Using information to deliver safer care: a mixed-methods study exploring general practitioners’ information needs in North West London primary care

The National Health Service in England has given increasing priority to improving inter-professional communication, enabling better management of patients with chronic conditions and reducing medical errors through effective use of information. Despite considerable efforts to reduce patient harm through better information usage, medical errors continue to occur, posing a serious threat to patient safety.This study explores the range, quality and sophistication of existing information systems in primary care with the aim to capture what information practitioners need to provide a safe service and identify barriers to its effective use in care pathways.Data were collected through semi-structured interviews with general practitioners from surgeries in North West London and a survey evaluating their experience with information systems in care pathways.Important information is still missing, specifically discharge summaries detailing medication changes and changes in the diagnosis and management of patients, blood results ordered by hospital specialists and findings from clinical investigations. Participants identified numerous barriers, including the communication gap between primary and secondary care, the variable quality and consistency of clinical correspondence and the inadequate technological integration.Despite attempts to improve integration and information flow in care pathways, existing systems provide practitioners with only partial access to information, hindering their ability to take informed decisions. This study offers a framework for understanding what tools should be in place to enable effective use of information in primary care

First principles study of adsorbed Cu_n (n=1-4) microclusters on MgO(100): structural and electronic properties

We present a density functional study of the structural and electronic properties of small Cu_n (n=1,4) aggregates on defect-free MgO(100). The calculations employ a slab geometry with periodic boundary conditions, supercells with up to 76 atoms, and include full relaxation of the surface layer and of all adsorbed atoms. The preferred adsorption site for a single Cu adatom is on top of an oxygen atom. The adsorption energy and Cu-O distance are E_S-A = 0.99 eV and d_S-A = 2.04 Angstroems using the Perdew-Wang gradient corrected exchange correlation functional. The saddle point for surface diffusion is at the "hollow" site, with a diffusion barrier of around 0.45 eV. For the adsorbed copper dimer, two geometries, one parallel and one perpendicular to the surface, are very close in energy. For the adsorbed Cu_3, a linear configuration is preferred to the triangular geometry. As for the tetramer, the most stable adsorbed geometry for Cu_4 is a rhombus. The adsorption energy per Cu atom decreases with increasing the size of the cluster, while the Cu-Cu cohesive energy increases, rapidly becoming more important than the adsorption energy.Comment: Major revision, Latex(2e) document, 23 pages, 11 figures, accepted for publication in J. of Chem. Phys., paper available at http://irrmawww.epfl.ch/vm/vm_wor

Momentum distribution, vibrational dynamics and the potential of mean force in ice

By analyzing the momentum distribution obtained from path integral and phonon calculations we find that the protons in hexagonal ice experience an anisotropic quasi-harmonic effective potential with three distinct principal frequencies that reflect molecular orientation. Due to the importance of anisotropy, anharmonic features of the environment cannot be extracted from existing experimental distributions that involve the spherical average. The full directional distribution is required, and we give a theoretical prediction for this quantity that could be verified in future experiments. Within the quasi-harmonic context, anharmonicity in the ground state dynamics of the proton is substantial and has quantal origin, a finding that impacts the interpretation of several spectroscopies

Displaced path integral formulation for the momentum distribution of quantum particles

The proton momentum distribution, accessible by deep inelastic neutron scattering, is a very sensitive probe of the potential of mean force experienced by the protons in hydrogen-bonded systems. In this work we introduce a novel estimator for the end to end distribution of the Feynman paths, i.e. the Fourier transform of the momentum distribution. In this formulation, free particle and environmental contributions factorize. Moreover, the environmental contribution has a natural analogy to a free energy surface in statistical mechanics, facilitating the interpretation of experiments. The new formulation is not only conceptually but also computationally advantageous. We illustrate the method with applications to an empirical water model, ab-initio ice, and one dimensional model systems

