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Development of graphene-organic hybrid electronics is one of the most promising directions for next-generation electronic materials. However, it remains challenging to understand the graphene-organic semiconductor interactions right at the interface, which is key to designing hybrid electronics. Herein, we study the influence of graphene on the multiscale morphology of solution-processed monolayers of conjugated polymers (PII-2T, DPP-BTz, DPP2T-TT, and DPP-T-TMS). The strong interaction between graphene and PII-2T was manifested in the high fiber density and high film coverage of monolayer films deposited on graphene compared to plasma SiO

A unique feature of two-dimensional (2D) materials is the ultralow friction at their van der Waals interfaces. A key question in a new generation of 2D heterostructure-based nanoelectromechanical systems (NEMS) is how the low friction interfaces will affect the dynamic performance. Here, we apply the exquisite sensitivity of graphene nanoelectromechanical drumhead resonators to compare the dissipation from monolayer, Bernal-stacked bilayer, and twisted bilayer graphene membranes. We find a significant difference in the average quality factors of three resonator types: 53 for monolayer, 40 for twisted and 31 for Bernal-stacked membranes. We model this difference as a combination of change in stiffness and additional dissipation from interlayer friction during motion. We find even the lowest frictions measured on sliding 2D interfaces are sufficient to alter dissipation in 2D NEMS. This model provides a generalized approach to quantify dissipation in NEMS based on 2D heterostructures which incorporate interlayer slip and friction.

Waveguides for mechanical signal transmission in the megahertz to gigahertz regimes enable on-chip phononic circuitry, which brings new capabilities complementing photonics and electronics. Lattices of coupled nano-electromechanical drumhead resonators are suitable for these waveguides due to their high Q-factor and precisely engineered band structure. Here, we show that thermally induced elastic buckling of such resonators causes a phase transition in the waveguide leading to reversible control of signal transmission. Specifically, when cooled, the lowest-frequency transmission band associated with the primary acoustic mode vanishes. Experiments show the merging of the lower and upper band gaps, such that signals remain localized at the excitation boundary. Numerical simulations show that the temperature-induced destruction of the pass band is a result of inhomogeneous elastic buckling, which disturbs the waveguide's periodicity and suppresses the wave propagation. Mechanical phase transitions in waveguides open opportunities for drastic phononic band reconfiguration in on-chip circuitry and computing.

Two-dimensional (2D) materials and heterostructures are promising candidates for nanoelectronics. However, the quality of material interfaces often limits the performance of electronic devices made from atomically thick 2D materials and heterostructures. Atomic force microscopy (AFM) tip-based cleaning is a reliable technique to remove interface contaminants and flatten heterostructures. Here, we demonstrate AFM tip-based cleaning applied to hBN-encapsulated monolayer MoS2 transistors, which results in electrical performance improvements of the devices. To investigate the impact of cleaning on device performance, we compared the characteristics of as-transferred heterostructures and transistors before and after tip-based cleaning using photoluminescence (PL) and electronic measurements. The PL linewidth of monolayer MoS2 decreased from 84 meV before cleaning to 71 meV after cleaning. The extrinsic mobility of monolayer MoS2 field-effect transistors increased from 21 cm2/Vs before cleaning to 38 cm2/Vs after cleaning. Using the results from AFM topography, photoluminescence, and back-gated field-effect measurements, we infer that tip-based cleaning enhances the mobility of hBN-encapsulated monolayer MoS2 by reducing interface disorder. Finally, we fabricate a MoS2 field-effect transistor (FET) from a tip-cleaned heterostructure and achieved a device mobility of 73 cm2/Vs. The results of this work could be used to improve the electrical performance of heterostructure devices and other types of mechanically assembled van der Waals heterostructures.

Objective To explore barriers to planned dental visiting, investigating how barriers interlink, how they accumulate and change, and how individuals envisage overcoming their combination of barriers through personal strategies. Methods An ethnographic study was conducted of adult urgent dental care attenders who did not have a dentist, including 155 hours of nonparticipant observations, 97 interviews and 19 follow-up interviews in six urgent dental care settings. Data were analysed using constant comparison, first identifying barriers and personal strategies to overcome them, and subsequently analysing interlinks between barriers and personal strategies. Results Accounts of barriers to planned dental visiting encompassed multiple barriers, which related to socioeconomic circumstances as well as experiences of oral health care. Barriers were multi-layered and more difficult to overcome when occurring together. Personal strategies to overcome diverse barriers often hinged on increasing importance of oral health to individuals, yet this was not always sufficient. The combination of barriers participants experience was dynamic, changing due to personal, family, or employment circumstances, and with increasing severity of barriers over time. Over time, this could lead to higher cost, and additional barriers, particularly embarrassment. Conclusion Barriers to planned dental visiting are complex, multi-layered and change over time, constituting a 'web of causation'. This adds a novel perspective to the literature on barriers to dental visiting, and requires that researchers, dental practitioners and policy makers remain open to barriers' interlinked effects, changes in primacy among individual patients' barriers, and their accumulation over time to better support uptake of planned dental visiting.

Carbonate budgets are increasingly being used as a key metric to establish reef condition. To better under-stand spatial variations in framework and sediment net carbonate budgets, we quantied biogenic carbonateproduction, erosion, and dissolution within and between ve distinct geomorphological habitats of Heron Reefon the southern Great Barrier Reef. The protected reef slope had the greatest estimated net framework carbonatebudget (22.6 kgCaCO3m−2yr−1 2.4 SE), driven by abundant, fast-growing acroporid corals coupled with lowlevels of macro- and micro-bioerosion. The estimate of the exposed reef slope was signicantly lower due tolocalized damage from a single tropical cyclone that occurred 7 years prior to this study (9.7kgCaCO3m−2yr−1 2.8 SE). Within the extensive lagoon, net framework carbonate budgets ranged from0.24 kgCaCO3m−2yr−1( 0.1 SE) to 3.0 kgCaCO3m−2yr−1( 0.7 SE). The greatest net sediment carbonatebudget was estimated within the reef crest (6.0 kgCaCO3m−2yr−1 1.1 SE) and the lowest in the shallowlagoon (1.2 kgCaCO3m−2yr−1 0.2 SE). Chemical dissolution of the sediments exhibited spatial variability,with reef crest and reef  at sediments in a state of net production. Considering the area of each habitat, the netreef framework and sediment budgets across Heron Reef were 4.06 kgCaCO3m−2yr−1and2.82 kgCaCO3m−2yr−1, respectively. The results of this study improve our understanding of spatial variabilityin carbonate production and bioerosion and provide a comprehensive reef-scale carbonate budget for a rela-tively undisturbed coral reef ecosystem.

Despite recent efforts to curtail greenhouse gas emissions, current global emission trajectories are still following the business-as-usual representative concentration pathway (RCP) 8.5 emission pathway. The resulting ocean warming and acidification have transformative impacts on coral reef ecosystems, detrimentally affecting coral physiology and health, and these impacts are predicted to worsen in the near future. In this study, we kept fragments of the symbiotic corals Acropora intermedia (thermally sensitive) and Porites lobata (thermally tolerant) for 7 weeks under an orthogonal design of predicted end-of-century RCP8.5 conditions for temperature and pCO(2) (3.5 degrees C and 570 ppm above present-day, respectively) to unravel how temperature and acidification, individually or interactively, influence metabolic and physiological performance. Our results pinpoint thermal stress as the dominant driver of deteriorating health in both species because of its propensity to destabilize coral-dinoflagellate symbiosis (bleaching). Acidification had no influence on metabolism but had a significant negative effect on skeleton growth, particularly when photosynthesis was absent such as in bleached corals or under dark conditions. Total loss of photosynthesis after bleaching caused an exhaustion of protein and lipid stores and collapse of calcification that ultimately led to A. intermedia mortality. Despite complete loss of symbionts from its tissue, P. lobata maintained small amounts of photosynthesis and experienced a weaker decline in lipid and protein reserves that presumably contributed to higher survival of this species. Our results indicate that ocean warming and acidification under business-as-usual CO2 emission scenarios will likely extirpate thermally sensitive coral species before the end of the century, while slowing the recovery of more thermally tolerant species from increasingly severe mass coral bleaching and mortality. This could ultimately lead to the gradual disappearance of tropical coral reefs globally, and a shift on surviving reefs to only the most resilient coral species.

