Monitoring clinical quality in rare disease services--experience in England.

After some well-publicised problems with paediatric cardiac surgery, there has been great interest in England in monitoring clinical quality in specialised medical services. The National Commissioning Group plans, funds and monitors a set of highly specialised services for the National Health Service in England. We have developed systems for monitoring clinical quality that perform two interrelated but distinct functions: performance measurement and performance improvement. The aim is to collect information on all patients seen during each year--a 100% consecutive case series. Generally, there is no conceptual difficulty identifying an appropriate outcome for surgical interventions: the indication for surgery usually defines the outcome to monitor. This is not so for the medical and psychiatric services, where the relevant outcome to monitor is sometimes not obvious. There are a number of problems in interpreting, and acting on, outcome data for rare conditions and treatments. These problems include statistical problems due to small numbers, the need to risk adjust data and coding problems.

FEM/BEM impedance and power analysis for measured LGS SH-SAW devices.

Pure shear horizontal piezoelectrically active surface and bulk acoustic waves (SH-SAW and SH-BAW) exist along rotated Y-cuts, Euler angles (0 degrees, theta, 90 degrees), of trigonal class 32 group crystals, which include the LGX family of crystals (langasite, langatate, and langanite). In this paper both SH-SAW and SH-BAW generated by finite-length, interdigital transducers (IDTs) on langasite, Euler angles (0 degrees, 22 degrees, 90 degrees), are simulated using combined finite- and boundary-element methods (FEM/BEM). Aluminum and gold IDT electrodes ranging in thickness from 600 A to 2000 A have been simulated, fabricated, and tested, with both free and metalized surfaces outside the IDT regions considered. Around the device's operating frequency, the percent difference between the calculated IDT impedance magnitude using the FEM/BEM model and the measurements is better than 5% for the different metal layers and thicknesses considered. The proportioning of SH-SAW and SH-BAW power is analyzed as a function of the number of IDT electrodes; type of electrode metal; and relative thickness of the electrode film, h/wavelength, where wavelength is the SH-SAW wavelength. Simulation results show that moderate mechanical loading by gold electrodes increases the proportion of input power converted to SH-SAW. For example, with a split-electrode IDT, comprising 238 electrodes with a relative thickness h/wavelength = 0.63% and surrounded by an infinitesimally thin conducting film, nearly 9% more input power is radiated as SH-SAW when gold instead of aluminum electrodes are used.

Pure SH-SAW propagation, transduction and measurements on KNbO3.

Potassium niobate (KNbO3) supports the electromechanically active pure shear horizontal surface acoustic wave (SH-SAW) mode along Z-axis cylinder orientations, Euler angles (phi, 90 degrees, 0 degrees), in which two uncoupled wave solutions exist: a purely mechanical sagittal Rayleigh SAW and a piezoelectrically stiffened pure SH-SAW. Within this family of cuts, a maximum electromechanical coupling coefficient for the pure SH-SAW, K2 = 53%, is observed along (0 degrees, 90 degrees, 0 degrees). This pure SH-SAW orientation also has the maximum value of electromechanical coupling observed along rotated Y-cut X propagation directions, Euler angles (0 degrees, theta, 0 degrees). The use of the pure SH-SAW mode is attractive for liquid-sensing applications because the SH-SAW is modestly attenuated by the adjacent liquid, unlike the generalized SAW (GSAW), which has particle displacement normal to the surface. This work investigates propagation and excitation properties of the SH-SAW and the shear horizontal bulk acoustic wave (SH-BAW) on single crystal KNbO3, Euler angles (0 degrees, 90 degrees, 0 degrees). Interdigital transducer (IDT) arrays are analyzed using boundary element method (BEM) techniques, addressing IDT properties such as: power partitioning between the SH-SAW and SH-BAW, SH-BAW radiation as a function of wave vector direction and radiation angle, and overall IDT impedance. The percentage of SH-SAW power to total input power is above 98% for IDTs containing 1.5 to 5.5 wavelengths of active electrodes with surrounding metalized regions. For nonmetalized regions outside the IDT, the ratio drops to between 1 and 2%, showing the importance of an energy trapping structure for efficient SH-SAW excitation and propagation along this orientation. Simulated and experimental IDT admittance results are compared, verifying the validity of the analysis performed. The reported measurements on the frequency variation with temperature indicate that the orientation considered is temperature compensated at about 8 degrees C. The surface of the SH-SAW devices fabricated have been loaded with deionized water and showed additional 1.6 dB transmission loss with respect to the unloaded surface, verifying the suitability of the pure SH-SAW mode on KNbO3 for liquid sensor applications.