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Calculating Repeating Thermal Bridges (RTBs) for Timber Frame (TF) closed panels that could occur in Offsite Manufactured (OSM) Modern Methods of Construction (MMC), such as exterior walls for nearly-to-zero operational energy dwellings to be constructed in Wales, United Kingdom (UK) is discussed in this paper. Detailed calculations for linear RTBs due to the TF components are often neglected when evaluating thermal transmittance (known as U-values hereafter). The use of standard TF fractions does not allow the designer to perceive their detrimental impact on RTBs and consequent U-values for exterior walls. With the increase of the thermal performance of exterior walls and as such lower U-values due to ever-tightening Building Regulations, specifically related to the energy use and carbon emissions from the space heating of dwellings, then the impacts of RTBs requires more investigation. By not calculating the potential of linear RTB at the design stage could lead to a performance gap where assumed U-values for exterior walls differ from manufacture to onsite. A TF detail from the Welsh manufacture has been chosen as a case study, to develop and apply a methodology using manufacturing drawings to evaluate TF fraction and their effect on the thermal performance. [ABSTRACT FROM AUTHOR]

Abstract: Possible solutions for zero energy building design in UK are discussed in this paper. Simulation software (EnergyPlus and TRNSYS 16) are employed in this study, where EnergyPlus simulations are applied to enable facade design studies considering building materials, window sizes and orientations and TRNSYS is used for the investigation of the feasibility of zero energy houses with renewable electricity, solar hot water system and energy efficient heating systems under Cardiff weather conditions. Various design methods are compared and optimal design strategies for typical homes and energy systems are provided. [Copyright &y& Elsevier]

Background: Transgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility. The pathway through primary care to specialist services is a particularly precarious time for trans people, and misinformation and poorly applied protocols can have a detrimental impact on wellbeing.Method: We recruited trans participants from an HIV Self-Testing Public Health Intervention (SELPHI) trial to interviews which explored contemporary gender-affirming service experiences, with an aim to examine the path from primary care services through to specialist gender services, in the UK.Results: A narrative synthesis of vignettes and thematic analysis of in-depth qualitative interviews were conducted with twenty trans individuals. We summarise positive and negative accounts of care under three broad categories: Experiences with primary care physicians, referrals to gender identity clinics (GICs), and experiences at GICs.Conclusions: We discuss implications of this research in terms of how to improve best practice for trans people attempting to access gender-affirming healthcare in the UK. Here we highlight the importance of GP's access to knowledge around pathways and protocols and clinical practice which treats trans patients holistically. [ABSTRACT FROM AUTHOR]

Background Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of 'prudent healthcare' championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. Methods A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. Results A sum of £86.9 million was spent on respiratory care in 2012-13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. Conclusions This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. [ABSTRACT FROM AUTHOR]