Micro-fabricated components for cold atom sensors

Laser cooled atoms have proven transformative for precision metrology, playing a pivotal role in state-of-the-art clocks and interferometers and having the potential to provide a step-change in our modern technological capabilities. To successfully explore their full potential, laser cooling platforms must be translated from the laboratory environment and into portable, compact quantum sensors for deployment in practical applications. This transition requires the amalgamation of a wide range of components and expertise if an unambiguously chip-scale cold atom sensor is to be realized. We present recent developments in cold-atom sensor miniaturization, focusing on key components that enable laser cooling on the chip-scale. The design, fabrication, and impact of the components on sensor scalability and performance will be discussed with an outlook to the next generation of chip-scale cold atom devices.

Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective

Introduction

The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service

Methods

We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory.

Results

Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient.

Conclusions

By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.

Participatory codesign of patient involvement in a Learning Health System: How can data-driven care be patient-driven care?

BACKGROUND

A Learning Health System (LHS) is a model of how routinely collected health data can be used to improve care, creating 'virtuous cycles' between data and improvement. This requires the active involvement of health service stakeholders, including patients themselves. However, to date, research has explored the acceptability of being 'data donors' rather than considering patients as active contributors. The study aimed to understand how patients should be actively involved in an LHS.

DESIGN

Ten participatory codesign workshops were conducted with eight experienced public contributors using visual, collective and iterative methods. This led contributors to challenge and revise not only the idea of an LHS but also revise the study aims and outputs.

RESULTS

The contributors proposed three exemplar roles for patients in patient-driven LHS, which aligned with the idea of three forms of transparency: informational, participatory and accountability. 'Epistemic injustice' was considered a useful concept to express the risks of an LHS that did not provide active roles to patients (testimonial injustice) and that neglected their experience through collecting data that did not reflect the complexity of their lives (hermeneutic injustice).

DISCUSSION

Patient involvement in an LHS should be 'with and by' patients, not 'about or for'. This requires systems to actively work with and respond to patient feedback, as demonstrated within the study itself by the adaptive approach to responding to contributor questions, to work in partnership with patients to create a 'virtuous alliance' to achieve change.

PATIENT OR PUBLIC CONTRIBUTION

Public contributors were active partners throughout, and co-authored the paper.

More than a method: trusting relationships, productive tensions, and two-way learning as mechanisms of authentic co-production

BACKGROUND

Knowledge mobilisation requires the effective elicitation and blending of different types of knowledge or ways of knowing, to produce hybrid knowledge outputs that are valuable to both knowledge producers (researchers) and knowledge users (health care stakeholders). Patients and service users are a neglected user group, and there is a need for transparent reporting and critical review of methods used to co-produce knowledge with patients. This study aimed to explore the potential of participatory codesign methods as a mechanism of supporting knowledge sharing, and to evaluate this from the perspective of both researchers and patients.

METHODS

A knowledge mobilisation research project using participatory codesign workshops to explore patient involvement in using health data to improve services. To evaluate involvement in the project, multiple qualitative data sources were collected throughout, including a survey informed by the Generic Learning Outcomes framework, an evaluation focus group, and field notes. Analysis was a collective dialogic reflection on project processes and impacts, including comparing and contrasting the key issues from the researcher and contributor perspectives.

RESULTS

Authentic involvement was seen as the result of "space to talk" and "space to change". "Space to talk" refers to creating space for shared dialogue, including space for tension and disagreement, and recognising contributor and researcher expertise as equally valuable to the discussion. 'Space to change' refers to space to adapt in response to contributor feedback. These were partly facilitated by the use of codesign methods which emphasise visual and iterative working, but contributors emphasised that relational openness was more crucial, and that this needed to apply to the study overall (specifically, how contributors were reimbursed as a demonstration of how their input was valued) to build trust, not just to processes within the workshops.

CONCLUSIONS

Specific methods used within involvement are only one component of effective involvement practice. The relationship between researcher and contributors, and particularly researcher willingness to change their approach in response to feedback, were considered most important by contributors. Productive tension was emphasised as a key mechanism in leading to genuinely hybrid outputs that combined contributor insight and experience with academic knowledge and understanding.

Developing a patient safety guide for primary care: A co-design approach involving patients, carers and clinicians

BACKGROUND

Patients and carers should be actively involved in patient safety and empowered to use person-centred approaches where they are asked to both identify safety concerns and partner in preventing them.

OBJECTIVES

The aim of this study was to co-design a patient safety guide for primary care (PSG-PC) to support patients and carers to address key patient safety questions and identify key points where they can make their care safer. The objectives were to i) identify when and how patients and carers can be involved in primary care patient safety, and ii) identify the relevant information to include in the PSG-PC.

