What does palliative care look like in a New Zealand aged residential care facility when patients are admitted to die?

Aims: New Zealanders dying in public hospitals or hospices are increasingly being discharged and admitted-to-die in aged residential care (ARC) facilities as hospitals and hospices struggle to meet demand. This study sought to investigate how care is delivered to patients admitted-to-die in an ARC facility.

Methods: A mixed-methods case study including a clinical notes review of seven patients who died in one ARC facility within three months of admission and a focus group with ARC facility staff and visiting professionals from other organisations.

Trainee experiences of intellectual disability psychiatry and an innovative leaderless support group: a qualitative study.

There is very little research into the challenges of training in intellectual disability psychiatry or into interventions which may address these challenges. Using focus groups, we explored the experiences of intellectual disability psychiatry trainees, and evaluated a leaderless trainee support group developed in Bristol. Five distinct themes were identified via framework analysis: that trainees felt unprepared for the difference from previous posts; the need for support; the value of the group; that trainees were concerned about judgement in supervision; that the group structure was valued.

Why management skills are a priority for nurses.

Newly qualified nurses and new nurse managers are often expected to hit the ground running with no management training. Management skills are as important as leadership skills in addressing some of the failings identified in the Francis report. A management framework is required to provide a consistent approach to management development for all staff in healthcare, irrespective of discipline, role, function or seniority.

Leading change: 3--implementation.

The potential for all staff to contribute to service improvement, irrespective of discipline, role or function, is outlined in the 2011 NHS leadership framework. This advocates developing the skills of the entire workforce to create a climate of continuous service improvement. As nurses are often required to take the lead in managing change in clinical practice, this final article in a three-part series focuses on implementing ande potentia reviewing change.

Leading change: 2--planning.

National initiatives have outlined the importance of involving frontline staff in service improvement, and the ability to influence and manage change has been identified as an essential skill for delivering new models of care. Nurses often have to take the lead in managing change in clinical practice. The second in a three-part series is designed to help nurses at all levels develop the knowledge and skills to function as change agents within their organisations.

Leading change: 1--identifying the issue.

To enable sustainable change, nurses need to take the lead in managing it. Recent national initiatives have emphasised the importance of frontline staff in service improvement. The ability to influence and manage change has been identified as an essential skill for delivering new models of care.

Changing the culture of hand hygiene compliance using a bundle that includes a violation letter.

Hand hygiene is the best method of preventing transmission of infections in health care, but compliance is usually suboptimal. In one hospital, compliance with hand hygiene was improved and sustained using a multifaceted bundle approach. A unique aspect of the bundle was the creation of a violation letter that was sent to and enforced by managers of noncompliant personnel.

Supporting student nurses on placement in nursing homes: the challenges for the link-tutor role.

Practice-based learning has always been a key feature of nursing education, and the quality of student learning is heavily influenced by the quality of the clinical experience. In addition, with an ageing population, nurses will need to better develop the particular clinical skills related to meeting the needs of older people in diverse settings. Increasingly, health care faculties in universities are turning to nursing homes to provide clinical placements for student nurses.

Formation and processing of organics in the early solar system.

Until pristine samples can be returned from cometary nuclei, primitive meteorites represent our best source of information about organic chemistry in the early solar system. However, this material has been affected by secondary processing on asteroidal parent bodies which probably did not affect the material now present in cometary nuclei. Production of meteoritic organic matter apparently involved the following sequence of events: Molecule formation by a variety of reaction pathways in dense interstellar clouds; Condensation of those molecules onto refractory interstellar grains; Irradiation of organic-rich interstellar-grain mantles producing a range of molecular fragments and free radicals; Inclusion of those interstellar grains into the protosolar nebula with probable heating of at least some grain mantles during passage through the shock wave bounding the solar accretion disc; Agglomeration of residual interstellar grains and locally produced nebular condensates into asteroid-sized planetesimals; Heating of planetesimals by decay of extinct radionuclides; Melting of ice to produce liquid water within asteroidal bodies; Reaction of interstellar molecules, fragments and radicals with each other and with the aqueous environment, possibly catalysed by mineral grains; Loss of water and other volatiles to space yielding a partially hydrated lithology containing a complex suite of organic molecules; Heating of some of this organic matter to generate a kerogen-like complex; Mixing of heated and unheated material to yield the meteoritic material now observed.

Nitrogen in solar energetic particles: isotopically distinct from solar wind.

Stepwise etching of lunar soil ilmenite grains reveals that the 15N/14N ratio of implanted nitrogen decreases with increasing implantation depth within the ilmenite grains, i.e., with increasing energy of implantation.

Nitrogen isotope abundances in the recent solar wind.

Although lunar crystalline rocks are essentially devoid of nitrogen, the same is not true of the lunar regolith. The nitrogen contents of individual regolith samples (which can be as high as 0.012% by mass) correlate strongly with abundances of noble gases known to be implanted in the lunar surface by solar radiation, indicating that lunar regolith nitrogen is also predominantly of solar origin.

