Evolving a DSL implementation

Domain Specific Languages (DSLs) are small languages designed for use in a specific domain. DSLs typically evolve quite radically throughout their lifetime, but current DSL implementation approaches are often clumsy in the face of such evolution. In this paper I present a case study of an DSL evolving in its syntax, semantics, and robustness, implemented in the Converge language. This shows how real-world DSL implementations can evolve along with changing requirements

Improving Patient Experience in Hospital Settings: Assessing the Role of Toolkits and Action Research through a Process Evaluation of a Complex Intervention

This article presents a process evaluation of the implementation and refinement of a patient experience toolkit (PET) by action researchers in six hospital wards in the English National Health Service (NHS). An initial assumption that health care professionals (HCPs) would use PET to improve patient experience proved unrealistic due to staff and service pressures. However, the action researchers' facilitation of PET and their support during the implementation of quality improvement efforts filled in for HCPs' lack of time. The findings suggest that the PET can be a successful guide for skilled facilitators working with HCPs, although excessive staff pressures should be avoided. Toolkits designed for implementation by HCPs should, therefore, be used sparingly; a more appropriate target audience may be facilitators. Furthermore, while the potential of action research is confirmed by this evaluation, HCPs' time to engage in service improvement is found to moderate the success of this increasingly prominent methodology

Advancing Complexity Theory in Health Services Research: The Logic of Logic Models

Background: Logic models are commonly used in evaluations to represent the causal processes through which interventions produce outcomes, yet significant debate is currently taking place over whether they can describe complex interventions which adapt to context. This paper assesses the logic models used in healthcare research from a complexity perspective. A typology of existing logic models is proposed, as well as a formal methodology for deriving more flexible and dynamic logic models. Analysis: Various logic model types were tested as part of an evaluation of a complex Patient Experience Toolkit (PET) intervention, developed and implemented through action research across six hospital wards/departments in the English NHS. Three dominant types of logic model were identified, each with certain strengths but ultimately unable to accurately capture the dynamics of PET. Hence, a fourth logic model type was developed to express how success hinges on the adaption of PET to its delivery settings. Aspects of the Promoting Action on Research Implementation in Health Services (PARIHS) model were incorporated into a traditional logic model structure to create a dynamic “type 4” logic model that can accommodate complex interventions taking on a different form in different settings. Conclusion: Logic models can be used to model complex interventions that adapt to context but more flexible and dynamic models are required. An implication of this is that how logic models are used in healthcare research may have to change. Using logic models to forge consensus among stakeholders and/or provide precise guidance across different settings will be inappropriate in the case of complex interventions that adapt to context. Instead, logic models for complex interventions may be targeted at facilitators to enable them to prospectively assess the settings they will be working in and to develop context-sensitive facilitation strategies. Researchers should be clearas to why they are using a logic model and experiment with different models to ensure they have the correct type

Trapping Ultracold Atoms in a Time-Averaged Adiabatic Potential

We report the first experimental realization of ultracold atoms confined in a time-averaged, adiabatic potential (TAAP). This novel trapping technique involves using a slowly oscillating ($\sim$ kHz) bias field to time-average the instantaneous potential given by dressing a bare magnetic potential with a high frequency ($\sim$ MHz) magnetic field. The resultant potentials provide a convenient route to a variety of trapping geometries with tunable parameters. We demonstrate the TAAP trap in a standard time-averaged orbiting potential trap with additional Helmholtz coils for the introduction of the radio frequency dressing field. We have evaporatively cooled 5 $\times 10^4$ atoms of $^{87}$Rb to quantum degeneracy and observed condensate lifetimes of over \unit[3]{s}.-Comment: 4 pages, 6 figure

Anomalous quantum reflection of Bose-Einstein condensates from a silicon surface: the role of dynamical excitations

We investigate the effect of inter-atomic interactions on the quantum-mechanical reflection of Bose-Einstein condensates from regions of rapid potential variation. The reflection process depends critically on the density and incident velocity of the condensate. For low densities and high velocities, the atom cloud has almost the same form before and after reflection. Conversely, at high densities and low velocities, the reflection process generates solitons and vortex rings that fragment the condensate. We show that this fragmentation can explain the anomalously low reflection probabilities recently measured for low-velocity condensates incident on a silicon surface.Comment: 5 figures, 5 pages, references correcte

Creation of solitons and vortices by Bragg reflection of Bose-Einstein condensates in an optical lattice

