Maine’s Culture of Reuse and Its Potential to Advance Environmental and Economic Policy Objectives

Policies designed to extend the lifetime of products—by encouraging reuse rather than disposal—are proliferating. Research suggests that reuse can ease pressure on natural resources and improve economic efficiency, all while preventing waste. In Maine, there are clear signs of a tradition of reuse that might be used to advance these goals. But beyond discrete observations, proverbs, and anecdotal stories, little data have been collected upon which to estimate the potential of Maine’s reuse economy. This paper draws upon findings generated during the first year of a five-year interdisciplinary, mixed-methods research project designed to explore the environmental, social, and economic dimensions of reuse in Maine. Our preliminary findings suggest that Maine does, indeed, have a vibrant but underestimated reuse economy. Less expected are findings that suggest reuse has promise to enhance economic resilience and contribute to culturally appropriate economic development

The Role of Domestic Heat Pumps in Providing Flexibility to the UK Electricity System

Widespread adoption of residential heat pumps is predicted to create challenges for national and local electricity systems. Flexible operation of heat pumps could help smooth peak demand and better utilise renewables. Achieving these benefits involves many stakeholders from the heat pump and electricity sectors with different perspectives and expectations. This work brought together 52 experts from different parts of the UK system to discuss and debate the role of heat pump flexibility in a decarbonised electricity system in 2035. A co-production research model was adopted, designed to integrate diverse forms of knowledge and perspectives in the co-production of knowledge on heat pump flexibility. A series of participatory activities were undertaken including a one-day workshop. Elements of a common vision emerged, such as the anticipated widespread flexible operation of heat pumps as the cheapest way of running a heat pump and the likelihood of a highly automated and remote-controlled manner of operation. Disagreements and unknowns also emerged. This work aims to support stakeholders in planning for the social, technical and economic aspects of flexible heat pump operation in their own organisations

Simultaneous development of the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ) in American English and American Spanish

BACKGROUND: The objective of this study was to develop simultaneously a new questionnaire, the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ), in American English and American Spanish in order to elucidate the impact of caring for a child with GERD. METHODS: Two focus group discussions were conducted in American English and American Spanish to develop a relevant conceptual model. Focus group participants were the primary caregivers of children with GERD (newborn through 12 years of age). Participant responses were qualitatively analyzed to identify potential differences in caregiver perspectives by the caregiver's language, socio-economic status and demographic profile as well as the child's age and disease severity level. Items in the PGCIQ were generated simultaneously in English and Spanish by reviewing results of qualitative analysis from focus groups in each language. The PGCIQ was finalized in both languages after testing content validity and conducting an in-depth translatability assessment. RESULTS: Analysis of focus group comments resulted in the development of a first draft questionnaire consisting of 58 items in 10 domains. Content validity testing and an in-depth translatability assessment resulted in wording modification of 37 items, deletion of 14 items and the addition of a domain with five items. Feedback from the content validity testing interviews indicated that the instrument is conceptually relevant in both American English and American Spanish, clear, comprehensive and easy to complete within 10 minutes. The final version of the PGCIQ contains 49 items assessing ten domains. An optional module with nine items is available for investigative research purposes and for use only at baseline. CONCLUSION: The PGCIQ was developed using simultaneous item generation, a process that allows for consideration of concept relevance in all stages of development and in all languages being developed. The PGCIQ is the first questionnaire to document the multidimensional impact of caring for an infant or young child with GERD. Linguistic adaptation of the PGCIQ in multiple languages is ongoing. A validation study of the PGCIQ is needed to examine its psychometric properties, further refine the items and develop an appropriate scoring model

Demand response with heat pumps: Practical implementation of three different control options

