Exploiting the potential of large databases of electronic health records for research using rapid search algorithms and an intuitive query interface.

Objective: UK primary care databases, which contain diagnostic, demographic and prescribing information for millions of patients geographically representative of the UK, represent a significant resource for health services and clinical research. They can be used to identify patients with a specified disease or condition (phenotyping) and to investigate patterns of diagnosis and symptoms. Currently, extracting such information manually is time-consuming and requires considerable expertise. In order to exploit more fully the potential of these large and complex databases, our interdisciplinary team developed generic methods allowing access to different types of user. Materials and methods: Using the Clinical Practice Research Datalink database, we have developed an online user-focused system (TrialViz), which enables users interactively to select suitable medical general practices based on two criteria: suitability of the patient base for the intended study (phenotyping) and measures of data quality. Results: An end-to-end system, underpinned by an innovative search algorithm, allows the user to extract information in near real-time via an intuitive query interface and to explore this information using interactive visualization tools. A usability evaluation of this system produced positive results. Discussion: We present the challenges and results in the development of TrialViz and our plans for its extension for wider applications of clinical research. Conclusions: Our fast search algorithms and simple query algorithms represent a significant advance for users of clinical research databases

A comparison of the cost-effectiveness of treatment of prolonged acute convulsive epileptic seizures in children across Europe

In the majority of children and adolescents with epilepsy, optimal drug therapy adequately controls their condition. However, among the remaining patients who are still uncontrolled despite mono-, bi- or tri-therapy with chronic anti-epileptic treatment, a rescue medication is required. In Western Europe, the licensed medications available for first-line treatment of prolonged acute convulsive seizures (PACS) vary widely, and so comparators for clinical and economic evaluation are not consistent. No European guidelines currently exist for the treatment of PACS in children and adolescents and limited evidence is available for the effectiveness of treatments in the community setting. The authors present cost-effectiveness data for BUCCOLAM® (midazolam oromucosal solution) for the treatment of PACS in children and adolescents in the context of the treatment pathway in seven European countries in patients from 6 months to 18 years. For each country, the health economic model consisted of a decision tree, with decision nodes informed by clinical data and expert opinion obtained via a Delphi methodology. The events modelled are those associated with a patient experiencing a seizure in the community setting. The model assessed the likelihood of medication being administered successfully and of seizure cessation. The associated resource use was also modelled, and ambulance call-outs and hospitalisations were considered. The patient's quality of life was estimated by clinicians, who completed a five-level EuroQol five dimensions questionnaire from the perspective of a child or adolescent suffering a seizure. Despite differences in current therapy, treatment patterns and healthcare costs in all countries assessed, BUCCOLAM was shown to be cost saving and offered increased health-related benefits for patients in the treatment of PACS compared with the current local standard of care

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people

Unveiling the origins of quasi-phase matching spectral imperfections in thin-film lithium niobate frequency doublers

Thin-film lithium niobate (TFLN) based frequency doublers have been widely recognized as essential components for both classical and quantum optical communications. Nonetheless, the efficiency of these devices is hindered by imperfections present in the quasi-phase matching (QPM) spectrum. In this study, we present a thorough analysis of the spectral imperfections in TFLN frequency doublers with varying lengths, ranging from 5 mm to 15 mm. Employing a non-destructive diagnostic method based on scattered light imaging, we identify the sources and waveguide sections that contribute to the imperfections in the QPM spectrum. Furthermore, by mapping the TFLN film thickness across the entire waveguiding regions, we successfully reproduce the QPM spectra numerically, thus confirming the prominent influence of film thickness variations on the observed spectral imperfections. This comprehensive investigation provides valuable insights into the identification and mitigation of spectral imperfections in TFLN-based frequency doublers, paving the way toward the realization of nonlinear optical devices with enhanced efficiency and improved spectral fidelity

Religious faith and psychosocial adaptation among stroke patients in Kuwait: A mixed method study