The creation and movement of dislocations determine the nonlinear mechanics of materials. At the nanoscale, the number of dislocations in structures become countable, and even single defects impact material properties. While the impact of solitons on electronic properties is well studied, the impact of solitons on mechanics is less understood. In this study, we construct nanoelectromechanical drumhead resonators from Bernal stacked bilayer graphene and observe stochastic jumps in frequency. Similar frequency jumps occur in few-layer but not twisted bilayer or monolayer graphene. Using atomistic simulations, we show that the measured shifts are a result of changes in stress due to the creation and annihilation of individual solitons. We develop a simple model relating the magnitude of the stress induced by soliton dynamics across length scales, ranging from0.01 N/m for the measured 5 μm diameter to ∼1.2 N/m for the 38.7 nm simulations. These results demonstrate the sensitivity of 2D resonators are sufficient to probe the nonlinear mechanics of single dislocations in an atomic membrane and provide a model to understand the interfacial mechanics of different kinds of van der Waals structures under stress, which is important to many emerging applications such as engineering quantum states through electromechanical manipulation and mechanical devices like highly tunable nanoelectromechanical systems, stretchable electronics, and origami nanomachines.

This talk presents the benefit of buckling in strongly tuning nonlinear MEMS resonators. In particular, the talk shows experimental buckling achieving more than 230% tuning in the natural frequency of drumhead MEMS resonators. Moreover, the experiments demonstrate that buckling switches the frequency response between purely stiffening, purely softening, and stiffening-to-softening nonlinearities. We tune the buckling state in these experiments by controlling the electric voltage and the temperature of the resonators. Therefore, these resonators undergo electrostatically-mediated thermoelastic buckling where specific combinations of temperature and voltage are required to access the distinct vibrational responses. We explain the observed linear and nonlinear responses by a reduced-order model (ROM) that lumps the resonator into a 1-degree-of-freedom mass connected to springs reflecting bending, stretching, electrostatic forces, thermal expansions, and residual stresses. The ROM mimics von Mises trusses to model the buckling in the membrane resonators without the need for exact geometry or structure to model the resonators. This developed ROM and the electro-thermoelastic buckling tunability present useful applications for on-chip acoustic devices in different fields such as signal manipulation, filtering, and MEMS waveguides.

Na-ion batteries (NIBs) are proposed as a promising candidate for beyond Li-ion chemistries, however, a key challenge associated with NIBs is the inability to achieve intercalation in graphite anodes. This phenomenon has been investigated and is believed to arise due to the thermodynamic instability of Na-intercalated graphite. We have recently demonstrated theoretical calculations showing it is possible to achieve thermodynamically stable Na-intercalated graphene structures with a fluorine surface modifier. Here, we present experimental evidence that Na+ intercalation is indeed possible in fluorinated few-layer graphene (F-FLG) structures using cyclic voltammetry (CV), ion-sensitive scanning electrochemical microscopy (SECM) and in situ Raman spectroscopy. SECM and Raman spectroscopy confirmed Na+ intercalation in F-FLG, while CV measurements allowed us to quantify Na-intercalated F-FLG stoichiometries around NaC14–18. These stoichiometries are higher than the previously reported values of NaC186 in graphite. Our experiments revealed that reversible Na+ ion intercalation also requires a pre-formed Li-based SEI in addition to the surface fluorination, thereby highlighting the critical role of SEI in controlling ion-transfer kinetics in alkali-ion batteries. In summary, our findings highlight the use of surface modification and careful study of electrode-electrolyte interfaces and interphases as an enabling strategy for NIBs.

Structural symmetry-breaking is a key strategy to modify the physical and chemical properties of two-dimensional transition metal dichalcogenides. However, little is known about defect formation during this process. Here, with atomic-scale microscopy, we investigate the evolution of defect formation in monolayer MoS2 exposed indirectly to hydrogen plasma. At the beginning of the treatment only top-layer sulfur atoms are removed, while vacancies and the molybdenum atomic layer are maintained. As processing continues, hexagonal-shaped nanocracks are generated along the zigzag edge during relaxation of defect-induced strain. As defect density increases, both photoluminescence and conductivity of MoS2 gradually decreases. Furthermore, MoS2 showed increased friction by 50% due to defect-induced contact stiffness. Our study reveals the details of defect formation during the desulfurization of MoS2 and helps to design the symmetry-breaking transition metal dichalcogenides, which is of relevance for applications including photocatalyst for water splitting, and Janus heterostructures. Desulfurization of MoS2 alters its chemical and physical properties by breaking structural symmetry. Here, the atomic-scale mechanistic pathway by which this occurs is investigated during plasma etching, and changes in chemical structure and physical properties are revealed.

Photosynthesis is an important driver of calcium carbonate deposition on tropical coral reefs largely due to the symbiosis of numerous invertebrates with photosynthetic dinoflagellates in the family Symbiodiniaceae. In bioeroding sponges, however, similar symbioses appear to support the decalcification of carbonate substrates. Compared to its role in calcification, the relative importance of photosynthesis to decalcification processes is less known. Here, the daytime and night-time chemical bioerosion rates of the common Indo-Pacific sponge Cliona orientalis were examined under varying levels of photosynthetic activity and/or varying abundances of intracellular dinoflagellates. Photosynthesis was manipulated either by preconditioning the sponges with the photosynthetic inhibitor diuron (DCMU), or by exposing them to short-term heat stress to achieve bleaching (loss of symbionts). DCMU reduced symbiont numbers and diminished their ability to evolve oxygen. Thermal stress caused a significantly greater loss of symbionts, but photosynthesis was less inhibited. In both cases, decreases in photosynthetic activity and symbiont densities led to proportionately lowered daytime chemical bioerosion rates. Moreover, increased rates of night-time bioerosion were linked to greater daytime rates of photosynthesis, rather than to the night-time respiration of the sponge holobiont. Our findings support the conclusion that photosynthetic products (photosynthates) and/or by-products (oxygen) stimulate sponge bioerosion. This work further reveals the importance of symbionts in the ecology of such sponges and in their ability to sustain high bioerosion activity in otherwise nutrient-poor ecosystems.

MoS2 are two-dimensional (2D) materials that exhibit emerging photoluminescence (PL) at the monolayer level and have potential optoelectronic applications. Monolayers of MoS2 typically achieved by ...

Monolayer MoS2 is a promising material for nanoelectronics; however, the lack of nanofabrication tools and processes has made it very challenging to realize nanometer-scale electronic devices from monolayer MoS2. Here, we demonstrate the fabrication of monolayer MoS2 nanoribbon field-effect transistors as narrow as 30 nm using scanning probe lithography (SPL). The SPL process uses a heated nanometer-scale tip to deposit narrow nanoribbon polymer structures onto monolayer MoS2. The polymer serves as an etch mask during a XeF2 vapor etch, which defines the channel of a field-effect transistor (FET). We fabricated seven devices with a channel width ranging from 30 to 370 nm, and the fabrication process was carefully studied by electronic measurements made at each process step. The nanoribbon devices have a current on/off ratio > 104 and an extrinsic field-effect mobility up to 8.53 cm2/(V s). By comparing a 30 nm wide device with a 60 nm wide device that was fabricated on the same MoS2 flake, we found the na...

We describe the development of a technique to transfer micrometer patterns of organic thin films with sub-50 nm edge resolution and sub-20 nm pattern fidelity. Large-area transfer of homopolymers, diblock copolymers, and small molecules films is demonstrated, and extended to multitudes of different shapes. Moreover, this technique is amenable to sequential printing (i.e. multilayer stacking) and can be integrated with 2D atomic crystals. This high-fidelity pattern transfer work has broad scope for potential uses from the construction of van der Waals heterostructures interfaced with self-assembled block copolymer thin films to the development of platforms to investigate the influence of hierarchical patterning on cell differentiation.

Coral reefs, especially those located near-shore, are increasingly exposed to anthropogenic, eutrophic conditions that are often chronic. Yet, corals under unperturbed conditions may frequently receive natural and usually temporary nutrient supplementation through biological sources such as fishes. We compared physiological parameters indicative of long- and short-term coral health (day and night calcification, fragment surface area, productivity, energy reserves, and tissue stoichiometry) under continuous and temporary nutrient enrichment. The symbiotic coral Acropora intermedia was grown for 7 weeks under continuously elevated (press) levels of ammonium (14 µmol L−1) and phosphate (10 µmol L−1) as separate and combined treatments, to discern the individual and interactive nutrient effects. Another treatment exposed A. intermedia twice-daily to an ammonium and phosphate pulse of the same concentrations as the press treatments to simulate natural biotic supplementation. Press exposure to elevated ammonium or phosphate produced mixed effects on physiological responses, with little interaction between the nutrients in the combined treatment. Overall, corals under press exposure transitioned resources away from calcification. However, exposure to nutrient pulses often enhanced physiological responses. Our findings indicate that while continuous nutrient enrichment may pose a threat to coral health, episodic nutrient pulses that resemble natural nutrient supplementation may significantly benefit coral health and physiology.

While many technologies rely on multilayer heterostructures, most of the studies on chemical functionalization have been limited to monolayer graphene. In order to use functionalization in multilayer systems, we must first understand the interlayer interactions between functionalized and nonfunctionalized (intact) layers and how to selectively functionalize one layer at a time. Here, we demonstrate a method to fabricate single- or double-sided fluorinated bilayer graphene (FBG) by tailoring substrate interactions. Both the top and bottom surfaces of bilayer graphene on the rough silicon dioxide (SiO2) are fluorinated; meanwhile, only the top surface of graphene on hexagonal boron nitride (hBN) is fluorinated. The functionalization type affects electronic properties; double-sided FBG on SiO2 is insulating, whereas single-sided FBG on hBN maintains conducting, showing that the intact bottom layer becomes electrically decoupled from the fluorinated top insulating layer. Our results define a straightforward method to selectively functionalize the top and bottom surfaces of bilayer graphene.

Due to their high in-plane stiffness and low flexural rigidity, two-dimensional (2D) materials are excellent candidates for engineering three-dimensional (3D) nanostructures using crumpling. An important new direction is to integrate 2D materials into crumpled heterostructures, which can have much more complex device geometries. Here, we demonstrate phototransistors from crumpled 2D heterostructures formed from graphene contacts to a monolayer transition-metal dichalcogenide (MoS2, WSe2) channel and quantify the membrane morphology and optoelectronic performance. First, we examined the morphology of folds in the heterostructure and constituent monolayers under uniaxial compression. The 2D membranes relieve the stress by delaminating from the substrate and creating nearly periodic folds whose spacing depends on the membrane type. The matched mechanical stiffness of the constituting layers allows the 2D heterostructure to maintain a conformal interface through large deformations. Next, we examined the optoelectronic performance of a biaxially crumpled graphene-WSe2 phototransistor. Photoluminescence (PL) spectroscopy shows that the optical band gap of WSe2 shifts by less than 2 meV between flat and 15% biaxial crumpling, corresponding to a change in strain of less than 0.05%. The photoresponsivity scaled as P-0.38 and reached 20 A/W under an illumination power density of 4 μW/cm2 at 20 V bias, a performance comparable to flat photosensors. Using photocurrent microscopy, we observe that the photoresponsivity increases by only 20% after crumpling. Both the PL and photoresponse confirm that crumpling and delamination prevent the buildup of compressive strain leading to highly deformed materials and devices with similar performance to their flat analogs. These results set a foundation for crumpled all-2D heterostructure devices and circuitry for flexible and stretchable electronic applications.

