Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP

Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice’s performance to the same time period in the previous year as well as patient satisfaction questionnaires.

Secure Transmission in MIMO Wiretap Channels Using General-Order Transmit Antenna Selection with Outdated CSI

In this paper, we propose general-order transmit antenna selection to enhance the secrecy performance of multiple-input–multiple-output multieavesdropper channels with outdated channel state information (CSI) at the transmitter. To evaluate the effect of the outdated CSI on the secure transmission of the system, we investigate the secrecy performance for two practical scenarios, i.e., Scenarios I and II, where the eavesdropper's CSI is not available at the transmitter and is available at the transmitter, respectively. For Scenario I, we derive exact and asymptotic closed-form expressions for the secrecy outage probability in Nakagami- m fading channels. In addition, we also derive the probability of nonzero secrecy capacity and the \varepsilon -outage secrecy capacity, respectively. Simple asymptotic expressions for the secrecy outage probability reveal that the secrecy diversity order is reduced when the CSI is outdated at the transmitter, and it is independent of the number of antennas at each eavesdropper N_text\rm{E} , the fading parameter of the eavesdropper's channel m_text\rm{E} , and the number of eavesdroppers M . For Scenario II, we make a comprehensive analysis of the average secrecy capacity obtained by the system. Specifically, new closed-form expressions for the exact and asymptotic average secrecy capacity are derived, which are valid for general systems with an arbitrary number of antennas, number of eavesdroppers, and fading severity parameters. Resorting to these results, we also determine a high signal-to-noise ratio power offset to explicitly quantify the impact of the main c- annel and the eavesdropper's channel on the average secrecy capacity.

Hierarchical energy management system for multi-source multi-product microgrids

This paper proposes a hierarchical energy management system for multi-source multi-product (MSMP) microgrids. Traditional energy hub based scheduling method is combined with a hierarchical control structure to incorporate transient characteristics of natural gas flow and dynamics of energy converters in microgrids. The hierarchical EMS includes a supervisory control layer, an optimizing control layer, and an execution control layer. In order to efficiently accommodate the systems multi time-scale characteristics, the optimizing control layer is decomposed into three sub-layers: slow, medium and fast. Thermal, gas and electrical management systems are integrated into the slow, medium, and fast control layer, respectively. Compared with wind energy, solar energy is easier to integrate and more suitable for the microgrid environment, therefore, potential impacts of the hierarchical EMS on MSMP microgrids is investigated based on a building energy system integrating photovoltaic and microturbines. Numerical studies indicate that by using a hierarchical EMS, MSMP microgrids can be economically operated. Also, interactions among thermal, gas, and electrical system can be effectively managed.

A Reliability Assessment Approach for the Urban Energy System and Its Application in Energy Hub Planning

With the increasing utilization of combined heat and power plants (CHP), electrical, gas, and thermal systems are becoming tightly integrated in the urban energy system (UES). However, the three systems are usually planned and operated separately, ignoring their interactions and coordination. To address this issue, the coupling point of different systems in the UES is described by the energy hub model. With this model, an integrated load curtailment method is proposed for the UES. Then a Monte Carlo simulation based approach is developed to assess the reliability of coordinated energy supply systems. Based on this approach, a reliability-optimal energy hub planning method is proposed to accommodate higher renewable energy penetration. Numerical studies indicate that the proposed approach is able to quantify the UES reliability with different structures. Also, optimal energy hub planning scheme can be determined to ensure the reliability of the UES with high renewable penetration.

Design of an automated solar concentrator for the pyrolysis of scrap rubber

An automated solar reactor system was designed and built to carry out catalytic pyrolysis of scrap rubber tires at 550°C. To maximize solar energy concentration, a two degrees-of-freedom automated sun tracking system was developed and implemented. Both the azimuth and zenith angles were controlled via feedback from six photo-resistors positioned on a Fresnel lens. The pyrolysis of rubber tires was tested with the presence of two types of acidic catalysts, H-beta and H-USY. Additionally, a photoactive TiO<inf>2</inf> catalyst was used and the products were compared in terms of gas yields and composition. The catalysts were characterized by BET analysis and the pyrolysis gases and liquids were analyzed using GC-MS. The oil and gas yields were relatively high with the highest gas yield reaching 32.8% with H-beta catalyst while TiO<inf>2</inf> gave the same results as thermal pyrolysis without any catalyst. In the presence of zeolites, the dominant gasoline-like components in the gas were propene and cyclobutene. The TiO<inf>2</inf> and non-catalytic experiments produced a gas containing gasoline-like products of mainly isoprene (76.4% and 88.4% respectively). As for the liquids they were composed of numerous components spread over a wide distribution of C<inf>10</inf> to C<inf>29</inf> hydrocarbons of naphthalene and cyclohexane/ene derivatives.

