The 'dis-ease' of dying: challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

BACKGROUND: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/resuscitative care. AIMS: The aims were to explore nurses' 'recognition of' and 'responsiveness to' dying patients and to understand the nurses' influence on end-of-life care. DESIGN: A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and individual semi-structured interviews for clarification. SETTING/PARTICIPANTS: This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. RESULTS: Nurses took a passive role in recognising dying, providing active care until a medical officer's declaration of dying. Ward design, nurse allocation and nurses' attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. CONCLUSION: When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

Acidic potassium permanganate chemiluminescence for the determination of antioxidant potential in three cultivars of Ocimum basilicum

Ocimum basilicum, a member of the family Lamiaceae, is a rich source of polyphenolics that have antioxidant properties. The present study describes the development and application of an online HPLC-coupled acidic potassium permanganate chemiluminescence assay for the qualitative and quantitative assessment of antioxidants in three cultivars of O. basilicum grown under greenhouse conditions. The chemiluminescence based assay was found to be a sensitive and efficient method for assessment of total and individual compound antioxidant potential. Leaves, flowers and roots were found to be rich reserves of the antioxidant compounds which showed intense chemiluminescence signals. The polyphenolics such as rosmarinic, chicoric, caffeic, p-coumaric, m-coumaric and ferulic acids showed antioxidant activity. Further, rosmarinic acid was found to be the major antioxidant component in water-ethanol extracts. The highest levels of rosmarinic acid was found in the leaves and roots of cultivars "holy green" (14.37; 11.52 mM/100 g DW respectively) followed by "red rubin" (10.02; 10.75 mM/100 g DW respectively) and "subja" (6.59; 4.97 mM/100 g DW respectively). The sensitivity, efficiency and ease of use of the chemiluminescence based assay should now be considered for its use as a primary method for the identification and quantification of antioxidants in plant extracts.

End-user control in web-based electronic services : a case study

This paper reports a case study of end-user control in delivery of Web-based electronic services. The case study concentrates the adoption of a Web-based electronic system being implemented in processing student’s admission applications on a Web site. The end-user’s control interface provides information on the detail existing in the Web-based electronic service. This insight into end-user synthesis in developing effective control in Web service environment relates to ease of use in doing the task. To assume the leverage of end-user control strictly on the basis of the Web service usage would limit the purpose of understanding. Rather it is suggested that it would be better to develop an approach to study the end-user ease of use interface in doing the task with the user’s perception towards Web-based interactivity.

Consumer complaint channel choice in self-service technology encounters

Consumers’ choice of channel to communicate complaints, following the decision to voice to the organisation, has received very little research attention. This study contributes to filling this gap by exploring the drivers of consumers’ choice of complaint channel in the self-service technology (SST) context. Surprisingly, in this context, consumers have often chosen interpersonal complaint channels over electronic channels, resulting in some of the value of using SSTs being lost for consumers and organisations alike. Preliminary findings indicate that the perceived ease of use, the likelihood of organisational response, the desire for social interaction and the source of the SST-related complaint, might provide some clues as to the organisational strategies that can be used to encourage greater utilisation of technology-based complaint channels.

Testing the design for Web-based electronic services acceptance model (E-SAM)

This paper reports on the design and testing of a model, which evaluates the relationship components of a Web-based EServices Acceptance Model (E-SAM). The paper proposes that user experience, user motivation, perceived usefulness, perceived ease of use that may determine user acceptance of web-based eServices. The model is tested in a university environment where students and staff use services that have moved from an old paper-based to Web-based eService system. The results of data analysis highlight that user experience is strongly related to perceived ease of use; and perceived usefulness to user motivation in user acceptance of Web-based eServices. The strength of these relationships and the lack of strong relationships between other components suggest that the model's application to eServices is able to highlight the complexity of the eService process and the need for researchers to seek additional components in studying technology acceptance on the World Wide Web.

A usability instrument for evaluating websites-navigation elements

Many small businesses websites have become an important advertising medium. However little consideration is given to how these websites might be made more effective. Many factors impact on website effectiveness, including navigation. Research here describes a usability instrument developed for evaluating small business websites and uses navigation as an example of its application. The research found that the quality of navigation does have an impact on ease-of-use of a site, user's emotional response and frustration levels and a user's intention to return to that website. The research also established the statistically significant elements that contribute to navigation.

SME myths: if we put up a website customers will come to us-why usability is important

Many businesses use their Websites primarily as an alternative marketing strategy. How a business’s image, via a Website, is presented to potential customers is therefore important. There are many factors that will influence the effectiveness of a Website, two critical factors are how easily users are able to navigate and how easy the site is to use. The research reported here examined these two factors on users’ responses to small and medium-sized business Websites. The research found that the quality of navigation and how easy a site is to use does have an impact, how much information is read, the importance of the graphical components, a user's emotional response to a Website, users’ frustration and the user’s intention to return to that Website. The research established the statistically significant elements that contribute to navigation and ease-of-use, and describes the design and successful application of a usability evaluation instrument.

Blood glucose meters : an independent head to head comparison

A new generation of blood glucose meters is now available for use by people with diabetes and health professionals, but little independent evaluation data is available. Previous models are prone to a variety of errors. We compared the accuracy, precision and features of the six latest meters available in Australia as of 1996. Meters studied were the Mini-Accutrend and Advantage (Boehringer Mannheim), Precision QID and Companion 2 (MediSense), Glucometer Elite (Bayer) and Lynx (National Diagnostic Products). We measured the blood glucose levels of 50 people with diabetes with these meters, and compared them to a reference method (YSI glucose analyser). Error grid analysis confirmed that accuracy of all meters was sufficient for their intended use as patient monitors. Precision was assessed using 25 samples from control solutions provided for each meter, and the coefficient of variation calculated. Improvements in strip and meter technology in some models have increased ease of use and reduced the likelihood of user error. This study, when considered with individual preferences for various features and price should assist patients in choosing a new blood glucose meter.

Programmer friendly and efficient distributed shared memory integrated into a distributed operating system

Distributed Shared Memory (DSM) provides programmers with a shared memory environment in systems where memory is not physically shared. Clusters of Workstations (COWs), an often untapped source of computing power, are characterised by a very low cost/performance ratio. The combination of Clusters of Workstations (COWs) with DSM provides an environment in which the programmer can use the well known approaches and methods of programming for physically shared memory systems and parallel processing can be carried out to make full use of the computing power and cost advantages of the COW. The aim of this research is to synthesise and develop a distributed shared memory system as an integral part of an operating system in order to provide application programmers with a convenient environment in which the development and execution of parallel applications can be done easily and efficiently, and which does this in a transparent manner. Furthermore, in order to satisfy our challenging design requirements we want to demonstrate that the operating system into which the DSM system is integrated should be a distributed operating system. In this thesis a study into the synthesis of a DSM system within a microkernel and client-server based distributed operating system which uses both strict and weak consistency models, with a write-invalidate and write-update based approach for consistency maintenance is reported. Furthermore a unique automatic initialisation system which allows the programmer to start the parallel execution of a group of processes with a single library call is reported. The number and location of these processes are determined by the operating system based on system load information. The DSM system proposed has a novel approach in that it provides programmers with a complete programming environment in which they are easily able to develop and run their code or indeed run existing shared memory code. A set of demanding DSM system design requirements are presented and the incentives for the placement of the DSM system with a distributed operating system and in particular in the memory management server have been reported. The new DSM system concentrated on an event-driven set of cooperating and distributed entities, and a detailed description of the events and reactions to these events that make up the operation of the DSM system is then presented. This is followed by a pseudocode form of the detailed design of the main modules and activities of the primitives used in the proposed DSM system. Quantitative results of performance tests and qualitative results showing the ease of programming and use of the RHODOS DSM system are reported. A study of five different application is given and the results of tests carried out on these applications together with a discussion of the results are given. A discussion of how RHODOS’ DSM allows programmers to write shared memory code in an easy to use and familiar environment and a comparative evaluation of RHODOS DSM with other DSM systems is presented. In particular, the ease of use and transparency of the DSM system have been demonstrated through the description of the ease with which a moderately inexperienced undergraduate programmer was able to convert, write and run applications for the testing of the DSM system. Furthermore, the description of the tests performed using physically shared memory shows that the latter is indistinguishable from distributed shared memory; this is further evidence that the DSM system is fully transparent. This study clearly demonstrates that the aim of the research has been achieved; it is possible to develop a programmer friendly and efficient DSM system fully integrated within a distributed operating system. It is clear from this research that client-server and microkernel based distributed operating system integrated DSM makes shared memory operations transparent and almost completely removes the involvement of the programmer beyond classical activities needed to deal with shared memory. The conclusion can be drawn that DSM, when implemented within a client-server and microkernel based distributed operating system, is one of the most encouraging approaches to parallel processing since it guarantees performance improvements with minimal programmer involvement.

A technology to expose a cluster as a service in a cloud

Clouds refer to computational resources (in particular, clusters) that are accessible as scalable, on demand, pay-as- you-go services provided in the Internet. However, clouds are in their infancy and lack a high level abstraction. Specifically, there is no effective discovery and selection service for clusters and offer little to no ease of use for clients. Here we show a technology that exposes clusters as Web services in the form of a Cluster as a Service for publishing via WSDL, discovering, selecting and using clusters.

Toward higher level abstractions for cloud computing

The general idea of cloud computing is offering computational resources as scalable, on demand services accessible over the internet. However, this new realisation of on demand computing is hindered by the amount of user involvement. Currently, high level abstractions in cloud computing only exist in the form of services. In particular, there is no effective means to publish, discover and finally use required services in clouds. In response, we propose a user level abstraction on top of already available cloud abstraction layers, present its concept using the resources via web services (RVWS) framework and demonstrate its feasibility by simplifying the exposure and use of clusters, a commonly used resource in cloud computing.

Extending technology acceptance model to the E-recruitment context in Iran

Using a sample of 332 job applicants in Iran, this study integrates Technology Acceptance Model (TAM) and signaling theory to explain factors influencing applicants' behavioral intentions to apply for jobs online. Of the two main constructs of TAM, perceived usefulness was found to have a significant impact on applicants' behavioral intentions, while perceived ease of use was not. Based on the signaling theory, impression of the organizational website appeared to create interests in organization as a potential employer; hence, prompt applicants to apply for jobs. These results extend our understanding of the online recruitment in different context and provide further insights with regard to possible effects of website features on applicants' attractions toward organizations operating in Iran.

Integrated microfluidic drug delivery devices : a component view

Research on drug delivery devices is progressing rapidly with the main objective being the delivery of precise quantity of drugs into the target area of the body. A drug delivery device (DDD) needs to accurately control the flow rate of drug delivery and protects the body from undesired additional doses. An integrated microfluidic drug delivery device (IMDDD) is a miniature device that can regulate and monitor the delivery of the right amount of drug using micro-scale components. IMDDDs offer several advantages including ease of use, electro-chemical controllability, low power consumption, simplicity, fast fabrication, and good bio-compatibility. Various IMDDDs have been developed for treatment of cancer, cardiovascular disorder, eye and brain diseases, stress, and diabetes. This paper presents a generic architecture for IMDDDs, discusses the existing drug delivery methods, summarizes the specifications of the components, and identifies a number of performance evaluation parameters. The operation of IMDDDs is presented through fourteen potential internal components. In addition, recommendations on how enhance the design and fabrication process of IMDDDs are given.

Examining customer evaluations across different self-service technologies

Purpose – This study aims to examine the influence of different self-service technologies (SSTs) on customer satisfaction with and continued usage of SSTs. Specifically, it compares an interactive voice response (IVR) SST and an online SST from the same provider to assess how to manage these parallel SSTs.

Design/methodology/approach – A tracking study was used, beginning with a survey of n = 957 SST users to test a model pertaining to SST satisfaction across IVR and online SSTs. These SST users were then tracked over 12 months. The association between customer satisfaction with and continued usage of the SSTs was examined using behavioural data from the service provider.

Findings – While the overall model was found to be valid across both types of SSTs, perceptions of factors including ease of use, perceived control and reliability differed for IVR and online SSTs. Satisfaction with SSTs is linked with users’ continued use of SSTs, but is not a barrier to users’ adoption of newer SST forms.

Research limitations/implications – Highlighting the rapid developments in this field, a new SST was introduced by the provider to respondents during the 12-month tracking period, thus complicating the results. Further studies could include the customer purpose for using SSTs as a variable.

Practical implications – The findings offer support for organisations offering a suite of SSTs, even if they serve the same purpose. Customers evaluate SST types differently, and even satisfied SST users switch to different SSTs when they become available. Allowing customers to choose the SST that best suits them appears to be good practice.

Originality/value – This study develops a comprehensive model of customer SST satisfaction that is used to undertake a comparison of two different types of SSTs, which has been missing from prior research.

A theory-based video messaging mobile phone intervention for smoking cessation: randomized controlled trial

BACKGROUND: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called "STUB IT") used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques.

OBJECTIVE: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation.

METHODS: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks.

RESULTS: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated.

CONCLUSIONS: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation.