Managing Achilles Pain (the MAP study) – A process evaluation of data collection methods

Background Process evaluations explore the way in which a study was conducted. The Managing Achilles Pain study (MAP study) had the primary aim of assessing the feasibility of the protocol for a future large longitudinal cohort study that would investigate the association and predictive relationship of self-efficacy, working alliance and expectations with outcome in the management of Achilles tendinopathy. Objectives This study aimed to evaluate the processes conducted in the MAP study by exploring the acceptability of the study procedures from the participants' and physiotherapists' perspectives. Design A qualitative evaluation using semi-structured telephone interviews. Method All physiotherapists and participants who participated in the MAP study were invited. Data from physiotherapists (n = 6) and participants (n = 7) were transcribed and analysed using the Framework Approach. Findings From the physiotherapists' perspective 4 themes were identified relating to obstacles; (1) access to participants; (2) recall; (3) visibility; (4) time, and 4 themes were identified relating to facilitating success; (1) training; (2) motivation; (3) incentives; (4) simplicity. From the participants' perspective 2 themes were identified relating to obstacles; (1) information from the physiotherapist; (2) follow up, 3 themes were identified relating to facilitating success; (1) motivation; (2) website; (3) questionnaire, and 1 theme relating to unintended consequences of participating in the study; positive experience. Conclusions Although clinicians are enthused to be involved in research, organisational factors impact levels of engagement. Key influences to optimising the potential success of a study include the publicising of the study; optimising verbal recruitment strategies; and clarity in communication

Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus

<p>Abstract</p> <p>Background</p> <p>Individual health education is considered to be essential in the overall care of patients with type 2 diabetes (DM2), although there is some uncertainty regarding its metabolic control benefits. There have been very few randomized studies on the effects of individual education on normal care in DM2 patients with a control group, and none of these have assessed the long-term results. Therefore, this study aims to use this design to assess the effectiveness of the PRECEDE (Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation) education model in the metabolic control and the reduction of cardiovascular risk factors, in patients with type 2 diabetes.</p> <p>Methods</p> <p>An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area (Spain). Six hundred patients with DM2 were randomized in two groups: PRECEDE or conventional model for health promotion education. The main outcome measures were glycated hemoglobin A1c, body mass index (BMI), blood pressure, lipids and control criteria during the 2-year follow-up period.</p> <p>Results</p> <p>Glycated hemoglobin A1c and systolic blood pressure (SBP) levels decreased significantly in the PRECEDE group (multivariate analysis of covariance, with baseline glycated hemoglobin A1c, SBP, and variables showing statistically significant differences between groups at baseline visits). The decrease levels in diastolic blood pressure (DBP), triglycerides and LDL cholesterol were nonsignificant. PRECEDE increased compliance in all control criteria, except for LDL cholesterol. BMI did not change during the study in either of the two models analyzed.</p> <p>Conclusions</p> <p>PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes, which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria, except for LDL cholesterol.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01316367">NCT01316367</a></p

Biomass combustion with in situ CO2 capture by CaO in a 300 kWth circulating fluidized bed facility

This paper reports experimental results from a new 300 kWth calcium looping pilot plant designed to capture CO2 “in situ” during the combustion of biomass in a fluidized bed. This novel concept relies on the high reactivity of biomass as a fuel, which allows for effective combustion around 700 °C in air at atmospheric pressure. In these conditions, CaO particles fed into the fluidized bed combustor react with the CO2 generated during biomass combustion, allowing for an effective CO2 capture. A subsequent step of regeneration of CaCO3 in an oxy-fired calciner is also needed to release a concentrated stream of CO2. This regeneration step is assumed to be integrated in a large scale oxyfired power plant and/or a larger scale post-combustion calcium looping system. The combustor-carbonator is the key reactor in this novel concept, and this work presents experimental results from a 300 kWth pilot to test such a reactor. The pilot involves two 12 m height interconnected circulating fluidized bed reactors. Several series of experiments to investigate the combustor-carbonator reactor have been carried out achieving combustion efficiencies close to 100% and CO2 capture efficiencies between 70 and 95% in dynamic and stationary state conditions, using wood pellets as a fuel. Different superficial gas velocities, excess air ratios above stoichiometric requirements, and solid circulating rates between combustor-carbonator and combustor-calciner have been tested during the experiments. Closure of the carbon and oxygen balances during the combustion and carbonation trials has been successful. A simple reactor model for combustion and CO2 capture in the combustor-carbonator has been applied to aid in the interpretation of results, which should facilitate the future scaling up of this process concept.This work was partially funded under the MENOS CO2 project (CDTI, Spanish Ministry of Economy and Competitivity). M.E. Diego acknowledges the award of a fellowship Grant under the CSIC JAE Programme, co-funded by the European Social Fund.Peer reviewe