Inverse design of disordered stealthy hyperuniform spin chains

Positioned between crystalline solids and liquids, disordered many-particle systems which are stealthy and hyperuniform represent new states of matter that are endowed with novel physical and thermodynamic properties. Such stealthy and hyperuniform states are unique in that they are transparent to radiation for a range of wavenumbers around the origin. In this work, we employ recently developed inverse statistical-mechanical methods, which seek to obtain the optimal set of interactions that will spontaneously produce a targeted structure or configuration as a unique ground state, to investigate the spin-spin interaction potentials required to stabilize disordered stealthy hyperuniform one-dimensional (1D) Ising-like spin chains. By performing an exhaustive search over the spin configurations that can be enumerated on periodic 1D integer lattices containing $N=2,3,\ldots,36$ sites, we were able to identify and structurally characterize \textit{all} stealthy hyperuniform spin chains in this range of system sizes. Within this pool of stealthy hyperuniform spin configurations, we then utilized such inverse optimization techniques to demonstrate that stealthy hyperuniform spin chains can be realized as either unique or degenerate disordered ground states of radial long-ranged (relative to the spin chain length) spin-spin interactions. Such exotic ground states are distinctly different from spin glasses in both their inherent structural properties and the nature of the spin-spin interactions required to stabilize them. As such, the implications and significance of the existence of such disordered stealthy hyperuniform ground state spin systems warrants further study, including whether their bulk physical properties and excited states, like their many-particle system counterparts, are singularly remarkable, and can be experimentally realized.Comment: 11 pages, 9 figure

Optical study of the anisotropic erbium spin flip-flop dynamics

We investigate the erbium flip-flop dynamics as a limiting factor of the electron spin lifetime and more generally as an indirect source of decoherence in rare-earth doped insulators. Despite the random isotropic arrangement of dopants in the host crystal, the dipolar interaction strongly depends on the magnetic field orientation following the strong anisotropy of the $g$-factor. In Er$^{3+}$:Y$_2$SiO$_5$, we observe by transient optical spectroscopy a three orders of magnitude variation of the erbium flip-flop rate (10ppm dopant concentration). The measurements in two different samples, with 10ppm and 50ppm concentrations, are well-supported by our analytic modeling of the dipolar coupling between identical spins with an anisotropic $g$-tensor. The model can be applied to other rare-earth doped materials. We extrapolate the calculation to Er$^{3+}$:CaWO$_4$, Er$^{3+}$:LiNbO$_3$ and Nd$^{3+}$:Y$_2$SiO$_5$ at different concentrations

Electronic Properties of Molecules and Surfaces with a Self\uad-Consistent Interatomic van der Waals Density Functional.

How strong is the effect of van der Waals (vdW) interactions on the electronic properties of molecules and extended systems? To answer this question, we derived a fully self-consistent implementation of the density-dependent interatomic vdW functional of Tkatchenko and Scheffler [Phys. Rev. Lett. 102, 073005 (2009)]. Not surprisingly, vdW self-consistency leads to tiny modifications of the structure, stability, and electronic properties of molecular dimers and crystals. However, unexpectedly large effects were found in the binding energies, distances, and electrostatic moments of highly polarizable alkali-metal dimers. Most importantly, vdW interactions induced complex and sizable electronic charge redistribution in the vicinity of metallic surfaces and at organic-metal interfaces. As a result, a substantial influence on the computed work functions was found, revealing a nontrivial connection between electrostatics and long-range electron correlation effects

Hybrid Superconductor-Quantum Point Contact Devices using InSb Nanowires

Proposals for studying topological superconductivity and Majorana bound states in nanowires proximity coupled to superconductors require that transport in the nanowire is ballistic. Previous work on hybrid nanowire-superconductor systems has shown evidence for Majorana bound states, but these experiments were also marked by disorder, which disrupts ballistic transport. In this letter, we demonstrate ballistic transport in InSb nanowires interfaced directly with superconducting Al by observing quantized conductance at zero-magnetic field. Additionally, we demonstrate that the nanowire is proximity coupled to the superconducting contacts by observing Andreev reflection. These results are important steps for robustly establishing topological superconductivity in InSb nanowires