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Abstract Background Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion. Results Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change. Conclusion The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is weak or unknown. Our proposed framework is the first step towards advocating a more systematic approach to designing, evaluating and reporting interventions in group settings, which is necessary to improve this currently weak evidence base. This framework will enable policy makers and practitioners to be better informed about what works, how it works and in which contexts when aiming to improve health in a group setting.

Abstract Background The UNICEF Baby Friendly Initiative includes a community component to help women who want to breastfeed. This study aimed to document the health visitor role in promoting and supporting breastfeeding in Glasgow during 2000 and the effect it had on breastfeeding rates. Methods Glasgow, UK, has a population of 906,000, with approximately 10,000 births per year. Glasgow has high levels of material deprivation and traditionally low breastfeeding rates. This was a cross-sectional study in January 2000 which used a postal questionnaire to document individual health visitors' interventions, activities and attitude towards breastfeeding. Infant's breastfeeding data collected routinely by the Child Health Surveillance programme from 1 August 1998 to 28 February 1999 was directly matched with interventions, activities and attitudes reported by their own health visitor. Results 146/216 (68%) health visitors completed and returned the questionnaire. 5401 child health records were eligible and 3,294 (58.2%) could be matched with health visitors who returned questionnaires. 2145 infants had the first visit from 8 to 20 days of age and the second 3 to 7 weeks later. At the first postnatal visit 835 of 2145 (39%) infants were breastfed (median age of 13 days) and 646 (30%) continued to breastfeed at the second visit (median age 35 days). Infants being breastfed at the first visit were significantly more likely to be fed infant formula at the second visit if their health visitors had had no breastfeeding training in the previous two years (OR1.74 95%CI 1.13, 2.68). Conclusion It is essential that Health Visitors are specially trained to support breastfeeding postnatally.

Laser energy absorption and subsequent heat removal from diffraction gratings in chirped pulse compressors poses a significant challenge in high repetition rate, high peak power laser development. In order to understand the average power limitations, we have modeled the time-resolved thermo-mechanical properties of current and advanced diffraction gratings. We have also developed and demonstrated a technique of actively cooling Petawatt scale, gold compressor gratings to operate at 600W of average power - a 15x increase over the highest average power petawatt laser currently in operation. Combining this technique with low absorption multilayer dielectric gratings developed in our group would enable pulse compressors for petawatt peak power lasers operating at average powers well above 40kW.

Precise assessment of the high fluence performance of pulse compressor gratings is necessary to determine the safe operational limits of short-pulse high energy lasers. We have measured the picosecond laser damage behavior of multilayer dielectric (MLD) diffraction gratings used in the compression of chirped pulses on the Advanced Radiographic Capability (ARC) kilojoule petawatt laser system at the Lawrence Livermore National Laboratory (LLNL). We present optical damage density measurements of MLD gratings using the raster scan method in order to estimate operational performance. We also report results of R-on-1 tests performed with varying pulse duration (1-30 ps) in air, and clean vacuum. Measurements were also performed in vacuum with controlled exposure to organic contamination to simulate the grating use environment. Results show sparse defects with lower damage resistance which were not detected by small-area damage test methods.

The ability to fabricate 4-level diffractive structures with 1 µm critical dimensions has been demonstrated for the creation of fast (∼f/3.1 at 633 nm) Fresnel zone lenses (FZLs) with >60% diffraction efficiency into the -1 focusing order and nearly complete suppression of 0 and +1 orders. This is done using tooling capable of producing optics with 800 mm apertures. A 4-level grating fabricated in glass at 300 mm aperture is shown to have <15  nm rms holographic phase error. Glass FZLs have also been used as mandrels for casting zero-thermal-expansion, 20 µm thick polymer films created with the 4-level structure as a route to mass replication of efficient diffractive membranes for ultralight segmented space-based telescope applications.

A highly-sensitive optical fiber surface-enhanced Raman scattering (SERS) sensor has been developed by interference lithography. While one facet of the optical fiber is patterned with silver-coated nanopillar array as a SERS platform, the other end of the probe is used, in a remote end detection, to couple the excitation laser into the fiber and send the SERS signal to the spectrometer. SERS performance of the probe is characterized using trans-1,2-bis(4-pyridyl)-ethylene (BPE) monolayer and an enhancement factor of 1.2 × 10(7) can be achieved by focusing the laser directly onto the nanopillar array (front end detection). We also demonstrate that this probe can be used for in situ remote sensing of toluene vapor by the remote end detection. Such a fiber SERS probe shows great potential for molecular detection in various sensing applications.

