Miniaturized Circular-Waveguide Probe Antennas Using Metamaterial Liners

This work presents the radiation performance of open-ended circular-waveguide probe antennas that have been miniaturized by the introduction of thin metamaterial liners. The liners introduce an HE$_{11}$ mode well below the natural cutoff frequency, which provides substantial gain improvements over a similarly sized waveguide probe. A new feeding arrangement employing a shielded-loop source embedded inside the miniaturized waveguide is developed to efficiently excite the HE$_{11}$ mode and avoid the excitation of other modes across the frequency reduced band while maintaining the antenna's compactness. A metamaterial-lined circular-waveguide probe antenna operating over 42% below its natural cutoff frequency is designed to provide a radiation efficiency of up to 28.8%. A simple, printed-circuit implementation of the metamaterial liner based on inductively loaded wires is proposed and its dispersion features are discussed.Comment: The manuscript has been revised for publication as a 6 page communication in the IEEE Transactions on Antennas and Propagation. This included a reduction of material in the theory section, removal of all discussion on anisotropic theory, and introduction of a novel excitation sourc

Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains.

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability

Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England.

Background: Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service. Methods: Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework. Results: Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of ‘normalisation’. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns. Conclusions: The co-produced digital educational intervention increases pharmacy professionals’ awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients’ health and medicines management could be substantial if supported and promoted effectively

Supporting underserved patients with their medicines: a study protocol for a patient/professional coproduced education intervention for community pharmacy staff to improve the provision and delivery of Medicine Use Reviews (MURs)

Introduction Community pharmacy increasingly features in global strategies to modernise the delivery of primary healthcare. Medicine Use Reviews (MURs) form part of the English Government's medicines management strategy to improve adherence and reduce medicine waste. MURs provide space for patient–pharmacist dialogue to discuss the well-known problems patients experience with medicine taking. However, ‘underserved’ communities (eg, black and minority ethnic communities, people with mental illness), who may benefit the most, may not receive this support. This study aims to develop, implement and evaluate an e-learning education intervention which is coproduced between patients from underserved communities and pharmacy teams to improve MUR provision. Methods and analysis This mixed-methods evaluative study will involve a 2-stage design. Stage 1 involves coproduction of an e-learning resource through mixed patient–professional development (n=2) and review (n=2) workshops, alongside informative semistructured interviews with patients (n=10) and pharmacy staff (n=10). Stage 2 involves the implementation and evaluation of the intervention with community pharmacy staff within all community pharmacies within the Nottinghamshire geographical area (n=237). Online questionnaires will be completed at baseline and postintervention (3 months) to assess changes in engagement with underserved communities and changes in self-reported attitudes and behaviour. To triangulate findings, 10 pharmacies will record at baseline and postintervention, details of actual numbers of MURs performed and the proportion that are from underserved communities. Descriptive and inferential statistics will be used to analyse the data. The evaluation will also include a thematic analysis of one-to-one interviews with pharmacy teams to explore the impact on clinical practice (n=20). Interviews with patients belonging to underserved communities, and who received an MUR, will also be conducted (n=20). Ethics and dissemination The study has received ethical approval from the NHS Research Ethics Committee (East Midlands–Derby) and governance clearance through the NHS Health Research Authority. Following the evaluation, the educational intervention will be freely accessible online

Quantum plasticity and dislocation-induced supersolidity

We suggest that below a certain temperature T_k, the free energy for the creation of kinks-antikinks pairs in the dislocation network of solid He4 becomes negative. The underlying physical mechanism is the related liberation of vacancies which initiate Feynman's permutation cycles in the bulk. Consequently, dislocations should wander and sweep an increasingly larger volume at low temperatures. This phenomenon should lead both to a stiffening of the solid below T_k and to the appearance of a non zero superfluid fraction at a second temperature T_c < T_k.Comment: Longer revised version with more detailed discussion, submitted to EPJ

Mechanisms of action and outcomes for students in Recovery Colleges

Objective\ud Recovery Colleges are widespread, with little empirical research on how they work and outcomes they produce. This study aimed to co-produce a change model characterising mechanisms of action and outcomes for mental health service users attending as students at a Recovery College.\ud Methods\ud A systematised review identified all Recovery College publications. Inductive collaborative data analysis by academic researchers and co-researchers with lived experience of ten key papers informed a theoretical framework for mechanisms and outcome for students, which was refined through deductive analysis of 34 further publications. A change model was co-produced and then refined through stakeholder interviews (n=33).\ud Results\ud Three mechanisms of action for Recovery College students were identified: empowering environment (safety, respect, supporting choices), enabling different relationships (power, peers, working together) and facilitating personal growth (e.g. co-produced learning, strengths, celebrating success). Outcomes were change in the student (e.g. self-understanding, self-confidence) and changes in the student’s life (e.g. occupational, social, service use). A co-produced change model mapping mechanisms of action to outcomes was created.\ud Conclusions\ud The key features identified as differentiating Recovery Colleges from traditional services are an empowering environment, enabling relationships and growth orientation. Recovery Colleges may benefit most attenders, but mental health service users to particularly encourage to enrol may include those who lack confidence, those who services struggle to engage with, those who will benefit from exposure to peer role models, and those lacking social capital. The change model provides the first testable characterisation of mechanisms and outcomes, allowing formal evaluation of Recovery Colleges

Managing medicines at the end of life: a position paper for health policy and practice

Purpose: The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care. Design/methodology/approach: Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities. Findings: Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered. Originality/value: The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery

Deformation mechanisms and defect structures in Heusler intermetallic MnCu2_2 Al

Intermetallics with crystals derived from body-centered cubic structures are promising materials to enhance the performance and high temperature capability of high-strength alloys both as matrix materials and as strengthening precipitates. Given the ordered nature of these materials, the defect structures that ultimately mediate plasticity can be complex and strongly dependent on processing vis-à-vis the extent of disorder inherited from high temperature phases. Here, we elucidate the elementary characteristics of the defect structures in the Heusler (L2$_1$) intermetallic MnCu$_2$Al as investigated by the orientation-dependent strength and compressive plasticity measured from in situ micro-compression experiments and post-mortem transmission electron microscopy. Our experiments reveal single crystal compressive yield strengths as high as 1.2 GPa and a capacity for stable plastic deformation, accompanied by slip characteristics reminiscent of bcc-derived crystals