Inhomogeneous and three-dimensional strain engineering in two dimensional materials opens up new avenues to straintronic devices for control strain sensitive photonic properties. Here we present a method to tune strain by wrinkling monolayer WSe2 attached to a 15 nm thick ALD support layer and compressing the heterostructure on a soft substrate. The ALD film stiffens the 2D material, enabling optically resolvable micron scale wrinkling rather than nanometer scale crumpling and folding. Using photoluminescence spectroscopy, we show the wrinkling introduces periodic modulation of the bandgap by 47 meV, corresponding with strain modulation from +0.67% tensile strain at the wrinkle crest to -0.31% compressive strain at the trough. Moreover, we show that cycling the substrate strain mechanically reconfigures the magnitude and direction of wrinkling and resulting band tuning. These results pave the way towards stretchable multifuctional devices based on strained 2D materials.

Inducing and controlling three-dimensional deformations in monolayer two-dimensional materials is important for applications from stretchable electronics to origami nanoelectromechanical systems. For these applications, it is critical to understand how the properties of different materials influence the morphologies of two-dimensional atomic membranes under mechanical loading. Here, we systematically investigate the evolution of mechanical folding instabilities in uniaxially compressed monolayer graphene and MoS

To overview current developments in e-health and digitalisation in dentistry and identify gaps in the dental literature on this topic; Basic research design: a critical narrative review of published articles and relevant online materials; Results: Four themes are identified as characterising the current dental literature on e-health and digitalisation: 1) the impact of digitalisation on dental surgeries, 2) digital technology and practice management, 3) digitalisation beyond the dental surgery and in dentist-patient communication, and 4) digital technology and education. However, gaps remain in our understanding of the impact of digital technology on dental practice, particularly in relation to its ethical considerations. Following the example of the wider medical literature, the review introduces the field of critical digital health studies and identifies areas for future investigation and exploration based on its four characteristics: devices and software, data materialisation, data practices and data mobilities; Conclusion and Clinical significance: Digital technology is changing clinical practice and patient care. Dentistry needs to expand its understanding of how dental apps, digital workflow models and digital health information are transforming and disrupting dental practice in order to anticipate how this digital shift will impact on dentistry. The emerging field of critical digital health studies can signpost ways to improve research and practice on the topic in the future.

Atomic membranes of monolayer 2D materials represent the ultimate limit in the size of nano-electromechanical systems. However, new properties and new functionalities emerge by looking at the interface between layers in heterostructures of 2D materials. Here, we demonstrate the integration of 2D heterostructures as tunable nano-electromechanical systems, exploring the competition between the mechanics of the ultrathin membrane and the incommensurate van der Waals interface. We fabricate electrically contacted 5 or 6 μm circular drumheads of suspended heterostructure membranes of monolayer graphene on monolayer molybdenum disulfide (MoS2), which we call a 2D bimorph. We characterize the mechanical resonance through electrostatic actuation and laser interferometry detection. The 2D bimorphs have resonance frequencies of 5–20 MHz and quality factors of 50–700, comparable to resonators from monolayer or few-layer 2D materials. The frequencies and eigenmode shapes of the higher harmonics display split degenera...

Objectives: To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account. Methods: A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists’ Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal–Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice. Results: The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from “Immediate results” and “Craftsmanship” than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales “Focus” and “Added value to dentist” explained 50% of the variance in the number of technologies a dentist uses. Conclusion: Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.

