scholarly journals Realist evaluation of the implementation and impact of the NHS carbon reduction strategy in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044259
Author(s):  
Syed Aleem Husain ◽  
Manbinder Sidhu
Keyword(s):  
Management Plan ◽  
Realist Evaluation ◽  
Reduction Strategy ◽  
Carbon Reduction ◽  
Net Zero ◽  
Contractual Relationships ◽  
Multiple Case ◽  
Study Sites ◽  
The Uk ◽  
Organisational Factors

ObjectivesTo evaluate the extent to which organisational factors facilitate or inhibit the implementation of the National Health Service (NHS) carbon reduction strategy within acute hospital settings.SettingA single acute NHS Trust with four satellite sites which serve more than 2 million patients annually in Central England.ParticipantsInterviews with a purposive sample of 10 stakeholders, including those who conceptualised the intervention and those who were responsible for its implementation.InterventionThe NHS is a major carbon emitter and therefore developed the ‘NHS carbon reduction strategy (NHSCRS)’ in 2009. NHS organisations are contractually obliged to develop a local carbon reduction strategy known as a Sustainable Development Management Plan (SDMP) which details carbon reduction measures (CRM), as described in the NHSCRS. However, the organisational context within which the SDMP is implemented is likely to determine the extent of its success. We undertook an adapted realist evaluation cycle to develop refined initial programme theories. Documents were analysed using thematic content analysis. Interview data were analysed using thematic analysis.ResultsCRM were most likely to be implemented if the Trust Board were sufficiently pressured by staff and reputational fears, and the potential impacts of CRM were perceived to align with wider organisational aims. Differences in implementation of CRM across hospital sites were related to logistical factors, accessibility to regional partners and contractual relationships. There were expected carbon, energy and long-term financial savings, with variability in the effectiveness of some CRM post implementation.ConclusionsOrganisational factors, particularly Board leadership and internal implementation pathways, have a significant bearing on whether CRM are implemented or not. However, greater national support and guidance is needed for NHS organisations to effectively reduce their carbon emissions. Further cycles of this evaluation are necessary in multiple case study sites to illuminate the path to a net-zero NHS carbon footprint by 2045.

scholarly journals Our Evolving Understanding of ME/CFS

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 200 ◽  
Author(s):  
Kenneth J. Friedman ◽  
Modra Murovska ◽  
Derek F. H. Pheby ◽  
Paweł Zalewski
Keyword(s):  
Active Phase ◽  
Case Definitions ◽  
Diagnostic Laboratory ◽  
Biochemical Pathways ◽  
Patient Organizations ◽  
Clinical Consequences ◽  
Potential Benefits ◽  
Multiple Case ◽  
Use Of The Internet ◽  
The Uk

The potential benefits of the scientific insights gleaned from years of treating ME/CFS for the emerging symptoms of COVID-19, and in particular Longhaul- or Longhauler-COVID-19 are discussed in this opinion article. Longhaul COVID-19 is the current name being given to the long-term sequelae (symptoms lasting beyond 6 weeks) of SARS-CoV-2 infection. Multiple case definitions for ME/CFS exist, but post-exertional malaise (PEM) is currently emerging as the ‘hallmark’ symptom. The inability to identify a unique trigger of ME/CFS, as well as the inability to identify a specific, diagnostic laboratory test, led many physicians to conclude that the illness was psychosomatic or non-existent. However, recent research in the US and the UK, championed by patient organizations and their use of the internet and social media, suggest underlying pathophysiologies, e.g., oxidative stress and mitochondrial dysfunction. The similarity and overlap of ME/CFS and Longhaul COVID-19 symptoms suggest to us similar pathological processes. We put forward a unifying hypothesis that explains the precipitating events such as viral triggers and other documented exposures: For their overlap in symptoms, ME/CFS and Longhaul COVID-19 should be described as Post Active Phase of Infection Syndromes (PAPIS). We further propose that the underlying biochemical pathways and pathophysiological processes of similar symptoms are similar regardless of the initiating trigger. Exploration of the biochemical pathways and pathophysiological processes should yield effective therapies for these conditions and others that may exhibit these symptoms. ME/CFS patients have suffered far too long. Longhaul COVD-19 patients should not be subject to a similar fate. We caution that failure to meet the now combined challenges of ME/CFS and Longhaul COVID-19 will impose serious socioeconomic as well as clinical consequences for patients, the families of patients, and society as a whole.

scholarly journals Post Occupancy Evaluation of School Refurbishment Projects: Multiple Case Study in the UK

