The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey.

BACKGROUND: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients' primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. OBJECTIVE: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). METHODS: We categorized practices as "low-use" or "high-use" according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models-shorter "free text" input with an embedded single workflow OC system (FT practices) and longer "mixed text" input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience-overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. RESULTS: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8% (odds ratio [OR] 0.802, 95% CI 0.782-0.823) less likely to report a good overall experience; 24.5% (OR 0.755, 95% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9% (OR 0.811, 95% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8% (OR 1.278, 95% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups-patients from urban and deprived areas, younger patients, and non-White patients. CONCLUSIONS: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients.

High-Entropy Doping Boosts Ion/Electronic Transport of Na4 Fe3 (PO4 )2 (P2 O7 )/C Cathode for Superior Performance Sodium-Ion Batteries.

Fe-based mixed phosphate cathodes for Na-ion batteries usually possess weak rate capacity and cycle stability challenges resulting from sluggish diffusion kinetics and poor conductivity under the relatively low preparation temperature. Here, the excellent sodium storage capability of this system is obtained by introducing the high-entropy doping to enhance the electronic and ionic conductivity. As designed high-entropy doping Na4 Fe2.85 (Ni,Co,Mn,Cu,Mg)0.03 (PO4 )2 P2 O7 (NFPP-HE) cathode can release 122 mAh g-1 at 0.1 C, even 85 mAh g-1 at ultrahigh rate of 50 C, and keep a high retention of 82.3% after 1500 cycles at 10 C. Besides, the cathode also exhibits outstanding fast charge capacity in terms of the cyclability and capacity with 105 mAh g-1 at 5 C/1 C, corresponding 94.3% retention after 500 cycles. The combination of in situ X-ray diffraction, density functional theory, conductive-atomic force microscopy, and galvanostatic intermittent titration technique tests reveal that the reversible structure evolution with optimized Na+ migration path and energy barrier boost the Na+ kinetics and improve the interfacial electronic transfer, thus improving performance.

Ultra-compact channel drop filter based on photonic crystal nanobeam cavities utilizing a resonant tunneling effect.

The design, fabrication, and characterization of a compact photonic crystal nanobeam drop filter based on the tunneling effect of the degenerate modes are presented. The degeneracy was achieved by tuning the coupling distance between the nanobeam and input/output waveguides. The tunneling effect of degenerate resonances with different symmetries has been verified experimentally. Channel drop filters with an extinction ratio larger than 10 dB and a quality factor of ∼5000 have been experimentally demonstrated.

Anion Substitution Strategy toward an Advanced NASICON-Na4Fe3(PO4)2P2O7 Cathode for Sodium-Ion Batteries.

Superior sodium-ion batteries (SIBs) greatly need cathode materials with higher capacity and better durability. Herein, the anion group substitution strategy is proposed to design a cathode material with extraordinary Na+ storage performance, NASICON-Na4Fe3(PO4)1.9(SiO4)0.1P2O7 (NFPP-Si0.1). The experimental and theoretical research revealed that modification in the local structure by anion substitution significantly boosts the ionic/electronic transfer kinetics via optimizing the electronic conductivity and reducing the Na+ diffusion energy barrier. Furthermore, the SiO44- substitution generates a slight expansion of the crystal lattice to broaden the Na+ diffusion channel. Specifically, the custom-designed NFPP-Si0.1 could deliver a high rate capability of 77.6 mAh g-1 at constant 50 C charge-discharge and excellent recyclability of 79.4% retention rate after 7000 cycles at 10 C. Besides, it also possesses outstanding low temperature reversible capacity of 95.5 mAh g-1 at 0.1 C and long-term cyclability of 93.6% capacity retention after 1000 cycles at 5 C in -10 °C. This strategy of heterogeneous and isostructural anion group substitution provides a method for unlocking high-rate and long-life-span mixed polyanionic cathodes.

Super-thin Mikaelian's lens of small index as a beam compressor with an extremely high compression ratio.

Based on a focusing Mikaelian's lens with small refraction index (0

Robust Artificial Interphases Constructed by a Versatile Protein-Based Binder for High-Voltage Na-Ion Battery Cathodes.

The multiple issues of unstable electrode/electrolyte interphases, sluggish reaction kinetics, and transition-metal (TM) dissolution have long greatly affected the rate and cycling performance of cathode materials for Na-ion batteries. Herein, a multifunctional protein-based binder, sericin protein/poly(acrylic acid) (SP/PAA), is developed, which shows intriguing physiochemical properties to address these issues. The highly hydrophilic nature and strong H-bond interaction between crosslinking SP and PAA leads to a uniform coating of the binder layer, which serves as an artificial interphase on the high-voltage Na4 Mn2 Fe(PO4 )2 P2 O7 cathode material (NMFPP). Through systematic experiments and theoretical calculations, it is shown that the SP/PAA binder is electrochemically stable at high voltages and possesses increased ionic conductivity due to the interaction between sericin and electrolyte anion ClO4 - , which can provide additional sodium-migration paths with greatly reduced energy barriers. Besides, the strong interaction force between the binder and the NMFPP can effectively protect the cathode from electrolyte corrosion, suppress Mn-dissolution, stabilize crystal structure, and ensure electrode integrity during cycling. Benefiting from these merits, the SP/PAA-based NMFPP electrode displays enhanced rate and cycling performance. Of note, the universality of the SP/PAA binder is further confirmed on Na3 V2 (PO4 )2 F3 . It is believed that the versatile protein-based binder is enlightening for the development of high-performance batteries.

Flexible Transient Optical Waveguides and Surface-Wave Biosensors Constructed from Monocrystalline Silicon.

Optical technologies offer important capabilities in both biological research and clinical care. Recent interest is in implantable devices that provide intimate optical coupling to biological tissues for a finite time period and then undergo full bioresorption into benign products, thereby serving as temporary implants for diagnosis and/or therapy. The results presented here establish a silicon-based, bioresorbable photonic platform that relies on thin filaments of monocrystalline silicon encapsulated by polymers as flexible, transient optical waveguides for accurate light delivery and sensing at targeted sites in biological systems. Comprehensive studies of the mechanical and optical properties associated with bending and unfurling the waveguides from wafer-scale sources of materials establish general guidelines in fabrication and design. Monitoring biochemical species such as glucose and tracking physiological parameters such as oxygen saturation using near-infrared spectroscopic methods demonstrate modes of utility in biomedicine. These concepts provide versatile capabilities in biomedical diagnosis, therapy, deep-tissue imaging, and surgery, and suggest a broad range of opportunities for silicon photonics in bioresorbable technologies.

Creating a zero-order resonator using an optical surface transformation.

A novel zero-order resonator has been designed by an optical surface transformation (OST) method. The resonator proposed here has many novel features. Firstly, the mode volume can be very small (e.g. in the subwavelength scale). Secondly, the resonator is open (no reflecting walls are utilized) and resonant effects can be found in a continuous spectrum (i.e. a continuum of eigenmodes). Thirdly, we only need one homogenous medium to realize the proposed resonator. The shape of the resonator can be a ring structure of arbitrary shape. In addition to the natural applications (e.g. optical storage) of an optical resonator, we also suggest some other applications of our novel optical open resonator (e.g. power combination, squeezing electromagnetic energy in the free space).

Experimental realization of an open cavity.

The design and experimental demonstration of an open cavity in the microwave region is presented. The resonance condition is achieved through the cancellation of lightpaths in positive and negative refractive index materials. The positive index material is a structured aluminium surface supporting a spoof surface plasmon mode, and the negative index material is a photonic crystal made of alumina. A resonance peak is observed in the measured spectrum at which the electric field distribution agrees with numerical simulation.