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Patient perspectives of general practice consultation for musculoskeletal disorders: A qualitative study
Get PDFBackground: Musculoskeletal disorders (MSKDs) are a significant reason for general practice consultations in the United Kingdom. Current models of care include consultation with a General Practitioner (GP) or a First Contact Physiotherapy Practitioner (FCPP). Evidence suggests that FCPP led care is safe, yet it is unknown whether patients share this belief. Purpose: To explore patients' perspectives of general practice consultation for MSKDs, including views on safety, satisfaction and recommendations for future practice. Methods: A secondary data analysis utilising qualitative data from the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire completed by 426 general practice patients who consulted with a MSKD between December 2019 and October 2022. Responses to the question ‘What changes, if any, would you suggest to your GP surgery to make sure that health care is provided safely?’ were analysed using content analysis. Results: 606 responses across three timepoints were analysed. Two themes and six subthemes were identified; views on safety and satisfaction (inherent trust in the system, provision of face-to-face appointments, prompt access to care, person-centred care) and recommendations for future practice (appointment system: prompt access to face-to-face appointments, delivery of care: co-ordinated and collaborative person-centred care). Conclusions: Patients commented that FCPP consultations provided quick and accurate diagnoses and targeted advice. Recommendations for future practice included prompt access to face-to-face appointments, phone calls to be answered more quickly, improved communication for test results and follow ups, patients to feel listened to with a more individualised approach, and better continuity of care
Micromechanical modeling of longitudinal compression behavior and failure mechanism of unidirectional carbon fiber reinforced aluminum composites involving initial fiber misalignment
Get PDFA micromechanical model with realistic initial fiber misalignment (IFM) was developed to simulate the longitudinal compression behavior of unidirectional carbon fiber/aluminum composites. The matrix and fiber were modeled using ductile damage law and brittle fracture model, respectively. The interfacial properties were firstly determined by the single-fiber push-out and transverse tensile tests, and the cohesive zone model was adopted to capture the interfacial behavior. The calculated compressive response curve is in alignment with the experimental data. Compression failure can be attributed to fiber kinking, possibly triggered by the matrix shear damage. The increase of IFM angle makes the failure mode being transformed from fiber crushing to fiber kinking, along with a significant decrease in compressive strength. With the fiber content increasing, the compressive strength increases first and then decreases, while the compressive modulus increases monotonically. Increasing interfacial strength significantly improves the compressive strength, but this is limited by the matrix properties
Electrical signal transfer characteristics of mycelium-bound composites and fungal fruiting bodies
Get PDFMycelium-bound composites are normally made of discrete lignocellulosic substrate elements bound together by filamentous fungal hyphae. They can be formed into bespoke components of desired geometries by moulding or extrusion. Mycelium-bound composites with live fungi have been shown to be electrically conductive with memfractive and capacitive attributes. They can be integrated into electrical circuits with nonlinear electrical properties. Advancing fungal electronics, we studied the AC conductive properties of mycelium-bound composites and fungal fruit bodies at higher frequencies across three overlapping bands; 20 Hz to 300 kHz, 10 Hz to 4 MHz and 50 kHz to 3 GHz. Measurements indicate that mycelium-bound composites typically act as low-pass filters with a mean cutoff frequency of ~500 kHz; with ~ 14 dB/decade roll-off, and mean attenuation across the pass band of <1 dB. Fruiting bodies have between one or two orders of magnitude lower mean cutoff frequency (5 kHz-50 kHz depending on species); with 20 dB/decade to 30 dB/decade roll-off, and mean attenuation across the pass band of <3 dB. The mechanism for the frequency-dependent attenuation is uncertain; however, the high water content, which is electrically conductive due to dissolved ionisable solids is probably a key factor. The potential for mycelium-bound composites and fruiting bodies in analog computing is explored
Environmental assessment of cement production with added graphene
Get PDFCement production significantly contributes to climate change, necessitating alternatives to mitigate the environmental impacts of this essential construction material. This study evaluates 18 environmental impacts of producing Ordinary Portland Cement (OPC) and Graphene (Gr) using life cycle assessment (LCA). Additionally, we explore whether mixing OPC and Gr can lower the life cycle environmental impacts of the final product (OPCGr). Our results show that OPC production in the United Kingdom generates 775 kg CO2 eq./t, 57% only from geogenic CO2 emissions. Gr production via electrochemical exfoliation in Australia results in 121,000-143,000 kg CO2 eq./t, primarily due to electricity generation. Using hydro and nuclear power (e.g., in Brazil and France) can sharply reduce these impacts (global warming potential in the range of 11,000-35,000 kg CO2 eq./t). Adding 0.02 wt% of Gr in powder form (Grpowder) from Australia to the OPC and assuming a 16.5% reduction in its usage due to increased strength, results in 674 kg CO2 eq./t OPCGr (a 13% reduction). However, some impact categories like marine eutrophication and freshwater ecotoxicity potentials increase sharply (> 28%). Using Grpowder from Brazil and France further reduces the OPCGr global warming potential and the overall environmental footprint
Natural soundscapes enhance mood recovery amid anthropogenic noise pollution
