Experiences of telehealth in general practice in Australia: research protocol for a mixed-methods study

Background: Owing to the COVID-19 pandemic, the use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood. Aim: This study will explore interactional practices of GPs and patients in telehealth consultations to develop evidence-based resources to improve communication. Design & setting: The study will be conducted within the Australian general practice setting. Method: Conversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews, and collaborative workshops with telehealth users including both GPs and patients. Conclusion: Effective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. Evidence-based guidelines encompassing effective telehealth communication strategies will be co-developed with end-users in this study

Production of biocompatible gold nanoparticles for drug delivery using droplet based glass capillary microfluidic [Abstract]

Production of biocompatible gold nanoparticles for drug delivery using droplet based glass capillary microfluidic [Abstract

Ensembles of ecosystem service models can improve accuracy and indicate uncertainty

Many ecosystem services (ES) models exist to support sustainable development decisions. However, most ES studies use only a single modelling framework and, because of a lack of validation data, rarely assess model accuracy for the study area. In line with other research themes which have high model uncertainty, such as climate change, ensembles of ES models may better serve decision-makers by providing more robust and accurate estimates, as well as provide indications of uncertainty when validation data are not available. To illustrate the benefits of an ensemble approach, we highlight the variation between alternative models, demonstrating that there are large geographic regions where decisions based on individual models are not robust. We test if ensembles are more accurate by comparing the ensemble accuracy of multiple models for six ES against validation data across sub-Saharan Africa with the accuracy of individual models. We find that ensembles are better predictors of ES, being 5.0 6.1% more accurate than individual models. We also find that the uncertainty (i.e. variation among constituent models) of the model ensemble is negatively correlated with accuracy and so can be used as a proxy for accuracy when validation is not possible (e.g. in data-deficient areas or when developing scenarios). Since ensembles are more robust, accurate and convey uncertainty, we recommend that ensemble modelling should be more widely implemented within ES science to better support policy choices and implementation. © 2020 The Author

Include me in: user involvement in research and evaluation

yesPurpose: This paper discusses the experiences of a group of ten user and carer researchers from mental health and learning disability services who worked together in a research and evaluation project between 2009 and 2012. The research project aimed to identify changes that took place as over 300 people moved from hostel accommodation into independent tenancies in flats and bungalows. These moves were part of a three year project involving a partnership between a local authority and a housing association. Design / approach: The paper describes the process of involving user and carers in the research process, identifying the challenges and benefits of involving users and carers. The ways in which people were trained and supported to take part and stay involved are outlined, as well as how the group felt they learnt new skills and increased their confidence. Findings: User involvement in research can mean different things with different levels of involvement, from consultation through to user-controlled research. The collaborative study had a range of benefits for the lives of the co-researchers, as well as contributing to the development of a new independent living service. A number of factors contribute to the success of user involvement in research and these are listed. Originality / value: This paper adds the voices of the co-researchers to the literature and provides ‘lessons learned’ for other researchers in this area

Advantages of block copolymer synthesis by RAFT-controlled dispersion polymerization in supercritical carbon dioxide

Reversible addition-fragmentation chain transfer (RAFT)-controlled block copolymer synthesis using dispersion polymerization in supercritical carbon dioxide (scCO2) shows unprecedented control over blocking efficiency. For PMMA-b-PBzMA and PMMA-b-PSt the blocking efficiency was quantified by measuring homopolymer contaminants using the techniques of GPC deconvolution, gradient polymer elution chromatography (GPEC), and GPC dual RI/UV detection. A new, promising method was also developed which combined GPC deconvolution and GPEC. All techniques showed that blocking efficiency was significantly improved by reducing the radical concentration and target molecular weight. Estimated values agreed well with (and occasionally exceeded) theory for PMMA-b-PBzMA. The heterogeneous process in scCO2 appeared to cause little or no further hindrance to the block copolymerization procedure when reaction conditions were optimized. High blocking efficiencies were achieved (up to 82%) even at high conversion of MMA (>95%) and high molecular weight. These data compare favorably to numerous published reports of heterogeneous syntheses of block copolymers

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Abstract Background Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting. Methods The study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website. Results Participants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management. Conclusions Overall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved

Model Ensembles of Ecosystem Services Fill Global Certainty and Capacity Gaps

Sustaining ecosystem services (ES) critical to human wellbeing is hindered by many practitioners lacking access to ES models (‘the capacity gap’) or knowledge of the accuracy of available models (‘the certainty gap’), especially in the world’s poorer regions. We developed ensembles of multiple models at an unprecedented global scale for five ES of high policy relevance. Ensembles were 2-14% more accurate than individual models. Ensemble accuracy was not correlated with proxies for research capacity – indicating accuracy is distributed equitably across the globe and that countries less able to research ES suffer no accuracy penalty. By making these ES ensembles and associated accuracy estimates freely available, we provide globally consistent ES information that can support policy and decision making in regions with low data availability or low capacity for implementing complex ES models. Thus, we hope to reduce the capacity and certainty gaps impeding local to global-scale movement towards ES sustainability

Crosslinker Copolymerization for Property Control in Inverse Vulcanization.

Sulfur is an underused by-product of the petrochemicals industry. Recent research into inverse vulcanization has shown how this excess sulfur can be transformed into functional polymers, by stabilization with organic crosslinkers. For these interesting new materials to realize their potential for applications, more understanding and control of their physical properties is needed. Here we report four new terpolymers prepared from sulfur and two distinct alkene monomers that can be predictively tuned in glass transition, molecular weight, solubility, mechanical properties, and color

Evidence of Similarities in Ecosystem Service Flow across the Rural-Urban Spectrum

In 2006, the world’s population passed the threshold of being equally split between rural and urban areas. Since this point, urbanisation has continued, and the majority of the global population are now urban inhabitants. With this ongoing change, it is likely that the way people receive benefits from nature (ecosystem services; ES) has also evolved. Environmental theory suggests that rural residents depend directly on their local environment (conceptualised as green-loop systems), whereas urban residents have relatively indirect relationships with distant ecosystems (conceptualised as red-loop systems). Here, we evaluate this theory using survey data from >3000 households in and around Hyderabad, India. Controlling for other confounding socioeconomic variables, we investigate how flows of 10 ES vary across rural, peri-urban and urban areas. For most of the ES we investigated, we found no statistical differences in the levels of direct or indirect use of an ecosystem, the distance to the ecosystem, nor the quantities of ES used between rural and urban residents (p > 0.05). However, our results do show that urban people themselves often travel shorter distances than rural people to access most ES, likely because improved infrastructure in urban areas allows for the transport of ES from wider ecosystems to the locality of the beneficiaries’ place of residence. Thus, while we find some evidence to support red-loop–green-loop theory, we conclude that ES flows across the rural-urban spectrum may show more similarities than might be expected. As such, the impact of future urbanisation on ES flows may be limited, because many flows in both rural and urban areas have already undergone globalisation

Land cover change and carbon emissions over 100 years in an African biodiversity hotspot

Agricultural expansion has resulted in both land use and land cover change (LULCC) across the tropics. However, the spatial and temporal patterns of such change and their resulting impacts are poorly understood, particularly for the pre-satellite era. Here we quantify the LULCC history across the 33.9 million ha watershed of Tanzania's Eastern Arc Mountains, using geo-referenced and digitised historical land cover maps (dated 1908, 1923, 1949 and 2000). Our time series from this biodiversity hotspot shows that forest and savanna area both declined, by 74% (2.8 million ha) and 10% (2.9 million ha), respectively, between 1908 and 2000. This vegetation was replaced by a five-fold increase in cropland, from 1.2 million ha to 6.7 million ha. This LULCC implies a committed release of 0.9 Pg C (95% CI: 0.4-1.5) across the watershed for the same period, equivalent to 0.3 Mg C ha(-1) yr(-1) . This is at least three-fold higher than previous estimates from global models for the same study area. We then used the LULCC data from before and after protected area creation, as well as from areas where no protection was established, to analyse the effectiveness of legal protection on land cover change despite the underlying spatial variation in protected areas. We found that, between 1949 and 2000, forest expanded within legally protected areas, resulting in carbon uptake of 4.8 (3.8-5.7) Mg C ha(-1) , compared to a committed loss of 11.9 (7.2-16.6) Mg C ha(-1) within areas lacking such protection. Furthermore, for nine protected areas where LULCC data is available prior to and following establishment, we show that protection reduces deforestation rates by 150% relative to unprotected portions of the watershed. Our results highlight that considerable LULCC occurred prior to the satellite era, thus other data sources are required to better understand long-term land cover trends in the tropics. This article is protected by copyright. All rights reserved