Damp building moulds: Assessment of sensitization in patients and studies into mechanisms of airway inflammation using experimental models

Exposure to water-damaged buildings and the associated health problems have evoked concern and created confusion during the past 20 years. Individuals exposed to moisture problem buildings report adverse health effects such as non-specific respiratory symptoms. Microbes, especially fungi, growing on the damp material have been considered as potential sources of the health problems encountered in these buildings. Fungi and their airborne fungal spores contain allergens and secondary metabolites which may trigger allergic as well as inflammatory types of responses in the eyes and airways. Although epidemiological studies have revealed an association between damp buildings and health problems, no direct cause-and-effect relationship has been established. Further knowledge is needed about the epidemiology and the mechanisms leading to the symptoms associated with exposure to fungi. Two different approaches have been used in this thesis in order to investigate the diverse health effects associated with exposure to moulds. In the first part, sensitization to moulds was evaluated and potential cross-reactivity studied in patients attending a hospital for suspected allergy. In the second part, one typical mould known to be found in water-damaged buildings and to produce toxic secondary metabolites was used to study the airway responses in an experimental model. Exposure studies were performed on both naive and allergen sensitized mice. The first part of the study showed that mould allergy is rare and highly dependent on the atopic status of the examined individual. The prevalence of sensitization was 2.7% to Cladosporium herbarum and 2.8% to Alternaria alternata in patients, the majority of whom were atopic subjects. Some of the patients sensitized to mould suffered from atopic eczema. Frequently the patients were observed to possess specific serum IgE antibodies to a yeast present in the normal skin flora, Pityrosporum ovale. In some of these patients, the IgE binding was partly found to be due to binding to shared glycoproteins in the mould and yeast allergen extracts. The second part of the study revealed that exposure to Stachybotrys chartarum spores induced an airway inflammation in the lungs of mice. The inflammation was characterized by an influx of inflammatory cells, mainly neutrophils and lymphocytes, into the lungs but with almost no differences in airway responses seen between the satratoxin producing and non-satratoxin producing strain. On the other hand, when mice were exposed to S. chartarum and sensitized/challenged with ovalbumin the extent of the inflammation was markedly enhanced. A synergistic increase in the numbers of inflammatory cells was seen in BAL and severe inflammation was observed in the histological lung sections. In conclusion, the results in this thesis imply that exposure to moulds in water damaged buildings may trigger health effects in susceptible individuals. The symptoms can rarely be explained by IgE mediated allergy to moulds. Other non-allergic mechanisms seem to be involved. Stachybotrys chartarum is one of the moulds potentially responsible for health problems. In this thesis, new reaction models for the airway inflammation induced by S. chartarum have been found using experimental approaches. The immunological status played an important role in the airway inflammation, enhancing the effects of mould exposure. The results imply that sensitized individuals may be more susceptible to exposure to moulds than non-sensitized individuals.

Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania.

It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.

The Architecture of Home in Cairo: Socio-Spatial Practice of the Hawari's Everyday Life

The hawari of Cairo - narrow non-straight alleyways - are the basic urban units that have formed the medieval city since its foundation back in 969 AD. Until early in the C20th, they made up the primary urban divisions of the city and were residential in nature. Contemporary hawari, by contrast, are increasingly dominated by commercial and industrial activity. This medieval urban maze of extremely short, broken, zigzag streets and dead ends are defensible territories, powerful institutions, and important social systems. While the hawari have been studied as an exemplar for urban structure of medieval Islamic urbanism, and as individual building typologies, this book is the first to examine in detail the socio-spatial practice of the architecture of home in the city. It investigates how people live, communicate and relate to each other within their houses or shared spaces of the alleys, and in doing so, to uncover several new socio-spatial dimensions and meanings in this architectural form.

In an attempt to re-establish the link between architecture past and present, and to understand the changing social needs of communities, this book uncovers the notion of home as central to understand architecture in such a city with long history as Cairo. It firstly describes the historical development of the domestic spaces (indoor and outdoor), and provides an inclusive analysis of spaces of everyday activities in the hawari of old Cairo. It then broadens its analysis to other parts of the city, highlighting different customs and representations of home in the city at large. Cairo, in the context of this book, is represented as the most sophisticated urban centre in the Middle East with different and sometimes contrasting approaches to the architecture of home, as a practice and spatial system.

In order to analyse the complexity and interconnectedness of the components and elements of the hawari as a 'collective home', it layers its narratives of architectural and social developments as a domestic environment over the past two hundred years, and in doing so, explores the in-depth social meaning and performance of spaces, both private and public.

