Experiences and views of people who frequently call emergency ambulance services: A qualitative study of UK service users

Introduction: People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. Methods: We used a two-stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third sector organisations, we also recruited nine individuals with health care experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore results. Results: People said they make frequent calls to emergency ambulance services as a last resort, when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended by police and arrested for behaviour associated with their health need. Those callers receiving case management did not know they were selected for this. Some respondents were concerned case management could label frequent callers as troublemakers. Conclusion: People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements in order to inform design and delivery of accessible and effective services. Patient or Public contribution: People with relevant experience were involved throughout developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee

Burn contracture risk factors and measurement in low-middle income countries: A clinical perspective

There is a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n=13), Burn injury factors (n=14), Family and community factors (n=9), Treatment factors (n=18), Complications (n=2), Healthcare capacity factors (n=19) and Societal and environmental factors (n=12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians’ diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contracture

‘Cythryblus a thrychinebus’: Gwrthryfel y Pasg, 1916, a’r Wasg Gymreig

Fe esgorodd Gwrthryfel y Pasg yn Nulyn yn 1916 ar gyfres o ddigwyddiadau a arweiniodd at annibyniaeth trwch yr ynys, ond ar y pryd nid oedd gwerthfawrogiad o’i arwyddocâd yng Nghymru. I fwyafrif helaeth y Cymry, roedd hwn yn weithred fradwrol gan ei fod yn digwydd ar adeg pan oedd Iwerddon (fel gweddill y Deyrnas Gyfunol) yng nghanol rhyfel gwaedlyd na welwyd ei fath o’r blaen. Mae’r erthygl hon yn olrhain sut edrychwyd ar ddigwyddiadau yn Iwerddon yng nghyd-destun y rhyfel yn erbyn yr Almaen, a sut oedd y cysyniad ei fod yn fuddiol i Iwerddon (fel Cymru) i aros yng nghôl yr Ymerodraeth Brydeinig wedi ei wreiddio mor ddwfn fel nad oedd modd ei herio

Short communication: Complete dissolution of MX-phase nanoprecipitates in fusion steels during irradiation by heavy-ions

This material in this paper was a result of a £50K EUROFERAP Castable Nano-structured Radiation Resistant Steel funded by UKAEA and completed in March 2022. This project used rapid alloy prototyping of new reduced Activation Ferritic/Martensitic steels and compared them to the industry ITER standard steel Eurofer-97.  The project was jointly funded by Swansea and UKAEA and delivered on time with promising results, proving the MACH1 rapid alloying techniques developed over the last 5-6 years within the Prosperity project (EP/S005218/1) could also be applied to steel for nuclear applications

Treatment of Emerging Contaminants in Wastewater by Advanced Oxidation Processes

This study evaluated the effectiveness of ozonation and activated carbon for the degradation and removal of three main emerging contaminants (ECs) in wastewater; fluoranthene (FLT), di (2- ethyl hexyl) phthalate (DEHP) and cypermethrin (CYM). The effects of key semi-batch ozonation parameters related to gas-liquid mass transfer and reaction kinetics were identified for all contaminants. The degradation rates were evaluated in solutions of DI water, using concentration change of ozone and EC versus time. With an ozone gas concentration of 20 g/m3 NTP, the change in concentration from an initial concentration of 0.05 mg/L over time was measured using HPLC. To decrease by 75 %, it took less than a minute for FLT, two minutes for DEHP and six minutes for CYM. The adsorption of the emerging contaminants with granulated activated carbon (GAC) were evaluated in solutions of DI water at an initial concentration of 1 mg/L. For the decrease in concentration of 60 %, the time for each contaminant varied. For FLT this was achieved in 5 minutes, DEHP was decreased within 20 minutes, and it took CYM 20 minutes to reach this decrease. The effects of ozonation and adsorption onto GAC were also investigated in samples of final wastewater effluent

An Empirical Study on Public Sector versus Third Sector Circular Economy-Oriented Innovations

Extensive research has explored organisational dynamics across various sectors in relation to circular economy (CE) innovation practices. However, a critical gap exists in understanding CE innovation activities in the public sector versus the third sector. This distinction is crucial as the third sector’s role in CE innovation is growing, necessitating tailored policies instead of homogenous integration into public sector-based approaches. We address this gap by focusing on nuanced comparisons between the public and third sectors, delving into the motivations and constraints surrounding CE innovations across these different sectors. Employing an exploratory sequential design, we integrate qualitative insights from 12 interviews with quantitative measures derived from 153 survey responses within CE innovation communities. The findings reveal subtle yet significant disparities in innovation activities between the public and third sectors within a CE innovation community. Notably, cost factor differences related to the availability of finance and knowledge factors associated with the lack of information on technology emerge. This research contributes evidence-based insights, offering practitioners and policymakers a nuanced understanding of the motivations and constraints of circular economy innovation. These findings can be instrumental in steering the transition towards a more sustainable and circular economy, emphasising the need for tailored strategies rather than a one-size-fits-all approach

Caffeine ingestion compromises thermoregulation and does not improve cycling time to exhaustion in the heat amongst males

Purpose Caffeine is a commonly used ergogenic aid for endurance events; however, its efficacy and safety have been questioned in hot environmental conditions. The aim of this study was to investigate the effects of acute caffeine supplementation on cycling time to exhaustion and thermoregulation in the heat. MethodsIn a double-blind, randomised, cross-over trial, 12 healthy caffeine-habituated and unacclimatised males cycled to exhaustion in the heat (35 °C, 40% RH) at an intensity associated with the thermoneutral gas exchange threshold, on two separate occasions, 60 min after ingesting caffeine (5 mg/kg) or placebo (5 mg/kg). ResultsThere was no effect of caffeine supplementation on cycling time to exhaustion (caffeine; 28.5 ± 8.3 min vs. placebo; 29.9 ± 8.8 min, P = 0.251). Caffeine increased pulmonary oxygen uptake by 7.4% (P = 0.003), heat production by 7.9% (P = 0.004), whole-body sweat rate by 21% (P = 0.008), evaporative heat transfer by 16.5% (P = 0.006) and decreased estimated skin blood flow by 14.1% (P 0.05). ConclusionThe greater heat production and storage, as indicated by a sustained increase in core temperature, corroborate previous research showing a thermogenic effect of caffeine ingestion. When exercising at the pre-determined gas exchange threshold in the heat, 5 mg/kg of caffeine did not provide a performance benefit and increased the thermal strain of participants

Antecedents of memorable heritage tourism experiences: an application of stimuli–organism–response theory

Purpose: Based on stimulus-organism-response theory, this study develops and tests a model of memorable heritage tourism experiences. The model proposes that experiencescape, experience co-creation, education and photography are important antecedents of memorable heritage tourism experiences, which is then a driver of place attachment.Design/methodology/approach: Data for this study were collected using a web-based questionnaire of people aged 18 years and over who had a heritage tourism experience during the previous three months (February–April 2023). The survey was distributed in May 2023 using Amazon Mechanical Turk. A survey link was posted on MTurk, which remained active for the first week of May 2023. Out of the 283 responses received, 272 were valid responses from individuals who met the participation criteria.Findings: Experiencescape, experience co-creation, education and photography were found to be positive drivers of the memorable heritage tourism experience, with a positive relationship between memorable heritage tourism experience and place attachment. Originality: Many studies linked to memorable tourism experience mainly replicate Kim et al.’s (2012) memorable tourism experience scale, regardless of the specific study context. This study offers an alternative framework through which alternative antecedents and outcomes of tourists’ memorable tourism experiences can be identified