A GaAs-based self-aligned stripe distributed feedback laser

We demonstrate operation of a GaAs-based self-aligned stripe (SAS) distributed feedback (DFB) laser. In this structure, a first order GaInP/GaAs index-coupled DFB grating is built within the p-doped AlGaAs layer between the active region and the n-doped GaInP opto-electronic confinement layer of a SAS laser structure. In this process no Al-containing layers are exposed to atmosphere prior to overgrowth. The use of AlGaAs cladding affords the luxury of full flexibility in upper cladding design, which proved necessary due to limitations imposed by the grating infill and overgrowth with the GaInP current block layer. Resultant devices exhibit single-mode lasing with high side-mode-suppression of >40 dB over the temperature range 20 °C–70 °C. The experimentally determined optical profile and grating confinement correlate well with those simulated using Fimmwave

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

Narrow Linewidth 780 nm Distributed Feedback Lasers for Cold Atom Quantum Technology

Cold atom quantum technology systems have a wide range of potential applications which includes atomic clocks, rotational sensors, inertial sensors, quantum navigators, magnetometers and gravimeters. The UK Quantum Technology Hub in Sensors and Metrology has the aim of developing miniature cold atom systems using an approach similar to that pioneered by the chip scale atomic clock where microfabricated vacuum chambers have atomic transitions excited and probed by lasers. Whilst narrow linewidth Ti:Sa and external cavity diode lasers have been required for cooling and control, such lasers are too large, power hungry and expensive for future miniature cold atom systems. Here we demonstrate 1 mm long 780.24 nm GaAs/AlGaAs distributed feedback (DFB) lasers aimed at 87Rb cold atom systems operating at 20 ˚C with over 50 mW of power and side-mode suppression ratios of 46 dB using sidewall gratings and no regrowth. Rb spectroscopy is used to demonstrate linewidths below the required 6.07 MHz natural linewidth of the 87Rb D2 optical transition used for cooling. Initial packaged fibre-coupled devices demonstrate lifetimes greater than 200 hours. We also investigate the use of integrated semiconductor amplifiers (SOAs) and longer devices to further reduce the linewidths well below 1 MHz. A range of options to control the populations of electrons in the hyperfine split energy levels spaced by 3.417 GHz are examined. Two integrated lasers, integrated electro-absorption modulators (EAMs) and the direct modulation of a single DFB laser approaches are investigated and we will discuss which is best suited to integrated cold atom systems

SiGe p-channel MOSFETs with tungsten gate

A self-aligned SiGe p-channel MOSFET tungsten gate process with 0.1 μm resolution is demonstrated. Interface charge densities of MOS capacitors realised with the low pressure sputtered tungsten process are comparable with thermally evaporated aluminium gate technologies (5×1010cm-2 and 2×1011 cm -2 for W and Al, respectively). Initial results from 1 μm gate length SiGe p-channel MOSFETs using the tungsten-based process show devices with a transconductance of 33 mS/mm and effective channel mobility of 190 cm

Heparin-stabilised iron oxide for MR applications: a relaxometric study

Superparamagnetic nanoparticles have strong potential in biomedicine and have seen application as clinical magnetic resonance imaging (MRI) contrast agents, though their popularity has plummeted in recent years, due to low efficacy and safety concerns, including haemagglutination. Using an in situ procedure, we have prepared colloids of magnetite nanoparticles, exploiting the clinically approved anti-coagulant, heparin, as a templating stabiliser. These colloids, stable over several days, produce exceptionally strong MRI contrast capabilities particularly at low fields, as demonstrated by relaxometric investigations using nuclear magnetic resonance dispersion (NMRD) techniques and single field r1 and r2 relaxation measurements. This behaviour is due to interparticle interactions, enhanced by the templating effect of heparin, resulting in strong magnetic anisotropic behaviour which closely maps particle size. The nanocomposites have also reliably prevented protein-adsorption triggered thrombosis typical of non-stabilised nanoparticles, showing great potential for in vivo MRI diagnostics

High-Q Si3N4 Ring Resonators for Locking 780nm GaAs-Based Distributed Feedback Laser

