Background‘Treatment burden’, defined as both the workload and impact of treatment regimens on function and well-being, has been associated with poor adherence and unfavourable outcomes. Previous research focused on treatment workload but our understanding of treatment impact is limited. This research aimed to systematically review qualitative research to identify: 1) what are the treatment generated disruptions experienced by patients across all chronic conditions and treatments? 2) what strategies do patients employ to minimise these treatment generated disruptions?Methods and FindingsThe search strategy centred on: treatment burden and qualitative methods. Medline, CINAHL, Embase, and PsychINFO were searched electronically from inception to Dec 2013. No language limitations were set. Teams of two reviewers independently conducted paper screening, data extraction, and data analysis. Data were analysed using framework synthesis informed by Cumulative Complexity Model. Eleven papers reporting data from 294 patients, across a range of conditions, age groups and nationalities were included. Treatment burdens were experienced as a series of disruptions: biographical disruptions involved loss of freedom and independence, restriction of meaningful activities, negative emotions and stigma; relational disruptions included strained family and social relationships and feeling isolated; and, biological disruptions involved physical side-effects. Patients employed “adaptive treatment work” and “rationalised non-adherence” to minimise treatment disruptions. Rationalised non-adherence was sanctioned by health professionals at end of life; at other times it was a “secret-act” which generated feelings of guilt and impacted on family and clinical relationships.ConclusionsTreatments generate negative emotions and physical side effects, strain relationships and affect identity. Patients minimise these disruptions through additional adaptive work and/or by non-adherence. This affects physical outcomes and care relationships. There is a need for clinicians to engage with patients in honest conversations about treatment disruptions and the ‘adhere-ability’ of recommended regimens. Patient-centred practice requires management plans which optimise outcomes and minimise disruptions.

An experimental design methodology has been drawn regarding the model contaminant 2,4-dichlorophenol (2,4-DCP) oxidation using Fenton's reagent. This multivariable and multilevel approach allowed us to investigate the effects between the experimental variables (temperature and iron(II) and hydrogen peroxide concentrations) in the process performance, with the minimum number of experiments. Response factors considered were 2,4-DCP degradation after 5, 10, and 20 min of reaction time, for an initial 2,4-DCP concentration of 100 mg/L. This approach provided statistically significant models, which allowed process optimization. It was found that, within the range studied, the ferrous concentration has a positive effect on the oxidation performance. However, for the peroxide load, and particularly for temperature, an optimal value exists that must be taken into account in order to obtain the best results. Besides, the optimal conditions depend on the response considered, with it being advisable to use less-aggressive conditions if responses are taken at longer reaction times. Finally, the kinetic model proposed was useful for predicting the evolution of the 2,4-DCP concentration within the batch reactor over time. Moreover, this kinetic analysis also allowed us to establish the reaction rate for 2,4-DCP degradation.

In order to achieve the targets underlined in the European Strategy for climate change and energy efficiency, the so called 20-20-20 package, the European Commission launched the Covenant of Mayors to endorse and support the efforts deployed by local authorities in the implementation of sustainable energy plans, and at the same time contribute to greenhouse gases emissions mitigation. This paper explores how the Covenant of Mayors (CoM) has been adopted in Portugal, and which type of measures are being defined and implemented by the municipalities. For that, all Sustainable Energy Action Plan (SEAP) submitted by Portuguese municipalities (124) have been examined, for which a detailed analysis was performed, including the Baseline Emission Inventory (70, i.e., around 50%). The municipalities that submitted SEAP cover 60% of the total population of the country because the main urban centres are a part of the 30% that have signed the CoM. Most common measures are related with changes on behaviour and infrastructure related to energy (such as renewable energies, energy efficiency in buildings, public lighting, etc.), waste and transport (for example optimization of: transport infrastructures, used vehicles and road operations). Public lighting is one of the energy measures present in all submitted SEAP, which plays a key role in energy consumption, reaching values of upwards of 12%, particularly in coastal areas due to higher population density and urban residential areas. Besides all efforts there is still a long way to go in terms of energy consumption reduction at local level.

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