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2012 Springer Science+Business Media.Religious faith is central to life for Muslim patients in Kuwait, so it may influence adaptation and rehabilitation. This study explored quantitative associations among religious faith, self-efficacy, and life satisfaction in 40 female stroke patients and explored the influence of religion within stroke rehabilitation through qualitative interviews with 12 health professionals. The quantitative measure of religious faith did not relate to life satisfaction or self-efficacy in stroke patients. However, the health professionals described religious coping as influencing adaptation post-stroke. Fatalistic beliefs were thought to have mixed influences on rehabilitation. Measuring religious faith among Muslims through a standardized scale is debated. The qualitative accounts suggest that religious beliefs need to be acknowledged in stroke rehabilitation in Kuwait

Ultrabroadband Polarization Insensitive Hybrid using Multiplane Light Conversion

We designed, fabricated and tested an optical hybrid that supports an octave of bandwidth (900-1800 nm) and below 4-dB insertion loss using multiplane light conversion. Measured phase errors are below 3-degree across a measurement bandwidth of 390 nm.Comment: 3 pages, 4 figures, accepted by OFC 202

Permeability of rapid prototyped artificial bone scaffold structures

In this work, various three-dimensional (3D) scaffolds were produced via micro-stereolithography (µ-SLA) and 3D printing (3DP) techniques. This work demonstrates the advantages and disadvantages of these two different rapid prototyping methods for production of bone scaffolds. Compared to 3DP, SLA provides for smaller feature production with better dimensional resolution and accuracy. The permeability of these structures was evaluated experimentally and via numerical simulation utilizing a newly derived Kozeny–Carman based equation for intrinsic permeability. Both experimental and simulation studies took account of porosity percentage, pore size, and pore geometry. Porosity content was varied from 30% to 70%, pore size from 0.34 mm to 3 mm, and pore geometries of cubic and hexagonal closed packed were examined. Two different fluid viscosity levels of 1 mPa·s and 3.6 mPa·s were used. The experimental and theoretical results indicated that permeability increased when larger pore size, increased fluid viscosity, and higher percentage porosity were utilized, with highest to lowest degree of significance following the same order. Higher viscosity was found to result in permeabilities 2.2 to 3.3 times higher than for water. This latter result was found to be independent of pore morphology type. As well as demonstrating method for determining design parameters most beneficial for scaffold structure design, the results also illustrate how the variations in patient's blood viscosity can be extremely important in allowing for permeability through the bone and scaffold structures

High frequency resistive switching behavior of amorphous TiO₂ and NiO.

Resistive switching (RS) of Transition Metal Oxides (TMOs) has become not only an attractive choice for the development of next generation non-volatile memory, but also as a suitable family of materials capable of supporting high-frequency and high-speed switching needed for the next generation wireless communication technologies, such as 6G. The exact mechanism of RS is not yet clearly understood; however, it is widely accepted to be related to the formation and rupture of sub-stoichiometric conductive filaments (Magnéli phases) of the respective oxides upon activation. Here, we examine the switching behaviour of amorphous TiO2 and NiO both under the DC regime and in the high frequency mode. We show that the DC resistance of amorphous TiO2 is invariant of the length of the active region. In contrast, the resistance of the NiO samples exhibits a strong dependence on the length, and its DC resistance reduces as the length is increased. We further show that the high frequency switching characteristics of TiO2, reflected in insertion losses in the ON state and isolation in the OFF state, are far superior to those of NiO. Fundamental inferences stem from these findings, which not only enrich our understanding of the mechanism of conduction in binary/multinary oxides but are essential for the enablement of widespread use of binary/multinary oxides in emerging non-volatile memory and 6G mm-wave applications. As an example of a possible application supported by TMOs, is a Reflective-Type Variable Attenuator (RTVA), shown here. It is designed to operate at a centre frequency of 15 GHz. The results indicate that it has a dynamic range of no less than 18 dB with a maximum insertion loss of 2.1 dB