Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Managing Transition from Curative to Palliative: GP and Bereaved Parent Experiences

Background Children with cancer in the UK are treated in regional childhood cancer centres (RCCC). Families and health care professionals can develop close working relationships over the often-long duration of treatment. Cancer still accounts for largest numbers of childhood disease related deaths and as home is commonly the choice of location for palliative and end of life care, the child and family can face transitions both from curative to palliative care and from hospital to home. This paper reports on findings relating to these transitions from the perspectives of parents and family doctors highlighting implications for both hospital and community based health care practitioners. Aims To explore the experiences of bereaved parents and family doctors following the death of a child with cancer in the family home. Methods Ethical approval was sought and obtained. In this qualitative study one-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents. The parents were those whose child had received treatment for cancer at a RCCC in the UK and who died at home, the GPs were those involved in the palliative care. Chronological comparative data analysis using grounded theory was completed. Results Cessation of contact with the RCCC when the child receives palliative care at home can be traumatic for parents. Hospital and community based health care professionals need to carefully consider how they establish, maintain and end working relationships with the child and family. Conclusions Findings from this study provide a new perspective to the effective management of transition in paediatric oncology palliative care; managing working relationships. Findings highlight the need for hospital and community based staff to identify and employ strategies that ensure working relationships with families are effectively managed prior to, during and following the child’s transition from curative to palliative care.

Interface entre arquitetura bioclimática e decisões projetuais

This research has as its object study focus bioclimatic in architecture and its conection with projects decisions, on what regards to environmental comfort for single-family dwelling. From the analysis of five architectural projects inserted in Natal/RN, warm-moist weather, this research gather informations regarding architectural features guided by shape and space arrengement, which embody important elements for the project design development. Computer simulations assisted as foundation to verify the efficiency grade for these projects strategies from shading analysis. Related strategies for the demands of natural ventilation circulation and thermal mass for refrigeration were analysed as well. Results show that there is an hierarchizing of priorities for the decisions made when it comes to shape and space disposition variables, as well as the way these variables will consider the bioclimatic demands. The analysis, even, show that there is no single way to respond to specific bioclimatic demands, as it points out the value of examination of the projectual solutions throughtout the conception process, in order to achieve an efficient project performance for the envimonment comfort

Casas modernas na orla marítima de João Pessoa 1960 a 1974

This paper studies modern houses built in the neighborhoods of Cabo Branco, Tambaú and Manaíra by the seafront in Joao Pessoa, built between 1960 and 1974. We start from the already widespread notion that Brazilian Modern Architecture was inspired by foreign ways, mainly European but also American here recast, adapted, often innovating repertoire and ideas received (Y. BRUAND, 2005; H. SEGAWA, 2002; C. E. COMAS, 2002; C. E. COMAS, 2002; M. M. ACAYABA e S. FICHER, 1982; M. B. C. ARANHA, 2008; F. C. L. LARA, 2001; R. V. ZEIN, 2005; L. E. AMORIM, 1999, C. V. STINCO, 2010). With this look, after a field study, we collected 61 specimens in the collection of the Central Archive of João Pessoa City Hall, in order to identify which reformulations, adaptations or innovations would exist in modern houses built along the coast in João Pessoa. As we try to analyze the houses by what the bibliography had suggested (G. C. ARGAN, 1992; L. CORBUSIER, 2002; C.E.D. e M. ADRIÀ, 2007; K. FRAMPTON, 1997; H. H. HITCHCOCK, 1976; L. BENEVOLO, 2004; R. DE FUSCO, 1992, N . PEVSNER, 2002; M. RAGON, 1986; B. RISEBERO, 1982; E. ROBBINS, 1997; W. J. R. CURTIS, 1982; V. SCULLY, 2003; B. ZEVI, 1984; D. DUNST, 1999; A. COLQUHOUN, 2002; R. WESTON, 2005; A. IÑAKI, 2006; J. PETER, 1994) the starting idea seemed to us not sufficiently developed. So we decided, first, to undertake a literature review comparing speech and image of modern houses most often cited by international and national literature, following a script freely inspired the Vitruvian triad: the functional and spatial (sectorization, guidance, spatiality, movement); constructive aspects (structural elements, modulation, deck, sealing), and aesthetic aspects (composition, apertures, ornaments) (Cap.1), then cast a look under this same route in 61 specimens obtained initially, trying to verify any specificities they would have (Cap.2). Failing to deepen the analysis of all these examples, we chose 10 projects which were redesigned and described in more detail to which we supplement with the aspects of place - location / lot location, access, axiality. (E. C. MAHFUZ, 2002; J. C. MIGUEL, 2000; E. C. CHEREGATI, 2007; M. COTRIM, 2007). (Cap. 3). The documentation and description resulting allowed us to approach some related questions about the canonical transcripts hybridizing, adoptions and any vernacular innovations of modern houses along the coast, We conclude that the appellants and anachronistic elements isolates found in each of the studied bind to the Brazilian Modern Architecture

Crime and Punishment.

