The COVID‐19 pandemic has transformed healthcare for both clinicians and patients. This conceptual article uses ideas from the moral distress literature to understand the challenges MedFTs and ...physicians face during the COVID‐19 pandemic. The authors highlight earlier themes from the moral distress literature and share current reflections to illustrate similar challenges. Some clinicians who were already experiencing a rise in burnout due to the mass digitization of healthcare are now facing increased moral distress due to ethical dilemmas, pervasive uncertainty, boundary ambiguity, isolation, and burnout brought about by emerging COVID‐19 policies. Fears about personal safety, exposing loved ones, financial concerns, self‐doubt, and frustrations with telehealth have contributed to increased moral distress during the COVID‐19 pandemic. Building resilience by setting one's personal moral compass can help clinicians avoid the pitfalls of moral distress. Five steps for developing resilience and implications for guiding trainees in developing resilience are discussed.
IntroductionBetween 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not ...seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator. The evolution of a patient-reported symptom-based risk stratification system to redesign the sHNC referral pathway (EVEREST-HN) Programme comprises six work packages (WPs). This protocol describes WP1 and WP2. WP1 will obtain an understanding of language to optimise the SYmptom iNput Clinical (SYNC) system patient-reported symptom questionnaire for sHNC referrals and outline requirements for the SYNC system. WP2 will codesign key elements of the SYNC system, including the SYNC Questionnaire, and accompanying behaviour change materials.Methods and analysisWP1 will be conducted at three acute National Health Service (NHS) trusts with variation in service delivery models and ensuring a broad mixture of social, economic and cultural backgrounds of participants. Up to 150 patients with sHNC (n=50 per site) and 15 clinicians (n=5 per site) will be recruited. WP1 will use qualitative methods including interviews, observation and recordings of consultations. Rapid qualitative analysis and inductive thematic analysis will be used to analyse the data. WP2 will recruit lay patient representatives to participate in online focus groups (n=8 per focus group), think-aloud technique and experience-based codesign and will be analysed using qualitative and quantitative approaches.Ethics and disseminationThe committee for clinical research at The Royal Marsden, a research ethics committee and the Health Research Authority approved this protocol. All participants will give informed consent. Ethical issues of working with patients on an urgent cancer diagnostic pathway have been considered. Findings will be disseminated via journal publications, conference presentations and public engagement activities.
This paper presents the results for the operating energy performance of the smart operation for a low carbon energy region (SOLCER) house. The house design is based on a ‘systems’ approach, which ...integrates the building technologies for electrical and thermal energy systems, together with the architectural design. It is based on the concept of ‘energy positive’ buildings, utilising renewable energy systems which form part of the building envelope construction. The paper describes how the building energy model HTB2, with a range of additional ‘plugins’, has been used to simulate specific elements of the design and the overall energy performance of the house. Measurement data have been used in combination with the energy simulation results to evaluate the performance of the building together with its systems, and identifying the energy performance of individual components of the building. The study has indicated that an energy-positive performance can be achieved through an integrative systems approach. The analysis has indicated that the house, under normal occupancy, needs to import about 26% of its energy from the grid, but over the year its potential export to import ratio can reach 1.3:1. The paper discusses the performance gap between design and operation. It also considers the contribution of a transpired solar air collector (TSC) to space heating. The results have been used to gain a detailed understanding of energy-positive performance.
This paper explores the concept of advocacy in head and neck cancer. We define inherent challenges in the development and success of advocacy within this context and offer ways to embed it within ...clinical practice. We outline what advocacy is, ways in which it may benefit people with head and neck cancer and the engagement required from healthcare professionals to facilitate advocacy to improve outcomes.
The status of immigrant families resettled to the United States in the past decade has been fraught with upsurges of governmental policies that have systematically increasing the levels of ...oppression, violence, and abuses of human rights. The socio‐political‐economic toll of xenophobic practices on specifically targeted immigrant populations is magnified by the psychological and relational impact they have on individuals, families, and communities. This manuscript is conceptualized as an ongoing call for social action and specific mobilization by mental health professionals in response to the increasing threats to civility and dignity faced by various immigrant communities. The paper is organized in three sections: (a) an overview of the effects of immigration policy on immigrant family experiences; (b) the impact of mental and relational health on immigrant populations; and (c) elaborations of three exemplar community projects designed to support immigrant families. The manuscript concludes with a discussion exploring avenues for promoting a stronger base for solidarity and social action.
