Requirements and access needs of patients with chronic disease to their hospital electronic health record: results of a cross-sectional questionnaire survey

Objectives: To identify patient’s views on the functionality required for personalised access to the secondary care EHR and their priorities for development. Design: Quantitative analysis of a cross-sectional self-complete survey of patient views on required EHR functionality from a secondary care EHR, including a patient ranking of functionality. Setting: Secondary care patients attending a regional cystic fibrosis unit in the north of England Participants: 201 adults [106 (52.7%) male], median age 29 years (range 17-58 years) entered and completed the study. Inclusion criteria; a confirmed diagnosis of CF, aged 16 years and over, at a time of clinical stability Outcome measures: Quantitative responses within 4 themes; 1) value placed on aspects of the EHR; 2) access requirements to functions of the EHR; 3) views on information sent to the EHR 4) patient feedback entered into the EHR. A ranked score for 15 functions of the EHR was obtained Results: Highest ratings (% reporting item as very important/important) were reported for access to clinical measures [lung function (94%), CRP (84%), sputum microbiology (81%) and blood results (80%)], medication changes (82%) and lists (83%) and sending repeat prescription (83%) and treatment requests (80%), whilst sending symptom diaries was less so (62%). Email contact with clinicians was the most valuable communication element of the EHR (84% very important/important). Of 15 features of the EHR [1=most desirable to 15=least desirable) patients identified ‘clinical measures’ [2.62 (CI 2.07-3.06)], and ‘access to medication lists’ [4.91 (CI 4.47-5.44)], as highest priority for development and the ability to comment on errors/ommissions [11.0 (CI 10.6-11.5)] or experience of care [11.8 (CI 11.4-12.2)] as lowest. Conclusions: Patients want extensive personal access to their hospital EHR, placing high importance on the viewing of practical clinical measures and medication management. These influence routine day to day care and are priorities for developmen

SPAD-Array Contention Signal and Noise Model Suitable for Multilevel Modulation Schemes with Signal Processing

The first signal model for a single photon avalanche diode (SPAD)-array communication receiver for multilevel modulation schemes is reported. This paper proposes a novel, generalised SPAD array signal and noise model for both digital and analogue, synchronous and asynchronous SPAD readout arrays, which includes the competition between the input photons, dark counts and after-pulsing counts. With this contention signal and noise model, multilevel signals including the signal variation after distortion or equalisation can be evaluated. Also, we report the first numerical investigation for SPAD-based, high data rate, free space, visible light communication using higher order pulse amplitude modulation (PAM) with matched filter, linear and non-linear Volterra post-equalization. Simulations have been carried out to analyze and compare the bit error rate (BER) performances under a variety of conditions. The model is verified by comparison with published experimental results.UK EPSRC via the TOWS project (EP/S016570/1

Single-lane > 100 Gb/s CAP-based data transmission over VCSEL-MMF links using low-complexity equalization

In this paper, we review recent work on the development of a novel low-complexity equalizer that can enable single-lane <100 Gb/s short-reach optical links based on carrierless amplitude and phase modulation. This equalizer, named the CAP equalizer, can mitigate the transmission impairments in the link due to a non-ideal channel frequency response, providing significant performance advantage over conventional FFE and DFE equalizers and enabling higher data rates and longer reach. Its use is demonstrated in a VCSEL-based MMF link achieving data transmission of 112 and 124 Gb/s over 100 m OM4 MMF

A new equalizer structure for high-speed optical links based on carrierless amplitude and phase modulation