Surface enhanced Raman spectroscopy (SERS) has been increasingly utilized as an analytical technique with significant chemical and biological applications (Qian et al 2008 Nat. Biotechnol. 26 83; Fujita et al 2009 J. Biomed. Opt. 14 024038; Chou et al 2008 Nano Lett.8 1729; Culha et al 2003 Anal. Chem. 75 6196; Willets K A 2009 Anal. Bioanal. Chem. 394 85; Han et al 2009 Anal. Bioanal. Chem. 394 1719; Sha et al 2008 J. Am. Chem. Soc. 130 17214). However, production of a robust, homogeneous and large-area SERS substrate with the same ultrahigh sensitivity and reproducibility still remains an important issue. Here, we describe a large-area ultrahigh-uniformity tapered silver nanopillar array made by laser interference lithography on the entire surface of a 6 inch wafer. Also presented is the rigorous optical characterization method of the tapered nanopillar substrate to accurately quantify the Raman enhancement factor, uniformity and repeatability. An average homogeneous enhancement factor of close to 10(8) was obtained for benzenethiol adsorbed on a silver-coated nanopillar substrate.

We investigate tunable plasmon resonant cavity arrays in paired parallel nanowire waveguides. Resonances are observed when the waveguide length is an odd multiple of quarter plasmon wavelengths, consistent with boundary conditions of node and antinode at the ends. Two nanowire waveguides satisfy the dispersion relation of a planar metal-dielectric-metal waveguide of equivalent width equal to the square field average weighted gap. Confinement factors over 10(3) are possible due to plasmon focusing in the interwire space.

Segmented (tiled) grating arrays are being intensively investigated for petawatt-scale pulse compression due to the expense and technical challenges of fabricating monolithic diffraction gratings with apertures of over 1m. However, the considerable freedom of motion among grating segments complicates compression and laser focusing. We constructed a real compressor system using a segmented grating for an 18cm aperture laser beam of the Gekko MII 100TW laser system at Osaka University. To produce clean pulse shapes and single focal spots tolerant of misalignment and groove density difference of grating tiles, we applied a new compressor scheme with image rotation in which each beam segment samples each grating segment but from opposite sides. In high-energy shots of up to 50J, we demonstrated nearly Fourier-transform-limited pulse compression (0.5ps) with an almost diffraction-limited spot size (20microm).

We have demonstrated broad bandwidth large area (229 mm x 114 mm) multilayer dielectric diffraction gratings for the efficient compression of high energy 800 nm laser pulses at high average power. The gratings are etched in the top layers of an aperiodic (Nb0.5Ta0.5)2O5-SiO2 multilayer coating deposited by ion beam sputtering. The mean efficiency of the grating across the area is better than 97% at the center wavelength and remains above 96% at wavelengths between 820 nm and 780 nm. The gratings were used to compress 5.5 J pulses from a Ti:sapphire laser with an efficiency above 80 percent.

We have developed improved cavity-finesse methods for characterizing the diffraction efficiencies of large gratings at the Littrow angle. These methods include measuring cavity length with optical techniques, using a Michelson interferometer to calibrate piezoelectric transducer nonlinearities and angle-tuning procedures to confirm optimal alignment. We used these methods to characterize two 20 cm scale dielectric gratings. The values taken from across their surfaces collectively had means and standard deviations of micro=99.293% and sigma=0.164% and micro=99.084% and sigma=0.079%. The greatest efficiency observed at a single point on a grating was (99.577+/-0.002)%, which is also the most accurate measurement of the diffraction efficiency in the literature of which we are aware. These results prove that a high diffraction efficiency with low variation is achievable across large apertures for gratings., ((c) 2009 Optical Society of America.)

We introduce a four-pass laser pulse compressor design based on two grating apertures with two gratings per aperture that is tolerant to some alignment errors and, importantly, to grating-to-grating period variations. Each half-beam samples each grating in a diamond-shaped compressor that is symmetric about a central bisecting plane. For any given grating, the two half-beams impinge on opposite sides of its surface normal. It is shown that the two split beams have no pointing difference from paired gratings with different periods. Furthermore, no phase shift between half-beams is incurred as long as the planes containing a grating line and the surface normal for each grating of the pair are parallel. For grating pairs satisfying this condition, gratings surfaces need not be on the same plane, as changes in the gap between the two can compensate to bring the beams back in phase.

Future energy scaling of high-energy chirped-pulse amplification systems will benefit from the capability to coherently tile diffraction gratings into larger apertures. Design and operation of a novel, accurate alignment diagnostic for coherently tiled diffraction gratings is required for successful implementation of this technique. An invariant diffraction direction and phase for special moves of a diffraction grating is discussed, allowing simplification in the design of the coherently tiled grating diagnostic. An analytical proof of the existence of a unique diffraction grating eigenvector for translational and rotational motion that conserves the diffraction direction and diffracted wave phase is presented.