Introduction People around the world are increasingly affected by multimorbidity, where conditions in different medical specialties can correlate in complex ways. This increases the relevance of multidisciplinary integrated care pathways. Modern software solutions provide vast opportunities to enhance information exchange between patients and various healthcare professionals, thereby improving patient-centered and inter-professional care. This paper describes the development and validation of a mobile patient application which exploits Patient Reported Outcomes to enhance patient-centered medical-dental integration with a focus on integrated management of periodontitis and diabetes. Methods This study was part of a multidisciplinary project for enhancement of medical-dental integration. The Intervention Mapping Protocol was supplemented by the RAND/UCLA Appropriateness Method, including literature reviews, focus group discussions and a Delphi panel in cooperation with various stakeholders. A mobile application was developed in close collaboration with patients, physicians and dentists. The usability of the application’s core components was validated in two medical and two dental practices using the System Usability Scale (SUS). Results 39 questions were identified to provide relevant patient-reported information which can be collected via a mobile application to enhance integrated management of periodontitis and diabetes. Usability testing of the application’s core components (14 questions) among 137 participants in medical and dental practices indicated a good SUS score of 77.88 (±12.17). Discussion The systematically developed mobile application offers the potential to provide physicians and dentists with treatment-relevant information to enhance medical-dental integration, thereby reducing the workload of medical staff, improving the quality of routinely collected data, and enabling automated data processing. This unique, novel, and validated approach can serve as an open framework for the development and evaluation of interdisciplinary healthcare software.

Voor de mondzorg komen steeds meer digitale technologieen beschikbaar. Digitale radiologie, maar ook digitale afsprakensystemen voor patienten hebben in veel praktijken toepassing gevonden. Een belangrijke vraag hierbij is welke nieuwe technieken de mondzorg daadwerkelijk verbeteren of het werk in tandartspraktijken vergemakkelijken. Technische kenmerken van digitale technologieen zijn vaak onderzocht, maar de effecten van het werken ermee op de mondzorg en op het werk in de praktijk zijn vaak onbekend. Marieke van der Zande onderzocht de invloed van digitale technologieen op het werken in tandartspraktijken, en welke afwegingen tandartsen maken bij het gebruik ervan.

Background Antimicrobial resistance (AMR) is a prominent threat to public health. Although many guidelines have been developed over the years to tackle this issue, their impact on health care practice varies. Guidelines are often based on evidence from clinical trials, but these have limitations, particularly in the breadth and generalisability of the evidence and evaluation of the guidelines’ uptake. The aim of this study was to investigate how national and local guidelines for managing common infections are developed and explore guideline committee members’ opinions about using real-world observational evidence in the guideline development process. Methods Six semi-structured interviews were completed with participants who had contributed to the development or adjustment of national or local guidelines on antimicrobial prescribing over the past 5 years (from the English National Institute for Health and Care Excellence (NICE)). Interviews were audio recorded and transcribed verbatim. Data was analysed thematically. This also included review of policy documents including guidelines, reports and minutes of guideline development group meetings that were available to the public. Results Three key themes emerged through our analysis: perception versus actual guideline development process, using other types of evidence in the guideline development process, and guidelines are not enough to change antibiotic prescribing behaviour. In addition, our study was able to provide some insight between the documented and actual guideline development process within NICE, as well as how local guidelines are developed, including differences in types of evidence used. Conclusions This case study indicates that there is the potential for a wider range of evidence to be included as part of the guideline development process at both the national and local levels. There was a general agreement that the inclusion of observational data would be appropriate in enhancing the guideline development process, as well providing a potential solution for monitoring guideline use in clinical practice, and improving the implementation of treatment guidelines in primary care.

