Combined impact of future trends on healthcare utilisation of older people: A Delphi study.

PURPOSE: To explore the combined effect of trends in older people on their future healthcare utilisation. METHODS: A Delphi study consisting of two rounds was conducted. The heterogeneous expert panel (n = 16) in the field of elderly care rated the effect of combinations of trends in the Netherlands on the use of seven healthcare services: i.e. informal, home, general practitioner, acute, specialist, nursing home and mental health care. The percentage and direction of the overall consensus, for the different health services, and for three main trends were analysed. RESULTS: Experts reached consensus in 57 of 92 ratings (62%). Taking into account the interaction between trends, they expected an extra increase for informal, home, and general practitioner care, but no additional effect of interaction for specialist and acute care. Combinations that included trends leading to less support were expected to lead to an extra increase in utilisation. CONCLUSIONS: Experts expect that interaction between trends will lead to an extra increase in the use of general practitioner, home, and informal care. This increase is mainly the result of interaction with trends leading to less support for older persons. The present results show the need to take the effect of interaction into account when designing new health policy and in research on future healthcare utilisation.

Nanoscale spatial limitations of large-area substrate conformal imprint lithography.

We demonstrate a soft-imprint nanofabrication technique offering nanometer resolution over an area as large as a 150 mm diameter wafer. It makes use of a composite imprint stamp composed of a quaternary siloxane-modified poly-di-methyl-siloxane patterned rubber layer with a relatively high Young's modulus that is laminated on a thin glass support. The in-plane stiffness of the stamp avoids pattern deformation over large areas, while out-of-plane flexibility allows conformal contact to be made over the entire substrate area. The stamp is used in conjunction with a novel tetra-methyl-ortho-siloxane/methyl-tri-methoxy-siloxane sol-gel imprint resist material developed to replicate nanoscale features in rigid silica at room temperature. We demonstrate better than 10 nm resolution in imprinted line gratings and individual pillars with aspect ratio as high as 5:1. Gaps as small as 6 nm can be reproduced. The patterns can be used as an etch mask to pattern 150 mm diameter silicon and quartz substrates while maintaining sub-10 nm resolution.

The effect of adverse intrauterine conditions, early childhood growth and famine exposure on age at menopause: a systematic review.

When the follicle reserve, which is developed solely during the fetal period, is depleted, women enter menopause. Intrauterine and childhood adverse conditions might affect the ovarian capacity by influencing follicle production in the first trimester, limiting the initial follicle pool or mediate an accelerated follicular loss thereafter. To investigate if adverse early life influences result in younger age at menopause, the following online databases were systematically searched: PubMed, EMBASE, CINHAL (EBSCO) and Cochrane library (Wiley) up to 1 January 2017. Eligibility, data extraction and quality assessment was independently performed by two researchers. A total of 5278 studies were identified, 11 studies were deemed eligible and included. Nine were cohort studies, 1 case-control study and 1 twin study. Due to the diversity of reported data and risk estimates we were unable to pool data or perform meta-analysis on pooled data. Prenatal and childhood exposure to famine was significantly associated to an earlier age at menopause in three studies. Mean differences in age at menopause varied from 4 months up to 1.7 years between famine exposed and unexposed women. Three studies described a significant association between a low weight at ages 1 or 2 and a younger age at menopause. A younger age at menopause was associated with a higher weight at birth in only one study and with a high ponderal index, a measure for fatness at birth in another study. None of the nine studies reporting on low birth weight and age at natural menopause find a significant association.

In silico synchronization reveals regulators of nuclear ruptures in lamin A/C deficient model cells.

The nuclear lamina is a critical regulator of nuclear structure and function. Nuclei from laminopathy patient cells experience repetitive disruptions of the nuclear envelope, causing transient intermingling of nuclear and cytoplasmic components. The exact causes and consequences of these events are not fully understood, but their stochastic occurrence complicates in-depth analyses. To resolve this, we have established a method that enables quantitative investigation of spontaneous nuclear ruptures, based on co-expression of a firmly bound nuclear reference marker and a fluorescent protein that shuttles between the nucleus and cytoplasm during ruptures. Minimally invasive imaging of both reporters, combined with automated tracking and in silico synchronization of individual rupture events, allowed extracting information on rupture frequency and recovery kinetics. Using this approach, we found that rupture frequency correlates inversely with lamin A/C levels, and can be reduced in genome-edited LMNA knockout cells by blocking actomyosin contractility or inhibiting the acetyl-transferase protein NAT10. Nuclear signal recovery followed a kinetic that is co-determined by the severity of the rupture event, and could be prolonged by knockdown of the ESCRT-III complex component CHMP4B. In conclusion, our approach reveals regulators of nuclear rupture induction and repair, which may have critical roles in disease development.

Breaking the symmetry of forward-backward light emission with localized and collective magnetoelectric resonances in arrays of pyramid-shaped aluminum nanoparticles.

We propose aluminum nanopyramids (ANPs) as magnetoelectric optical antennas to tailor the forward versus backward luminescence spectrum. We present light extinction and emission experiments for an ANP array wherein magnetoelectric localized resonances couple to in-plane diffracted orders. This coupling leads to spectrally sharp collective resonances. Luminescent molecules drive both localized and collective resonances, and we experimentally demonstrate an unconventional forward versus backward luminescence spectrum. Through analytical calculations, we show that the magnetic, magnetoelectric, and quadrupolar moments of ANPs­which lie at the origin of the observed effects­are enhanced by their tapering and height. Full-wave simulations show that localized and delocalized magnetic surface waves, with an excitation strength depending on the plane wave direction, direct the forward versus backward emitted intensity.

Tailor-made directional emission in nanoimprinted plasmonic-based light-emitting devices.

We demonstrate an enhanced and tailor-made directional emission of light-emitting devices using nanoimprinted hexagonal arrays of aluminum nanoparticles. Fourier microscopy reveals that the luminescence of the device is not only determined by the material properties of the organic dye molecules but is also strongly influenced by the coherent scattering resulting from periodically arranged metal nanoparticles. Emitters can couple to lattice-induced hybrid plasmonic-photonic modes sustained by plasmonic arrays. Such modes enhance the spatial coherence of an emitting layer, allowing the efficient beaming of the emission along narrow angular and spectral ranges. We show that tailoring the separation of the nanoparticles in the array yields an accurate angular distribution of the emission. This combination of large-area metal nanostructures fabricated by nanoimprint lithography and light-emitting devices is beneficial for the design and optimization of solid-state lighting systems.

Thermalization and cooling of plasmon-exciton polaritons: towards quantum condensation.

We present indications of thermalization and cooling of quasiparticles, a precursor for quantum condensation, in a plasmonic nanoparticle array. We investigate a periodic array of metallic nanorods covered by a polymer layer doped with an organic dye at room temperature. Surface lattice resonances of the array--hybridized plasmonic-photonic modes--couple strongly to excitons in the dye, and bosonic quasiparticles which we call plasmon-exciton polaritons (PEPs) are formed. By increasing the PEP density through optical pumping, we observe thermalization and cooling of the strongly coupled PEP band in the light emission dispersion diagram. For increased pumping, we observe saturation of the strong coupling and emission in a new weakly coupled band, which again shows signatures of thermalization and cooling.

Hybrid plasmonic-photonic modes in diffractive arrays of nanoparticles coupled to light-emitting optical waveguides.

We study the hybridized plasmonic-photonic modes supported by two-dimensional arrays of metallic nanoparticles coupled to light-emitting optical waveguides. Localized surface plasmon polaritons in the metallic nanoparticles can couple to guided modes in the underlying waveguide, forming quasi-guided hybrid modes, or to diffracted orders in the plane of the array, forming surface lattice resonances. We consider three kinds of samples: one sustains quasi-guided modes only, another sustains surface lattice resonances only, and a third sample sustains both modes. This third sample constitutes the first demonstration of simultaneous coupling of localized surface plasmons to guided modes and diffracted orders. The dispersive properties of the modes in the samples are investigated through light extinction and emission spectroscopy. We elucidate the conditions that lead to the coexistence of surface lattice resonances and quasi-guided hybrid modes, and assess their potential for enhancing the luminescence of emitters embedded in the coupled waveguide. We find the largest increase in emission intensity for the surface lattice resonances, reaching up to a factor of 20.

Light-emitting waveguide-plasmon polaritons.

We demonstrate the generation of light in an optical waveguide strongly coupled to a periodic array of metallic nanoantennas. This coupling gives rise to hybrid waveguide-plasmon polaritons (WPPs), which undergo a transmutation from plasmon to waveguide mode and vice versa as the eigenfrequency detuning of the bare states transits through zero. Near zero detuning, the structure is nearly transparent in the far-field but sustains strong local field enhancements inside the waveguide. Consequently, light-emitting WPPs are strongly enhanced at energies and in-plane momenta for which WPPs minimize light extinction. We elucidate the unusual properties of these polaritons through a classical model of coupled harmonic oscillators.

Broadband omnidirectional antireflection coating based on subwavelength surface Mie resonators.

Reflection is a natural phenomenon that occurs when light passes the interface between materials with different refractive index. In many applications, such as solar cells or photodetectors, reflection is an unwanted loss process. Many ways to reduce reflection from a substrate have been investigated so far, including dielectric interference coatings, surface texturing, adiabatic index matching and scattering from plasmonic nanoparticles. Here we present an entirely new concept that suppresses the reflection of light from a silicon surface over a broad spectral range. A two-dimensional periodic array of subwavelength silicon nanocylinders designed to possess strongly substrate-coupled Mie resonances yields almost zero total reflectance over the entire spectral range from the ultraviolet to the near-infrared. This new antireflection concept relies on the strong forward scattering that occurs when a scattering structure is placed in close proximity to a high-index substrate with a high optical density of states.

Improved performance of polarization-stable VCSELs by monolithic sub-wavelength gratings produced by soft nano-imprint lithography.

We present a novel method for fabricating polarization-stable oxide-confined single-mode GaAs based vertical cavity surface emitting lasers (VCSELs) emitting at 850 nm using a new soft-lithography nano-imprint technique. A monolithic surface grating is etched in the output mirror of the laser cavity using a directly imprinted silica-based sol-gel imprint resist as an etch mask. The opto-electronic performance of these devices is compared to VCSELs fabricated by state-of-the-art electron-beam lithography. The lasers made using the soft nano-imprint technique show single-mode TM lasing at a threshold and laser slope similar to that of devices made by e-beam lithography. The soft nano-imprint technique also enables the fabrication of gratings with sub-wavelength pitch, which avoids diffraction losses in the laser cavity. The resulting single-mode VCSEL devices exhibit 29% enhanced efficiency compared to devices equipped with diffractive gratings.

Enhanced coupling of plasmons in hole arrays with periodic dielectric antennas.

We compare the angle-dependent transmission spectra of a metal hole array with dielectric pillars in each hole with that of a conventional metal hole array. The pillars enhance the optical transmission as well as the interaction between surface plasmon modes. This results in an observed splitting Delta omega/omega as large as 6%, at normal incidence, for the modes on the pillar side of the array.