The electrification of heating and transport and decarbonisation of supply creates a need for demand side flexibility to balance the grid. Heat pumps are expected to form a major part of heat delivery, and many modelling studies have investigated the technical potential of heat pump demand response. However, little empirical work has been reported on the practical implementation of such demand response in occupied homes. This paper presents a cross-case comparison of three early adopters of heat pump demand response in the UK. The aim was to reduce heat pump electricity consumption during the same peak period, but each employed a different control strategy: lowered air temperature setpoints, lowered flow temperature and blocked heat pump compressor. A 56–90% electricity reduction during the peak period was observed; the success of the demand response depended on how the control strategy affected the heat pump and the rest of the heating system. However, no one stakeholder is responsible for all these system components. The fabric, heating distribution and control system and heat pumps installed are highly heterogeneous across the stock, highlighting that flexibility mechanisms must be developed that can be tailored to or work across their range

Cognitive-Behavioral Therapy with Youth

Cognitive-behavioral therapies (CBTs) with children and adolescents use enactive, performance-based procedures, as well as cognitive interventions to produce changes in thinking, feeling, and behavior. Various forms of CBT have a common goal to help the child develop a constructive worldview and a problem-solving attitude. The problem-solving orientation can also be referred to as a coping template. Through the provision of carefully planned experiences, CBT helps the child and family build an adaptive, problem-solving perspective

CBT repackaged or a novel treatment? The Lightning Process® compared with specialist medical care for paediatric Chronic Fatigue Syndrome.

RationaleUK specialist medical care (SMC) for paediatric Chronic Fatigue Syndrome (CFS/ME) includes behavioural approaches (Graded Exercise Therapy; Activity Management) and Cognitive Behavioural Therapy for fatigue (CBT-F). Treatment is suboptimal with a third of children not recovering after 6 months of SMC. Many families seek alternative treatments at personal cost, including the Lightning Process (LP). Evidence shows LP can improve patient outcomes, though this intervention is not widely known/understood.ObjectivesTo describe LP in comparison with SMC approaches in order to identify distinct elements, inform clinicians about treatment options, and generate hypotheses around effectiveness.MethodsTheoretical comparison including stakeholder consultation.ResultsWhile overlaps with SMC approaches were identified, and CBT-F in particular, distinct elements of LP were its focus on language style, neurophysiological rationale, affective/physiological change technique and mode of delivery.ConclusionThis theoretical comparison identified distinct elements of LP which could be explored in future interventions or research aiming to improve clinical outcomes for children with CFS/ME, and informs clinicians about treatment options available for families

Qualitative study of the acceptability and feasibility of acceptance and commitment therapy for adolescents with chronic fatigue syndrome

BACKGROUND: Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is disabling and relatively common. Although evidenced-based treatments are available, at least 15% of children remain symptomatic after one year of treatment. Acceptance and commitment therapy (ACT) is an alternative therapy option; however, little is known about whether it is an acceptable treatment approach. Our aim was to find out if adolescents who remain symptomatic with CFS/ME after 12 months of treatment would find ACT acceptable, to inform a randomised controlled trial (RCT) of ACT. METHODS: We recruited adolescents (diagnosed with CFS/ME; not recovered after one year of treatment; aged 11–17 years), their parent/carer and healthcare professionals (HCPs) from one specialist UK paediatric CFS/ME service. We conducted semi-structured interviews to explore barriers to recovery; views on current treatments; acceptability of ACT; and feasibility of an effectiveness RCT. Thematic analysis was used to identify patterns in data. RESULTS: Twelve adolescents, eleven parents and seven HCPs were interviewed. All participants thought ACT was acceptable. Participants identified reasons why ACT might be efficacious: pragmatism, acceptance and compassion are valued in chronic illness; values-focussed treatment provides motivation and direction; psychological and physical needs are addressed; normalising difficulties is a useful life-skill. Some adolescents preferred ACT to cognitive behavioural therapy as it encouraged accepting (rather than challenging) thoughts. Most adolescents would consent to an RCT of ACT but a barrier to recruitment was reluctance to randomisation. All HCPs deemed ACT feasible to deliver. Some were concerned patients might confuse ‘acceptance’ with ‘giving up’ and called for clear explanations. All participants thought the timing of ACT should be individualised. CONCLUSIONS: All adolescents with CFS/ME, parents and HCPs thought ACT was acceptable, and most adolescents were willing to try ACT. An RCT needs to solve issues around randomisation and timing of the intervention