Large scale test of a novel back-pass non-perforated unglazed solar air collector

This paper describes large scale tests conducted on a novel unglazed solar air collector system. The proposed system, referred to as a back-pass solar collector (BPSC), has on-site installation and aesthetic advantages over conventional unglazed transpired solar collectors (UTSC) as it is fully integrated within a standard insulated wall panel. This paper presents the results obtained from monitoring a BPSC wall panel over one year. Measurements of temperature, wind velocity and solar irradiance were taken at multiple air mass flow rates. It is shown that the length of the collector cavities has a direct impact on the efficiency of the system. It is also shown that beyond a height-to-flow ratio of 0.023m/m³/hr/m², no additional heat output is obtained by increasing the collector height for the experimental setup in this study, but these numbers would obviously be different if the experimental setup or test environment (e.g. location and climate) change. An equation for predicting the temperature rise of the BPSC is proposed.

The views of general practitioners on advance care planning for patients living with dementia

Background Advance care planning (ACP) facilitates communication
and understanding of preferences, nevertheless the use of
ACPs in primary care for patients with dementia is low. The disease’s
uncertain course and the inability to communicate with
the patient living with dementia are significant challenges for
GPs.
Aim The purpose of this study was to describe the attitudes and
practice preferences of GPs working within the UK’s National
Health System (NHS) regarding communication, and decisionmaking
for patients with dementia and their families
Methods A cross-sectional survey, using a purposive, cluster sample
of GPs across Northern Ireland with registered dementia
patients was used.
Results One hundred and thirty-three GPs (40.6%) participated
in the survey, representing 60.9% of surveyed practices. While
most respondents regarded dementia as a terminal disease
(96.2%) only 37.6% felt that palliative care applied equally from
the time of diagnosis to severe dementia. While most respondents
thought that early discussions would facilitate decision-making
during advanced dementia (61%), respondents were divided
on whether ACP should be initiated at the time of diagnoses
(39.8% in favour vs 45.8% disagreed). Interestingly, GPs who
were longer in practice placed greater importance on the presence
of an advance directive (F (2, 124) = 3.38, p = 0.037).
Discussion The timing of initiating ACP varies across individuals
requiring GPs to carefully consider strategies and receptiveness
of the patient and family carer.
Conclusion The findings promote both ongoing training in communication
and dementia management for GPs to meet the
needs of their patients living with dementia.

The application of a novel fluidised photo reactor under UV-Visible and natural solar irradiation in the photocatalytic generation of hydrogen

With advancements in the development of visible light responsive catalysts for H2 production frequently being reported, photocatalytic water splitting has become an attractive method as a potential ‘solar fuel generator’. The development of novel photo reactors which can enhance the potential of such catalyst, however, is rarely reported. This is particularly important as many reactor configurations are mass transport limited, which in term limits the efficiency of more effective photocatalysts in larger scale applications. This paper describes the performance of a novel fluidised photo reactor for the production of H2 over two catalysts under UV-Visible light and natural solar illumination. Catalysts Pt-C3N4 and NaTaO3.La were dispersed in the reactor and the rate of H2 was determined by GC-TCD analysis of the gas headspace. The unit was an annular reactor constructed from stainless steel 316 and quartz glass with a propeller located in the base to control fluidisation of powder catalysts. Reactor properties such as propeller rotational speed were found to enhance the photo activity of the system through the elimination of mass transport limitations and increasing light penetration. The optimum conditions for H2 evolution were found to be a propeller rotational speed of 1035 rpm and 144 W of UV-Visible irradiation, which produced a rate of 89 µmol h-1 g-1 over Pt-C3N4. Solar irradiation was provided by the George Ellery Hale Solar Telescope, located at the California Institute of Technology.

Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice.

Objective: To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease.

Design: A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction).

Setting: 48 general practices in the Republic of Ireland and Northern Ireland.

Participants: 903 patients with established coronary heart disease at baseline in the original trial.

Intervention: The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased.

Outcome measures: Primary outcome: hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control.

Results: At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol.

Conclusions: Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes.

Trial registration number: Current Controlled Trials ISRCTN24081411.

Chalcogenide thin films for solar cells: growth and properties

Thin film solar cells have in recent years gained market quota against traditional silicon photovoltaic panels. These developments were in a large part due to CdTe solar panels on whose development started earlier than their competitors. Panels based on Cu(In,Ga)Se2 (CIGS), despite being more efficient in a laboratory and industrial scale than the CdTe ones, still need a growth technology cheaper and easier to apply in industry. Although usually presented as a good candidate to make cheap panels, CIGS uses rare and expensive materials as In and Ga. The price evolution of these materials might jeopardize CIGS future. This thesis presents three different studies. The first is the study of different processes for the incorporation of Ga in a hybrid CIGS growth system. This system is based on sputtering and thermal evaporation. This technology is, in principle, easier to be applied in the industry and solar cells with efficiencies around to 7% were fully made in Aveiro. In the second part of this thesis, a new material to replace CIGS in thin film solar cells is studied. The growth conditions and fundamental properties of Cu2ZnSnSe4 (CZTSe) were studied in depth. Suitable conditions of temperature and pressure for the growth of this material are reported. Its band gap energy was estimated at 1.05 eV and the Raman scattering peaks were identified. Solar cells made with this material showed efficiencies lower than 0.1%. Finally, preliminary work regarding the incorporation of selenium in Cu2ZnSnS4 (CZTS) thin films was carried out. The structural and morphological properties of thin films of Cu2ZnSn(S,Se)4 have been studied and the results show that the incorporation of selenium is higher in films with precursors rather with already formed Cu2SnS3 or Cu2ZnSnS4 thin films. A solar cell with 0.9 % of efficiency was prepared.

