis of data from the National Survey of Bereaved People

Objectives To explore whether advance care planning is associated with place of death in England, as well as with sufficiency of support to care for a dying person at home, overall quality of care and pain management. Methods We undertook secondary analysis of data from the National Survey of Bereaved People, 2013, based on a stratified random sample of 49 607 people selected from 150 111 eligible registered deaths (n=22 661, 46% response rate). The indicator of advance care planning used was having expressed a preference for place of death and this being recorded by healthcare staff. Analysis was conducted using logistic regression models. Results Decedents with a recorded preference for place of death had significantly greater odds of dying at home rather than in hospital (OR 6.25; 99% CI 5.56 to 7.14) and in a care home rather than in hospital (OR 2.70; 99% CI 2.33 to 3.13). They also had significantly greater odds of receiving sufficient support to be cared for and to die at home, of receiving ‘outstanding’ or ‘excellent’ care, and of having pain relieved ‘completely, all the time’ while being cared for at home. Conclusions Advance care planning was found to be strongly associated with lower rates of hospital death and a range of quality outcomes. These findings provide support for the emphasis on advance care planning in end of life care policy in England, while also suggesting the need for further research to better understand the mechanisms underlying these relationships

An Identification of the Enabling Factors for the Development of a Unified Approach to Maintenance Strategy Development within the Automotive Supply Chain

The maintenance of modern production equipment has become an increasingly important and complex activity – particularly within the automotive supply chain. Tier-1 suppliers need a world-class manufacturing infrastructure to remain competitive, and therefore a matching maintenance strategy to support their operations. The opportunity exists for many automotive Tier 1, and potentially Tier 2 suppliers, to see substantial improvements to their competitiveness and profitability by improving their maintenance performance within an industry where research has shown modern maintenance practices are, at best, limited. Other Industrial sectors have a different performance profile in terms of maintenance. For example, aerospace production and their supply chain companies are seen to be ‘high achievers’ in maintenance. Part of the reason for these differences is the ability, within an individual sector, to identify the cost benefits of improving maintenance performance, as well as other drivers – such as health and safety, or regulatory requirements. The adoption of modern maintenance practices within the automotive industry is often led by available budgets and the absence of any strategic vision. This paper will present a review of the literature regarding manufacturing and Proceedings of 1st International Conference on Maintenance Engineering, IncoME-I 2016 The University of Manchester, UK Paper No ME2016_1110 maintenance practices within two industrial sectors, automotive and aerospace. In addition, the paper will identify the need for the development of a unified approach to maintenance which could be suited to automotive Tier 1 and Tier 2 suppliers

Student Engagement in Final Year Independent Project Work

Final Year Projects are a common component of many degree programmes and often contribute heavily to final award marks. In addition to providing students the opportunity to demonstrate the skills and knowledge they have developed during the course of their studies, final year projects also allow students to exercise a wider set of employability and professional skills. This means that in many disciplines projects are significant in the transformation of students into professionals. Despite the significance of Final Year Projects they have received very little attention in terms of student engagement. Student engagement with project work is critical given the independent nature of many final year projects. It is important that students not only appreciate and understand the technical or subject specific requirements of a given project but also appreciate the wider needs of a significant piece of independent work such as project management and control, objective setting and evaluation of both the outcomes of the project and the process undertaken to achieve this. In this paper we will review three types of student engagement, namely cognitive engagement, behavioural engagement and emotional engagement, with final year project work based on the three-part model of student engagement proposed by a number of authors . Based on this review and evidence gathered from monitoring the progress of an entire cohort of students we describe an approach for structuring final year project work without compromising the degree of independence required from the students or degrading the opportunity for them to progress on the transition from student to professional

Development of maintenance framework for modern manufacturing systems

Modern manufacturing organizations are designing, building and operating large, complex and often ‘one of a kind’ assets, which incorporate the integration of various systems under modern control systems. Due to such complexity, machines failures became more difficult to interpret and rectify and the existing maintenance strategies became obsolete without development and enhancement. As a result, the need for more advanced strategies to ensure effective maintenance applications that ensures high operation efficiency arise. The current research aims to investigate the existing maintenance strategies, the levels of machines complexity and automation within manufacturing companies from different sectors and sizes including, oil and gas, food and beverages, automotive, aerospace, and Original Equipment Manufacturer. Results analysis supports in the development of a modern maintenance framework that overcome the highlighted results and suits modern manufacturing assets using systematic approaches and utilisation of pillars from Total productive maintenance (TPM, Reliability Centred Maintenance (RCM) and Industry 4.0