Get PDFIn urbanised landscapes, the scarcity of green spaces and increased exposure to anthropogenic noise have adverse effects on health and wellbeing. While reduced speed limits have historically been implemented to address traffic safety, their potential impact on residents’ wellbeing, especially in relation to engagement with natural soundscapes, remains understudied. Our study investigates the influence of i) natural soundscapes, including bird song, and ii) the addition of traffic noise to natural soundscapes at two speeds (20 mi/h and 40 mi/h) on mood. We found that natural soundscapes were strongly linked with the lowest levels of anxiety and stress, with an increase in stress levels associated with mixed natural soundscapes with the addition of 20 mi/h traffic noise and the highest levels with 40 mi/h traffic noise. Higher levels of hedonic tone, indicative of positive mood, was noted with natural soundscapes, but diminished when combined with 40 mi/h traffic noise. Our results show that anthropogenic soundscapes including traffic sounds can mask the positive impact of natural soundscapes including birdsong on stress and anxiety. However, reducing traffic speeds in cities could be a positive intervention for enhancing access to nature. Technological solutions, such as the widespread adoption of hybrid and electric vehicles, and urban planning strategies like integrating green spaces into transit routes, offer potential opportunities to mitigate the impact of noise pollution and benefit humans in urban environments
Ambient Literature Guidebook
No full textAmbient Literature is a way to describe and codify immersive, narrative-led experiences that respond to the presence of a reader within their fabric. Taking the form of a series of short conversations, this book explains what Ambient Literature is, discusses how it works and what to expect, and explains how the whole project came to be
Globalised climate precarity: Environmental degradation, disasters and the international brick trade
No full textClimate-linked disasters result when natural hazards meet socioeconomic precarity. Recognizing this, scholarship in recent years has emphasized how the precarity that turns climate-linked hazards into disasters is produced within the same global political economy that enables climate change. Nevertheless, despite growing interest in the ways in which the dynamics of global economic history shapes contemporary hazard vulnerability, less attention has been directed toward the dynamism of the contemporary global economy and particularly the ways in which global material flows shape environmental risk. From this standpoint, this article argues, first, the need to account for the economic dynamics of global trade in shaping the factors that intensify disaster risk, and second, the role of multiscalar agency. Exemplifying this issue through a case study of international brick imports from South Asia to the United Kingdom, the article provides a heuristic example of how contemporary globalized flows of goods link local vulnerabilities to economic processes originating thousands of miles away. In an increasingly globalized world, it thus foregrounds a dynamic, global perspective on the genus of climate precarity
Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care: A qualitative study
Get PDFBACKGROUND: The Additional Roles Reimbursement Scheme (ARRS) was set up to recruit 26 000 additional staff into general practice by 2024, with the aim of increasing patient access to appointments. Despite the potential benefits of integrating ARRS practitioners into primary care, their implementation has not always been straightforward. AIM: To explore the challenges and enablers to implementation of the ARRS including its impact on primary and secondary care systems. DESIGN AND SETTING: Qualitative interview study with ARRS healthcare professionals and key professional stakeholders involved in staff education or scheme implementation across three integrated care systems in England. METHOD: Participants (n = 37) were interviewed using semi-structured individual or paired interviews. Interviews were audio-recorded and transcribed. Data were analysed using framework analysis until data saturation occurred. RESULTS: Using framework analysis, 10 categories were identified. Three were categorised as successes: staff valued but their impact unclear; multiple and certain roles maximise impact; and training hub support. Seven were categorised as challenges: scheme inflexibility; creating a sustainable workforce with career progression; managing scope and expectations; navigating supervision and roadmap progression; infrastructure and integration challenges; ARRS roles impact on wider systems; and tensions and perspectives of existing staff. CONCLUSION: Most ARRS staff felt valued, but the scheme broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated. Some PCNs, especially those in areas of high deprivation, found it difficult to meet the population's needs as a result of the scheme's inflexibility, potentially leading to greater health inequalities in primary care. Recommendations are proposed to optimise the effective implementation of the primary care workforce model. Further research is required to explore administrative role solutions, further understand the impact of health inequalities, and investigate the wellbeing of ARRS staff
Development of analytical model for bonding of CFRP rod in concrete subjected to cyclic loads
Get PDFRecent material science advances have resulted in the use of High-Performance Concrete (HPC) and Ultra-High-Performance Concrete (UHPC) in superstructures, which were chosen for their superior strength. However, under cyclic loads, these materials frequently show fatigue. Carbon-Fibre-Reinforced Polymer (CFRP) rods are replacing steel rebars due to their corrosion resistance and excellent strength-to-weight ratio and are thus gaining popularity in both infrastructural and superstructural design. However, due to a lack of understanding of their bond mechanics, modelling the interaction between CFRP rods and these advanced concretes in finite element simulations remains complex, particularly under cyclic loading. The bond behaviour of CFRP rods and both standard Grade 40 concrete and Ultra High-Performance Fibre-Reinforced Concrete (UHPFRC) under cyclic stresses is investigated in this work. A finite element model of connected concrete cube samples was built and analysed under cyclic stress, combining these concretes with CFRP rods. Furthermore, these samples were subjected to dynamic actuation testing to develop a traction-based constitutive model for the CFRP–concrete interface. In finite element models, an interface element devised for this study effectively approximated the binding, matching experimental data. The new analytical interface element improved simulation precision by 19% in displacement and 49% in pull-out force, resulting in a significant improvement in predicting the performance of the CFRP–UHPFRC bond under cyclic loading. The improved performance of the CFRP–UHPFRC bond under cyclic loading is attributed to the optimised interface model that enhances the bond integrity between CFRP rods and concrete