© 2020 IEEE. Spectral efficient modulation formats can enable the transmission of higher data rates than conventional on-off keying (OOK). Carrierless amplitude and phase modulation (CAP) is such an attractive modulation scheme that has been widely considered for use in different types of optical links. The scheme however can suffer from intersymbol interference (ISI) and channel crosstalk (CCI) when the frequency response of the channel is not ideal. Conventional equalizers based on feedforward (FFE) and decision feedback (DFE) equalizers are easy to implement in practice and can mitigate some of the induced ISI. However, they fail to suppress the induced CCI in the link as each channel is equalized independently. As a result, we have recently proposed the use of a new equalizer structure for use in CAP-based optical links to mitigate these transmission impairments. This new equalizer, named CAP equalizer, can be formed with conventional FFEs and DFEs with minimal additional complexity whilst providing significant performance advantages. In this paper therefore, we review the equalizer structure and report recent demonstrations of its use in short-reach optical links. We present experimental studies on a 112 Gb/s CAP-16 VCSEL-based OM4 MMF link and a 4 Gb/s CAP-16 LED-based POF link and compare the performance of the links when both a conventional FFE and DFE equalizer and the newly proposed CAP equalizer are used. The results clearly demonstrate that the CAP equalizer offers improved receiver sensitivity and enables successful data transmission over longer fibre reaches.UK EPSRC via the UP-VLC (EP/K00042X/1) and TOWS (EP/S016570/1) project

A Novel Equalizer for 112 Gb/s CAP-Based Data Transmission over 150 m MMF Links

© 1983-2012 IEEE. In this paper a novel feedforward and decision feedback equalizer is proposed for the first time for use in short-reach high-speed communication links based on carrierless amplitude and phase (CAP) modulation. The proposed new equalizer mitigates crosstalk between the in-phase (I-) and quadrature (Q-) channels resulting from the non-linear phase response of the link enabling significant improvement in the link performance when operating at high data rates. The structure of this novel equalizer is introduced, its operation is described, and simulation and experimental studies on short-reach high-speed MMF links using 850 nm multimode VCSELs are presented. Data transmission tests are carried out over 150 m of OM4 MMF at 112 Gb/s using CAP modulation and the proposed CAP equalizer, and a bit-error-rate (BER) within the hard-decision forward error-correction (HD-FEC) threshold of 3.8 × 10-3 is achieved. The link is also tested when a conventional equalizer is used instead of the CAP equalizer and when adaptive discrete multitone (DMT) modulation is applied. The performance of the link is compared for these different transmission schemes and it is shown that the use of the novel equalizer and CAP modulation outperforms the other two schemes. The proposed equalizer can be implemented with low additional complexity, providing a potential cost-effective solution enabling >100 Gb/s single-lane data transmission in short-reach MMF-based links.UK EPSRC via the Terabit Bidirectional Multi-user Optical Wireless System project (TOWS) (EP/S016570/1)

High Performance 400 Gigabit Ethernet Links using Hybrid Multiband CAP/QAM Scheme

We propose the first combined 4×100Gb/s hybrid multiband CAP-16 transmitter and QAM-16 receiver system and simulations show that it has 0.7 dBo (2.2 dBo) more power margin than 8×50Gb/s (4×100Gb/s) PAM-4 over DML (EML) SMF link.This work was partly supported by the European Union under a Marie Curie Intra-European Fellowship for Career Development (CEEOALAN project) and by the UK EPSRC via the INTERNET project.This is the accepted manuscript. The final version is available at https://www.osapublishing.org/abstract.cfm?uri=OFC-2015-Th2A.65

Variation in lung function as a marker of adherence to oral and inhaled medication in cystic fibrosis

Study aim: The aim of this study was to characterise adherence in an adult population with CF and to investigate if variation in lung function was a predictor of adherence to treatment. Patients and methods: Patients aged ≥ 16 years from an adult CF centre undertook adherence measures by medication possession ratio (MPR) and self-report and were assigned to one of three adherence categories (<50%, 50-<80%, 80% and above) by their composite score (MPR). Ordinal regression was used to identify predictors of adherence including coefficient variation measures for forced expiratory volume in 1 second (FEV1), weight and C-reactive protein, measured up to 6 and 12 months. Results: MPR data for 106 of 249 patients [mean age 29.8 (±9.2) years] was retrieved, indicating a mean adherence of 63%. Coefficient of variation FEV1 was inversely related to adherence and was a univariate predictor of adherence (6 months: 0.92 [0.87-0.98] p= 0.005 and 12 months: 0.94 [0.93-0.99], p=0.03]) and remained significant in the final models. The coefficient variation of weight and C-reactive protein were not predictive of adherence. Conclusions: Coefficient of variation FEV1 was identified as an objective predictor of adherence. Further evaluation of this potential marker of adherence is now required