Homes Heat Health protocol: an observational cohort study measuring the effect of summer temperatures on sleep quality.

INTRODUCTION: Quality sleep is essential to our health and well-being. Summertime temperatures in the bedrooms of homes in temperate climates are increasing, especially in city apartments. There is very little empirical evidence of the effect of temperature on sleep when people are sleeping in their own bedroom. The Homes Heat Health project seeks to develop a measurable definition of temperature-related sleep disturbance and the effects on health, and so produce a credible criterion for identifying overheating in new and existing homes. METHODS AND ANALYSIS: A cohort of at least 95 people that live in London apartments and who are free of significant personal and health factors that could affect sleep are being recruited for an ongoing observational cohort study. A baseline questionnaire determines their customary sleep patterns and health. The geometrical form and thermal characteristics of their apartments is being recorded along with temperature, relative humidity and in some apartments CO2 levels, throughout one summer. Actigraphy records nightly sleep disturbance and every morning an app-based diary captures perceived sleep quality. Questionnaires following spells of hot weather capture changes in sleep pattern, sleep quality, and consequential health and well-being. ETHICS AND DISSEMINATION: The study protocol was approved by the Loughborough University ethics committee. The participants will receive both verbal and written information explaining the purpose of the study, what is expected of them, the incentives for participating and the feedback that will be provided. The results will be reported bi-annually to a project advisory board. Presentations will be made at conferences and the methods, intermediary and final results, in academic journals. Informing government bodies, professional organisations, construction industry representatives and housing providers is of particular importance.

Rural trauma telementoring: a pilot project.

BACKGROUND: Given Canada's geographically dispersed population, initial trauma care may occur at rural sites that may not manage patients with trauma frequently; thus, telementoring can play a life-saving role. In this article, we describe a rural trauma telementoring pilot program in British Columbia and report the results of an evaluation of its strengths and weaknesses. METHODS: Trauma surgeons from a quaternary trauma centre in Vancouver helped facilitate 3 in situ trauma simulation sessions at a rural BC hospital between fall 2019 and summer 2020. The sessions involved 4 physician participants (a trauma surgeon telementor, a family physician with additional expertise in emergency medicine acting as trauma team leader, a family physician with additional expertise in anesthesia and a family physician with Enhanced Surgical Skills), an emergency department nurse, 2 operating room/trauma team nurses, and laboratory and radiology technicians. The sessions involved simulated damage-control procedures and lasted about 2 hours. The participants completed surveys assessing comfort and confidence regarding aspects of trauma care and use of the telehealth unit before and after each session, and the facilitators assessed team dynamics using the Modified Non-Technical Skills for Trauma (T-NOTECHS) tool. Focus groups were held to gather qualitative data, and costs were tracked. RESULTS: The average presimulation confidence survey score was 19.6/30, and the average postsimulation score was 24.0/30. The mean score improved significantly after both the first and second sessions (p = 0.01 and p = 0.004, respectively). Across the 3 sessions, the average T-NOTECHS score improved significantly, from 18.5/25 to 21.5/25 (p = 0.02). Qualitative analysis identified 3 dominant themes: telementoring increased provider confidence, telementoring increased order to the resuscitation procedure and the technical aspects of telementorship. The telementoring program was well received by all participants. CONCLUSION: A significant improvement was seen across simulations in physician confidence and trauma team dynamics with telementorship support. Telementoring in trauma may provide a way to lessen the difference between rural and urban patient outcomes within Canada's geographically dispersed population, although further work investigating the impact of its use in real-life patients, as well as barriers to its implementation, is required.

A proposal for the curriculum and evaluation for training rural family physicians in enhanced surgical skills.

SUMMARY: Rural western Canada relies heavily on family physicians with enhanced surgical skills (ESS) for surgical services. The recent decision by the College of Family Physicians of Canada (CFPC) to recognize ESS as a "community of practice" section offers a potential home akin to family practice anesthesia and emergency medicine. To our knowledge, however, a skill set for ESS in Canada has never been described formally. In this paper the Curriculum Committee of the National ESS Working Group proposes a generic curriculum for the training and evaluation of the ESS skill set.