DESIGN

An experience-based co-design approach.

SETTING AND PARTICIPANTS

We conducted three workshops with patients, carers, community pharmacists and general practitioners to develop and refine the PSG-PC.

RESULTS

Participants identified both explicit and implicit issues of primary care patient safety especially relating to technical and relational components of involving patients and carers. The importance of communication, understanding roles and responsibilities, and developing partnerships between patients and health-care providers were considered essential for actively involving patients in patient safety. Co-developing the PSG-PC provided insight to improve care to develop the PSG-PC.

DISCUSSION

The PSG-PC is the first guide to be developed for primary care, co-designed with patients, carers, general practitioners and pharmacists. The PSG-PC will support patients and carers to partner with health-care professionals to improve patient safety addressing international and national priorities to continuously improve patient safety.

Protocol for a non-randomised feasibility study evaluating a codesigned patient safety guide in primary care

INTRODUCTION

Patients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This protocol paper details a study to examine the feasibility of a multicomponent intervention to involve patients and/or carers in patient safety in primary care in the UK.

METHODS AND ANALYSIS

This is a two-phase, non-randomised feasibility mixed methods pragmatic study of a patient safety guide for primary care (PSG-PC). 8 general practices will recruit 120 patient and/or carer participants. All patient and/or carer participants will receive the PSG-PC. It will examine the feasibility and acceptability of the PSG-PC in primary care settings in patients aged 18 years or older who attend appointments at general practice with health professionals four or more times per year as either patients or carers. It will identify secondary outcomes for improving patient safety, health status and patient empowerment, and reducing health service utilisation over 6 months between baseline and 6-month follow-ups. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients and practices will be needed. The study will be undertaken between January 2020 and September 2021.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the National Health Service London-West London and Gene Therapy Advisory Committee Research Ethics Committee (reference: 19/LO/1289). Research findings will be disseminated with participating general practices and shared in a range of different ways to engage different audiences, including presenting at international and national conferences, publishing in open-access, peer-reviewed journals and facilitating dissemination workshops within local communities with patients, carers and healthcare professionals.

TRIAL REGISTRATION NUMBER

ISRCTN90222092.

Engaging with stakeholders to inform the development of a decision-support tool for the NHS health check programme: qualitative study

BACKGROUND

The NHS Health Check Programme is a risk-reduction programme offered to all adults in England aged 40-74 years. Previous studies mainly focused on patient perspectives and programme delivery; however, delivery varies, and costs are substantial. We were therefore working with key stakeholders to develop and co-produce an NHS Health Check Programme modelling tool (workHORSE) for commissioners to quantify local effectiveness, cost-effectiveness, and equity. Here we report on Workshop 1, which specifically aimed to facilitate engagement with stakeholders; develop a shared understanding of current Health Check implementation; identify what is working well, less well, and future hopes; and explore features to include in the tool.

METHODS

This qualitative study identified key stakeholders across the UK via networking and snowball techniques. The stakeholders spanned local organisations (NHS commissioners, GPs, and academics), third sector and national organisations (Public Health England and The National Institute for Health and Care Excellence). We used the validated Hovmand "group model building" approach to engage stakeholders in a series of pre-piloted, structured, small group exercises. We then used Framework Analysis to analyse responses.

RESULTS

Fifteen stakeholders participated in workshop 1. Stakeholders identified continued financial and political support for the NHS Health Check Programme. However, many stakeholders highlighted issues concerning lack of data on processes and outcomes, variability in quality of delivery, and suboptimal public engagement. Stakeholders' hopes included maximising coverage, uptake, and referrals, and producing additional evidence on population health, equity, and economic impacts. Key model suggestions focused on developing good-practice template scenarios, analysis of broader prevention activities at local level, accessible local data, broader economic perspectives, and fit-for-purpose outputs.

CONCLUSIONS

A shared understanding of current implementations of the NHS Health Check Programme was developed. Stakeholders demonstrated their commitment to the NHS Health Check Programme whilst highlighting the perceived requirements for enhancing the service and discussed how the modelling tool could be instrumental in this process. These suggestions for improvement informed subsequent workshops and model development.