Buildings ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 169
Author(s):  
Hamad Ahmed ◽  
David J. Edwards ◽  
Joseph H. K. Lai ◽  
Chris Roberts ◽  
Caleb Debrah ◽  
...  
Keyword(s):  
Intelligent Systems ◽  
Client Satisfaction ◽  
Current Trend ◽  
Inductive Reasoning ◽  
Primary Data ◽  
Philosophical Approach ◽  
Post Occupancy Evaluation ◽  
Multiple Case ◽  
The Uk ◽  
Building Project

Buildings inevitably deteriorate with time. Schools buildings are no exception and require refurbishment at times. Despite the UK Government announcing the £1 billion funding for rebuilding 50 schools over 10 years starting 2010–2021, it is common practice for builders and designers to, upon completion of a building project, move on to the next development without considering how the completed building performs. This research undertakes a post occupancy evaluation (POE) of three schools in the West Midlands, UK with specific focus on building services, viz., heating, lighting, and air conditioning and ventilation. The research adopted a mixed philosophical approach of interpretivism and post-positivism to conduct inductive reasoning. A questionnaire that collected both quantitative and qualitative primary data was distributed to the end-users of the schools. Data was analysed using the Cronbach’s alpha, one sample t-test and Kruskal–Wallis test to identify any differences between the questionnaire responses. Findings revealed that building users demanded greater control of the internal environment thus contradicting the current trend for automated ‘intelligent systems’ approaches. This research represents the first work to consider the contractor’s perspective towards developing a better understanding of client satisfaction with the school buildings. Moreover, the POE result represents a notable pragmatic advancement to knowledge that will influence the contractor’s knowledge and understanding of client satisfaction, and where to improve upon these.

scholarly journals P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mia Rodziewicz ◽  
Terence O'Neill ◽  
Audrey Low
Keyword(s):  
Patient Satisfaction ◽  
Physical Examination ◽  
Management Plan ◽  
Service Development ◽  
Telephone Consultation ◽  
Face To Face ◽  
Communication Difficulties ◽  
Strongly Agree ◽  
The Uk

Abstract Background/Aims  Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods  All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results  233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion  Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure  M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

Net zero carbon: Energy performance targets for offices

2021 ◽  
Vol 42 (3) ◽  
pp. 349-369
Author(s):  
Robert Cohen ◽  
Karl Desai ◽  
Jennifer Elias ◽  
Richard Twinn
Keyword(s):  
Energy Efficiency ◽  
Minimum Energy ◽  
Energy Performance ◽  
Consultation Process ◽  
Net Zero ◽  
Extensive Consultation ◽  
Operational Energy ◽  
Legislative Framework ◽  
Zero Carbon ◽  
The Uk

The UKGBC Net Zero Carbon Buildings Framework was published in April 2019 following an industry task group and extensive consultation process. The framework acts as guidance for achieving net zero carbon for operational energy and construction emissions, with a whole life carbon approach to be developed in the future. In consultation with industry, further detail and stricter requirements are being developed over time. In October 2019, proposals were set out for industry consultation on minimum energy efficiency targets for new and existing commercial office buildings seeking to achieve net zero carbon status for operational energy today, based on the performance levels that all buildings will be required to achieve by 2050. This was complemented by modelling work undertaken by the LETI network looking into net zero carbon requirements for new buildings. In January 2020 UKGBC published its guidance on the levels of energy performance that offices should target to achieve net zero and a trajectory for getting there by 2035. This paper describes the methodology behind and industry perspectives on UKGBC’s proposals which aim to predict the reduction in building energy intensity required if the UK’s economy is to be fully-powered by zero carbon energy in 2050. Practical application: Many developers and investors seeking to procure new commercial offices or undertake major refurbishments of existing offices are engaging with the ‘net zero carbon’ agenda, now intrinsic to the legislative framework for economic activity in the UK. A UKGBC initiative effectively filled a vacuum by defining a set of requirements including energy efficiency thresholds for commercial offices in the UK to be considered ‘net zero carbon’. This paper provides all stakeholders with a detailed justification for the level of these thresholds and what might be done to achieve them. A worked example details one possible solution for a new office.

scholarly journals Net-zero emission vehicles shift and equitable ownership in low-income households and communities: why responsible and circularity business models are essential

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Nana O. Bonsu
Keyword(s):  
Air Pollution ◽  
Low Income ◽  
Value Chain ◽  
Business Models ◽  
Industrial Revolution ◽  
Technological Development ◽  
Middle Income ◽  
Net Zero ◽  
Zero Emission ◽  
The Uk

AbstractThe UK Plan for a Green Industrial Revolution aims to ban petrol and diesel cars by 2030 and transition to electric vehicles (EVs). Current business models for EV ownership and the transition to net-net zero emissions are not working for households in the lowest income brackets. However, low-income communities bear the brunt of environmental and health illnesses from transport air pollution caused by those living in relatively more affluent areas. Importantly, achieving equitable EV ownership amongst low-and middle-income households and driving policy goals towards environmental injustice of air pollution and net-zero emissions would require responsible and circular business models. Such consumer-focused business models address an EV subscription via low-income household tax rebates, an EV battery value-chain circularity, locally-driven new battery technological development, including EV manufacturing tax rebates and socially innovative mechanisms. This brief communication emphasises that consumer-led business models following net-zero emission vehicles shift and decisions must ensure positive-sum outcomes. And must focus not only on profits and competitiveness but also on people, planet, prosperity and partnership co-benefits.

Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

1998 ◽  
Vol 4 (2) ◽  
pp. 95-100 ◽  
Author(s):  
M A Loane ◽  
R Corbett ◽  
S E Bloomer ◽  
D J Eedy ◽  
H E Gore ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Management ◽  
Low Cost ◽  
Treatment Plan ◽  
Management Plan ◽  
Face To Face ◽  
Management Plans ◽  
Video Link ◽  
The Uk ◽  
Management Recommendations

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44 of the patients were seen by the same dermatologist at both consultations, while 56 were seen by a different dermatologist. In 64 of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8 of cases; and in 9 of cases the video-link management plans were judged to be inappropriate. In 20 of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.

scholarly journals Measuring progress towards carbon reduction in the UK

2008 ◽  
Vol 66 (4) ◽  
pp. 594-604 ◽  
Author(s):  
A. Druckman ◽  
P. Bradley ◽  
E. Papathanasopoulou ◽  
T. Jackson
Keyword(s):  
Carbon Reduction ◽  
The Uk

Hybrid modelling of long-term carbon reduction scenarios for the UK

2008 ◽  
Vol 30 (6) ◽  
pp. 2947-2963 ◽  
Author(s):  
Neil Strachan ◽  
Ramachandran Kannan
Keyword(s):  
Hybrid Modelling ◽  
Carbon Reduction ◽  
The Uk

scholarly journals Pelvic floor muscle training for women with pelvic organ prolapse: the PROPEL realist evaluation

2020 ◽  
Vol 8 (47) ◽  
pp. 1-104
Author(s):  
Margaret Maxwell ◽  
Karen Berry ◽  
Sarah Wane ◽  
Suzanne Hagen ◽  
Doreen McClurg ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Symptom Score ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Organ ◽  
Realist Evaluation ◽  
Muscle Training ◽  
Patient Reported ◽  
Study Sites

Background Pelvic organ prolapse is estimated to affect 41–50% of women aged > 40 years. A multicentre randomised controlled trial of individualised pelvic floor muscle training found that pelvic floor muscle training was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. Provision of pelvic floor muscle training for prolapse has continued to vary across the UK, with limited availability of specialist physiotherapists to deliver it. Objectives This project aimed to study the implementation and outcomes of different models of delivery to increase the service provision of pelvic floor muscle training, and to follow up treatment outcomes for the original trial participants. Design A realist evaluation of pelvic floor muscle training implementation conducted within three full case study sites and two partial case study sites; an observational prospective cohort study comparing patient-reported outcomes pre and post intervention in all five sites; and a long-term follow-up study linking previous trial participants to routine NHS hospital data. Setting The setting for the realist evaluation was pelvic floor muscle training service delivery models in three NHS sites. The setting for the patient-reported outcome measures study was pelvic floor muscle training services in five NHS sites. Methods Realist evaluation qualitative data were collected at four time points in three case study sites to understand the implementation models, uptake, adherence and impact. Interviews involved service managers/leads, consultants, staff delivering pelvic floor muscle training and women receiving pelvic floor muscle training. Main outcomes measures Patient-reported outcomes were collected at baseline and at 6 and 12 months across five sites, including the Pelvic Organ Prolapse Symptom Score, health-related quality of life (measured using the EuroQol-5 Dimensions, five-level version, questionnaire), prolapse severity (measured using the Pelvic Organ Prolapse Quantification System), urinary incontinence (measured using International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form) and need for further treatment. Results A total of 102 women were recruited to the patient-reported outcome measures cohort study (target, n = 120), and 65 women had matched baseline and 6-month Pelvic Organ Prolapse Symptom Scores. The mean Pelvic Organ Prolapse Symptom Score was 10.18 (standard deviation 5.63) at baseline and 6.98 (standard deviation 5.23) at 6 months, representing a statistically significant and clinically meaningful difference. There was no statistically significant difference between the outcomes obtained from delivery by specialist physiotherapists and the outcomes obtained from delivery by other health-care professionals (mean change in Pelvic Organ Prolapse Symptom Score: –3.95 vs. –2.81, respectively). Services delivered using higher-band physiotherapists only were more costly than services delivered using other staff mixes. The effect of the original pelvic floor muscle training intervention, over a post-intervention period of > 10 years, was a reduction in the odds of any treatment during follow-up (odds ratio 0.61, 95% confidence interval 0.37 to 0.99). The realist evaluation revealed stark differences in implementation. The site with a specialist physiotherapy service resisted change because of perceived threats to the specialist role and concerns about care quality. Pelvic floor muscle training delivery by other health-care staff was easier when there was a lack of any existing specialist service; staff had prior training and interest in pelvic health; staff had support, autonomy, time and resources to deliver pelvic floor muscle training as part of their core role; and surrounding services supported a flow of pelvic floor muscle training referrals. Limitations The number of available matched pre and post outcomes for women and the lack of Pelvic Organ Prolapse Quantification System examinations were limitations of this study. Conclusions It is possible to train different staff to effectively deliver pelvic floor muscle training to women. Women’s self-reported outcomes significantly improved across all service models. Training should be adequately tailored to differential skill mix needs. Future work Future work should include further implementation of pelvic floor muscle training and should include pre- and post-outcome data collection using the Pelvic Organ Prolapse Symptom Score. Study registration This study is registered as Research Registry 4919. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 47. See the NIHR Journals Library website for further project information.

