Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

Fermion absorption cross section of a Schwarzschild black hole

We study the absorption of massive spin-half particles by a small Schwarzschild black hole by numerically solving the single-particle Dirac equation in Painleve-Gullstrand coordinates. We calculate the absorption cross section for a range of gravitational couplings Mm/m_P^2 and incident particle energies E. At high couplings, where the Schwarzschild radius R_S is much greater than the wavelength lambda, we find that the cross section approaches the classical result for a point particle. At intermediate couplings we find oscillations around the classical limit whose precise form depends on the particle mass. These oscillations give quantum violations of the equivalence principle. At high energies the cross section converges on the geometric-optics value of 27 \pi R_S^2/4, and at low energies we find agreement with an approximation derived by Unruh. When the hole is much smaller than the particle wavelength we confirm that the minimum possible cross section approaches \pi R_S^2/2.Comment: 11 pages, 3 figure

Electromagnetic Simulation and Design of a Novel Waveguide RF Wien Filter for Electric Dipole Moment Measurements of Protons and Deuterons

The conventional Wien filter is a device with orthogonal static magnetic and electric fields, often used for velocity separation of charged particles. Here we describe the electromagnetic design calculations for a novel waveguide RF Wien filter that will be employed to solely manipulate the spins of protons or deuterons at frequencies of about 0.1 to 2 MHz at the COoler SYnchrotron COSY at J\"ulich. The device will be used in a future experiment that aims at measuring the proton and deuteron electric dipole moments, which are expected to be very small. Their determination, however, would have a huge impact on our understanding of the universe.Comment: 10 pages, 10 figures, 4 table

The devil's in the detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes

professionals, NHS staff, service users, citizens, academics and evaluation scholars. It should be read in conjunction with our Year 1 reports on the SCR programme (May 2008) 1 and data quality (May 2008). 2 2. The SCR is an electronic summary of key health data, currently drawn from a patient’s GP-held electronic record and accessible over a secure Internet connection by authorised healthcare staff. It is one of a suite of innovations being introduced as part of the National Programme for IT in the English National Health Service (NHS) and delivered via a central ‘Spine’. Policy documents published in 2005-8 anticipated a number of benefits of the SCR, including: 3-6 a. Better care (i.e. the SCR would improve clinical decision-making); b. Safer care (i.e. the SCR would reduce risk of harm, especially medication errors); c. More efficient care (e.g. the SCR would make consultations quicker); d. More equitable care (i.e. the SCR would be particularly useful in patients unable to communicate or advocate for themselves); e. Reduction in onward referral (e.g. the SCR would avoid unnecessary ambulanc

Highly Efficient F, Cu Doped TiO2 Anti-bacterial Visible Light Active Photocatalytic Coatings to Combat Hospital-Acquired Infections

Bacterial infections are a major threat to the health of patients in healthcare facilities including hospitals. One of the major causes of patient morbidity is infection with Staphylococcus aureus. One of the the most dominant nosocomial bacteria, Methicillin Resistant Staphylococcus aureus (MRSA) have been reported to survive on hospital surfaces (e.g. privacy window glasses) for up to 5 months. None of the current anti-bacterial technology is efficient in eliminating Staphylococcus aureus. A novel transparent, immobilised and superhydrophilic coating of titanium dioxide, co-doped with fluorine and copper has been prepared on float glass substrates. Antibacterial activity has demonstrated (by using Staphylococcus aureus), resulting from a combination of visible light activated (VLA) photocatalysis and copper ion toxicity. Co-doping with copper and fluorine has been shown to improve the performance of the coating, relative to a purely fluorine-doped VLA photocatalyst. Reductions in bacterial population of log10 = 4.2 under visible light irradiation and log10 = 1.8 in darkness have been achieved, compared with log10 = 1.8 under visible light irradiation and no activity, for a purely fluorine-doped titania. Generation of reactive oxygen species from the photocatalytic coatings is the major factor that significantly reduces the bacterial growth on the glass surfaces

Implementation of standard testbeds for numerical relativity

We discuss results that have been obtained from the implementation of the initial round of testbeds for numerical relativity which was proposed in the first paper of the Apples with Apples Alliance. We present benchmark results for various codes which provide templates for analyzing the testbeds and to draw conclusions about various features of the codes. This allows us to sharpen the initial test specifications, design a new test and add theoretical insight.Comment: Corrected versio

The Day-to-Day Co-Production of Ageing in Place.

We report findings from a study that set out to explore the experience of older people living with assisted living technologies and care services. We find that successful 'ageing in place' is socially and collaboratively accomplished - 'co-produced' - day-to-day by the efforts of older people, and their formal and informal networks of carers (e.g. family, friends, neighbours). First, we reveal how 'bricolage' allows care recipients and family members to customise assisted living technologies to individual needs. We argue that making customisation easier through better design must be part of making assisted living technologies 'work'. Second, we draw attention to the importance of formal and informal carers establishing and maintaining mutual awareness of the older person's circumstances day-to-day so they can act in a concerted and coordinated way when problems arise. Unfortunately, neither the design of most current assisted living technologies, nor the ways care services are typically configured, acknowledges these realities of ageing in place. We conclude that rather than more 'advanced' technologies, the success of ageing in place programmes will depend on effortful alignments in the technical, organisational and social configuration of support

Telecare call centre work and ageing in place

© 2016, The Author(s).We report findings from a study of call centre staff working to deliver a telecare service designed to enable older people to ‘age in place’. We show the steps they routinely take to produce a care system on behalf of their clients and their families that is both workable within the constraints of available resources and fit-for-purpose. In doing so, we have seen how call centre staff share with one another their experiences and solutions to problems, carry out liaison work with networks of lay carers, and generally act as the ‘glue’ providing the all-important link between otherwise fragmented services. We conclude with some thoughts on the significant technical and organizational challenges if the ‘ageing in place’ vision is to be realized in a practical, secure, dependable and cost-effective way

Implementation of higher-order absorbing boundary conditions for the Einstein equations

We present an implementation of absorbing boundary conditions for the Einstein equations based on the recent work of Buchman and Sarbach. In this paper, we assume that spacetime may be linearized about Minkowski space close to the outer boundary, which is taken to be a coordinate sphere. We reformulate the boundary conditions as conditions on the gauge-invariant Regge-Wheeler-Zerilli scalars. Higher-order radial derivatives are eliminated by rewriting the boundary conditions as a system of ODEs for a set of auxiliary variables intrinsic to the boundary. From these we construct boundary data for a set of well-posed constraint-preserving boundary conditions for the Einstein equations in a first-order generalized harmonic formulation. This construction has direct applications to outer boundary conditions in simulations of isolated systems (e.g., binary black holes) as well as to the problem of Cauchy-perturbative matching. As a test problem for our numerical implementation, we consider linearized multipolar gravitational waves in TT gauge, with angular momentum numbers l=2 (Teukolsky waves), 3 and 4. We demonstrate that the perfectly absorbing boundary condition B_L of order L=l yields no spurious reflections to linear order in perturbation theory. This is in contrast to the lower-order absorbing boundary conditions B_L with L<l, which include the widely used freezing-Psi_0 boundary condition that imposes the vanishing of the Newman-Penrose scalar Psi_0.Comment: 25 pages, 9 figures. Minor clarifications. Final version to appear in Class. Quantum Grav

n-type chalcogenides by ion implantation.

Carrier-type reversal to enable the formation of semiconductor p-n junctions is a prerequisite for many electronic applications. Chalcogenide glasses are p-type semiconductors and their applications have been limited by the extraordinary difficulty in obtaining n-type conductivity. The ability to form chalcogenide glass p-n junctions could improve the performance of phase-change memory and thermoelectric devices and allow the direct electronic control of nonlinear optical devices. Previously, carrier-type reversal has been restricted to the GeCh (Ch=S, Se, Te) family of glasses, with very high Bi or Pb 'doping' concentrations (~5-11 at.%), incorporated during high-temperature glass melting. Here we report the first n-type doping of chalcogenide glasses by ion implantation of Bi into GeTe and GaLaSO amorphous films, demonstrating rectification and photocurrent in a Bi-implanted GaLaSO device. The electrical doping effect of Bi is observed at a 100 times lower concentration than for Bi melt-doped GeCh glasses.This work was supported by the UK EPSRC grants EP/I018417/1, EP/I019065/1 and EP/I018050/1.This is the author accepted manuscript. The final version is available from NPG via http://dx.doi.org/10.1038/ncomms634