HEALTHWATCH INVESTIGATIONS: Developing good practice

Investigating issues and concerns raised by service users, carers, patients and the wider public and getting feedback, is core business for local Healthwatch. This is an extremely challenging role. Local Healthwatch are small organisations who are charged with influencing large organisations and local health systems. In order to be successful local Healthwatch have to provide an analysis of the experiences of the public in a way that is credible and understandable to large organisations who will have much greater analytical and professional expertise and who may feel (rightly or wrongly) that they have a better grasp on what the challenges are and ‘what needs to be done’ than a local Healthwatch! This report summarises some of the thinking and practice that has emerged from work that has been led by Health Together1 and involved Healthwatch Leeds, Healthwatch Wakefield and other local Healthwatch in West Yorkshire - Bradford, Calderdale and Kirklees - as well as a briefing session facilitated by Involve Yorkshire and Humber which was attended by a further six Yorkshire and Humber Healthwatch

Retrospective cohort follow-up study of individuals detained under Section 136.

Background: An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. Aims: To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. Method: Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. Results: After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. Conclusions: Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention. Declaration of interest: None. Copyright and usage: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license

Posterior cricoid region fluoroscopic findings: the posterior cricoid plication.

The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing studies performed between June 16, 2009, and February 9, 2010, were reviewed for features seen in the PC region. These findings were categorized into distinct patterns and compared to fluoroscopic studies performed in a cohort of normal volunteers. Two hundred patient studies and 149 healthy volunteer studies were reviewed. The mean age of the referred patient cohort and the volunteer cohort was 57 years (±19) and 61 years (±16), respectively (p > 0.05). The patient cohort was 53% male and the control cohort was 56% female (p > 0.05). Four groups were identified. Pharyngoesophageal webs were seen in 7% (10/149) of controls and 14% (28/200) of patients (p = 0.03). A PC arch impression was seen in 16% of patients (32/200) and controls (24/149) (p = 1). A PC plication was demonstrated in 23% (34/149) of controls and 30% (60/200) of patients (p = 0.13). No distinctive PC region findings were seen in 54% (81/149) of controls and 42% (84/200) of referred patients (p = 0.02). Four patients (2%) had both a web and a PC plication. Four categories of PC region findings were identified (unremarkable PC region, web, PC arch impression, and PC plication). Both patients referred for swallowing studies and healthy volunteers demonstrated esophageal webs, PC arch impressions, and PC plications. Only webs were more common in patients than in control subjects (p = 0.03). The PC impression and PC plication are likely to represent normal variants that may be identified on fluoroscopic swallow studies

Low-energy, high-performance lossless 8×8 SOA switch

We demonstrate the first monolithically-integrated active-passive lossless 8×8 SOA switch. A wide IPDR of 14.5dB for penalty <1dB is achieved. The switch paths through the device exhibit excellent uniformity.The research leading to these results has received funding from the UK EPSRC through the INTERNET, STAR and COPOS II grants and the European Commission under FP7 grant agreement ICT 257210 PARADIGM.This is the accepted manuscript. The final version is available from OSA at http://www.opticsinfobase.org/abstract.cfm?uri=OFC-2015-Th4E.6

Demonstration of the feasibility of large-port-count optical switching using a hybrid Mach-Zehnder interferometer-semiconductor optical amplifier switch module in a recirculating loop.

For what we believe is the first time, the feasibility of large-port-count nanosecond-reconfiguration-time optical switches is demonstrated using a hybrid approach, where Mach-Zehnder interferometric (MZI) switches provide low-loss, high-speed routing with short semiconductor optical amplifiers (SOAs) being integrated to enhance extinction. By repeatedly passing signals through a monolithic hybrid dilated 2×2 switch module in a recirculating loop, the potential performance of high-port-count switches using the hybrid approach is demonstrated. Experimentally, a single pass switch penalty of only 0.1 dB is demonstrated for the 2×2 module, while even after seven passes through the switch, equivalent to a 128×128 router, a penalty of only 2.4 dB is recorded at a data rate of 10 Gb/s.This is the author accepted manuscript. The final version is published in Optics Letters - http://www.opticsinfobase.org/ol/abstract.cfm?uri=ol-39-18-5244

