RESUMEN
OBJECTIVES: Advance care discussions are a useful communication tools for medical preferences and beneficial for shared decision-making processes in hospital settings. The present study developed the first screening tool for need for advance care planning (ACP). METHODS: In phase 1 (n=92), items were evaluated using feasibility analysis and item reduction. In phase 2 (n=201), reduced screening items were analysed for predictive value of need for ACP. Statistical analysis included receiver-operating characteristics analysis (area under the curve>0.80), optimal cut-off based on sensitivity and specificity, interpretation of OR and construct validity using correlation with death anxiety, communication avoidance within families and trust based on the relationship with the treating physician. RESULTS: Participants in both phases were approximately 60 years old with non-curative prognosis. After item reduction, predictive values of four possible items with good item difficulty and discrimination were compared for mild, moderate and great levels of death anxiety. A two-item combination of I am burdened by thoughts of an unfavourable course of the disease and I am burdened by the feeling of being ill-prepared for the end of life showed best prediction of death anxiety and communication avoidance. Clinical cut-off at sum-score ≥6 was of high sensitivity (95%) and specificity (81%). Previous use of social support and readiness for ACP was related to higher chance of interest in ACP. CONCLUSION: Screening for need of ACP is possible with two objective items and one subjective item. Positive screening therefore indicates when to offer ACP discussions and provides routine estimation of ACP need in clinical practice.
RESUMEN
We experimentally investigate an optical link relying on silicon photonics transmitter and receiver components as well as a single section semiconductor mode-locked laser as a light source and a semiconductor optical amplifier for signal amplification. A transmitter based on a silicon photonics resonant ring modulator, an external single section mode-locked laser and an external semiconductor optical amplifier operated together with a standard receiver reliably supports 14 Gbps on-off keying signaling with a signal quality factor better than 7 for 8 consecutive comb lines, as well as 25 Gbps signaling with a signal quality factor better than 7 for one isolated comb line, both without forward error correction. Resonant ring modulators and Germanium waveguide photodetectors are further hybridly integrated with chip scale driver and receiver electronics, and their co-operability tested. These experiments will serve as the basis for assessing the feasibility of a silicon photonics wavelength division multiplexed link relying on a single section mode-locked laser as a multi-carrier light source.
RESUMEN
We have investigated two novel concepts for the design of transmission lines in travelling wave Mach-Zehnder interferometer based Silicon Photonics depletion modulators overcoming the analog bandwidth limitations arising from cross-talk between signal lines in push-pull modulators and reducing the linear losses of the transmission lines. We experimentally validate the concepts and demonstrate an E/O -3 dBe bandwidth of 16 GHz with a 4V drive voltage (in dual drive configuration) and 8.8 dB on-chip insertion losses. Significant bandwidth improvements result from suppression of cross-talk. An additional bandwidth enhancement of ~11% results from a reduction of resistive transmission line losses. Frequency dependent loss models for loaded transmission lines and E/O bandwidth modeling are fully verified.