Design and simulation of losses in Ge/SiGe terahertz quantum cascade laser waveguides

The waveguide losses from a range of surface plasmon and double metal waveguides for Ge/Si_1-xGe_x THz quantum cascade laser gain media are investigated at 4.79 THz (62.6 μm wavelength). Double metal waveguides demonstrate lower losses than surface plasmonic guiding with minimum losses for a 10 μm thick active gain region with silver metal of 21 cm^-1 at 300 K reducing to 14.5 cm^-1 at 10 K. Losses for silicon foundry compatible metals including Al and Cu are also provided for comparison and to provide a guide for gain requirements to enable lasers to be fabricated in commercial silicon foundries. To allow these losses to be calculated for a range of designs, the complex refractive index of a range of nominally undoped Si_1-xGe_x with x = 0.7, 0.8 and 0.9 and doped Ge heterolayers were extracted from Fourier transform infrared spectroscopy measurements between 0.1 and 10 THz and from 300 K down to 10 K. The results demonstrate losses comparable to similar designs of GaAs/AlGaAs quantum cascade laser plasmon waveguides indicating that a gain threshold of 15.1 cm^-1 and 23.8 cm^-1 are required to produce a 4.79 THz Ge/SiGe THz laser at 10 K and 300 K, respectively, for 2 mm long double metal waveguide quantum cascade lasers with facet coatings.

Consensus Statement on Public Involvement and Engagement with Data Intensive Health Research

This consensus statement reflects the deliberations of an international group of stakeholders with a range of expertise in public involvement and engagement (PI&E) relating to data-intensive health research. It sets out eight key principles to establish a secure role for PI&E in and with the research community internationally and ensure best practice in its execution. Our aim is to promote culture change and societal benefits through ensuring a socially responsible trajectory for innovations in this field. Our key premise is that the public should not be characterised as a problem to be overcome but a key part of the solution to establish socially beneficial data-intensive health research for all.

Low loss Ge-on-Si waveguides operating in the 8-14 µm atmospheric transmission window

Germanium-on-silicon waveguides were modeled, fabricated and characterized at wavelengths ranging from 7.5 to 11 µm. Measured waveguide losses are below 5 dB/cm for both TE and TM polarization and reach values of ∼ 1 dB/cm for ≥ 10 µm wavelengths for the TE polarization. This work demonstrates experimentally for the first time that Ge-on-Si is a viable waveguide platform for sensing in the molecular fingerprint spectral region. Detailed modeling and analysis is presented to identify the various loss contributions, showing that with practical techniques losses below 1 dB/cm could be achieved across the full measurement range.

Flow-directed PCA for monitoring networks

Measurements recorded over monitoring networks often possess spatial and temporal correlation inducing redundancies in the information provided. For river water quality monitoring in particular, flow-connected sites may likely provide similar information. This paper proposes a novel approach to principal components analysis to investigate reducing dimensionality for spatiotemporal flow-connected network data in order to identify common spatiotemporal patterns. The method is illustrated using monthly observations of total oxidized nitrogen for the Trent catchment area in England. Common patterns are revealed that are hidden when the river network structure and temporal correlation are not accounted for. Such patterns provide valuable information for the design of future sampling strategies.

Analysis of Ge micro-cavities with in-plane tensile strains above 2

Ge on Si micro-disk, ring and racetrack cavities are fabricated and strained using silicon nitride stressor layers. Photoluminescence measurements demonstrate emission at wavelengths ≥ 2.3 μm, and the highest strained samples demonstrate in-plane, tensile strains of > 2 %, as measured by Raman spectroscopy. Strain analysis of the micro-disk structures demonstrate that shear strains are present in circular cavities, which can detrimentally effect the carrier concentration for direct band transitions. The advantages and disadvantages of each type of proposed cavity structure are discussed.

Minimally disruptive medicine: the evidence and conceptual progress supporting a new era of healthcare

Patients with chronic conditions or multimorbidity, and often their caregivers, have to adjust their lives and mobilise their capacity (ability) to respond to the workload (demands) imposed by treatments and the care of their conditions. There is a continuous and complex interaction between workload and capacity. When capacity proves insufficient to address the treatment workload, creating a burden, patients may place a lower priority on other aspects of their lives, or reduce engagement with healthcare. Guidelines usually focus on disease-centred outcomes without consideration of limited capacity or demanding workload (burden) from treatment regimens. It seems reasonable to consider that healthcare needs reshaping so that care that pursues goals important to patients as well as those suggested by evidence-based medicine. This can be achieved by using shared decision approaches guided by the expertise of clinicians to deliver optimal care while minimising the burden of treatment on patients, their caregivers, and the healthcare system. What we need is minimally disruptive medicine.