We study the dynamics of Bose-Einstein condensates in an optical lattice and harmonic trap. The condensates are set in motion by displacing the trap and initially follow simple semiclassical paths, shaped by the lowest energy band. Above a critical displacement, the condensate undergoes Bragg reflection. For high atom densities, the first Bragg reflection generates a train of solitons and vortices, which destabilize the condensate and trigger explosive expansion. At lower densities, soliton and vortex formation requires multiple Bragg reflections, and damps the center-of-mass motion.Comment: 5 pages including 5 figures (for higher resolution figures please email the authors

Professional medical writing support and the reporting quality of randomized controlled trial abstracts among high-impact general medical journals

Background : In articles reporting randomized controlled trials, professional medical writing support is associated with increased adherence to Consolidated Standards of Reporting Trials (CONSORT). We set out to determine whether professional medical writing support was also associated with improved adherence to CONSORT for Abstracts. Methods : Using data from a previously published cross-sectional study of 463 articles reporting randomized controlled trials published between 2011 and 2014 in five top medical journals, we determined the association between professional medical writing support and CONSORT for Abstracts items using a Wilcoxon rank-sum test. Results : The mean proportion of adherence to CONSORT for Abstracts items reported was similar with and without professional medical writing support (64.3% vs 66.5%, respectively; p=0.30). Professional medical writing support was associated with lower adherence to reporting study setting (relative risk [RR]; 0.40; 95% confidence interval [CI], 0.23–0.70), and higher adherence to disclosing harms/side effects (RR 2.04; 95% CI, 1.37–3.03) and funding source (RR 1.75; 95% CI, 1.18–2.60). Conclusions : Although professional medical writing support was not associated with increased overall adherence to CONSORT for Abstracts, important aspects were improved with professional medical writing support, including reporting of adverse events and funding source. This study identifies areas to consider for improvement.Publisher PDFPeer reviewe

Using patient experience data to develop a patient experience toolkit to improve hospital care: a mixed-methods study

Background Patients are increasingly being asked to provide feedback about their experience of health-care services. Within the NHS, a significant level of resource is now allocated to the collection of this feedback. However, it is not well understood whether or not, or how, health-care staff are able to use these data to make improvements to future care delivery. Objective To understand and enhance how hospital staff learn from and act on patient experience (PE) feedback in order to co-design, test, refine and evaluate a Patient Experience Toolkit (PET). Design A predominantly qualitative study with four interlinking work packages. Setting Three NHS trusts in the north of England, focusing on six ward-based clinical teams (two at each trust). Methods A scoping review and qualitative exploratory study were conducted between November 2015 and August 2016. The findings of this work fed into a participatory co-design process with ward staff and patient representatives, which led to the production of the PET. This was primarily based on activities undertaken in three workshops (over the winter of 2016/17). Then, the facilitated use of the PET took place across the six wards over a 12-month period (February 2017 to February 2018). This involved testing and refinement through an action research (AR) methodology. A large, mixed-methods, independent process evaluation was conducted over the same 12-month period. Findings The testing and refinement of the PET during the AR phase, with the mixed-methods evaluation running alongside it, produced noteworthy findings. The idea that current PE data can be effectively triangulated for the purpose of improvement is largely a fallacy. Rather, additional but more relational feedback had to be collected by patient representatives, an unanticipated element of the study, to provide health-care staff with data that they could work with more easily. Multidisciplinary involvement in PE initiatives is difficult to establish unless teams already work in this way. Regardless, there is merit in involving different levels of the nursing hierarchy. Consideration of patient feedback by health-care staff can be an emotive process that may be difficult initially and that needs dedicated time and sensitive management. The six ward teams engaged variably with the AR process over a 12-month period. Some teams implemented far-reaching plans, whereas other teams focused on time-minimising ‘quick wins’. The evaluation found that facilitation of the toolkit was central to its implementation. The most important factors here were the development of relationships between people and the facilitator’s ability to navigate organisational complexity. Limitations The settings in which the PET was tested were extremely diverse, so the influence of variable context limits hard conclusions about its success. Conclusions The current manner in which PE feedback is collected and used is generally not fit for the purpose of enabling health-care staff to make meaningful local improvements. The PET was co-designed with health-care staff and patient representatives but it requires skilled facilitation to achieve successful outcomes. Funding The National Institute for Health Research Health Services and Delivery Research programme

A Demonstration of LISA Laser Communication

Over the past few years questions have been raised concerning the use of laser communications links between sciencecraft to transmit phase information crucial to the reduction of laser frequency noise in the LISA science measurement. The concern is that applying medium frequency phase modulations to the laser carrier could compromise the phase stability of the LISA fringe signal. We have modified the table-top interferometer presented in a previous article by applying phase modulations to the laser beams in order to evaluate the effects of such modulations on the LISA science fringe signal. We have demonstrated that the phase resolution of the science signal is not degraded by the presence of medium frequency phase modulations.Comment: minor corrections found in the CQG versio