The study of Victorian crime and punishment is a rich area of research that has attracted the interest not only of literary scholars but also of social historians, legal historians, and criminologists. Related scholarship therefore often situates itself at the intersection of traditional disciplinary boundaries, facilitating interdisciplinary conversation. Crime and punishment was a pressing issue for the Victorians and provoked a wealth of responses from contemporaneous commentators in literature, culture, and science. As a new phase of industrialization brought immense wealth for some and abject poverty for others, Victorian urban centers in particular were afflicted by crime. Without an effective system of social welfare in place, social inequality and deprivation drove women, men, and children into petty crime and more serious offenses, resulting in severe punishment ranging from incarceration via penal transportation to hanging. Public executions, not abolished until 1868, attracted huge crowds of spectators, including authors such as Charles Dickens and William Thackeray, who wrote about these experiences. A forerunner of the popular press, street literature conveyed and illustrated these events for a broad audience. Execution broadsides of famous cases, printing the alleged last lamentations of convicts on the scaffold in verse, are estimated to have sold by the million. As the legal system was undergoing reform (comprising changes in legal evidence procedure, divorce law, women’s property rights, and punishment for sexual offenses, for example), sensational trials caused furor and stimulated commentary in literature and the media. Crime and punishment was discussed in a range of literary and popular genres, poetry, and reformist writing. The “Newgate School” of fiction was accused of glamorizing crime, and the popular penny dreadfuls were feared to corrupt public morals. Sensational fiction in the 1860s, which often drew on real-life criminal cases and newspaper reports, depicted the supposedly respectable middle-class family home as a center of transgression. Similarly, detective fiction typically focused on crime in the world of the middle classes. For the student new to the subject of crime and punishment, this area’s interdisciplinary nature can pose an initial challenge.

Aparências da forma e forma do espaço: análise da configuração espacial de residências unifamiliares dos anos 1970 em João Pessoa PB

Assuming that the form of a building shell and its content the spatial form are distinct dimensions of architecture - however indivisible and interdependent -, this study focus, in the light of the Social Logic of Space (HILLIER; HANSON, 1984), on the intrinsic properties through which domestic space was structured in a sample of single-family dwellings built in João Pessoa (PB) during the 1970s - when the vocabulary of modern architecture still prevailed in Brazil though sharing the urban scene with other architectural trends -, in order to investigate regularities or divergences underlying their conception. These dwellings were originally classified (ARAÚJO, 2010a) in five categories defined according to the form of their building shells and to their prevailing construction techniques: (1) Brazilian modern legacy (considered as truly Brazilian modern style); (2) Paulista architecture (that refers to the modern production of São Paulo, Brazil, from the 1950s through the 1970s); (3) experiences of rationalization and prefabrication ; (4) experiences of adaptation to the climate (referring to a design strongly influenced by the hot and humid climate of North-eastern Brazil); and (5) hybrid (to account for a kind of stylistic hybridism that includes formal attributes, which evoke our colonial past). This study aims to determine, through the analyses of nineteen cases that represent each category, whether this taxonomy corresponds to distinct modes of spatial configuration. This research therefore proposes an approach to the classification of domestic architecture based on topological properties. The dwellings spatial organization was represented, quantified and analyzed, their spatial properties explored in consonance with one another and with the literature. Results pointed out that there is no evidence of a reciprocal relationship between the formal look of the built shells and their respective spatial structures

La integración social de las familias africanas y latinoamericanas reagrupadas en la España mediterránea

La investigación se basa en una encuesta específica realizada en 2009-2010 a 348 reagrupantes africanos y a 457 latinoamericanos, que residen con sus familias en las provincias litorales entre Girona y Almería. Los reagrupantes también informan sobre sus cónyuges y sus hijos. La información ahora utilizada se centra en factores de integración social relevantes para los grupos familiares; se utiliza la escala del conjunto territorial estudiado, y también de las tres subáreas: Cataluña litoral, Comunidad Valenciana y Murcia-Almería. Los factores de integración estudiados son el conocimiento del idioma español (para los africanos); las relaciones de convivencia; las parejas matrimoniales deseadas para los hijos/as; los deseos de permanencia en España; ingresos económicos y bienestar percibido; las relaciones de la familia con el país de origen, y la vivienda familiar en España. Africanos y latinoamericanos ofrecen respuestas diferentes a los factores de integración, más positivas entre los segundos, y dentro de los colectivos familiares, los hijos muestran actitudes más favorables para su integración.