High-Q microring resonators have applications in gyroscopes, frequency comb generation, and feedback systems to control narrow linewidth integrated lasers [1–3]. This paper demonstrates the highest Q values measured for microring resonators at 780 nm wavelength. These sub mm integrated cavities can be used to provide an error signal for locking a distributed feedback laser (DFB), Fig. 1(a), using the Pound-Drever-Hall (PDH) method. High stability DFBs can also be achieved using a micro-electro-mechanical system (MEMS) cell containing 87 Rb vapour and taking advantage of the absorption line at 780.24 nm. This provides an absolute reference for locking the laser but only to the 87 Rb transition wavelengths. The microring resonator can be tailor made for any wavelength but is susceptible to thermal effects; this could in part be overcome using a top cladding with a thermo-optic coefficient that counteracts that of the waveguide core

Factors that influence clinicians’ decisions to offer intravenous alteplase in acute ischemic stroke patients with uncertain treatment indication:Results of a discrete choice experiment

Background: Treatment with intravenous alteplase for eligible patients with acute ischemic stroke is underused, with variation in treatment rates across the UK. This study sought to elucidate factors influencing variation in clinicians’ decision-making about this thrombolytic treatment. Methods: A discrete choice experiment using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results: A total of 138 clinicians completed the discrete choice experiment. Seven patient factors were individually predictive of increased likelihood of immediately offering IV alteplase (compared to reference levels in brackets): stroke onset time 2 h 30 min [50 min]; pre-stroke dependency mRS 3 [mRS 4]; systolic blood pressure 185 mm/Hg [140 mm/Hg]; stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 [NIHSS 2 without aphasia]; age 85 [68]; Afro-Caribbean [white]. Factors predictive of withholding treatment with IV alteplase were: age 95 [68]; stroke onset time of 4 h 15 min [50 min]; severe dementia [no memory problems]; SBP 200 mm/Hg [140 mm/Hg]. Three clinician-related factors were predictive of an increased likelihood of offering IV alteplase (perceived robustness of the evidence for IV alteplase; thrombolyzing more patients in the past 12 months; and high discomfort with uncertainty) and one with a decreased likelihood (high clinician comfort with treating patients outside the licensing criteria). Conclusions: Both patient- and clinician-related factors have a major influence on the use of alteplase to treat patients with acute ischemic stroke. Clinicians’ views of the evidence, comfort with uncertainty and treating patients outside the license criteria are important factors to address in programs that seek to reduce variation in care quality regarding treatment with IV alteplase. Further research is needed to further understand the differences in clinical decision-making about treating patients with acute ischemic stroke with IV alteplase

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

Background: This study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient's mouth). Methods: A multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models. Results: A total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p Conclusions: Although a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

Peer reviewedPublisher PD

Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial

Objective To determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care. Design Economic evaluation within a randomised controlled trial. Setting Four National Health Service (NHS) centres in the UK: Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust; Northwick Park Hospital, London Northwest Healthcare NHS Trust; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; and North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust. Participants 770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke. Interventions Participants randomised to one of three programmes provided over a 12-week period: robot-assisted training plus usual care; the EULT programme plus usual care or usual care. Main economic outcome measures Mean healthcare resource use; costs to the NHS and personal social services in 2018 pounds; utility scores based on EQ-5D-5L responses and quality-adjusted life years (QALYs). Cost-effectiveness reported as incremental cost per QALY and cost-effectiveness acceptability curves. Results At 6 months, on average usual care was the least costly option (£3785) followed by EULT (£4451) with robot-assisted training being the most costly (£5387). The mean difference in total costs between the usual care and robot-assisted training groups (£1601) was statistically significant (p<0.001). Mean QALYs were highest for the EULT group (0.23) but no evidence of a difference (p=0.995) was observed between the robot-assisted training (0.21) and usual care groups (0.21). The incremental cost per QALY at 6 months for participants randomised to EULT compared with usual care was £74 100. Cost-effectiveness acceptability curves showed that robot-assisted training was unlikely to be cost-effective and that EULT had a 19% chance of being cost-effective at the £20 000 willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis. Conclusions The cost-effectiveness analysis suggested that neither robot-assisted training nor EULT, as delivered in this trial, were likely to be cost-effective at any of the cost per QALY thresholds considered