Constructing a global understanding of the social ecology of leaving out of home care

Engagement with globalisation is growing in the field of youth transitions from out of home care. This includes cross national exchange of research, policy and practise, regional advocacy networking and global policy development. Furthering this emerging international child welfare perspective requires extending it to countries in the developing world and building conceptual frameworks which encompass a social ecology of care leaving, including its global dimension, the latter needs to address not only the needs, expectations and rights of care leavers but also the theories of change underpinning service design and delivery. Such a model is presented combining resilience and social capital as personal assets situated within a social ecology of support. To illustrate how this provides a means to help engage with the experience of countries where there appears to be very little information available on care leaving, a small scale South African initiative is considered. SA-YES is a youth mentoring project for young people leaving a variety of out of home placements. Planned as a three-year pilot, initial results are encouraging but require more rigorous evaluation focusing on program process and outcomes, quality of interpersonal relationships and synchronisation with cultural expectations and policy environment.

Assessing Lifetime Homes Standards and Part M Building Regulations for Housing Design in the UK

The aims of this article are to examine Lifetime Home Standards (LTHS) and Part M of the UK Building Regulations and to discuss how relevant and successful they are. The UK government expects all new homes to be built to LTHS by 2013. This is increasingly important with an ageing population. The home environment can enable independence and provide a therapeutic place for everyone. As Part M of the building regulations are compulsory in all housing and LTHS are mandatory for public sector housing, a review of research articles was undertaken on these standards. The paper begins with a brief background on accessibility regulations, followed by a critical review of the standards that takes the body of literature that has been written around them into account. This review suggests that the standards should be improved and that designers and architects face challenges to creatively incorporate them into housing design.

Being observant and observed: embodied citizenship training in the Home Guard and the Boy Scout Movement, 1907-1945

Building upon recent studies by geographers and social scientists on the everyday practices of (scientific) observation, this paper focuses on the role of two distinct, yet similar organisations that held observation as an essential and 'automatic' embodied skill. Utilising the examples of Home Guard camouflage and the Boy Scout Movement, the paper critically examines how these organisations sought to articulate the individual as both observer and observed, thereby exposing a much more complex entanglement of different visual positions and practices hitherto neglected in studies of observation. Moreover, the paper emphasises the importance of the act of 'not-being-seen' as a complementary and fundamental aspect of (non-)observational practice, accentuated and promoted by civic institutions in terms of duty and responsibility. Finally, the paper considers the evolutionary aspects of observation through the lifecourse, revealing a complex, relational geography of expertise, experience and skill that crossed age-distinctions. © 2012 Elsevier Ltd.

Comfort Care Rounds: A Staff Capacity-Building Initiative in Long-Term Care Homes

This article reports a pilot evaluation of Comfort Care Rounds (CCRs)-a strategy for addressing long-term care home staff's palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members' perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation.

Exploring the Perceptions of Cultural Competence Among Personal Support Workers in an Ontario Long-Term Care Home: A Case Study

Personal Support Workers (PSWs) spend a large amount of time with long-term care (LTC) home residents providing assistance with their activities of daily living. The s limited research on their perceptions of cultural competence presents the need to bridge this knowledge gap. The researcher conducted a qualitative case study at a LTC home in Ontario. Data were collected by conducting a policy document analysis, a key informant interview with the Director of Care (DOC), and two focus groups with PSWs. The five major overarching themes were: The Culture of the LTC Home, Provision of a Supportive Environment, Collaborative Team Approach to Care, Building a Relationship with the Residents, and Maintenance of Staff Morale. The findings illuminated the broad nature of culture, connections to person centered care, and the factors that facilitate or hinder PSWs’ culturally competent care. The ambiguous perception of cultural competence among PSWs suggests further research and education on cultural competence in LTC home settings.