Improving the installation of renewable heating technology in UK social housing properties through user centred design.

Social housing organisations are increasingly installing renewable energy technologies, particularly for the provision of heating and hot water. To meet carbon reduction targets, uptake and installation must allow occupants to use the technology effectively. This paper describes research which investigated the service of installing heat pumps into UK social housing properties, from both landlords' and tenants' experiences. Adopting a user centred design approach, the research was in three phases: an exploration study to investigate landlords' and tenants' experiences of heat pump installation and use; refinement and development of the requirements for improved service delivery, primarily technology introduction and control; and the development and initial evaluation of an information leaflet as a key touchpoint in the service delivery. Recommendations for improved service delivery, to enable heat pumps to be accepted and used more effectively, are presented, as well as reflection on the process of applying user centred design in this context. In a relatively immature area of industry, installations to date have been heavily focused on technical aspects. This paper provides an insight into the human aspects of the service delivery of heat pumps in social housing, providing designers and social housing landlords with insight about how to improve the service.

Joint position paper on rural surgery and operative delivery.

Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations.

Nos organisations professionnelles ont préparé cet article dans le cadre d'un plan multidisciplinaire intégré visant à assurer la disponibilité d'équipes soignantes bien formées pour offrir des services obstétricaux interventionnels et chirurgicaux sécuritaires, efficaces et de grande qualité en milieu rural. Sans de tels solides services chirurgicaux locaux (ou de proximité), il est beaucoup plus difficile d'assurer les soins obstétricaux en milieu rural. Cet article décrit le « modèle en réseau ¼ comme une solution au chapitre des ressources humaines en santé pour répondre aux besoins chirurgicaux des populations rurales, y compris pour les services obstétricaux interventionnels. On y décrit aussi les orientations politiques nécessaires à l'application de cette solution et on formule une série de recommandations préparatoires.

Design and evaluation: end users, user datasets and personas.

Understanding the needs and aspirations of a suitable range of users during the product design process is an extremely difficult task. Methods such as ethnographic studies can be used to gain a better understanding of users needs, but they are inherently time consuming and expensive. The time pressures that are evident in the work performed by design consultancies often make these techniques impractical. This paper contains a discussion about the use of 'personas', a method used by designers to overcome these issues. Personas are descriptive models of archetypal users derived from user research. The discussion focuses on two case studies, the first of which examines the use of personas in the car design process. The second examines the use of personas in the field of 'inclusive design', as demonstrated by the HADRIAN system. These case studies exemplify the benefits 'data rich' personas contribute as opposed to 'assumption based' personas.

The effect of microbiological containment systems on dexterity.

Microbiology laboratories use containment equipment such as safety cabinets and isolators or respiratory protective equipment to protect workers against aerosol infection hazards. There is a perception among microbiologists that the use of containment equipment reduces dexterity to a point where the risks associated with using sharps are increased. Thus, in a situation where it is essential to use sharps, the use of respiratory protection is frequently the favored method of operator protection. Using three methods of manual dexterity testing, the effect of latex gloves, a positive pressure respirator, and three forms of containment equipment, (a Class II safety cabinet, a half suit, and a flexible film isolator) were tested against performance in these tests using bare hands in 10 subjects. The study was extended to additionally assess Class III cabinets using 20 subjects. With the exception of latex gloves, the personal protective equipment and containment equipment all had a statistically significant detrimental effect on manual dexterity compared with working solely with bare hands. The use of containment systems, especially barrier containment systems such as Class III cabinets and isolators, significantly reduces dexterity and may increase the chance of accidents. The use of positive pressure respirators with double gloves also affects dexterity but to a lesser extent. The use of sharps should be minimized within containment equipment. Risk assessment may be required to address the comparative risk of aerosol and needlestick infection with different agents to choose the most appropriate containment systems.