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

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

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/

Translating Glutamate: From Pathophysiology to Treatment

The neurotransmitter glutamate is the primary excitatory neurotransmitter in mammalian brain and is responsible for most corticocortical and corticofugal neurotransmission. Disturbances in glutamatergic function have been implicated in the pathophysiology of several neuropsychiatric disorders—including schizophrenia, drug abuse and addiction, autism, and depression—that were until recently poorly understood. Nevertheless, improvements in basic information regarding these disorders have yet to translate into Food and Drug Administration–approved treatments. Barriers to translation include the need not only for improved compounds but also for improved biomarkers sensitive to both structural and functional target engagement and for improved translational models. Overcoming these barriers will require unique collaborative arrangements between pharma, government, and academia. Here, we review a recent Institute of Medicine–sponsored meeting, highlighting advances in glutamatergic theories of neuropsychiatric illness as well as remaining barriers to treatment development.National Institute of Mental Health (U.S.) (grant R37MH49334)National Institute of Mental Health (U.S.) (Intramural Research Program)National Institute of Mental Health (U.S.) (R01DA03383)National Institute of Mental Health (U.S.) (P50MH086385)National Institutes of Health (U.S.)FRAXA Research FoundationHoward Hughes Medical InstituteSimons Foundatio

Molecular Mechanisms Associated with Nicotine Pharmacology and Dependence.

Tobacco dependence is a leading cause of preventable disease and death worldwide. Nicotine, the main psychoactive component in tobacco cigarettes, has also been garnering increased popularity in its vaporized form, as derived from e-cigarette devices. Thus, an understanding of the molecular mechanisms underlying nicotine pharmacology and dependence is required to ascertain novel approaches to treat drug dependence. In this chapter, we review the field's current understanding of nicotine's actions in the brain, the neurocircuitry underlying drug dependence, factors that modulate the function of nicotinic acetylcholine receptors, and the role of specific genes in mitigating the vulnerability to develop nicotine dependence. In addition to nicotine's direct actions in the brain, other constituents in nicotine and tobacco products have also been found to alter drug use, and thus, evidence is provided to highlight this issue. Finally, currently available pharmacotherapeutic strategies are discussed, along with an outlook for future therapeutic directions to achieve to the goal of long-term nicotine cessation

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

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