Implicação das Alterações Legislativas ao Regulamento de Desempenho Energético de Edifícios de Habitação nas Soluções Construtivas

A presente dissertação centra-se no estudo das implicações originadas, ao nível das soluções construtivas presentes na envolvente dos edifícios de habitação, pelas recentes alterações efetuadas ao Regulamento de Desempenho Energético de Edifícios de Habitação (REH). Com o intuito de aferir o desempenho energético, através da aplicação do REH, considerou-se como caso de estudo um edifício de habitação novo, unifamiliar com tipologia T3, localizado a cerca de 10 metros acima do nível médio das águas do mar e na periferia da zona urbana de Vila Nova de Gaia. Após o levantamento das necessidades energéticas do edifício em estudo, realizaram-se diversas simulações, com o intuito de identificar e quantificar as alterações provocadas pela entrada em vigor da Portaria 379-A/2015, de 22 de outubro. Inicialmente estudou-se o comportamento térmico da habitação unifamiliar admitindo diferentes soluções construtivas: as soluções que cumpriam com as exigências em vigor até ao final de 2015 e as que cumprem as imposições atuais. Desta forma tentou perceber-se quais as implicações dessas alterações nas necessidades energéticas da habitação. Em seguida, e utilizando o mesmo conceito da simulação inicial, fez-se um estudo considerando que a fração se situava nas diferentes zonas climáticas existentes em Portugal. Para que tal fosse possível, teve que se considerar a implantação da habitação em diferentes localizações geográficas e a diferentes altitudes. Também se procurou avaliar a importância que as pontes térmicas planas assumem nas transferências de calor, nas duas estações. Assim, foi necessário fazer um pré- dimensionamento da solução estrutural adotada, quantificar a área destes elementos e o respetivo coeficiente de transmissão. Quantificou-se, posteriormente, quais as necessidades energéticas obtidas com a solução estrutural perfeitamente definida e as que se obteriam se se desprezasse a sua existência. Com as análises comparativas dos diferentes resultados obtidos, verificou-se que as atualizações das exigências regulamentares a que os edifícios de habitação estão sujeitos originam grande impacto nos sistemas construtivos adotados.

School Development in Urbanizing Areas

Good schools are essential for building thriving urban areas. They are important for preparing the future human resource and directly contribute to social and economic development of a place. They not only act as magnets for prospective residents, but also are necessary for retaining current population. As public infrastructure, schools mirror their neighborhood. “Their location, design and physical condition are important determinants of neighborhood quality, regional growth and change, and quality of life.”2 They impact housing development and utility requirements among many things. Hence, planning for schools along with other infrastructure in an area is essential. Schools are very challenging to plan, especially in urbanizing areas with changing demographic dynamics, where the development market and housing development can shift drastically a number of times. In such places projecting the future school enrollments is very difficult and in case of large population influx, school development can be unable to catch up with population growth which results in overcrowding. Typical is the case of Arlington County VA. In the past two decades the County has changed dramatically from a collection of bedroom communities in Washington DC Metro Region to a thriving urban area. Its metro accessible urban corridors are among most desired locations for development in the region. However, converting single family neighborhoods into high density areas has put a lot of pressure on its school facilities and has resulted in overcrowded schools. Its public school enrollment has grown by 19% from 2009 to 2014.3 While the percentage of population under 5 years age has increased in last 10 years, those in the 5-19 age group have decreased4. Hence, there is more pressure on the elementary school facilities than others in the County. Design-wise, elementary schools, due to their size, can be imagined as a community component. There are a number of strategies that can be used to develop elementary school in urbanizing areas as a part of the neighborhood. Experimenting with space planning and building on partnership and mixed-use opportunities can help produce better designs for new schools in future. This thesis is an attempt to develop elementary school models for urbanizing areas of Arlington County. The school models will be designed keeping in mind the shifting nature of population and resulting student enrollments in these areas. They will also aim to be efficient and sustainable, and lead to the next generation design for elementary school education. The overall purpose of the project is to address barriers to elementary school development in urbanizing areas through creative design and planning strategies. To test above mentioned ideas, the Joint-Use School typology of housing +school design has been identified for elementary school development in urbanizing areas in this thesis project. The development is based on the Arlington Public School’s Program guidelines (catering to 600 students). The site selected for this project is Clarendon West (part of Red Top Cab Properties) in Clarendon, Arlington County VA.