Introduction: There is a growing body of evidence for associations between oral and other chronic non-communicable diseases. Early recognition and diagnosis can be important in treating these diseases and better integration of primary and dental care could improve patient care. With the Dent@Prevent project, we aim to develop an electronic decision support system (DSS) and interactive mobile application to promote better collaboration between general practitioners (GPs) and dentists. Methods: A mixed-methods approach, including a systematic literature review, routine data analysis, focus groups with GPs and dentists and a Delphi-method with GPs, dentists and patients, is used to acquire information to develop the interactive mobile application that assesses patient-reported measures and the DSS that supports GP and dentist decision-making in an evidence-oriented way. Both the mobile application and DSS will be piloted to validate the use of these products. Results Findings: from the systematic literature review yielded a primary focus for the mobile application and DSS on links between diabetes and periodontitis. From the focus groups with dentists and GPs it appeared that GPs are generally less aware of interactions between oral and non-communicable diseases than dentists. Furthermore, several intervention points and integration of care processes were discussed as a basis for the DSS. The developed mobile application includes patient-reported measures for diabetes and periodontitis risks, as well as measures of patient experiences and perceptions towards the integration of care. The DSS is being designed to support the GP and dentist to recognize respectively an increased risk for periodontitis in their diabetes patients and an increased risk for diabetes in their patients with periodontitis, and to care for their patients accordingly. Discussions and conclusions: Electronic decision support systems for integration of primary and dental care might provide innovative and novel possibilities to improve integration of care through better informed decision making, including at the health policy level. Lessons learned: Clinicians may be unaware of interactions between oral and non-communicable diseases, which may reduce the chance for early recognition of disease in both sectors of care. Limitations: The Delphi-method was used to determine the content of the mobile application with regards to measures of patient experiences and perceptions. It was performed with an anonymized panel including dentists, GPs and patients. Because of this anonymity, the characteristics such as gender and age of the panel are unknown. Furthermore, because of limited scientific evidence on integrated care for diabetes patients with periodontitis, several development steps of the DSS depend on expert opinions from clinicians which may not be generally representative. Finally, the DSS we are developing is a pilot version but this seems a sensible approach towards stepwise creation of the DSS. Suggestions for future research: The mobile application and DSS have to be tested and validated in real-life settings before implementation in actual practice. Once the mobile application and DSS have been validated, the system can be evaluated to assess the efficiency of the intervention to promote integrated health under day-to-day practice conditions.

Introduction: Several chronic non-communicable diseases share common risk factors.Integration of care is important to ensure the best quality and efficiency of care for patients with multiple conditions. Patients’ perceptions are important for assessing the integration of care. For example,oral and general health are closely related. However, oral and general healthcare often take place in a disintegrated manner. This study aimed to develop a short and simple survey to assess integration of oral and general healthcare through patient perceptions. In addition, the survey was intended to be developed such that it can easily be implemented as an add-on to other surveys. Methods: A literature search was performed to develop a conceptual framework and set of questions for the Intersectoral Care Reported by Patients (ICRP) survey. Thereafter, a modified Delphi-method was used to further elaborate the survey. A panel consisting of seven international experts assessed the survey in three rounds. The experts were based in the United States, Germany, and the Netherlands and had different professional backgrounds including general practice and dentistry. During two interactive discussion rounds and one online round of voting, the framework and the questions were assessed, adapted, and prioritized by the experts. During the online round, the experts were asked to rate the necessity of each question and rank the questions based on importance for inclusion in the ICRP survey. Results: The co-creative development process yielded thirteen questions for inclusion in the ICRP survey. These questions focus on five domains: patients’ wishes, expectations and awareness regarding communication between healthcare providers; patients’ perception of healthcare providers’ knowledge; healthcare provider-patient communication about health status; utilization of healthcare; and self-rated health. Discussion and conclusions: We developed a short, easy-to-understand survey to assess integration of oral and general healthcare as perceived by patients. The survey provides opportunities for usage in research and as a tool in feedback systems for healthcare providers. Lessons learned: During the first group discussion, there were many suggestions for questions, including many differently formatted questions for the same concept. By asking the experts to rate the necessity and rank the questions during the online round, we were able to determine which questions were deemed most apt and relevant for inclusion in the ICRP survey. Limitations: The panel included seven experts, although not all experts were able to participate in all rounds of group conversations. This was solved through individual discussion with some of the experts. Although patients were not involved in the development of the survey, they will soon be involved in usability and understandability testing and piloting of the survey. Suggestions for future research: The survey’s understandability will be assessed by patients. Furthermore, the survey will be tested for usability in real-life practice settings. In order to compare different countries, the survey will be translated to other languages such as Dutch and German.

MoS