A qualitative assessment of the impact of smart homes and environmentally beneficial technologies on the UK 2050 net-zero carbon emission target

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ghasson Shabha ◽  
Francesca Barber ◽  
Paul Laycock
Keyword(s):  
Climate Change ◽  
Carbon Emissions ◽  
Smart Home ◽  
Smart Homes ◽  
Content Type ◽  
Net Zero ◽  
Zero Carbon ◽  
The Uk ◽  
Home Technology ◽  
Smart Home Technology

PurposeThere are 29 million homes in the UK, accounting for 14% of the UK's energy consumption. This is given that UK has one of the highest water and energy demands in Europe which needs to be addressed according to the Committee on Climate Change (CCC). Smart homes technology holds a current perception that it is principally used by “tech-savvy” users with larger budgets. However, smart home technology can be used to control water, heat and energy in the entire house. This paper investigates how smart home technology could be effectively utilised to aid the UK government in meeting climate change targets and to mitigate the environmental impact of a home in use towards reducing carbon emissions.Design/methodology/approachBoth primary and secondary data were sought to gain insight into the research problem. An epistemological approach to this research is to use interpretivism to analyse data gathered via a semi-structured survey. Two groups of participants were approached: (1) professionals who are deemed knowledgeable about smart home development and implementation and (2) users of smart home technology. A variety of open-ended questions were formulated, allowing participants to elaborate by exploring issues and providing detailed qualitative responses based on their experience in this area which were interpreted quantitatively for clearer analysis.FindingsWith fossil fuel reserves depleting, there is an urgency for renewable, low carbon energy sources to reduce the 5 tonnes annual carbon emissions from a UK household. This requires a multi-faceted and a multimethod approach, relying on the involvement of both the general public and the government in order to be effective. By advancing energy grids to make them more efficient and reliable, concomitant necessitates a drastic change in the way of life and philosophy of homeowners when contemplating a reduction of carbon emissions. If both parties are able to do so, the UK is more likely to reach its 2050 net-zero carbon goal. The presence of a smart meter within the household is equally pivotal. It has a positive effect of reducing the amount of carbon emissions and hence more need to be installed.Research limitations/implicationsFurther research is needed using a larger study sample to achieve more accurate and acceptable generalisations about any future course of action. Further investigation on the specifics of smart technology within the UK household is also needed to reduce the energy consumption in order to meet net-zero carbon 2050 targets due to failures of legislation.Practical implicationsFor smart homes manufacturers and suppliers, more emphasis should be placed to enhance compatibility and interoperability of appliances and devices using different platform and creating more user's friendly manuals supported by step-by-step visual to support homeowners in the light of the wealth of knowledge base generated over the past few years. For homeowners, more emphasis should be placed on creating online knowledge management platform easily accessible which provide virtual support and technical advice to home owners to deal with any operational and technical issues or IT glitches. Developing technical design online platform for built environment professionals on incorporating smart sensors and environmentally beneficial technology during early design and construction stages towards achieving low to zero carbon homes.Originality/valueThis paper bridges a significant gap in the body of knowledge in term of its scope, theoretical validity and practical applicability, highlighting the impact of using smart home technology on the environment. It provides an insight into how the UK government could utilise smart home technology in order to reduce its carbon emission by identifying the potential link between using smart home technology and environmental sustainability in tackling and mitigating climate change. The findings can be applied to other building types and has the potential to employ aspects of smart home technology in order to manage energy and water usage including but not limited to healthcare, commercial and industrial buildings.

Sign in / Sign up

Export Citation Format

Share Document