This paper examines whether and how the challenging target of 95% decarbonisation can be achieved for the Welsh building stock. First, a critical review of the literature and relevant case studies ...are presented to understand the effectiveness of different retrofit approaches in practice, and the degree to which these approaches are evidence based, and applicable to the Welsh context. These findings are synthesised into a collection of 14 recurrent dwelling ‘archetypes’, with appropriate retrofit strategies developed for each. The impacts of these strategies are modelled in terms of capital cost, primary energy use, fuel bills and carbon emissions. Conclusions provide an evidence base for future policy and a decarbonisation strategy. Retrofit strategies should include fabric first-measures to minimise increases in household fuel bills and a consequent increase in fuel poverty. Retrofit options for a significant percentage of housing are constrained by character, which would limit changes to the external fabric. Given that decarbonisation of the future energy supply is currently uncertain, all other housing should be retrofitted to perform beyond SAP90. A flexible approach that pushes all housing to achieve stringent standards by 2050 is the only way to achieve targeted reductions in carbon emissions under the assumed energy supply scenarios. 'Policy relevance' The Welsh housing stock, among the oldest and least efficient in Europe, is responsible for 21% of Welsh carbon emissions. In 2019, the UK Committee for Climate Change (CCC) determined that Wales should target a 95% reduction in emissions by 2050. This paper assesses whether this challenging target can be achieved, and potential strategies for doing so. Key recommendations are drawn from the research, which encompass technical, social and organisational issues, and the importance of a holistic approach to decarbonisation is identified. These findings informed the Independent Steering Group recent report 'Better Homes, Better Wales, Better World' (2019), and the report’s recommendations were adopted by the Welsh Government on 24 September 2019. This work should continue to provide an evidence base upon which future policy can be developed through the development of retrofit strategies for recurring dwelling archetypes and a decarbonisation strategy for Wales that is likely to include legislation, regulation, incentives and penalties.
Retrofitting existing housing: how far, how much? Jones, Phil; Lannon, Simon; Patterson, Jo
Building research and information : the international journal of research, development and demonstration,
10/2013, Letnik:
41, Številka:
5
Journal Article
Recenzirano
The significance of retrofitting the existing housing stock is considered for the policy commitment of delivering an 80% CO
2
emission reduction by 2050. Background issues of energy, legislation, ...potential and actual CO
2
savings, socio-economics (payback, fuel poverty, health impacts, employment stimulus, etc.) are discussed. Different potential retrofit strategies for the housing stock are presented. Three large-scale housing retrofit programmes in Wales, UK, are analysed for energy savings (using the Energy and Environmental Prediction Model), CO
2
reduction and costs. Two 'whole house' retrofit projects in Wales are also assessed, one of which has been the subject of long-term monitoring. Data are compared on a range of retrofit options: different strategies (elemental, multiple and whole-house measures), costs, actual CO
2
reductions and associated benefits. The findings indicate that as the cost of measures rise in relation to the predicted savings, reasonable paybacks will be difficult to achieve, particularly for finance packages such as the 'Green Deal'. There are funding opportunities for installing 'shallow' elemental measures to reduce CO
2
emissions by 10-30%. However, the large-scale financing of 'deep' (60-80% reductions) whole-house packages of measures is not currently available and does not pay back.
L'importance de la rénovation du parc de logements existants est examinée dans la perspective d'assurer l'engagement politique d'une réduction de 80 % des émissions de CO
2
d'ici 2050. Les questions contextuelles touchant à l'énergie, à la législation, aux économies de CO
2
potentielles et réelles, aux aspects socioéconomiques (retour sur investissement, pauvreté énergétique, incidences sur la santé, incitation à l'emploi, etc.) sont traitées. Différentes stratégies possibles de rénovation du parc de logements sont présentées. Trois programmes de rénovation à grande échelle de logements au Pays de Galles, Royaume-Uni, sont analysés en termes d'économies d'énergie (en utilisant le Modèle de prévision énergétique et environnementale), de réduction du CO
2
et de coûts. Deux projets de rénovation « complète » de logements au Pays de Galles sont également évalués, dont l'un a fait l'objet d'un suivi à long terme. Les données sont comparées en fonction d'un éventail d'options de rénovation : stratégies différentes (mesures élémentaires, multiples et concernant l'ensemble de la maison), coûts, réductions réelles de CO
2
et avantages connexes. Les résultats indiquent qu'au fur et à mesure que le coût des mesures augmente par rapport aux économies prévues, il devient difficile d'obtenir des retours sur investissement d'un niveau raisonnable, s'agissant en particulier de modalités de financement telles que le « Green Deal ». Il existe des possibilités de financement pour la mise en place de mesures élémentaires « légères » visant à réduire les émissions de CO
2
de 10-30 %. Cependant, le financement à grande échelle de trains de mesures « lourdes » concernant l'ensemble de la maison (réductions de 60-80 %) n'est pas actuellement disponible et ne permet pas le retour sur investissement.