Мультимодальное лечение двусторонних опухолей почек как способ улучшения онкологических и функциональных результатов: клинический случай и обзор литературы

Почечно-клеточный рак (ПКР) может поражать как одну, так и обе почки. Описаны случаи мультифокального поражения одной почки. Синхронные и метахронные двусторонние опухоли почек представляют серьезную медицинскую проблему, которая должна быть решена наилучшим путем с точки зрения радикальности лечения и максимального сохранения функции почек. Мы представляем описание клинического случая метахронного ПКР с рецидивом в ипсилатеральной и контралатеральной почке. У этого пациента было использовано несколько методик, направленных на сохранение функции нефронов. Был проведен обзор литературы по заболеваемости, лечению и исходам синхронного и метахронного ПКР, а также по вариантам лечения, доступным таким больным. Мы использовали сочетание открытых и малоинвазивных методик, направленных на сохранение функции почек, включая открытую резекцию почки и лапароскопическую криотерапию. По прошествии 5 лет наблюдения пациент не имеет признаков болезни и ему не требуется проведение гемодиализа. Двусторонние опухоли почек встречаются нередко и могут представлять значительную проблему при выборе методов лечения с учетом необходимости сохранения функции почек. Результаты лечения можно улучшить при использовании мультимодального подхода, включающего малоинвазивные и открытые процедуры.

PITTSBURGH’S RACIAL DEMOGRAPHICS: DIFFERENCES AND DISPARITIES

Pittsburgh’s Racial Demographics: Differences and Disparities provides indicators of quality of life by race and ethnicity in the Pittsburgh region. Data are provided for four groups (Whites, African Americans, Asians, and Hispanics) and for four geographic areas (city of Pittsburgh, Allegheny County, Pittsburgh Metropolitan Statistical Area, and the U.S.). The most recent data available for the Pittsburgh area and the nation were used in this report. In some instances, however, only data from the 2000 census were available to make comparisons. It is also the case that data were not available on all of our topic areas in the same years. It is our hope to update this report every three years, particularly if the American Community Survey (which is designed to replace the decennial census) produces regular, reliable data by race for cities, counties, and regions

Obesity and cancer:the role of vitamin D

BACKGROUND It is estimated that 20% of all cancer cases are caused by obesity. Vitamin D is thought to be one of the mechanisms underlying this association. This review aims to summarise the evidence for the mediating effect of vitamin D on the link between obesity and cancer. METHODS Three literature searches using PubMed and Embase were conducted to assess whether vitamin D plays an important role in the pathway between obesity and cancer: (1) obesity and cancer; (2) obesity and vitamin D; and (3) vitamin D and cancer. A systematic review was performed for (1) and (3), whereas a meta-analysis including random effects analyses was performed for (2). RESULTS (1) 32 meta-analyses on obesity and cancer were identified; the majority reported a positive association between obesity and risk of cancer. (2) Our meta-analysis included 12 original studies showing a pooled relative risk of 1.52 (95% CI: 1.33-1.73) for risk of vitamin D deficiency (<50 nmol/L) in obese people (body mass index>30 kg/m2). (3) 21 meta-analyses on circulating vitamin D levels and cancer risk were identified with different results for different types of cancer. CONCLUSION There is consistent evidence for a link between obesity and cancer as well as obesity and low vitamin D. However, it seems like the significance of the mediating role of vitamin D in the biological pathways linking obesity and cancer is low. There is a need for a study including all three components while dealing with bias related to dietary supplements and vitamin D receptor polymorphisms