Origins of amino acids in the early solar system.

Synthesis of meteoritic amino acids probably took place in the aqueous sub-surface regions of one or more asteroid-sized parent bodies. Starting material for those reactions apparently consisted of a population of more simple compounds including a suite of aliphatic precursors characterised by (1) complete structural diversity, (2) prevalence of branched- over straight-chain species, (3) exponential decrease in abundance with increasing C number, (4) large enrichment in D, and, probably, (5) systematic decrease in 13C/12C with increasing C number. Those properties were apparently acquired during synthesis of the precursors by ion-molecule reactions in a presolar molecular cloud.

What can meteorites tell us about nebular conditions and processes during planetesimal accretion?

Analysis of the most primitive meteorites can yield detailed information about environmental conditions and physical/chemical processes in the earliest Solar System, including the nebular stage during which planetesimals were accreted. Such information pertains to time scales, thermal and chemical evolution, inhomogeneity and mixing, magnetic fields, and grain growth in the solar nebula. Nebular processes identified include evaporation, condensation, localized melting, and fractionation both of solids from gas and among different solids.

Compositional trends in rock-forming elements of comet Halley dust.

The VEGA 1 and 2 spacecraft flew by comet P/Halley in 1986 carrying, among other instruments, two mass spectrometers to measure the elemental composition of dust particles emitted from the comet. Most particles seem to be a mixture of silicates of variable magnesium-iron composition and organic matter. Comprehensive study of data and consideration of the mass of dust particles reveal cometary grains of "unusual" composition: magnesium-rich and iron-rich particles.

Isotopic analysis of cometary organic matter.

Carbon isotope ratios have been measured for CN in the coma of comet Halley and for several CHON particles emitted by Halley. Of these, only the CHON-particle data may be reasonably related to organic matter in the cometary nucleus, but the true range of 13C/12C values in those particles is quite uncertain. The D/H ratio in H2O in the Halley coma resembles that in Titan/Uranus.

A note on the prebiotic synthesis of organic acids in carbonaceous meteorites.

Strong similarities between monocarboxylic and hydroxycarboxylic acids in the Murchison meteorite suggest corresponding similarities in their origins. However, various lines of evidence apparently implicate quite different precursor compounds in the synthesis of the different acids. These seeming inconsistencies can be resolved by postulating that the apparent precursors also share a related origin.

What has caused the secular increase in solar nitrogen-15?

Well-documented variations in the (15)N/(14)N ratio in lunar surface samples apparently result from a secular increase in that ratio in the solar wind during the past few billion years. The cause of this change seems to lie in the solar convective zone but is inexplicable within our present understanding of solar processes. This problem therefore ranks with the solar neutrino deficiency as a major challenge to our solar paradigm.

Isotopic characteristics of simulated meteoritic organic matter: 1--Kerogen-like material.

Carbonaceous residues from a variety of laboratory syntheses yield release patterns for C and H isotopes during stepwise combustion that fail to mimic the striking patterns characteristic of meteoritic kerogen-like residues that otherwise superficially resemble them. It seems likely that the meteoritic material comprises a complex mixture of substances having different origins and/or synthesis conditions.

Deuterium exchange during acid-demineralisation.

Isotopic analyses of residues prepared by demineralisation of the Murchison meteorite using D-labelled reagents provide evidence for measurable exchange of H-isotopes between residue and reagents. Precise quantification of this effect is precluded by substantial inhomogeneity of the meteoritic organic matter. A conservative estimate of the degree of exchange is 3 to 5% of the H pyrolysable as H2O.

Carbonates and sulfates in CI chondrites: formation by aqueous activity on the parent body.

Compositions and morphologies of dolomites, breunnerites, Ca-carbonates, Ca-sulfates and Mg, Ni, Na-sulfates, and their petrologic interrelations, in four CI chondrites are consistent with their having been formed by aqueous activity on the CI parent body. Radiochronometric data indicate that this activity took place very early in Solar-System history. No evidence for original ("primitive") condensates seems to be present.

Isotopic characterisation of kerogen-like material in the Murchison carbonaceous chondrite.

Isotopic data for C, H and N in acid-resistant residues from carbonaceous chondrites show substantial variability during stepwise pyrolysis and/or combustion. After subtraction of contributions due apparently to inorganic C grains, of probably circumstellar origin, considerable isotopic variability remains, attributable to the kerogen-like organic fraction. That variability may be interpreted in terms of three or four distinct components, based on C, H and N isotopes.

Carbon, hydrogen and nitrogen in carbonaceous chondrites: abundances and isotopic compositions in bulk samples.

Whole-rock samples of 25 carbonaceous chondrites were analysed for contents of C, H and N and delta 13C, delta D and delta 15N. Inhomogeneous distribution of these isotopes within individual meteorites is pronounced in several cases. Few systematic intermeteorite trends were observed; N data are suggestive of isotopic inhomogeneity in the early solar system.