Evaluation of a digital consultation and self-care advice tool in primary care: a multi-methods study

Digital services are often regarded as a solution to the growing demands on primary care services. Provision of a tool offering advice to support self-management as well as the ability to digitally consult with a General Practitioner (GP) has the potential to alleviate some of the pressure on primary care. This paper reports on a Phase II, 6-month evaluation of eConsult, a web-based triage and consultation system that was piloted across 11 GP practices across Scotland. Through a multi-method approach the evaluation explored eConsult use across practices, exposing both barriers and facilitators to its adoption. Findings suggest that expectations that eConsult would offer an additional and alternative method of accessing GP services were largely met. However, there is less certainty that it has fulfilled expectations of promoting self-help. In addition, low uptake meant that evaluation of current effectiveness was difficult for practices to quantify. The presence of an eConsult champion(s) within the practice was seen to be a significant factor in ensuring successful integration of the tool. A lack of patient and staff engagement, insufficient support and lack of protocols around processes were seen as barriers to its success

The influence of the food environment on overweight and obesity in young children : a systematic review

The increasing prevalence of childhood obesity has led to interest in its prevention, particularly through school-based and family-based interventions in the early years. Most evidence reviews, to date, have focused on individual behaviour change rather than the ‘obesogenic environment’. This paper reviews the evidence on the influence of the food environment on overweight and obesity in children up to 8 years. Electronic databases (including MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), DARE, CINAHL and Psycho-Info) and reference lists of original studies and reviews were searched for all papers published up to 31 August 2011. Study designs included were either population-based intervention studies or a longitudinal study. Studies were included if the majority of the children studied were under 9 years, if they related to diet and if they focused on prevention rather than treatment in clinical settings. Data included in the tables were characteristics of participants, aim, and key outcome results. Quality assessment of the selected studies was carried out to identify potential bias and an evidence ranking exercise carried out to prioritise areas for future public health interventions. Thirty-five studies (twenty-five intervention studies and ten longitudinal studies) were selected for the review. There was moderately strong evidence to support interventions on food promotion, large portion sizes and sugar-sweetened soft drinks. Reducing food promotion to young children, increasing the availability of smaller portions and providing alternatives to sugar-sweetened soft drinks should be considered in obesity prevention programmes aimed at younger children. These environment-level interventions would support individual and family-level behaviour change

Proactive modulation of long-interval intracortical inhibition during response inhibition

Daily activities often require sudden cancellation of preplanned movement, termed response inhibition. When only a subcomponent of a whole response must be suppressed (required here on Partial trials), the ensuing component is markedly delayed. The neural mechanisms underlying partial response inhibition remain unclear. We hypothesized that Partial trials would be associated with nonselective corticomotor suppression and that GABA(B) receptor-mediated inhibition within primary motor cortex might be responsible for the nonselective corticomotor suppression contributing to Partial trial response delays. Sixteen right-handed participants performed a bimanual anticipatory response inhibition task while single- and paired-pulse transcranial magnetic stimulation was delivered to elicit motor evoked potentials in the left first dorsal interosseous muscle. Lift times, amplitude of motor evoked potentials, and long-interval intracortical inhibition were examined across the different trial types (Go, Stop-Left, Stop-Right, Stop-Both). Go trials produced a tight distribution of lift times around the target, whereas those during Partial trials (Stop-Left and Stop-Right) were substantially delayed. The modulation of motor evoked potential amplitude during Stop-Right trials reflected anticipation, suppression, and subsequent reinitiation of movement. Importantly, suppression was present across all Stop trial types, indicative of a “default” nonselective inhibitory process. Compared with blocks containing only Go trials, inhibition increased when Stop trials were introduced but did not differ between trial types. The amount of inhibition was positively correlated with lift times during Stop-Right trials. Tonic levels of inhibition appear to be proactively modulated by task context and influence the speed at which unimanual responses occur after a nonselective “brake” is applied

\u3ci\u3eLa pareja de la luna\u3c/i\u3e: The moon couple

Written by Natalie Rorick, Alana Schaffer, John Cowie, Cody May Translated by Mirela Butnar

Local pathways to low-carbon domestic heat : exploring the options in the UK

Currently, natural gas is the predominant source of domestic heat provision. Take-up of heat pumps and district heating remains at a minimal penetration of around 0.5%. In total, only around 2.5% of heat comes from low carbon sources, compared with more than 45% of electricity. As heat accounts for around 40% of UK energy consumption and 20% of GHG emissions, the decarbonisation of the heat sector is seen as vital for the UK to reach UK emission reduction targets. Different trajectories in heat provision using parallel energy vectors (electricity, gas, alternative gases, heat networks) imply a range of infrastructure impacts. In order to explore the form of different local energy systems under decarbonisation scenarios, this work seeks to: - Capture the broad forms of ’last-mile’ network: Urban, Suburban, Rural (on/off gas grid ) seen as exemplar of the UK energy system; - Downscale whole system-derived technology mixes and construct demonstrative local energy systems representing key use cases; - Using multi-carrier optimisation, determine the impacts of heat decarbonisation on current and future system actors

Simulation and implementation of heat load shifting in a low carbon building

A predictive load shifting control system for a heat pump has been developed and installed in a low carbon test house located at the BRE Innovation Park, Motherwell, near Glasgow. The house features an exhaust-air source heat pump supplying an under floor heating system. The controller predicted the day-ahead space heating requirements for the house, based on forecast air temperatures and solar radiation levels and then automatically set the heat pump’s start and stop times for the following day. The heat pump’s operation was restricted where possible to off-peak electricity tariff periods (00:00-07:00). The controller’s operating parameters were pre-set using a calibrated building simulation model. After installation, the controller’s performance was monitored during September 2015 and analysis of test data showed that the predictive control maintained indoor air temperatures between 18-23oC for around 87% of notional occupied hours between 07:00-22:00; this was better than predicted by simulation. However, the energy performance of the heat pump was extremely poor as it did not function well under intermittent load-shifting operation, with the majority of the heat was delivered primarily by an auxiliary immersion coil rather than the heat pump itself. The paper concludes with suggestions for refinements to the controller and further work