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Prioritising critical attributes for the management of materials procurement and construction waste
Get PDFConstruction and demolition waste constitutes the largest municipal solid waste (MSW) globally with environmental concerns. However, waste management is not considered a priority objective in construction compared to time and cost. Therefore, construction practitioners' waste management priority is evaluated in this study. A review of the literature revealed waste management attributes from multiple perspectives. A questionnaire survey was adopted to solicit practitioners' contributions on their importance. Then, the attributes were prioritised and categorised into high, medium and low priorities using the Voting Analytical Hierarchy Process (VAHP). Empirical results indicate that the high priority materials procurement attributes were alliance with suppliers, a take-back clause in suppliers' agreement document, accurate material quantification, accurate material ordering, and just-in-time delivery (JIT) plan. Senior managers' early commitment to waste minimisation, effective communication among project participants, making subcontractors responsible for their waste, identifying recyclable materials and identifying reusable materials were high-priority attributes for managing waste in the construction stage. The findings of this study indicate areas where contractors should focus effort to improve waste management in the industry by collaborating with subcontractors and suppliers. Future studies should focus on developing frameworks that provide actionable means for implementing waste management attributes identified in this research
Understanding paramedic work in general practice in the UK: A rapid realist synthesis
Get PDFBackground: General practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about ‘models of paramedic working in general practice’ in different UK contexts to understand their impact. Methods: The rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work.Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories. Results: Empirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models. Conclusions: Variability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various ‘models of paramedic working’ in different contexts
A qualitative exploration of postoperative bariatric patients’ psychosocial support for long-term weight loss and psychological wellbeing
Get PDFBackground: There is a paucity of research exploring postoperative psychosocial interventions for bariatric surgery patients exceeding 2 years, and therefore, an interdisciplinary postoperative approach is warranted. This qualitative study explored the psychosocial support that bariatric surgery patients feel they need to sustain long-term weight loss and their psychological wellbeing. Methods: Fifteen postoperative patients participated in recorded semi-structured online interviews that were transcribed verbatim and analysed using a reflexive thematic analysis approach. Results: Three themes and six subthemes emerged. Theme 1, Journey to surgery, has two subthemes: Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes: Continuity of care and Can’t cut the problem out. Theme 3, Bridging the Gap, has two subthemes: Doing it together and Taking back the reigns. The inconsistencies participants experienced in their pre- and postoperative care led to dissonance, and they felt unprepared for the demands of life postoperatively. Conclusions: Bariatric surgery is a catalyst for physical change, but surgery alone is insufficient to ensure sustained change. Surgical and psychosocial interventions are interdependent rather than mutually exclusive. Patients favour an integrative, personalised, stepped-care approach pre- and postoperatively, with active participation fostering autonomy and access to ongoing support extending into the long-term
Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG)
Get PDFBackground: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. Purpose: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term ‘thematic analysis’ and the default ‘relevance’ setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. Key learning points: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing – thoughtful, deliberative, reflexive and theoretically aware – practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods
Qualitative interview study of rheumatology patients’ experiences of COVID-19 shielding to explore the physical and psychological impact and identify associated support needs
Get PDFObjective: Many clinically extremely vulnerable rheumatology patients have only recently ceased shielding from COVID-19, while some continue to minimise in-person contact. The objective of this study was to understand the impact of shielding and associated support needs in patients with rheumatic conditions and to understand how rheumatology teams can meet these needs both currently and in future pandemics. Design, participants and setting: The study was conducted in the Southwest of England using a case-study design. The participants were 15 patients with rheumatic conditions who were advised to shield and/or chose to shield at any time during the COVID-19 pandemic. Methods: Qualitative data collected via telephone and online semi-structured interviews and analysed using reflexive thematic analysis. Results: Fifteen interviews were conducted. Three main themes represent the data: ‘Just shove them over there in the corner’ captures changes in patients’ self-perception. They felt different to most other people, vulnerable and left behind. The initial sense of shock was followed by a sense of loss as changes became long term. ‘A long and lonely road’ captures patients’ psychological isolation due to a perceived lack of understanding and support. This included having to prove their health status and justify their shielding behaviours, which impacted their relationships. At times, they felt abandoned by their healthcare providers. ‘You can’t just flip a switch’ captures the difficulty of getting back to pre-pandemic normal after shielding. Patients did not recognise themselves physically and mentally. They wanted to collaborate with health professionals and identified the need for specific guidance to support their recovery. Conclusion: Patients are dealing with lasting physical and mental effects from shielding and consequences of delayed healthcare. Health professionals need time and resources to ask about patients’ well-being, identify their health needs and refer/signpost to appropriate sources of support
Association of Dryocola boscaweniae, Gibbsiella greigii and Gibbsiella quercinecans with oak decline in Iran