Wet-etch figuring utilizes free surface flows driven by surface tension gradients (the Marangoni effect) to confine and stabilize the size and shape of an etchant droplet attached to the underside of a glass surface. This droplet, or wetted zone, is translated on the surface, etching where it contacts and leaving behind no residue, to facilitate an etching-based small-tool figuring process that is free of mechanical and thermal stresses. The optic needs no backing plate, and its back side is free for inspection by optical means. When transmissive optics is figured, the optical thickness between the front and the rear surfaces of the optic is measured interferometrically and used in real time to control the local dwell time of the etchant zone. This truly closed-loop figuring process is robust, environmentally insensitive, and fully automated. It is particularly suited for figuring patterns such as phase plates, corrective elements, and optical flats on very thin (<< 1-mm) substrates that are difficult to figure with traditional abrasive polishing methods.

We describe the advantages of using diffractive (Fresnel) lenses on thin membranes over conventional optics for, among others, future space telescope projects. Fabrication methods are presented for lenses on two types of freestanding membrane up to 50 cm in size. The first is a Fresnel lens etched into a thin (380-microm) glass sheet, and the second is an approximately 50-microm-thick polymer membrane containing a Fresnel lens made by replication process from a specially made fused-silica master. We show optical performance analysis of all the lenses that are fabricated, including a diffraction-limited Airy spot from a 20-m- focal-length membrane lens in a diffractive telescope system.

We have developed a hybrid Ti:sapphire-Nd:glass laser system that produces more than 1500 TW (1.5 PW) of peak power. The system produces 660 J of power in a compressed 440+/-20 fs pulse by use of 94-cm master diffraction gratings. Focusing to an irradiance of >7x10(20) W/cm (2) is achieved by use of a Cassegrainian focusing system employing a plasma mirror.

We combined functionalities of two diffractive optics with almost 100x lateral and vertical scale-length difference onto a single fused-silica surface. Fine-scale (2-mum-period) gratings for beam sampling were printed in photoresist by interference lithography and transferred to the substrate by a hydrofluoric acid etch. Subsequently, 115-mum-linewidth stairstep gratings for color separation at focus were proximity printed and wet etched in a two-mask process. Line shapes of the lamellar sampling grating are remarkably preserved following etching of the much deeper color separation grating structures with this nominally isotropic etch process. Model simulations of isotropic etching of topographical features show good agreement with the measured shape evolution of the sampling grating profiles, and the simulations reveal the sensitivity of the final feature shape to its initial aspect ratio. As a rule of thumb, lamellar grating profiles can be etched approximately 0.08A(-2) times their modulation depth, where A is their initial aspect ratio (height/width), before they evolve into a cusplike shape and begin to lose height.

We have demonstrated a Ti:sapphire/Nd:glass laser system that produces up to 51 J of energy in 395-fs pulses (125TW). Focusing at f/3 to a 2.5-times diffraction-limited spot results in a peak irradiance greater than 10(20) W/cm(2) . Our 40-cm-diameter gold diffraction gratings have a damage threshold of 0.42 J/cm(2) for 320-fs pulses.

We describe the design, fabrication, and performance of high-efficiency transmission gratings fabricated in bulk fused silica for use in high-power ultraviolet laser systems. The gratings exhibit a diffraction efficiency of 94% in order m=-1 and a damage threshold greater than 13>J/cm( 2) for 3-ns pulses at 351 nm. Model calculations and experimental measurements are in good agreement.

We have developed a holographically produced master metallic grating that achieves >91% diffraction efficiency over the wavelength range 800-1100 nm and a maximum diffraction efficiency at 1053 nm greater than 93% when used with TM polarization near the Littrow angle. The near-uniform diffraction efficiency with laser wavelength makes this design attractive for use in chirped-pulse amplification systems employing Ti:sapphire, Cr:LiSAF, or Nd:glass and permits high-fidelity stretching and compression of extremely short (10-fs) pulses.

The design and fabrication of large-area, high-efficiency metallic gratings for use in high-power laser systems is described. The gratings exhibit a diffraction efficiency in excess of 95% in the m = -1 order (Littrow mount) and have a high threshold for laser damage. Computations and experimental measurements are presented that illustrate the effect of grating shape and polarization on efficiency. A simple theory for optical damage to metallic diffraction gratings is developed and compared with experimental measurements of the laser-damage threshold over the pulse range from 400 fs to >1 ns.

Delayed post-traumatic erosion of the skull base is reported in three patients who presented as adults with cerebrospinal fluid fistulae and a history of recurrent meningitis. These skull defects were associated with herniation of the subarachnoid space into the diploe of the skull base, the paranasal sinuses and the orbit. This rare complication of head injury is assumed to have occurred as the result of a dural tear at the time of trauma. Its site probably determines whether a resulting meningocele widens the intradiploic space or broaches the cranial floor.