Salut i poder en la gènesi de l'home contemporani

Amb aquesta investigació, que s'emmarca dins l'àmbit de l'Antropologia Filosòfica, el que ens proposem és escriure un capítol per a una genealogia de l'home contemporani, intentant respondre a la pregunta: com hem arribat a ser el que som? No pretenem descriure els principals factors que han influït en la manera de ser de l'home contemporani, sinó que l'objectiu d'aquest treball és molt més limitat: dibuixar algunes de les principals relacions entre el saber i el poder que s'han donat en el si de la medicina contemporània, i més concretament en l'àmbit de la Salut Pública, i que han contribuït a subjectar els individus d'una determinada manera, creant un model: l'home saludable. Volem mostrar com el discurs i la pràctica mèdica que es van començar a perfilar entre el segle XVIII i el segle XIX moment en què es solidificaren els fonaments de l'art de guarir tal com ara l'entenem , a part d'aportar un conjunt de tècniques de curació, també van oferir una determinada visió de l'home, la qual va tenir importants repercussions en la manera de ser de l'individu contemporani. Ens interessa mostrar de quina manera la medicina, a partir de la Salut Pública, ha intervingut en la gestió de l'existència humana, prenent una postura normativa que l'ha autoritzat a governar la vida de les persones. L'objectiu de la nostra investigació és respondre les qüestions: quin tipus de subjectivació implica la medicina contemporània? Quin tipus de subjecte ha ajudat a crear, incitant l'home a establir unes determinades maneres de relacionar-se amb si mateix i amb els altres? En definitiva, desciure algunes de les principals estratègies dibuixades des de la Salut Pública que han actuat com a poders de normalització, en tant que han fomentat un determinat tipus d'home. Tal com veurem, la nostra medicina, almenys des del moment en què es va poder parlar d'una salut pública, ha anat lligada al projecte d'una determinada tecnologia de la població. Entre els segles XVIII i XIX, la medicina va anar desenvolupant una nova política de la salut en la qual les malalties van passar a ser considerades com un problema polític i econòmic que afectava les col.lectivitats i que demanava solucions globals. El que va aparèixer en el segle XVIII no es pot resumir només en el fet que l'estat va començar a intervenir d'una forma constant en la pràctica mèdica, sinó que el que va passar va ser que la salut i la malaltia, vistes com a problemes que exigien algun tipus de gestió col.lectiva, van ser considerades des de múltiples llocs del cos social. És a dir, la política de la salut que s'inaugura en el llindar de l'època contemporània, més que una iniciativa vertical, va prendre la forma d'un problema amb orígens i direccions múltiples. Pretenem mostrar aquesta política mèdica que es va posar en joc al voltant de l'origen de la nostra Salut Pública, fent sortir a la llum el que podríem anomenar l'«ètica de la bona salut» que es va potenciar i que va servir no solament per elaborar algunes indicacions per prevenir o curar les malalties, sinó que també fabricà prescripcions que feien referència a la forma de vida en general (des de l'alimentació i la vestimenta fins a la procreació, la sexualitat, el comportament, les relacions familiars, etc.). És a dir, es tractaria de veure com a l'interior del discurs i de les pràctiques de la nostra Salut Pública, s'ha anat contruint un cert espai de la normalitat, en el qual ha estat possible associar Salut i Raó, Malaltia i Desraó.

The contribution of building research to the independence and quality of life of older people

Many nations are experiencing rapid rises in the life expectancy of their citizens. The implications of this major demographic shift are considerable offering opportunities as well as challenges to reconsider how people should spend their later years. A key task is enhancing the quality of life of older people through enabling them to continue to live independently even though illness, accident or frailty may have severely reduced their physical and sensory abilities and, possibly, mental health. Yet the needs of older people and disabled people have been largely ignored in the design of everyday consumer products, the home, transport systems and the built environment in general. Whilst the need for designers, engineers and technologists to provide products, environments and systems which are inclusive of all members of society is widely accepted, there is little understanding of how this can be achieved. In 1998 the UK Engineering and Physical Sciences Research Council established its EQUAL Initiative. This has encouraged design, engineering and technology researchers in universities to join with their colleagues from the social, medical and health sciences to investigate a wide range of issues experienced by older and disabled people and to propose solutions. Their research, which directly involves older and disabled people and, for example, social housing providers, social services departments, charities, engineering and architectural consultants, and transport firms, has been extremely successful. In a very short time it has influenced government policy on housing, long-term care, and building standards, and findings have been taken up by architects, designers, health-care professionals and bodies which represent older and disabled people.

Advertising, promotion, and the rise of a national building society movement in interwar Britain

This article examines the role of advertisement and promotion in the successful development of nationwide building societies in interwar Britain and the rapid overall growth of the building society movement. Major building societies are shown to have used extensive advertising to compensate for their initial lack of established national brands, promote home-ownership, and make savers aware of the attractive earnings and high security of building society savings. During a period when most building societies had very limited branch networks, extensive advertising increased the public profile of the major societies and thus assisted their rapid expansion via lower-cost modes such as agency networks.

Framing evidence: policy design for the zero carbon home

In 2006 the UK government announced a move to zero carbon homes by 2016. The demand posed a major challenge to policy makers and construction professionals entailing a protracted process of policy design. The task of giving content to this target is used to explore the role of evidence in the policy process. Whereas much literature on policy and evidence treats evidence as an external input, independent of politics, this paper explores the ongoing mutual constitution of both. Drawing on theories of policy framing and the sociology of classification, the account follows the story of a policy for Zero Carbon Homes from the parameters and values used to specify the target. Particular attention is given to the role of Regulatory Impact Assessments (RIAs) and to the creation of a new policy venue, the Zero Carbon Hub. The analysis underlines the way in which the choices about how to model and measure the aims potentially transforms them, the importance of policy venues for transparency and the role of RIAs in the authorization of particular definitions. A more transparent, open approach to policy formulation is needed in which the framing of evidence is recognized as an integral part of the policy process.

Economic experiments used for the evaluation of building users’ energy-saving behavior

Different treatments that could be implemented in the home environ-ment are evaluated with the objective of reaching a more rational and efficient use of energy. We consider that a detailed knowledge of energy-consuming behaviour is paramount for the development and implementation of new technologies, services and even policies that could result in more rational energy use. The proposed evaluation methodology is based on the development of economic experiments implemented in an experimental economics laboratory, where the behaviour of individuals when making decisions related to energy use in the domestic environment can be tested.

Tha contribution of home-based technology to older people's quality of life in extra care housing

Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).  Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.  Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].  Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.