No full textTree decline is described as the loss in tree vigor and increased mortality initiated by climate change events, and also involves pathogens and pests. Stem bleeding and bark canker of oak (Quercus castaneifolia) were observed in Mazandaran and Golestan forests during summer 2020–2021. Symptoms included cracks in the outer bark, stem tissue necrosis, bleeding, dark exudate and dark brown lesions in the inner bark. Eighty-nine strains with a metallic green sheen pigment were isolated on eosin methylene blue agar. The pathogenicity of all strains recovered in this study was assessed on oak seedlings and acorns. Forty-four strains produced rotting on oak acorns 2 weeks after inoculation. Inoculation of six representative strains on oak seedlings resulted in twig dieback of the plants after 4 weeks. Strains were negative for Gram reaction, oxidase and levan formation from sucrose. The gyrB and infB gene sequence similarity values of strains were 98.87–99.57% with the type strain of Gibbsiella quercinecans, 98.66–98.86% with the type strain of Gibbsiella greigii and 99.46–99.64% with the type strain of Dryocola boscaweniae. In the phylogenetic tree based on concatenated sequences of gyrB and infB genes or each gene individually, the strains were divided into three clusters containing the type strains of G. quercinecans, G. greigii and D. boscaweniae, each with high bootstrap support and confirming their identity as belonging to these three species. To the best of our knowledge, this is the first report of oak bacterial canker caused by D. boscaweniae, G. greigii and G. quercinecans in Iran and the first report of D. boscaweniae associated with oak decline symptoms
An automated machine learning approach for classifying infrastructure cost data
Get PDFData on infrastructure project costs are often unstructured and lack consistency. To enable costs to be compared within and between organizations, large amounts of data must be classified to a common standard, typically a manual process. This is time-consuming, error-prone, inconsistent, and subjective, as it is based on human judgment. This paper describes a novel approach for automating the process by harnessing natural language processing identifying the relevant keywords in the text descriptions and implementing machine learning classifiers to emulate the expert's knowledge. The task was to identify “extra over” cost items, conversion factors, and to recognize the correct work breakdown structure (WBS) category. The results show that 94% of the “extra over” cases were correctly classified, and 90% of cases that needed conversion, correctly predicting an associated conversion factor with 87% accuracy. Finally, the WBS categories were identified with 72% accuracy. The approach has the potential to provide a step change in the speed and accuracy of structuring and classifying infrastructure cost data for benchmarking
The incidence of physician-diagnosed food allergy declines with age: A specialist UK centre experience
Get PDFThe incidence of physician-diagnosed food allergy declined with age in a cohort of UK adults.Men were more likely to be diagnosed with food allergy than women.The incidence of shellfish, wheat & cereals and vegetable & herb allergies increased with age
Resistance to bacteriophage incurs a cost to virulence in drug-resistant Acinetobacter baumannii
Get PDFIntroduction . Acinetobacter baumannii is a critical priority pathogen for novel antimicrobials (World Health Organization) because of the rise in nosocomial infections and its ability to evolve resistance to last resort antibiotics. A. baumannii is thus a priority target for phage therapeutics. Two strains of a novel, virulent bacteriophage (LemonAid and Tonic) able to infect carbapenem-resistant A. baumannii (strain NCTC 13420), were isolated from environmental water samples collected through a citizen science programme. Gap statement. Phage-host coevolution can lead to emergence of host resistance, with a concomitant reduction in the virulence of host bacteria; a potential benefit to phage therapy applications. Methodology. In vitro and in vivo assays, genomics and microscopy techniques were used to characterize the phages; determine mechanisms and impact of phage resistance on host virulence, and the efficacy of the phages against A. baumannii. Results. A. baumannii developed resistance to both viruses, LemonAid and Tonic. Resistance came at a cost to virulence, with the resistant variants causing significantly reduced mortality in a Galleria mellonella larval in vivo model. A replicated 8 bp insertion increased in frequency (~40 % higher frequency than in the wild-type) within phage-resistant A. baumannii mutants, putatively resulting in early truncation of a protein of unknown function. Evidence from comparative genomics and an adsorption assay suggests this protein acts as a novel phage receptor site in A. baumannii. We find no evidence linking resistance to changes in capsule structure, a known virulence factor. LemonAid efficiently suppressed growth of A. baumanni in vitro across a wide range of titres. However, in vivo, while survival of A. baumannii infected larvae significantly increased with both remedial and prophylactic treatment with LemonAid (107 p.f.u. ml–1), the effect was weak and not sufficient to save larvae from morbidity and mortality. Conclusion. While LemonAid and Tonic did not prove effective as a treatment in a Galleria larvae model, there is potential to harness their ability to attenuate virulence in drug-resistant A. baumannii
The effect of 3D printing speed and temperature on transferability of Staphylococcus aureus and Escherichia coli during 3D food printing
Get PDFThe current study aimed to determine if the 3D-printing speed and temperature would impact the transferability of foodborne pathogens from the stainless-steel (SS) food cartridge to the 3D-printed food ink. Staphylococcus aureus and Escherichia coli were inoculated onto the interior surface of the SS food cartridges. Subsequently, a model food ink was extruded with a recommended macronutrient contribution of 55.8, 23.7, and 20.5% of carbohydrates, proteins, and fat, respectively. The impact of 3D-printing temperatures and speeds on transfer rates was analysed using a Two-Way ANOVA. S. aureus was transferred more from the cartridge to the food ink with a population of 3.39, 2.98, and 3.09 log CFU/g compared to 2.03, 2.06, and 2.00 log CFU/g for E. coli at 2000, 3000, and 4000 mm/s printing speed, respectively, at 25 °C. A Kruskal-Wallis Test was employed to investigate the effect of different speeds and temperatures on the transferability of S. aureus and E. coli. Speed was the main factor affecting S. aureus transferability, while temperature (25 and 50 °C) had the greatest impact on E. coli transferability. This research seeks to advance the understanding of 3D-printing parameters in pathogen transferability and help the food industry move towards this technology's quick and safe adoption