The experiences of patients and carers in the daily management of care at the end of life

Background Home is the preferred location for most people with an advanced disease and at the end of life. A variety of care professionals work in community settings to provide support to this population. Patients and their spouses, who also care for them (spouse-carers), are rarely accompanied by these sources of support at all times, and have to manage independently between their contact with care professionals. Aim To explore how patients and spouse-carers manage their involvement with care professionals in the community setting. Method Interpretive phenomenology informs the design of the research, whereby 16 interviews were conducted with the patients and spouse-carers. Interviews were recorded and transcribed verbatim. Data were analysed using phenomenological techniques including template analysis. Findings Patients and spouse-carers were interdependent and both parties played a role in co-ordinating care and managing relationships with professional care providers. The patients and spouse-carers actively made choices about how to manage their situation, and develop and modify managing strategies based on their experiences. Conclusions When daily management is effective and care professionals acknowledge the dyadic nature of the patient and spouse-carer relationship, people have confidence in living with advanced disease

Simplified Prescriptive Options in the Texas Residential Building Energy Code Make Compliance Easy

Texas recently adopted the 2000 International Residential Code (“IRC”) energy chapter and the 2000 International Energy Conservation Code (“IECC”) as its residential building energy code for new construction and existing homes. The range of code compliance options in the new Texas code spans from simplified prescriptive methods on one end to more complex performance (whole building) methods on the other. This paper addresses how energy code compliance is much simpler through the use of simplified, easy-to-follow prescriptive compliance options, particularly in a state like Texas, which historically has had no uniform building codes. This paper also provides samples of simplified prescriptive energy code compliance aids that could make it easier for energy code compliance in Texas

Multi-year climate memory in shallow lake water levels

Landscape hydrologic memory of meteorological cycles can have an important impact on catchment hydrological responses by propagating clustering of wet or dry conditions into extreme events. The non-linear and hysteretic hydrologic response functions driven by memory are often only studied at shorter temporal scales (event, season) despite larger interannual hydrologic responses evident in some systems. Within the Canadian Boreal, lakes and lake water levels provide an important indicator that can be used to assess the role of landscape memory on catchment hydrological function. Landscape memory has also been hypothesised to control the hydrological dynamics of shallow lake ecosystems that are also important biogeochemically and ecologically. Here we combine measurements of lake water levels in 26 lakes of varying type at varying temporal frequencies within the glaciated sub-humid Boreal Plain, to examine the impact and variability of interdecadal, decadal, multi-year, and intra-annual memory on lake water levels. We show multi-annual hysteresis of precipitation-lake water levels with varied characteristics in space and time. These spatial variations in landscape memory are driven by differences in storage capacities controlled by heterogeneity in glacial landforms, wetland-forest landcover and lake properties. Thus, the propensity for drought years or wet years to persist or accumulate into extreme landscape drying or wetting varies significantly between different lake-landscape characteristics. We show how landscape memory is crucial to project lake water levels by defining spatial variability of the impact of periods of meteorological drought and deluge vital for understanding system sensitivity, duration of recovery and in turn infer resilience on Boreal Plain hydrology.<br/

Benefits of the International Residential Code's Maximum Solar heat Gain Coefficient Requirement for Windows

Texas adopted in its residential building energy code a maximum 0.40 solar heat gain coefficient (SHGC) for fenestration (e.g., windows, glazed doors and skylights)-a critical driver of cooling energy use, comfort and peak demand. An analysis of the expected costs and benefits of low solar heat gain glazing, and specifically the SHGC requirement in the new Texas Residential Building Energy Code,1 shows that the 0.40 SHGC requirement is ideal for Texas and that the benefits far outweigh the expected costs. For consumers, the requirement will increase comfort and reduce their cost of home ownership. The anticipated public benefits are also substantial - the result of full implementation can be expected to: 1) Reduce cumulative statewide cooling energy use over ten years by 15 billion kWh; 2) Reduce cumulative statewide electric peak demand over ten years by over 1200 MW; 3) Result in cooling cost savings of more than a billion dollars; and 4) Reduce cumulative statewide key air pollutants

Gender and racial disparity for hospital emergency service usage in USA: a quantitative analysis for various age groups during 2010–2017.

Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible for both communicable and non-communicable diseases. Methods: The objectives of this study were to quantify the existing disparity in ED usage between 2010– 2017 by age, race and gender primarily using the Federal and State databases and comparing the quantitative trends with prior works from 2006–2020 that shed lights on health disparity. Single user normalization was developed to achieve randomization to reduce the heterogeneity of the database. Results: Each age group was represented by the usage pattern of the “single” average individual revealing significantly different ED usage for different age groups. Black and white Americans as well as males and females showed large variation indicative of racial and gender disparity. Conclusions: This is the first comprehensive meta-analysis demonstrating racial and gender specific variation in the usage of emergency health care services that exist in USA and seem to be multifactorial and age specific. Using a tool of single user normalization developed in this work as a means of randomization these disparities were quantified and may help identify such disparity trends in other regions that suffer from similar disparities