Hybrid electronic-photonic sensors on a fibre tip

Most sensors rely on a change in an electrical parameter to the measurand of interest. Their direct readout via an electrical wire and an electronic circuit is, in principle, technically simple, but it is subject to electromagnetic interference, preventing its application in several industrial environments. Fibre-optic sensors can overcome these limitations because the sensing region and readout region can be spaced apart, sometimes by kilometres. However, fibre-optic sensing typically requires complex interrogation equipment due to the extremely high wavelength accuracy that is required. Here we combine the sensitivity and flexibility of electronic sensors with the advantages of optical readout, by demonstrating a hybrid electronic-photonic sensor integrated on the tip of a fibre. The sensor is based on an electro-optical nanophotonic structure that uses the strong co-localization of static and electromagnetic fields to simultaneously achieve a voltage-to-wavelength transduction and a modulation of reflectance. We demonstrate the possibility of reading the current-voltage characteristics of the electro-optic diode through the fibre and therefore its changes due to the environment. As a proof of concept, we show the application of this method to cryogenic temperature sensing. This approach allows fibre-optic sensing to take advantage of the vast toolbox of electrical sensing modalities for many different measurands.

Cavity Quantum Optomechanical Nonlinearities and Position Measurement beyond the Breakdown of the Linearized Approximation

Several optomechanics experiments are now entering the highly sought nonlinear regime where optomechanical interactions are large even for low light levels. Within this regime, new quantum phenomena and improved performance may be achieved; however, a corresponding theoretical formalism of cavity quantum optomechanics that captures the nonlinearities of both the radiation-pressure interaction and the cavity response is needed to unlock these capabilities. Here, we develop such a nonlinear cavity quantum optomechanical framework, which we then utilize to propose how position measurement can be performed beyond the breakdown of the linearized approximation. Our proposal utilizes optical general-dyne detection, ranging from single to dual homodyne, to obtain mechanical position information imprinted onto both the optical amplitude and phase quadratures and enables both pulsed and continuous modes of operation. These cavity optomechanical nonlinearities are now being confronted in a growing number of experiments, and our framework will allow a range of advances to be made in, e.g., quantum metrology, explorations of the standard quantum limit, and quantum measurement and control.

Expert survey on coverage and characteristics of pediatric palliative care in Europe - a focus on home care

Background

For children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries.

Methods

Online survey with in-country experts from N = 33 European countries.

Results

Pediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service.

Conclusions

Pediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01078-0.

Breakdown of Spin-to-Helicity Locking at the Nanoscale in Topological Photonic Crystal Edge States

We measure the local near-field spin in topological edge state waveguides that emulate the quantum spin Hall effect. We reveal a highly structured spin density distribution that is not linked to a unique pseudospin value. From experimental near-field real-space maps and numerical calculations, we confirm that this local structure is essential in understanding the properties of optical edge states and light-matter interactions. The global spin is reduced by a factor of 30 in the near field and, for certain frequencies, flipped compared to the pseudospin measured in the far field. We experimentally reveal the influence of higher-order Bloch harmonics in spin inhomogeneity, leading to a breakdown in the coupling between local helicity and global spin.

Barriers in care for children with life-threatening conditions: a qualitative interview study in the Netherlands

OBJECTIVE

To identify barriers, as perceived by parents, to good care for children with life-threatening conditions.

DESIGN

In a nationwide qualitative study, we held in-depth interviews regarding end-of-life care with parents of children (aged 1 to 12 years) who were living with a life-threatening illness or who had died after a medical trajectory (a maximum of 5 years after the death of the child). Sampling was aimed at obtaining maximum variety for a number of factors. The interviews were transcribed and analysed.

SETTING

The Netherlands.

PARTICIPANTS

64 parents of 44 children.

RESULTS

Parents identified six categories of difficulties that create barriers in the care for children with a life-threatening condition. First, parents wished for more empathetic and open communication about the illness and prognosis. Second, organisational barriers create bureaucratic obstacles and a lack of continuity of care. Third, parents wished for more involvement in decision-making. Fourth, parents wished they had more support from the healthcare team on end-of-life decision-making. Fifth, parents experienced a lack of attention for the family during the illness and after the death of their child. Sixth, parents experienced an overemphasis on symptom-treatment and lack of attention for their child as a person.

CONCLUSIONS

The barriers as perceived by parents focussed almost without exception on non-medical aspects: patient-doctor relationships; communication; decision-making, including end-of-life decision-making; and organisation. The perceived barriers indicate that care for children with a life-threatening condition focusses too much on symptoms and not enough on the human beings behind these symptoms.

The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians' critical reflections

Background

Because of practice variation and new developments in palliative pediatric care, the Dutch Association of Pediatrics decided to develop the clinical practice guideline (CPG) palliative care for children. With this guideline, the association also wanted to precipitate an attitude shift towards shared decision-making (SDM) and therefore integrated SDM in the CPG Palliative care for children. The aim was to gain insight if integrating SDM in CPGs can potentially encourage pediatricians to practice SDM. Its objectives were to explore pediatricians’ attitudes and thoughts regarding (1) recommendations on SDM in CPGs in general and the guideline Palliative care for children specifically; (2) other SDM enhancing strategies or tools linked to CPGs.

Methods

Semi-structured face-to-face interviews. Pediatricians (15) were recruited through purposive sampling in three university-based pediatric centers in the Netherlands. The interviews were audio-recorded and transcribed verbatim, coded by at least two authors and analyzed with NVivo.

Results

Some pediatricians considered SDM a skill or attitude that cannot be addressed by clinical practice guidelines. According to others, however, clinical practice guidelines could enhance SDM. In case of the guideline Palliative care for children, the recommendations needed to focus more on how to practice SDM, and offer more detailed recommendations, preferring a recommendation stating multiple options. Most interviewed pediatricians felt that patient decisions aids were beneficial to patients, and could ensure that all topics relevant to the patient are covered, even topics the pediatrician might not consider him or herself, or deems less important. Regardless of the perceived benefit, some pediatricians preferred providing the information themselves instead of using a patient decision aid.

Conclusions

For clinical practice guidelines to potentially enhance SDM, guideline developers should avoid blanket recommendations in the case of preference sensitive choices, and SDM should not be limited to recommendations on non-treatment decisions. Furthermore, preference sensitive recommendations are preferably linked with patient decision aids.

Thresholds for Resuscitation of Extremely Preterm Infants in the UK, Sweden, and Netherlands

BACKGROUND

It is widely acceptable to involve parents in decision-making about the resuscitation of extremely preterm infants (EPIs) in the gray zone. However, there are different views about where the boundaries of the gray zone should lie. Our aim in this study was to compare the resuscitation thresholds for EPIs between neonatologists in the United Kingdom, Sweden, and the Netherlands.

METHODS

We distributed an online survey to consultant neonatologists and neonatal registrars and fellows that included clinical scenarios in which parents requested resuscitation or nonresuscitation. Respondents were asked about the lowest gestational age and/or the worst prognosis at which they would provide resuscitation and the highest gestational age and/or the best prognosis at which they would withhold resuscitation. In additional scenarios, influence of the condition at birth or consideration of available health care resources was assessed.

RESULTS

The survey was completed by 162 neonatologists (30% response rate). There was a significant difference between countries; the gray zone for most UK respondents was 23 + 0/7 to 23 + 6/7 or 24 weeks' gestation, compared with 22 + 0/7 to 22 + 6/7 or 23 weeks' gestation in Sweden and 24 + 0/7 to 25 + 6/7 or 26 weeks' gestation in the Netherlands. Resuscitation thresholds were higher if an infant was born in poor condition. There was wide variation in the prognosis that warranted resuscitation or nonresuscitation. Consideration of resource scarcity did not alter responses.

CONCLUSIONS

In this survey, we found significant differences in approach to the resuscitation of EPIs, with a spectrum from most proactive (Sweden) to least proactive (Netherlands). Most survey respondents indicated shifts in decision-making that were associated with particular weeks' gestation. Despite the different approaches to decision-making in the 3 countries, there was relatively little difference between countries in neonatologists' prognostic thresholds for resuscitation.

Should Pediatric Euthanasia be Legalized?

Voluntary active euthanasia for adults at their explicit request has been legal in Belgium and the Netherlands since 2002. In those countries, acceptance of the practice for adults has been followed by acceptance of the practice for children. Opponents of euthanasia see this as a dangerous slippery slope. Proponents argue that euthanasia is sometimes ethically appropriate for minors and that, with proper safeguards, it should be legally available in appropriate circumstances for patients at any age. In this Ethics Rounds, we asked philosophers from the United States and the Netherlands, and a Dutch pediatrician, to discuss the ethics of legalizing euthanasia for children.

Quality control for the first large areas of triple-GEM chambers for the CMS endcaps

The CMS Collaboration plans to equip the very forward muon system with triple-GEM detectors that can withstand the environment of the High-Luminosity LHC. This project is at the final stages of R&D and moving to production. An unprecedented large area of several 100 m2 are to be instrumented with GEM detectors which will be produced in six different sites around the world. A common construction and quality control procedure is required to ensure the performance of each detector. The quality control steps will include optical inspection, cleaning and baking of all materials and parts used to build the detector, leakage current tests of the GEM foils, high voltage tests, gas leak tests of the chambers and monitoring pressure drop vs. time, gain calibration to know the optimal operation region of the detector, gain uniformity tests, and studying the efficiency, noise and tracking performance of the detectors in a cosmic stand using scintillators.

A novel application of Fiber Bragg Grating (FBG) sensors in MPGD

We present a novel application of Fiber Bragg Grating (FBG) sensors in the construction and characterisation of Micro Pattern Gaseous Detector (MPGD), with particular attention to the realisation of the largest triple (Gas electron Multiplier) GEM chambers so far operated, the GE1/1 chambers of the CMS experiment at LHC. The GE1/1 CMS project consists of 144 GEM chambers of about 0.5 m2 active area each, employing three GEM foils per chamber, to be installed in the forward region of the CMS endcap during the long shutdown of LHC in 2108-2019. The large active area of each GE1/1 chamber consists of GEM foils that are mechanically stretched in order to secure their flatness and the consequent uniform performance of the GE1/1 chamber across its whole active surface. So far FBGs have been used in high energy physics mainly as high precision positioning and re-positioning sensors and as low cost, easy to mount, low space consuming temperature sensors. FBGs are also commonly used for very precise strain measurements in material studies. In this work we present a novel use of FBGs as flatness and mechanical tensioning sensors applied to the wide GEM foils of the GE1/1 chambers. A network of FBG sensors have been used to determine the optimal mechanical tension applied and to characterise the mechanical tension that should be applied to the foils. We discuss the results of the test done on a full-sized GE1/1 final prototype, the studies done to fully characterise the GEM material, how this information was used to define a standard assembly procedure and possible future developments.

Head injuries in children's football-results from two prospective cohort studies in four European countries

Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput.

Upper extremity injuries in Danish children aged 6-12, mechanisms, and risk factors

Although injuries to the upper extremity are most costly, the picture of the upper extremity injury problem remains incomplete. This study is the first to describe the etiology and mechanisms of upper extremity injuries in Danish children. A 2.5-year observational prospective cohort study was conducted to record upper extremity injuries in 1048 children. Data were weekly collected by sending a text message. A total of 176 upper extremity injuries were reported (128 acute injuries). Of the acute upper extremity injuries, 55% were sprains, 47% occurred in the hand/wrist, and 53% of cases were caused by a fall. When corrected for exposure to physical activity, this resulted in an acute upper extremity injury incidence density of 0.18 per 1000 h of physical activity. The odds of sustaining an upper extremity injury was higher in the older children (HR: 1.84, 95% CI: 1.10-3.09), a tendency was found suggesting that girls are at increased acute upper extremity risk compared to boys (HR: 1.40 95% CI: 0.97-2.04). The findings that most injuries occur after a fall, that injury risk increases over age and that girls seem to be at increased injury risk provides essential information to guide future childhood injury prevention.

A multistate framework for the analysis of subsequent injury in sport (M-FASIS)

Physical activity is beneficial for many aspects of health but is associated with a risk of injury. Studies that assess causal risk factors of injury and reinjury provide valuable information to help develop and improve injury prevention programs. However, the underlying assumptions of analytical approaches often used to estimate causal factors in injury and subsequent injury research are often violated. This means that ineffective or even harmful interventions could be proposed because the underlying analyses produced unreliable or invalid causal effect estimates. We describe an adapted version of the multistate framework [multistate framework for the analysis of subsequent injury in sport (M-FASIS)] that makes investigator choices more transparent with respect to outcome and healing time. In addition, M-FASIS incorporates all previous sport injury analytical frameworks and accounts for injuries or conditions that heal or do not heal to 100%, acute and overuse injuries, illnesses, and competing event outcomes.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary prevention of osteoarthritis by joint injury prevention in sport and recreation

The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform the design, conduct and analytical approaches to RCTs evaluating the preventative effect of joint injury prevention strategies. Recommendations regarding the design, conduct, and reporting of RCTs evaluating injury prevention interventions were established based on the consensus of nine researchers internationally with expertise in epidemiology, injury prevention and/or osteoarthritis (OA). Input and resultant consensus was established through teleconference, face to face and email correspondence over a 1 year period. Recommendations for injury prevention RCTs include context specific considerations regarding the research question, research design, study participants, randomization, baseline characteristics, intervention, outcome measurement, analysis, implementation, cost evaluation, reporting and future considerations including the impact on development of PTOA. Methodological recommendations for injury prevention RCTs are critical to informing evidence-based practice and policy decisions in health care, public health and the community. Recommendations regarding the interpretation and conduct of injury prevention RCTs will inform the highest level of evidence in the field. These recommendations will facilitate between study comparisons to inform best practice in injury prevention that will have the greatest public health impact.

The effectiveness of the nationwide BokSmart rugby injury prevention program on catastrophic injury rates

Rugby Union ("rugby") participants have a higher than average risk of injury compared with participants of other popular team sports. BokSmart, a nationwide injury prevention program was launched in South Africa in mid-2009, with the goal of reducing catastrophic head/neck (serious) injuries in players. The program provides injury prevention information to coaches and referees. This study investigated if BokSmart has been associated with a reduction in these injuries. The BokSmart program collected data on all South African rugby-related serious injuries since 2008. Using a Poisson regression, injury numbers were compared pre-BokSmart (2008-2009) to the years post-implementation (2010-2013). Player numbers were assumed to be constant throughout this evaluation: junior = 529,483; senior = 121,663. In junior players, the "post-BokSmart" period had 2.5 less annual serious injuries than "pre-BokSmart" (incidence rate ratio: 0.6, 95% confidence interval: 0.5-0.7, P < 0.000). In contrast, there was no significant difference in these periods in seniors. The absence of effect in seniors may be a result of fewer players or of differences in effectiveness of BokSmart in this group--future studies should investigate these questions.

Positional OSA part 1: Towards a clinical classification system for position-dependent obstructive sleep apnoea

BACKGROUND

In 1984, Cartwright suggested that physicians should differentiate between patients with either positional obstructive sleep apnoea (POSA) or non-positional OSA. Treatment of POSA has advanced dramatically recently with the introduction of a new generation of positional therapy (PT), a small device attached to either the neck or chest which corrects the patient from adopting the supine position through a vibrating stimulus. Encouraging data have been published suggesting that this simple therapy successfully prevents patients with POSA from adopting the supine position without negatively influencing sleep efficiency, as well as allowing for good adherence. Unfortunately, evaluating the efficacy of PT and comparing results are hindered by the fact that there are no universally used POSA criteria. In 1984, Cartwright introduced the arbitrary cut-off point of a difference of 50% or more in apnoea index between supine and non-supine positions.

INTRODUCTION

The aim of this project was to introduce a new classification system, which ideally should identify suitable candidates for PT: patients that will benefit from a clinically significant improvement of their OSA with PT. The shared use of this classification can facilitate collection of data across multiple centres and comparison of results across studies. We report on the development and process that resulted in the Amsterdam Positional OSA Classification (APOC).

METHOD

A panel of three field experts were instructed to independently assign the diagnosis POSA to 100 randomly selected patients they considered likely to benefit from a clinically significant improvement of their OSA with PT. In a group setting, the completed lists were compared. Discrepancies were discussed until consensus was met. This resulted in the consensus standard used to calibrate the new classification. Using the nominal group technique, the APOC was developed.

RESULTS

The APOC criteria evolve around the percentage of total sleep time spent in either the worst sleeping position (WSP) or the best sleeping position (BSP) and the apnoea-hypopnoea index (AHI) in BSP. On applying APOC, one discriminates between the true positional patient, the non-positional patient and the multifactorial patient, whose OSA severity is influenced in part by sleep position. APOC has an increased sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) compared to previously applied POSA criteria in identifying patients that will benefit from positional therapy.

A systematic review of different jump-landing variables in relation to injuries

AIM

Injuries of the lower extremity tend to be associated with jump-landing movements. This review provides an overview of the kinematic variables and malalignments during jump-landing, which could be attributed to overuse or acute injury occurrence.

METHODS

We searched ISI Web of Knowledge, SPORTDiscus, PubMed, EMBASE and SCOPUS for all studies, published before October 2012, which looked at the relation between kinematic risk factors and malalignments of jump-landing and injuries. An article was included 1) if the article was an observational, retrospective or prospective study; 2) if the article investigated the relationship between injuries and the visible and easily measurable kinematic variables or malalignments of the jump-landing technique; 3) if the article met a predefined quality cut-off score.

RESULTS

Ten studies met all inclusion criteria. Literature shows that several kinematic factors are related to lower acute and overuse injuries.

CONCLUSION

A stiffer jump-landing technique is a risk factor in the development of overuse injuries and acute injuries. This is caused by less active motion in the lower extremity joints and by the increased valgus position of the knee during the jump-landing maneuver which creates an unfavorable alignment of the lower extremity. A valgus position of the knee during landing was also a predictor of acute lower extremity injuries. Future intervention programs should focus on the jump-landing technique and the performance of the athlete.

Medication regimes in the context of end-of-life decisions in neonatology: legal considerations with regard to Dutch NICU-practice

Developments in legal and medical research concerning end-of-life decisions regarding severely suffering neonates in the Netherlands provide good cause for reflection on specific items of this issue. This article deals with the outcomes of the first national survey on end-of-life practice in Dutch Neonatal Intensive Care Units (NICUs) and examines the legal aspects of the use of medication as a part of this practice. The authors particularly reflect on the application of analgesics and sedatives on the one hand and neuromuscular blockers (NMBs) on the other hand. Furthermore, they focus on different elements of medicinal use such as indication, the moment of administering, dosage, effects of combinations of drugs, the relationship to the causation of death and (failures in) documentation.

Childhood obesity in the Caribbean

OBJECTIVE

To determine the prevalence of overweight among school children in Bonaire, an island in the Caribbean, and to obtain clues for prevention of overweight.

METHODS

In a cross-sectional school-based study, weight and height were measured in all 4-16-year old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and nutrition.

RESULTS

The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern. Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day compared to normal weight children (56%).

CONCLUSION

The prevalence of overweight and obesity in children in Bonaire is high. Prevention of overweight should focus on stimulating healthy eating habits and more physical activity.

Controlling Fano lineshapes in plasmon-mediated light coupling into a substrate

Metal nanoparticles are efficient resonant plasmonic scatterers for light, and, if placed on top of a high-index substrate, can efficiently couple light into the substrate. This coupling, however, strongly depends on particle shape and surrounding environment. We study the effect of particle shape and substrate refractive index on the plasmonic resonances of silver nanoparticles and we systematically relate this to the efficiency of light scattering into a substrate. The light coupling spectra are dominated by Fano resonances for the corresponding dipolar and quadrupolar scattering modes. Varying the particle shape from spherical to cylindrical leads to large shifts in the Fano resonance for the dipolar mode, reducing the light incoupling integrated over the AM1.5 spectral range. Using a dielectric spacer layer, good light coupling is achieved for cylinders in the near-infrared. An asymmetric environment around the particles turns quadrupolar resonances into efficient radiators as well.