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

Nudges and other moral technologies in the context of power: Assigning and accepting responsibility

Strawson argues that we should understand moral responsibility in terms of our practices of holding responsible and taking responsibility. The former covers what is commonly referred to as backward-looking responsibility , while the latter covers what is commonly referred to as forward-looking responsibility . We consider new technologies and interventions that facilitate assignment of responsibility. Assigning responsibility is best understood as the second- or third-personal analogue of taking responsibility. It establishes forward-looking responsibility. But unlike taking responsibility, it establishes forward-looking responsibility in someone else. When such assignments are accepted, they function in such a way that those to whom responsibility has been assigned face the same obligations and are susceptible to the same reactive attitudes as someone who takes responsibility. One family of interventions interests us in particular: nudges. We contend that many instances of nudging tacitly assign responsibility to nudgees for actions, values, and relationships that they might not otherwise have taken responsibility for. To the extent that nudgees tacitly accept such assignments, they become responsible for upholding norms that would otherwise have fallen under the purview of other actors. While this may be empowering in some cases, it can also function in such a way that it burdens people with more responsibility that they can (reasonably be expected to) manage

Comparison of techniques for handling missing covariate data within prognostic modelling studies: a simulation study

Background: There is no consensus on the most appropriate approach to handle missing covariate data within prognostic modelling studies. Therefore a simulation study was performed to assess the effects of different missing data techniques on the performance of a prognostic model. Methods: Datasets were generated to resemble the skewed distributions seen in a motivating breast cancer example. Multivariate missing data were imposed on four covariates using four different mechanisms; missing completely at random (MCAR), missing at random (MAR), missing not at random (MNAR) and a combination of all three mechanisms. Five amounts of incomplete cases from 5% to 75% were considered. Complete case analysis (CC), single imputation (SI) and five multiple imputation (MI) techniques available within the R statistical software were investigated: a) data augmentation (DA) approach assuming a multivariate normal distribution, b) DA assuming a general location model, c) regression switching imputation, d) regression switching with predictive mean matching (MICE-PMM) and e) flexible additive imputation models. A Cox proportional hazards model was fitted and appropriate estimates for the regression coefficients and model performance measures were obtained. Results: Performing a CC analysis produced unbiased regression estimates, but inflated standard errors, which affected the significance of the covariates in the model with 25% or more missingness. Using SI, underestimated the variability; resulting in poor coverage even with 10% missingness. Of the MI approaches, applying MICE-PMM produced, in general, the least biased estimates and better coverage for the incomplete covariates and better model performance for all mechanisms. However, this MI approach still produced biased regression coefficient estimates for the incomplete skewed continuous covariates when 50% or more cases had missing data imposed with a MCAR, MAR or combined mechanism. When the missingness depended on the incomplete covariates, i.e. MNAR, estimates were biased with more than 10% incomplete cases for all MI approaches. Conclusion: The results from this simulation study suggest that performing MICE-PMM may be the preferred MI approach provided that less than 50% of the cases have missing data and the missing data are not MNAR

56 Gb/s PAM-4 data transmission over a 1 m long multimode polymer interconnect

Advanced modulation formats can enable >40 Gb/s data rates in waveguide-based optical interconnects without the need for high-specification optoelectronic components. Record 56 Gb/s PAM-4 data transmission is demonstrated over a 1 m-long multimode polymer waveguide.The authors acknowledge Dow Corning for providing the polymer samples, IQE for supplying the VCSEL epitaxial material, the Swedish Foundation for Strategic Research for financial support and Tektronix for the loan of the DSA.This is the author accepted manuscript. The final version is available from OSA Publishing via http://dx.doi.org/10.1364/CLEO_SI.2015.STu4F.