Interface entre arquitetura bioclimática e decisões projetuais

This research has as its object study focus bioclimatic in architecture and its conection with projects decisions, on what regards to environmental comfort for single-family dwelling. From the analysis of five architectural projects inserted in Natal/RN, warm-moist weather, this research gather informations regarding architectural features guided by shape and space arrengement, which embody important elements for the project design development. Computer simulations assisted as foundation to verify the efficiency grade for these projects strategies from shading analysis. Related strategies for the demands of natural ventilation circulation and thermal mass for refrigeration were analysed as well. Results show that there is an hierarchizing of priorities for the decisions made when it comes to shape and space disposition variables, as well as the way these variables will consider the bioclimatic demands. The analysis, even, show that there is no single way to respond to specific bioclimatic demands, as it points out the value of examination of the projectual solutions throughtout the conception process, in order to achieve an efficient project performance for the envimonment comfort

Casas modernas na orla marítima de João Pessoa 1960 a 1974

This paper studies modern houses built in the neighborhoods of Cabo Branco, Tambaú and Manaíra by the seafront in Joao Pessoa, built between 1960 and 1974. We start from the already widespread notion that Brazilian Modern Architecture was inspired by foreign ways, mainly European but also American here recast, adapted, often innovating repertoire and ideas received (Y. BRUAND, 2005; H. SEGAWA, 2002; C. E. COMAS, 2002; C. E. COMAS, 2002; M. M. ACAYABA e S. FICHER, 1982; M. B. C. ARANHA, 2008; F. C. L. LARA, 2001; R. V. ZEIN, 2005; L. E. AMORIM, 1999, C. V. STINCO, 2010). With this look, after a field study, we collected 61 specimens in the collection of the Central Archive of João Pessoa City Hall, in order to identify which reformulations, adaptations or innovations would exist in modern houses built along the coast in João Pessoa. As we try to analyze the houses by what the bibliography had suggested (G. C. ARGAN, 1992; L. CORBUSIER, 2002; C.E.D. e M. ADRIÀ, 2007; K. FRAMPTON, 1997; H. H. HITCHCOCK, 1976; L. BENEVOLO, 2004; R. DE FUSCO, 1992, N . PEVSNER, 2002; M. RAGON, 1986; B. RISEBERO, 1982; E. ROBBINS, 1997; W. J. R. CURTIS, 1982; V. SCULLY, 2003; B. ZEVI, 1984; D. DUNST, 1999; A. COLQUHOUN, 2002; R. WESTON, 2005; A. IÑAKI, 2006; J. PETER, 1994) the starting idea seemed to us not sufficiently developed. So we decided, first, to undertake a literature review comparing speech and image of modern houses most often cited by international and national literature, following a script freely inspired the Vitruvian triad: the functional and spatial (sectorization, guidance, spatiality, movement); constructive aspects (structural elements, modulation, deck, sealing), and aesthetic aspects (composition, apertures, ornaments) (Cap.1), then cast a look under this same route in 61 specimens obtained initially, trying to verify any specificities they would have (Cap.2). Failing to deepen the analysis of all these examples, we chose 10 projects which were redesigned and described in more detail to which we supplement with the aspects of place - location / lot location, access, axiality. (E. C. MAHFUZ, 2002; J. C. MIGUEL, 2000; E. C. CHEREGATI, 2007; M. COTRIM, 2007). (Cap. 3). The documentation and description resulting allowed us to approach some related questions about the canonical transcripts hybridizing, adoptions and any vernacular innovations of modern houses along the coast, We conclude that the appellants and anachronistic elements isolates found in each of the studied bind to the Brazilian Modern Architecture

Aparências da forma e forma do espaço: análise da configuração espacial de residências unifamiliares dos anos 1970 em João Pessoa PB

