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

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

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

Thyroid-Hormone–Disrupting Chemicals: Evidence for Dose-Dependent Additivity or Synergism

Endocrine disruption from environmental contaminants has been linked to a broad spectrum of adverse outcomes. One concern about endocrine-disrupting xenobiotics is the potential for additive or synergistic (i.e., greater-than-additive) effects of mixtures. A short-term dosing model to examine the effects of environmental mixtures on thyroid homeostasis has been developed. Prototypic thyroid-disrupting chemicals (TDCs) such as dioxins, polychlorinated biphenyls (PCBs), and poly-brominated diphenyl ethers have been shown to alter thyroid hormone homeostasis in this model primarily by up-regulating hepatic catabolism of thyroid hormones via at least two mechanisms. Our present effort tested the hypothesis that a mixture of TDCs will affect serum total thyroxine (T(4)) concentrations in a dose-additive manner. Young female Long-Evans rats were dosed via gavage with 18 different polyyhalogenated aromatic hydrocarbons [2 dioxins, 4 dibenzofurans, and 12 PCBs, including dioxin-like and non-dioxin-like PCBs] for 4 consecutive days. Serum total T(4) was measured via radioimmunoassay in samples collected 24 hr after the last dose. Extensive dose–response functions (based on seven to nine doses per chemical) were determined for individual chemicals. A mixture was custom synthesized with the ratio of chemicals based on environmental concentrations. Serial dilutions of this mixture ranged from approximately background levels to 100-fold greater than background human daily intakes. Six serial dilutions of the mixture were tested in the same 4-day assay. Doses of individual chemicals that were associated with a 30% TH decrease from control (ED(30)), as well as predicted mixture outcomes were calculated using a flexible single-chemical-required method applicable to chemicals with differing dose thresholds and maximum-effect asymptotes. The single-chemical data were modeled without and with the mixture data to determine, respectively, the expected mixture response (the additivity model) and the experimentally observed mixture response (the empirical model). A likelihood-ratio test revealed statistically significant departure from dose additivity. There was no deviation from additivity at the lowest doses of the mixture, but there was a greater-than-additive effect at the three highest mixtures doses. At high doses the additivity model underpredicted the empirical effects by 2- to 3-fold. These are the first results to suggest dose-dependent additivity and synergism in TDCs that may act via different mechanisms in a complex mixture. The results imply that cumulative risk approaches be considered when assessing the risk of exposure to chemical mixtures that contain TDCs

Engaging with patient online health information use: a survey of primary health care nurses

Internet health information is used by patients for health care decision making. Research indicates this information is not necessarily disclosed in interactions with health professionals. This study investigated primary health care nurses’ engagement with patient online health information use along with the respondents’ disclosure of online sources to their personal health care provider. A questionnaire was posted to a random sample of 1,000 New Zealand nurses with 630 responses. Half the respondents assessed patients’ online use (n = 324) and had encountered patients who had wrongly interpreted information. Health information quality evaluation activities with patients indicated the need for nursing information literacy skills. A majority of respondents (71%, n = 443) used online sources for personal health information needs; 36.3% (n = 155) of the respondents using online sources did not tell their personal health care provider about information obtained. This study identifies that there are gaps in supporting patient use but more nursing engagement with online sources when compared with earlier studies

On the spectrum of Farey and Gauss maps

In this paper we introduce Hilbert spaces of holomorphic functions given by generalized Borel and Laplace transforms which are left invariant by the transfer operators of the Farey map and its induced version, the Gauss map, respectively. By means of a suitable operator-valued power series we are able to study simultaneously the spectrum of both these operators along with the analytic properties of the associated dynamical zeta functions.Comment: 23 page