Mots clés: parc bâti, énergie, logement, bas carbone, politique publique, réhabilitation, rénovation
Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and ...social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.
最近的研究为家庭治疗师提供了个体生物结构及其社交身体环境间复杂互动方面的新信息。家庭和社会关系,特别是在人生早期敏感时期,可能影响儿童的生物学基础。此外,早期岁月中的压力可能对个人的身体和精神健康产生永久影响,并导致严重的精神疾病发作。已有社区项目对有风险子女的家庭进行早期干预以防止或尽力减少精神疾病的发作,包括为处于风险中的婴儿母亲提供合作以塑造情感关系。多个项目也制定个人和家庭干预以防止精神疾病的发作。从业的家庭治疗师能将新兴的神经科学和早期干预研究结合起来,并促进社区项目日益壮大以提高客户的精神健康结构的效力和可持续性。此外,家庭治疗教育项目应拓展学生培训,将日益增长的有关家庭关系如何影响个人精神健康发展方面的信息整合进来。
Investigaciones recientes están facilitando a terapeutas familiares información nueva sobre la compleja interacción entre la composición biológica de una persona y su entorno social y físico. Las relaciones familiares y sociales, particularmente durante periodos sensibles de los primeros años de vida pueden afectar la base biológica de un niño. Además, el estrés durante los primeros años puede tener un efecto duradero en la salud mental y física de una persona y contribuir a la manifestación de enfermedades mentales graves. Se han desarrollado programas comunitarios para intervenir de forma temprana en familias que tienen un niño en riesgo a fin de prevenir o minimizar la aparición de enfermedades mentales. Dichas intervenciones incluyen la asociación con madres de niños en riesgo a fin de forjar relaciones de apego. Estos programas también están desarrollando intervenciones individuales y familiares para prevenir la aparición de psicosis. Los terapeutas familiares activos pueden incorporar la neurociencia emergente y la investigación sobre intervención temprana y aprovechar la base creciente de programas comunitarios para mejorar la eficacia y sustentabilidad de los resultados de salud mental en los pacientes. Además, los programas de capacitación en terapia familiar deberían ampliar la formación de alumnos mediante la incorporación del creciente conjunto de información sobre cómo las relaciones familiares influyen en el desarrollo de la salud mental de una persona.
Video
•Combines computer energy simulations and field measurements to analyse the seasonal energy performance of five whole-house energy retrofits.•Presents the annual energy, CO2 and cost savings ...associated with combining energy efficiency measures, building integrated solar PV, and battery storage.•Presents the costs of retrofitting with an emphasis on affordability.•Estimates the in-house energy use of battery storage and associated costs and cost savings.
With around 1–2% annual replacement of the UK’s housing stock, housing retrofit must play a major role in reducing future energy use and CO2 emissions. This paper presents a whole-house approach for energy retrofit for five houses located in South Wales. This ‘systems based’ approach combines reduced energy demand, renewable energy supply and battery storage. The paper describes a combination of energy modelling, using the building energy model HTB2, and field measurements to analyse the performance of the houses before and after retrofit. The results indicate that significant reductions in energy use, CO2 emissions and energy costs can be achieved using a whole house approach, combining energy efficiency with building integrated renewable energy generation and energy storage. CO2 emission reductions are estimated to be in the range of 50–75%, with cost savings of £402 to £621 per year. The cost of carrying out the retrofitting ranges from £23,852 to £30,510. Although retrofits are still relatively expensive in relation to their annual cost savings, there are multiple benefits relating to reducing fuel poverty, reducing electricity grid stress and contributing to national CO2 emission reduction targets. Also, as costs of measures are further reduced and energy prices likely to rise in future, the cost balance will change more in favour of whole house retrofit. The paper demonstrates the advantages in using a combination of energy simulation and field monitoring to investigate the performance of buildings in use, which in this case concerns the impact of carrying out energy retrofits in housing.
Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional ...neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.
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