Challenges in implementing GP clusters in Scotland: a qualitative study comparing the views of senior primary care stakeholders in 2016 with those in 2021.

BACKGROUND: Formation of GP clusters began in Scotland in April 2016 as part of a new Scottish GP contract. They aim to improve the care quality for local populations (intrinsic role) and the integration of health and social care (extrinsic role). AIM: To compare predicted challenges of cluster implementation in 2016 with reported challenges in 2021. DESIGN & SETTING: Qualitative study of senior national stakeholders in primary care in Scotland. METHOD: Qualitative analysis of semi-structured interviews with 12 senior primary care national stakeholders in 2016 (n = 6) and 2021 (n = 6). RESULTS: Predicted challenges in 2016 included balancing intrinsic and extrinsic roles, providing sufficient support, maintaining motivation and direction, and avoiding variation between clusters. Progress of clusters in 2021 was perceived as suboptimal and was reported to vary significantly across the country, reflecting differences in local infrastructure. Practical facilitation (data, administrative support, training, project improvement support, and funded time) and strategic guidance from the Scottish Government was felt to be lacking. GP engagement with clusters was felt to be hindered by the significant time and workforce pressures facing primary care. These barriers were considered as collectively contributing to cluster lead 'burnout' and loss of momentum, exacerbated by inadequate opportunities for shared learning between clusters across Scotland. Such barriers preceded, but were perpetuated by, the impact of the COVID-19 pandemic. CONCLUSION: Apart from the COVID-19 pandemic, many of the challenges reported by stakeholders in 2021 were predicted in 2016. Accelerating progress in cluster working will require renewed investment and support applied consistently across the country.

Physiological and psychological characteristics of successful combat controller trainees.

OBJECTIVES: The United States Air Force (USAF) Combat Controller (CCT) training pipeline is extremely arduous and historically has an attrition rate of 70-80%. The primary objective of this study was to identify the physiological, psychological, or demographical characteristics associated with successful progression through the CCT pipeline program. METHODS: A battery of physiological measurements, biographical information, and psychological tests were used to determine the profile of a successful CCT trainee. These measures were chosen on the basis of being standard physical fitness parameters, CCT-specific physical attribute indicators or validated psychological surveys. A multiple of physical tests served as measurements for cardiovascular endurance (VO2max and running economy), ?anaerobic? capacity (Wingate power and loaded anaerobic endurance treadmill tests), body composition skinfolds measurements, power (Wingate and vertical jump), and reaction time (Makoto eye-hand test.) Each test was conducted using a standardized protocol. Psychological characteristics were explored through use of the International Personality Item Pool (IPIP-NEO) and the Mental Toughness Questionnaire 48 (MTQ 48). RESULTS: Our findings revealed the following mean characteristics of 109 CCTs who completed Phase I of the pipeline and achieved their 3-level rating: 23 years old, 1.8m tall, 81 kg, 12% body fat, VO2max of 59 ml/kg/min, vertical jump of 62 cm, able to generate 11.4 W/kg peak power and 9.3 W/Kg mean power during Wingate tests, overall mental toughness rating of 8 (out of 10) with high levels of extraversion and conscientiousness and low levels of neuroticism. The most popular competitive sport played in high school was football, followed by track, wrestling, and baseball. CONCLUSIONS: The results of the investigation confirm that CCT trainees who have achieved a 3-level rating possess much higher than average levels of aerobic and anaerobic fitness, power, mental toughness, extraversion and conscientiousness. They possess lower than average levels of neuroticism and openness to experience. These results may prove useful in refining the selection criteria and in designing training for CCT trainees.

Is performance of intermittent intense exercise enhanced by use of a commercial palm cooling device?

The purpose of this study was to determine if using the CoreControl Rapid Thermal Exchange (RTX), a commercial palm cooling device, during active rest periods of multiple set training is an effective means to increase performance. Ten volunteers (5 men, 5 women) completed a VO2max test on a motorized treadmill and 3 interval running tests on a human powered treadmill. This treadmill allowed the subjects to quickly reach their running speed while allowing for measurement of distance, speed, and force. During the interval running tests the subjects completed eight 30-second intervals at a hard/fast pace followed by a 90-second walking or light jogging recovery period. During the recovery period, the subjects placed their left hand on 1 of 3 media: the RTX held at 15 degrees C (R), a 15 degrees C standard refrigerant gel pack (P), or nothing at all (C). Although there were differences in core temperature (Tc), subjective heat stress ratings, distance, and power generated between intervals, there were no significant differences (p < 0.05) found between treatments for any of these variables, nor was the interaction effect of interval*treatment found to be significant. Mean distance completed per trial was 717.1 m +/- 124.4 m (R), 724.8 m +/- 130.3 m (P), and 728.6 m +/- 110.6 m (C). Change in Tc from baseline to end-test averaged 1.41 degrees C +/- 0.37 degrees C (R), 1.41 degrees C +/- 0.39 degrees C (P), and 1.41 degrees C +/- 0.59 degrees C (C). There were no significant differences (p < 0.05) in Tc, heart rate (HR), or VO2 between intervals or treatments. We conclude that the RTX, in its current iteration, is ineffective at improving performance and/or mitigating thermal stress during high-intensity intermittent exercise.