Process Development for the Fabrication of Spheroidal Microdevice Packages Utilizing MEMS Technologies

Sub-mm3 spherical microrobots are being researched as a path towards reconfigurable wireless networks and programmable matter. The microrobot design requires a spheroidal microdevice package compatible with solar energy collection, wireless sensing, and electrostatic actuation mechanisms to be developed. Throughout this research, a variety of MEMS fabrication techniques were evaluated with regards to their applicability to the packaging process. SF6-based plasma was determined to be a preferable alternative to wet HNA etching when producing repeatable bulk isotropic etches in silicon. The effect of silicon crystal orientation on etch variance and anisotropy was also investigated. HNA polishing was demonstrated as an effective method of reducing undercutting, surface roughness, and anisotropy. MatLab image processing routines were developed and incorporated into etch analysis, providing an efficient method of data collection. A method of performing sophisticated wafer alignment and photolithography processes by leveraging existing cleanroom devices was proposed. This research established a path forward for an advanced packaging scheme designed to move microelectronics packages away from the planar circuit board configurations of the past and into the autonomous architectures of the future. The proposed design is applicable to a wide variety of microelectronics applications while meeting the requirements of the sub-mm3 spherical microrobot system

Characterising the growth in palliative care prescribing 2011-2015: Analysis of national medical and non-medical activity

YesThe role of non-medical prescribers working in palliative care has been expanding in recent years and prescribers report improvements in patient care, patient safety, better use of health professionals’ skills and more flexible team working. Despite this, there is a lack of empirical evidence to demonstrate its clinical and economic impact, limiting our understanding of the future role of non-medical prescribers within a healthcare system serving an increasing number of people with palliative care needs. We developed a unique methodology to establish the level of non-medical prescribers’ activity in palliative care across England and consider the likely overall contribution these prescribers are making at a national level in this context in relation to medical prescribing. All prescriptions for 10 core palliative care drugs prescribed by general practitioners, nurses and pharmacists in England and dispensed in the community between April 2011 and April 2015 were extracted from the Prescribing Analysis Cost Tool system. The data were broken down by prescriber and basic descriptive analysis of prescription frequencies by opioid, non-opioids and total prescriptions by year were undertaken. To evaluate the yearly growth of non-medical prescribers, the total number of prescriptions was compared by year for each prescribing group. Non-medical prescribers issued prescriptions rose by 28% per year compared to 9% in those issued by medical prescribers. Despite this, the annual growth in non-medical prescribers prescriptions was less than 1% a year in relation to total community palliative care prescribing activity in England. Impact on medical prescribing is therefore minimal

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Bonded Hemishell Approach to Encapsulate Microdevices in Spheroidal Packages

Silicon-based micromachining techniques were investigated as a method of encapsulating electronics in thin-walled spheroidal shells. Various bulk isotropic etching methods were utilized to produce hemispherical cavities in silicon wafers. sulfur hexafluoride (SF6) based plasma was determined to be a preferable alternative to wet HNA etching when performing repeatable isotropic etches in silicon. Silicon crystal orientation’s effect on etch variance and anisotropy was also investigated. HNA polishing was demonstrated as an effective method of reducing undercutting, surface roughness, and anisotropy. Image processing routines were developed and incorporated into etch analysis, improving data collection efficiency. These hemispherical silicon cavities serve as a template for thin film deposition of a hemispherical shell, or hemishell. Photoresist can be patterned over the hemishells with 3D photolithography techniques, facilitating the deposition of metal traces and bonding sites. To improve throughput, a novel closed-loop photolithography technique was developed. This technique leverages the capabilities of existing cleanroom devices to perform precise alignment and patterning. After patterning, hemishells can be aligned and bonded using modern packaging technologies, and separated from the silicon wafers using selective etch chemistries. The 0.1–1 mm3, spheroidal structures present an innovative packaging alternative for a wide variety of microdevices. Particular applications include electrostatically actuated microrobots and non-invasive ubiquitous microsensors

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease