Mainstreaming quality and safety: a reformulation of quality and safety education for health professions students

The urgent need to expand the ability of health professionals to improve the quality and safety of patient care in the USA has been well documented. Yet the current methods of teaching quality and safety to health professionals are inadequate for the task. To the extent that quality and safety are addressed at all, they are taught using pedagogies with a narrow focus on content transmission, didactic sessions that are spatially and temporally distant from clinical work, and quality and safety projects segregated from the provision of actual patient care. In this article an argument for a transformative reorientation in quality and safety education for health professions is made. This transformation will require new pedagogies in which a) quality improvement is an integral part of all clinical encounters, b) health professions students and their clinical teachers become co-learners working together to improve patient outcomes and systems of care, c) improvement work is envisioned as the interdependent collaboration of a set of professionals with different backgrounds and perspectives skilfully optimising their work processes for the benefit of patients, and d) assessment in health professions education focuses on not just individual performance but also how the care team's patients fared and how the systems of care were improved

Modeling of light-sensitive resonant-tunneling-diode devices

We present a method to include the effects of light excitation on two different models of resonant-tunneling-diode-based devices. Our approach takes into account both photoconductive and charge accumulation effects responsible for shifting the static I –V curve when the structure is under light excitation. Computational simulations led to good agreement between the model and experimental result

Challenging the orthodoxy: union learning representatives as organic intellectuals

Teacher education and continuing professional development have become a key areas of controversy in England since the period of school sector restructuring following the 1988 Education Reform Act. More recently teacher training and professional development have often been used to promote and reinforce a narrow focus on the government’s ‘standards agenda’. However, the emerging discourse of ‘new professionalism’ has raised the profile of professional development in schools, and together with union learning representatives, there are opportunities to secure real improvements in teachers’ access to continuing professional development. This paper argues however that union learning representatives must go beyond advocating for better access to professional development and should raise more fundamental questions about the nature of professional development and the education system it serves. Drawing on Gramsci’s notion of the ‘organic intellectual’, the paper argues that union learning representatives have a key role as organisers of ideas – creating spaces in which the ideological dominance of current policy orthodoxy might be challenged

Optical modulation in a resonant tunneling relaxation oscillator

We report high-speed optical modulation in a resonant tunneling relaxation oscillator consisting of a resonant tunneling diode (RTD) integrated with a unipolar optical waveguide and incorporated in a package with a coplanar waveguide transmission line. When appropriately biased, the RTD can provide wide-bandwidth electrical gain. For wavelengths near the material band edge, small changes of the applied voltage give rise to large, high-speed electroabsorption modulation of the light. We have observed optical modulation at frequencies up to 14 GHz, associated with subharmonic injection locking of the RTD oscillation at the fundamental mode of the coplanar transmission line, as well as generation of 33 ps optical pulses due to relaxation oscillation

Optical modulation at around 1550 nm in an InGaAlAs optical waveguide containing an InGaAs/AlAs resonant tunneling diode

We report electroabsorption modulation of light at around 1550 nm in a unipolar InGaAlAs optical waveguide containing an InGaAs/AlAs double-barrier resonant tunneling diode ~RTD!. The RTD peak-to-valley transition increases the electric field across the waveguide, which shifts the core material absorption band edge to longer wavelengths via the Franz–Keldysh effect, thus changing the light-guiding characteristics of the waveguide. Low-frequency characterization of a device shows modulation up to 28 dB at 1565 nm. When dc biased close to the negative differential conductance region, the RTD optical waveguide behaves as an electroabsorption modulator integrated with a wide bandwidth electrical amplifier, offering a potential advantage over conventional pn modulators

Investigation of spectrally broad gain multiple-width quantum well material for colliding pulse mode-locked operation

Abstract: The first colliding pulse mode-locked operation of devices fabricated from broad gain spectrum multiple-width quantum well material is reported. Using multiple-width quantum wells in the active region of the InGaAs/InAlGaAs material system, 35% broader gain bandwidth has been obtained in comparison to the conventional identical width quantum well material. For the colliding pulse mode-locked operation, observation made from the optical spectra showed that the multiplewidth quantum well laser provided one extra optical mode with the pulse width narrowing by 7% in comparison to the identical width quantum well laser

A surface-patterned chip as a strong source of ultracold atoms for quantum technologies