Assuming that the form of a building shell and its content the spatial form are distinct dimensions of architecture - however indivisible and interdependent -, this study focus, in the light of the Social Logic of Space (HILLIER; HANSON, 1984), on the intrinsic properties through which domestic space was structured in a sample of single-family dwellings built in João Pessoa (PB) during the 1970s - when the vocabulary of modern architecture still prevailed in Brazil though sharing the urban scene with other architectural trends -, in order to investigate regularities or divergences underlying their conception. These dwellings were originally classified (ARAÚJO, 2010a) in five categories defined according to the form of their building shells and to their prevailing construction techniques: (1) Brazilian modern legacy (considered as truly Brazilian modern style); (2) Paulista architecture (that refers to the modern production of São Paulo, Brazil, from the 1950s through the 1970s); (3) experiences of rationalization and prefabrication ; (4) experiences of adaptation to the climate (referring to a design strongly influenced by the hot and humid climate of North-eastern Brazil); and (5) hybrid (to account for a kind of stylistic hybridism that includes formal attributes, which evoke our colonial past). This study aims to determine, through the analyses of nineteen cases that represent each category, whether this taxonomy corresponds to distinct modes of spatial configuration. This research therefore proposes an approach to the classification of domestic architecture based on topological properties. The dwellings spatial organization was represented, quantified and analyzed, their spatial properties explored in consonance with one another and with the literature. Results pointed out that there is no evidence of a reciprocal relationship between the formal look of the built shells and their respective spatial structures

La vivienda unifamiliar de interés social en el Área Metropolitana de Monterrey [AMM] México y el bienestar social del usuario; la vivienda VITAL

Tradicionalmente la vivienda social en México ha sido analizada de manera cuantitativa principalmente en cuanto al déficit y el rezago, omitiendo la aportación que el uso de esas viviendas ofrece al bienestar de sus ocupantes. Este artículo presenta a la "vivienda VITAL" como propuesta de vivienda unifamiliar con espacio interior dirigido al bienestar de su usuario, con base en una investigación1 cualitativa que incluyó a usuarios de vivienda de interés social ubicados en tres desarrollos habitacionales en el Área Metropolitana de Monterrey, Nuevo León, y a funcionarios públicos dedicados al diseño y ejecución de vivienda social en México. ABSTRACT Traditionally social housing in Mexico has been analyzed quantitatively mainly in regards to deficit and backlog, omitting the contribution that the usage of these houses offers to the welfare of their habitants. This article introduces the "housing VITAL" as a proposal for a single family housing with interior space focused to the welfare of its user, based on a qualitative research that included low income housing users in three housing developments located at the Metropolitan Area of Monterrey, Nuevo León, and public servants dedicated to the design and implementation of social housing in Mexico

Understanding the Impact of the Property Tax Appeal Process on Assessment Uniformity: Procedures, Structures, and Outcomes

Property taxes serve as a vital revenue source for local governments. The revenues derived from the property tax function as the primary funding source for a variety of critical local public service systems. Property tax appeal systems serve as quasi-administrative-judicial mechanisms intended to assure the public that property tax assessments are correct, fair, and equitable. Despite these important functions, there is a paucity of empirical research related to property tax appeal systems. This study contributes to property tax literature by identifying who participates in the property tax appeal process and examining their motivations for participation. In addition, the study sought to determine whether patterns of use and success in appeal systems affected the distribution of the tax burden. Data were collected by means of a survey distributed to single-family property owners from two Florida counties. In addition, state and county documents were analyzed to determine appeal patterns and examine the impact on assessment uniformity, over a three-year period. The survey data provided contextual evidence that single-family property owners are not as troubled by property taxes as they are by the conduct of local government officials. The analyses of the decision to appeal indicated that more expensive properties and properties excluded from initial uniformity analyses were more likely to be appealed, while properties with homestead exemptions were less likely to be appealed. The value change analyses indicated that appeals are clustered in certain geographical areas; however, these areas do not always experience a greater percentage of the value changes. Interestingly, professional representation did not increase the probability of obtaining a reduction in value. Other relationships between the variables were discovered, but often with weak predictive ability. Findings from the assessment uniformity analyses were also interesting. The results indicated that the appeals mechanisms in both counties improved assessment uniformity. On average, appealed properties exhibited greater horizontal and vertical inequities, as compared to non-appealed properties, prior to the appeals process. After, the appeal process was completed; the indicators of horizontal and vertical equity were largely improved. However, there were some indications of regressivity in the final year of the study.

Characterization of Chimney Flue Gas Flows : Flow Rate Measurements with Averaging Pitot Probes

Performance testing methods of boilers in transient operating conditions (start, stop and combustion power modulation sequences) need the combustion rate quantified to allow for the emissions to be quantified. One way of quantifying the combustion rate of a boiler during transient operating conditions is by measuring the flue gas flow rate. The flow conditions in chimneys of single family house boilers pose a challenge however, mainly because of the low flow velocity. The main objectives of the work were to characterize the flow conditions in residential chimneys, to evaluate the use of the Pitot-static method and the averaging Pitot method, and to develop and test a calibration method for averaging Pitot probes for low