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The polymorph selection in a continuous crystallization process combined with wet milling is investigated. To this end, a dimensionless population balance equation model accounting for secondary nucleation, crystal growth, and breakage is formulated and solved numerically. We show that a surprisingly small number of dimensionless parameter groups (combinations of kinetic parameters and operating conditions) is decisive in controlling the polymorphic outcome. Specifically, we show how the operating region where the stable polymorph is obtained can be enlarged by tuning the milling intensity, feed concentration, and residence time. We further rationalize the dependence of the mean size of the particles obtained, the fraction of solute recovered, and the productivity of such a process on the dimensionless variables. We showcase this for the model system l-glutamic acid crystallized from water and show that our analysis is in agreement with previously reported experimental studies. Summarizing, the analysis approach introduced here can be used to identify operating spaces for single-stage continuous crystallization processes where the right polymorph is reliably obtained and where size, solute recovery, and productivity are guaranteed to desired levels.

BackgroundLow back pain (LBP) is the most prevalent musculoskeletal condition. Guidelines advocate a multimodal approach, including prescription of medications. Advanced Physiotherapy Practitioners (APPs) are well placed to manage LBP. To date no trial has evaluated the efficacy of physiotherapist-prescribing for LBP. OPEN ACCESS Citation: Noblet T, Marriott J, Hensman-Crook A, O'Shea S, Friel S, Rushton A (2020) Independent prescribing by advanced physiotherapists for patients with low back pain in primary care: A feasibility trial with an embedded qualitative component. PLoS ONE 15(3): e0229792. https://

Background: It has long been known general practitioners suffer with burnout. First contact physiotherapists (FCP's) are a new role to primary care. However, concerns have been raised around the longevity and sustainability of the role and the risk of clinician burnout. Aims:To assess the prevalence of burnout amongst the FCP workforce.Method: A self-reporting online questionnaire was developed and captured key demographical data and burnout scores amongst FCP's between February 2022 and March 2022. The burnout assessment tool (BAT12) was used to assess clinician burnout.Results: A total of 332 responses were collected. Overall, 13% of clinicians were burnt out, and 16% at risk. The BAT12 also found 43% of the clinicians are exhausted and a further 35% are at risk of exhaustion. Non-clinical hours were significantly associated with burnout score. Clinicians who had more non-clinical time per month were the least burnt out. Increased non-clinical hours was significant in reducing burnout score.Conclusions: This study found 13% of clinicians are suffering from burnout with a further 16% at risk. Worryingly 78% of clinicians are either exhausted or at risk of exhaustion. Non-clinical hours have a direct impact on burnout and every effort is needed by employers to increase non-clinical time. This study supports the release by the Chartered Society of Physiotherapy whereby they recommend sufficient time be allocated within job plans for appropriate supervision, training and continued professional development. Further research is needed to explore the association of non-clinical time and clinician burnout.

BackgroundThe term limb girdle muscular dystrophy (LGMD) describes a group of genetic muscular disorders that require specialist input from neurologically trained clinicians. The plethora of potential symptoms of this heterogenous group can result in patients presenting initially to musculoskeletal (MSK) physiotherapists.Case presentationThe following case report highlights the presentation of a 21 year old female attending with 2 years of spinal pain and an unusual pattern of weakness, namely when rising from a sitting position the hips were abducted and then internally rotated. Formal testing in clinic revealed no isolated weakness initially despite the odd functional movements. There were no neural limb pains and no upper or lower motor neuron concerns on testing. There were no other health concerns. Some gains were reported with recent physiotherapy strengthening exercises and these were persisted with but proved ineffective overall. The Biopsychosocial model was used judiciously to explore alternative pathologies and led to appropriate investigations, onward referral, diagnosis and appropriate management of LGMD. Extensive atrophy of the spinal muscles was evident on imaging which was not particularly identified within the physiotherapy testing process in the earlier stages. Creatine kinase levels were also significantly raised.ConclusionsBeing mindful of this novel presentation in musculoskeletal clinics may well aid future, similar cases to be identified. The case highlights the importance of looking at the functional impact as opposed to traditional testing methods especially in the early stages of such conditions.