Laser-cooled atoms are central to modern precision measurements. They are also increasingly important as an enabling technology for experimental cavity quantum electrodynamics, quantum information processing and matter–wave interferometry. Although significant progress has been made in miniaturizing atomic metrological devices, these are limited in accuracy by their use of hot atomic ensembles and buffer gases. Advances have also been made in producing portable apparatus that benefits from the advantages of atoms in the microkelvin regime. However, simplifying atomic cooling and loading using microfabrication technology has proved difficult. In this Letter we address this problem, realizing an atom chip that enables the integration of laser cooling and trapping into a compact apparatus. Our source delivers ten thousand times more atoms than previous magneto-optical traps with microfabricated optics and, for the first time, can reach sub-Doppler temperatures. Moreover, the same chip design offers a simple way to form stable optical lattices. These features, combined with simplicity of fabrication and ease of operation, make these new traps a key advance in the development of cold-atom technology for high-accuracy, portable measurement devices

PRNP variation in UK sporadic and variant Creutzfeldt Jakob disease highlights genetic risk factors and a novel non-synonymous polymorphism

<p>Abstract</p> <p>Background</p> <p>Genetic analysis of the human prion protein gene (<it>PRNP</it>) in suspect cases of Creutzfeldt-Jakob disease (CJD) is necessary for accurate diagnosis and case classification. Previous publications on the genetic variation at the <it>PRNP </it>locus have highlighted the presence of numerous polymorphisms, in addition to the well recognised one at codon 129, with significant variability between geographically distinct populations. It is therefore of interest to consider their influence on susceptibility or the clinico-pathological disease phenotype. This study aimed to characterise the frequency and effect of <it>PRNP </it>open reading frame polymorphisms other than codon 129 in both disease and control samples sourced from the United Kingdom population.</p> <p>Methods</p> <p>DNA was extracted from blood samples and genetic data obtained by full sequence analysis of the prion protein gene or by restriction fragment length polymorphism analysis using restriction enzymes specific to the gene polymorphism under investigation.</p> <p>Results</p> <p>147 of 166 confirmed cases of variant CJD (vCJD) in the UK have had <it>PRNP </it>codon 129 genotyping and all are methionine homozygous at codon 129; 118 have had full <it>PRNP </it>gene sequencing. Of the latter, 5 cases have shown other polymorphic loci: at codon 219 (2, 1.69%), at codon 202 (2, 1.69%), and a 24 bp deletion in the octapeptide repeat region (1, 0.85%). E219K and D202D were not found in sporadic CJD (sCJD) cases and therefore may represent genetic risk factors for vCJD.</p> <p>Genetic analysis of 309 confirmed UK sCJD patients showed codon 129 genotype frequencies of MM: 59.5% (n = 184), MV: 21.4% (n = 66), and VV: 19.1% (n = 59). Thirteen (4.2%) had the A117A polymorphism, one of which also had the P68P polymorphism, four (1.3%) had a 24 bp deletion, and a single patient had a novel missense variation at codon 167. As the phenotype of this latter case is similar to sCJD and in the absence of a family history of CJD, it is unknown whether this is a form of genetic CJD, or simply a neutral polymorphism.</p> <p>Conclusions</p> <p>This analysis of <it>PRNP </it>genetic variation in UK CJD patients is the first to show a comprehensive comparison with healthy individuals (n = 970) from the same population, who were genotyped for the three most common variations (codon 129, codon 117, and 24 bp deletion). These latter two genetic variations were equally frequent in UK sCJD or vCJD cases and a normal (healthy blood donor) UK population.</p

Cathepsin D SNP associated with increased risk of variant Creutzfeldt-Jakob disease

<p>Abstract</p> <p>Background</p> <p>Variant Creutzfeldt-Jakob disease (vCJD) originally resulted from the consumption of foodstuffs contaminated by bovine spongiform encephalopathy (BSE) material, with 163 confirmed cases in the UK to date. Many thousands are likely to have been exposed to dietary infection and so it is important (for surveillance, epidemic modelling, public health and understanding pathogenesis) to identify genetic factors that may affect individual susceptibility to infection. This study looked at a polymorphism in the cathepsin D gene (refSNP ID: rs17571) previously examined in Alzheimer's disease (AD).</p> <p>Methods</p> <p>Blood samples taken from 110 vCJD patients were tested for the C-T base change, and genotype data were compared with published frequencies for a control population using multiple logistic regression.</p> <p>Results</p> <p>There was a significant excess of the cathepsin D polymorphism TT genotype in the vCJD cohort compared to controls. The TT genotype was found to have a 9.75 fold increase in risk of vCJD compared to the CT genotype and a 10.92 fold increase compared to the CC genotype.</p> <p>Conclusion</p> <p>This mutation event has been observed to alter the protease activity of the cathepsin D protein and has been linked to an increase in amyloid beta plaque formation in AD. vCJD neuropathology is characterised by the presence of amyloid plaques, formed from the prion protein, and therefore alterations in the amyloid processing activity of cathepsin D may affect the neuropathogenesis of this disease.</p