Extending the emission wavelength of Ge nanopillars to 2.25 μm using silicon nitride stressors

The room temperature photoluminescence from Ge nanopillars has been extended from 1.6 μm to above 2.25 μm wavelength through the application of tensile stress from silicon nitride stressors deposited by inductively-coupled-plasma plasma-enhanced chemical-vapour-deposition. Photoluminescence measurements demonstrate biaxial equivalent tensile strains of up to ∼ 1.35% in square topped nanopillars with side lengths of 200 nm. Biaxial equivalent strains of 0.9% are observed in 300 nm square top pillars, confirmed by confocal Raman spectroscopy. Finite element modelling demonstrates that an all-around stressor layer is preferable to a top only stressor, as it increases the hydrostatic component of the strain, leading to an increased shift in the band-edge and improved uniformity over top-surface only stressors layers.

Ge/SiGe quantum confined Stark effect electro-absorption modulation with low voltage swing at λ = 1550 nm

Low-voltage swing (≤1.0 V) high-contrast ratio (6 dB) electro-absorption modulation covering 1460 to 1560 nm wavelength has been demonstrated using Ge/SiGe quantum confined Stark effect (QCSE) diodes grown on a silicon substrate. The heterolayers for the devices were designed using an 8-band k.p Poisson-Schrödinger solver which demonstrated excellent agreement with the experimental results. Modelling and experimental results demonstrate that by changing the quantum well width of the device, low power Ge/SiGe QCSE modulators can be designed to cover the S- and C-telecommunications bands.

Fungal colonization of haematological patients receiving cytotoxic chemotherapy: emergence of azole-resistant Saccharomyces cerevisiae

Fungal colonization during cytotoxic chemotherapy was studied in 42 patients with a recent diagnosis of a haematological malignancy. In total, 2759 surveillance cultures were taken from the nostrils, throat, urine, stool and perineal region. Seven hundred and ninety-six positive surveillance cultures (28.9%) yielded 968 fungal isolates. The rate of fungal colonization did not differ between patients with acute leukaemia, patients with other haematological malignancies and control patients in the same ward at admission (71% vs. 67% vs. 80%). Patients with acute leukaemia were colonized at a significantly lower rate in samples from the throat (32%), urine (10%), stool (45%) and perineum (29%) taken during hospitalization when compared with other haematological patients (respective values 58%, 21%, 67% and 45%; P-values 0.001). This could be attributed to differences in the use of antifungal drugs. Although 21/42 (50%) of our patients had multiple-site fungal colonization at the end of follow-up, only one systemic Candida infection was diagnosed. Extensive use of antifungal treatment may have influenced the low incidence of systemic fungal infections during the follow-up. In addition to Candida species, Malassezia furfur, Geotrichum candidum and Saccharomyces cerevisiae were frequently isolated. The rate of S. cerevisiae isolation increased significantly over time after admission (1%, vs. 18% of isolates, P<0.001), suggesting hospital-acquired transmission. These isolates were highly resistant to azole antifungals (MIC90 128 microg/mL for fluconazole and 16 microg/ml, for itraconazole), and caused persistent multiple site colonization in 12 patients. Extensive use of antifungal agents in a haematological ward may keep the incidence of invasive fungal infections low in spite of heavy fungal colonization. However, there may be a risk of emergence of resistant fungal strains.

An outbreak of echovirus type 4 infections and its implications for diagnosis and management in general practice

Altogether, 133 patients with Echovirus type 4 infection were studied. Presenting illnesses and reasons for referral to hospital were analyzed. The reason for admission was commonly concern about meningitis, but also an unexplained rash or sore throat. More research is needed in general practice in order to clearly elucidate the spectrum of disease caused by Echoviruses.

Behavioral and postural changes observed with use of adaptive seating by clients with multiple handicaps

Adaptive seating devices (ASDs) are used in the treatment of children with multiple handicaps. This longitudinal study evaluated, through direct observation and parent-guardian assessment, the behavioral changes seen with the use of ASDs and programming. Nineteen individuals with multiple handicaps and developmental disabilities, aged 1 to 6 years, participated as subjects. Data were collected by a trained observer from eight on-site evaluations and from parent-guardian responses to a preequipment and postequipment questionnaire. Evaluations were made every six weeks, starting about three months before and ending about six months after receiving the seating devices. The activities observed were head control, controlled sitting posture, visual tracking, reach, and grasp. Rating scale data were analyzed using an analysis of variance and a Friedman's test. Other data were analyzed descriptively for frequencies and central tendencies. Sitting posture, head control, and grasp improved significantly. Parent perceptions of the equipment indicated that the chairs freed parents from the need to provide support for their children's activities of daily living, which enabled them to participate in other activities with the children and around the home.