Simulated patients' experiences and perspectives of an interprofessional ward simulation: an exploratory qualitative analysis.

Background: Interprofessional simulation-based education (IPSE) prepares healthcare students for future collaborative practice. Whilst experiences of IPSE have previously been reported by students and faculty, there is a limited understanding of simulated patients' (SPs) experience. Purpose: This study explored SPs' perceptions of the quality of an interprofessional ward simulation (IPWS); experiences of the interprofessional care (IPC) they received, and their perceptions of effective IPC. Method: Undergraduate nursing, medical and pharmacy students participated in an IPWS. Focus groups were used to collect data from 27 SPs following their participation in the IPWS. Discussion: IPC was perceived to vary between groups of students. Recognition of roles, responsibilities and boundaries to prevent overlap of workload and improve efficiency of teamwork were perceived as important for making IPC effective. Findings suggested that SPs may not be fully aware of the changing scope of practice in healthcare. SPs reported that they would have liked more involvement in the creation of their role and how this played out in the simulation. Conclusion: SPs' play an important role in IPSE in healthcare education and recognise that understanding roles and responsibilities contributes to effective IPC. An additional finding of this study was that the public may not be aware of the changing scope of professional practice

Impact of Analog and Digital Pre-emphasis on the Signal-to-Noise Ratio of Bandwidth-limited Optical Transceivers

The ever-growing machine-to-machine traffic in data centers has stimulated the increase of transceiver data rate from 25Gb/s/λ to 100Gb/s/λ and beyond. It is believed that advanced modulation formats and digital-to-analog converters (DACs) will be employed in next generation short-reach transceivers. Digital pre-emphasis techniques are widely employed in DAC-based transceivers to compensate for the high frequency roll-off due to the RF and optoelectronics components in optical transceivers. However, digital pre-emphasis essentially reduces the magnitude of the signal low frequency components for a flat frequency response, which unavoidably increases quantization error, reducing the overall signal-to-noise ratio. This trade-off between SNR and bandwidth conflicts with the high SNR requirement of advanced modulation formats such as the Nyquist-shaped pulse amplitude modulation (PAM). To mitigate the quantization error induced SNR degradation, we show that analog pre-emphasis filters can be used in conjunction with digital pre-emphasis for improved system performance. To understand the impact of the analog pre-emphasis filter on system performance, we analyze the relationship between the flatness of the system frequency response and the SNR degradation due to digital pre-emphasis, and demonstrate 1.1-dB increase of receiver sensitivities, for both 64-Gb/s and 128-Gb/s intensity-modulation direct detection (IM-DD) 20 PAM4 signals, respectively employing a directly modulated laser (DML) and an electroabsorption modulator (EAM)

Improving adherence to medication in stroke survivors (IAMSS): a randomised controlled trial: study protocol

Background: Adherence to therapies is a primary determinant of treatment success, yet the World Health Organisation estimate that only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. In a previous project, we found that 30% of stroke patients reported sub-optimal medication adherence, and this was associated with younger age, greater cognitive impairment, lower perceptions of medication benefits and higher specific concerns about medication. We now wish to pilot a brief intervention aimed at (a) helping patients establish a better medication-taking routine, and (b) eliciting and modifying any erroneous beliefs regarding their medication and their stroke. Methods/Design: Thirty patients will be allocated to a brief intervention (2 sessions) and 30 to treatment as usual. The primary outcome will be adherence measured over 3 months using Medication Event Monitoring System (MEMS) pill containers which electronically record openings. Secondary outcomes will include self reported adherence and blood pressure. Discussion: This study shall also assess uptake/attrition, feasibility, ease of understanding and acceptability of this complex intervention. Trial Registration: Current Controlled Trials ISRCTN3827495

Advances in small lasers

M.T.H was supported by an Australian Research council Future Fellowship research grant for this work. M.C.G. is grateful to the Scottish Funding Council (via SUPA) for financial support.Small lasers have dimensions or modes sizes close to or smaller than the wavelength of emitted light. In recent years there has been significant progress towards reducing the size and improving the characteristics of these devices. This work has been led primarily by the innovative use of new materials and cavity designs. This Review summarizes some of the latest developments, particularly in metallic and plasmonic lasers, improvements in small dielectric lasers, and the emerging area of small bio-compatible or bio-derived lasers. We examine the different approaches employed to reduce size and how they result in significant differences in the final device, particularly between metal- and dielectric-cavity lasers. We also present potential applications for the various forms of small lasers, and indicate where further developments are required.PostprintPeer reviewe

Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Oligoasthenoteratozoospermia and Infertility in Mice Deficient for miR-34b/c and miR-449 Loci

Male fertility requires the continuous production of high quality motile spermatozoa in abundance. Alterations in all three metrics cause oligoasthenoteratozoospermia, the leading cause of human sub/infertility. Post-mitotic spermatogenesis inclusive of several meiotic stages and spermiogenesis (terminal spermatozoa differentiation) are transcriptionally inert, indicating the potential importance for the post-transcriptional microRNA (miRNA) gene-silencing pathway therein. We found the expression of miRNA generating enzyme Dicer within spermatogenesis peaks in meiosis with critical functions in spermatogenesis. In an expression screen we identified two miRNA loci of the miR-34 family (miR-34b/c and miR-449) that are specifically and highly expressed in post-mitotic male germ cells. A reduction in several miRNAs inclusive of miR-34b/c in spermatozoa has been causally associated with reduced fertility in humans. We found that deletion of both miR34b/c and miR-449 loci resulted in oligoasthenoteratozoospermia in mice. MiR-34bc/449-deficiency impairs both meiosis and the final stages of spermatozoa maturation. Analysis of miR-34bc-/-;449-/- pachytene spermatocytes revealed a small cohort of genes deregulated that were highly enriched for miR-34 family target genes. Our results identify the miR-34 family as the first functionally important miRNAs for spermatogenesis whose deregulation is causal to oligoasthenoteratozoospermia and infertility