Bone marrow transplantation (BMT) is an established intervention for a range of conditions including those of a serious, life-threatening nature such as leukaemias. The experience of those who fail to respond to such aggressive treatment, however, or those who die as a result of treatment-induced complications, is currently under-researched. In this paper the authors suggest that despite the relatively high mortality associated with BMT, cultural, biological and professional factors have contributed to a lack of attention on issues of death and dying and emotional labour within BMT care settings. Current technological, biomedical and quality of life discourses which characterize much of the BMT literature are problematic and, we suggest, may serve to disadvantage those who will not survive such procedures. In addition, the provision of effective palliative care in BMT settings remains open to review through further research and development. As a first step, the authors argue that the role of nursing needs to be reconceptualized within BMT to allow key humane concerns such as suffering and the emotional labour of care to be explored and better understood.
A numerical method for the time-optimal control of the race car is presented. The method is then used to perform the role of the driver in numerical simulations of manoeuvres at the limit of race car performance. The method does not attempt to model the driver but rather replaces the driver with methods normally associated with numerical optimal control. The method simultaneously finds the optimal driven line and the driver control inputs (steer, throttle and brake) to drive this line in minimum time. In principle, the method is capable of operation with arbitrarily complex vehicle models as it requires only limited access to the vehicle model state vector. It also requires solution of the differential equation representing the vehicle model in only the forward time direction and is hence capable of simulating the full vehicle transient response.
Traditionally in the United Kingdom, reliance has been placed on unqualified support workers, such as student nurses, to deliver a high proportion of patient care. However, the move of nurse education into higher education and the accompanying supernumerary status of student nurses in the 1980s resulted in a shortfall of staff to deliver that care. The government has made a number of suggestions for increasing recruitment. One possible solution regarded as very promising is to encourage health care assistants (HCAs) with at least 12 months' experience in the National Health Service to enrol on existing pre-registration programmes, providing them with financial incentives to do so. Very little literature directly concerned with training opportunities for HCAs could be traced, but it was evident that financial constraints and family commitments had, in the past, operated as disincentives to training, although some HCAs would otherwise be keen to register. In 1999 one of the workforce development confederations in London responded to government policy by seconding HCAs onto a pre-registration programme operated by the local university. Plans for evaluation were made at the outset. Interviews were conducted with two consecutive intakes of secondees at three time intervals: after three months; after 12 months and during the final placement of the 36-month course. Interviews with other stakeholders were conducted just before the course ended. A qualitative approach was taken and the data were analysed employing the sequence recommended by Miles and Huberman (1994). Evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes. It is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories. Given the emphasis now being placed on the 'skills escalator' model of staff development in the NHS, such approaches will assume even greater importance in future, and more extensive evaluations will be needed.
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