Identification of prognostic inflammatory factors in colorectal liver metastases

BACKGROUND: The modified Glasgow Prognostic Score (mGPS) has been reported to be an important prognostic indicator in a number of tumor types, including colorectal cancer (CRC). The features of the inflammatory state thought to accompany elevated C-reactive protein (CRP), a key feature of mGPS, were characterized in patients with colorectal liver metastases. Additional inflammatory mediators that contribute to prognosis were explored. METHODS: In sera from 69 patients with colorectal liver metastases, a panel of 42 inflammatory mediators were quantified as a function of CRP levels, and as a function of disease-free survival. Multivariate statistical methods were used to determine association of each mediator with elevated CRP and truncated disease-free survival. RESULTS: Elevated CRP was confirmed to be a strong predictor of survival (HR 4.00, p = 0.001) and recurrence (HR 3.30, p = 0.002). The inflammatory state associated with elevated CRP was comprised of raised IL-1β, IL-6, IL-12 and IL-15. In addition, elevated IL-8 and PDGF-AB/BB and decreased eotaxin and IP-10 were associated with worse disease-free and overall survival. CONCLUSIONS: Elevated CRP is associated with a proinflammatory state. The inflammatory state is an important prognostic indicator in CRC liver metastases. The individual contributions of tumor biology and the host to this inflammatory response will require further investigation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2407-14-542) contains supplementary material, which is available to authorized users

Improving material flow by developing new warehouse layout

Our group was tasked to develop a facility layout for Duncan Ticking's new warehouse and determine appropriate shelving as well as material handling equipment. Duncan Ticking is a reseller of textiles and currently operates two warehouses in Fort Worth. Both are currently full of inventory. The company purchases ticking from international suppliers and resells them to domestic manufacturers. Demand is forecast for products they import based on sales history. As customers change styles and patterns, some products no longer sell at the same volumes, and they are left with the balance to try and sell elsewhere. The company plans to build a new warehouse adjacent to two existing ones, hoping to relieve some of the congestion and to improve the storage and flow of goods. The reseller is seeking assistance to design a facility layout for the additional warehouse. The goal of the project is to develop three recommendations for the proper shelving and supporting material handling processes and devices along with corresponding layouts. A cost-benefit analysis of each of the alternatives will be developed and presented to the client. The primary objectives are to minimize the travel of material and personnel within the warehouse and ensure that the incoming and outgoing orders are processed efficiently and effectively. Time permitting, an inventory analysis will also be conducted throughout the current warehouses along with a plan to implement new storage policies, disposal of unused equipment and materials for more than three years old, along with a cost-benefit analysis of our recommendations

Evaluating pharmacist input into the pharmaceutical care of patients in dispensing medical practices in remote and rural areas of Scotland.

Background. - The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit. Objective. - This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care. Methods. A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18). Results. - A total of 873 medicines related issues were identified in 473 patients reviewed, with the main issue being 'inappropriate dose, frequency, duration'. Just under half (39.7%) of issues were managed by the pharmacist without any medical input. Interviews indicated a high level of appreciation, although there was an increase in workload for some staff. While the need for telephone based pharmacist consultations for some patients was understood, there was a preference for face to face. All were supportive of continuing and extending the service. Conclusion. - The clinical pharmacist service was both needed and valued highly by staff and patients. In Scotland, this aligns with the Government vision and action plan, 'Prescription for Excellence', that by 2023 all patient facing pharmacists will be independent prescribers with those in remote and rural areas entitled to 'equity of access to such expertise'

Duffer’s Shoal: A Strategic Dream of the Pacific Command Area of Responsibility

This strategic assessment seeks to go beyond a traditional comparative analysis of the military, technological, political, cultural, and economic factors governing the relationships and capabilities of the Asia Pacific environment. To make sense of the intrinsic complexities unique to this region, we endeavor to broaden our view and rely on a tool often overlooked in government studies: imagination. Moreover, we aim to offer a strategic document that is readable, instructive, and provocative. Pulling from a well-referenced piece of military teaching, this assessment borrows a learning concept first employed in 1904 by Major General Sir Ernest Dunlop Swinton in The Defence of Duffer’s Drift. This fictional story describes the plight of young Lieutenant Backsight Forethought as he commands a 50-man platoon tasked to hold a tactically critical piece of land called Duffer’s Drift. The story unfolds in a series of six dreams, where the blunders of the unwitting lieutenant lead to disaster. As the dreams progress, he harnesses the lessons of each of his failures, and by applying these lessons, his platoon ultimately defends Duffer’s Drift.https://press.armywarcollege.edu/monographs/1445/thumbnail.jp