Model-based systems engineering: a system for traffic & environment

The contemporary world is crowded of large, interdisciplinary, complex systems made of other systems, personnel, hardware, software, information, processes, and facilities. The Systems Engineering (SE) field proposes an integrated holistic approach to tackle these socio-technical systems that is crucial to take proper account of their multifaceted nature and numerous interrelationships, providing the means to enable their successful realization. Model-Based Systems Engineering (MBSE) is an emerging paradigm in the SE field and can be described as the formalized application of modelling principles, methods, languages, and tools to the entire lifecycle of those systems, enhancing communications and knowledge capture, shared understanding, improved design precision and integrity, better development traceability, and reduced development risks. This thesis is devoted to the application of the novel MBSE paradigm to the Urban Traffic & Environment domain. The proposed system, the GUILTE (Guiding Urban Intelligent Traffic & Environment), deals with a present-day real challenging problem “at the agenda” of world leaders, national governors, local authorities, research agencies, academia, and general public. The main purposes of the system are to provide an integrated development framework for the municipalities, and to support the (short-time and real-time) operations of the urban traffic through Intelligent Transportation Systems, highlighting two fundamental aspects: the evaluation of the related environmental impacts (in particular, the air pollution and the noise), and the dissemination of information to the citizens, endorsing their involvement and participation. These objectives are related with the high-level complex challenge of developing sustainable urban transportation networks. The development process of the GUILTE system is supported by a new methodology, the LITHE (Agile Systems Modelling Engineering), which aims to lightening the complexity and burdensome of the existing methodologies by emphasizing agile principles such as continuous communication, feedback, stakeholders involvement, short iterations and rapid response. These principles are accomplished through a universal and intuitive SE process, the SIMILAR process model (which was redefined at the light of the modern international standards), a lean MBSE method, and a coherent System Model developed through the benchmark graphical modeling languages SysML and OPDs/OPL. The main contributions of the work are, in their essence, models and can be settled as: a revised process model for the SE field, an agile methodology for MBSE development environments, a graphical tool to support the proposed methodology, and a System Model for the GUILTE system. The comprehensive literature reviews provided for the main scientific field of this research (SE/MBSE) and for the application domain (Traffic & Environment) can also be seen as a relevant contribution.

Primary production in systems subject to natural and anthropogenic eutrophication

Tese dout., Química, Universidade do Algarve, 2005

Enabling solar electricity with electric vehicles in future energy systems

Tese de doutoramento, Sistemas Sustentáveis de Energia, Universidade de Lisboa, Faculdade de Ciências, 2015

Determination of Alternaria spp. Habitats Using 7-Day Volumetric Spore Trap, Hybrid Single Particle Lagrangian Integrated Trajectory Model and Geographic Information System

There are many species among the Alternaria genus, which hosts on economically important crops causing significant yield losses. Less attention has been paid to fungi hosting on plants constituting substantial components of pastures and meadows. Alternaria spp. spores are also recognised as important allergens. A 7-day volumetric spore trap was used to monitor the concentration of airborne fungal spores. Air samples were collected in Worcester, England (2006–2010). Days with a high spore count were then selected. The longest episode that occurred within a five year study was chosen for modelling. Two source maps presenting distribution of crops under rotation and pastures in the UK were produced. Back trajectories were calculated using the HYSPLIT model. In ArcGIS clusters of trajectories were studied in connection with source maps by including the height above ground level and the speed of the air masses. During the episode no evidence for a long distance transport from the continent of Alternaria spp. spores was detected. The overall direction of the air masses fell within the range from South-West to North. The back trajectories indicated that the most important sources of Alternaria spp. spores were located in the West Midlands of England.

Intelligent management of end consumers loads including electric vehicles through a SCADA system

The large penetration of intermittent resources, such as solar and wind generation, involves the use of storage systems in order to improve power system operation. Electric Vehicles (EVs) with gridable capability (V2G) can operate as a means for storing energy. This paper proposes an algorithm to be included in a SCADA (Supervisory Control and Data Acquisition) system, which performs an intelligent management of three types of consumers: domestic, commercial and industrial, that includes the joint management of loads and the charge/discharge of EVs batteries. The proposed methodology has been implemented in a SCADA system developed by the authors of this paper – the SCADA House Intelligent Management (SHIM). Any event in the system, such as a Demand Response (DR) event, triggers the use of an optimization algorithm that performs the optimal energy resources scheduling (including loads and EVs), taking into account the priorities of each load defined by the installation users. A case study considering a specific consumer with several loads and EVs is presented in this paper.