Leveraging Implementation Science to Integrate Digital Mental Health Interventions as part of Routine Care in a Practice Research Network.

The supply / demand issue in behavioral health care is a well-established fact, and the mental health toll of the COVID-19 pandemic continues to add challenges to an already taxed system. Existing healthcare models are not set up to adequately address the increasing mental health related needs. As such, innovative models are needed to provide patients with access to appropriate, evidence-based behavioral health care within routine clinical care. This paper introduces Precision Behavioral Health (PBH) as an example of such a model. PBH is an innovative, digital first care delivery model that provides an ecosystem of evidence-based digital mental health interventions to patients as a frontline behavioral health treatment within routine care in a large multispecialty group medical center in the United States. This paper describes the implementation of PBH within a practice research network set-up as part of an integrated behavioral health department. We will present how our team leveraged the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance; "What is RE-AIM?," n.d.) implementation science framework, which emphasizes the design, dissemination, and implementation processes at the individual, staff, and organizational levels, to prioritize key implementation constructs to enhance the successful integration of PBH within routine care. We describe how each of these constructs were operationalized to aid data gathering for rapid evaluation and lessons learned. We discuss the benefits of these types of initiatives across multiple stakeholders including patients, providers, organizations, payers, and digital intervention vendors.

Using centrally held data to validate carotid surgery outcome data.

BACKGROUND AND PURPOSE: Outcome audit data for peer group comparison must be transparent, objective, and independently reproducible. Personal data sets are difficult to maintain and often lack complete follow-up. Local coding difficulties make initial retrieval of centrally held data unreliable. However starting with a complete list of interventions, reliable identification of patients who have experienced an adverse postoperative event may be possible using record linkages. METHODS: A surgical database, augmented by a hand-search of all theater registries and personal logbooks, identified 378 carotid endarterectomies performed for stroke prevention in symptomatic patients, in a single hospital between 2002 and 2009. A list of the names, unique patient identifiers, and operation dates was sent to the Information Services Division of National Health Service Scotland. Data were requested pertaining to all deaths and potential diagnoses of stroke after surgery. Every identified case was scrutinized. RESULTS: There were 30 (8%) readmissions or transfers of care identified within 30 days of surgery. From this, 12 strokes were identified with another 2 strokes, occurring without readmission, diagnosed in the outpatient clinic. Only 6 of the postoperative strokes were identified during the index admission. There were 2 early deaths resulting in a combined stroke and death rate of 4.2% (95% confidence intervals, 2.4%-6.9%). CONCLUSIONS: These outcome data are similar to the outcomes of the major carotid surgery trials. Record-linked data retrieval seems to be an appropriate starting point for outcome-based audit. This has the potential to generate robust, transparent data for comparison between individuals and centers for a specific procedure.

Time-resolved surface-enhanced coherent sensing of nanoscale molecular complexes.

Nanoscale real-time molecular sensing requires large signal enhancement, small background, short detection time and high spectral resolution. We demonstrate a new vibrational spectroscopic technique which satisfies all of these conditions. This time-resolved surface-enhanced coherent anti-Stokes Raman scattering (tr-SECARS) spectroscopy is used to detect hydrogen-bonded molecular complexes of pyridine with water in the near field of gold nanoparticles with large signal enhancement and a fraction of a second collection time. Optimal spectral width and time delays of ultrashort laser pulses suppress the surface-enhanced non-resonant background. Time-resolved signals increase the spectral resolution which is limited by the width of the probe pulse and allow measuring nanoscale vibrational dephasing dynamics. This technique combined with quantum chemistry simulations may be used for the investigation of complex mixtures at the nanoscale and surface environment of artificial nanostructures and biological systems.

Carrier-envelope phase effect on atomic excitation by few-cycle rf pulses.

We present an experimental and theoretical study of the carrier-envelope phase effects on population transfer between two bound atomic states interacting with intense ultrashort pulses. Radio frequency pulses are used to transfer population among the ground state hyperfine levels in rubidium atoms. These pulses are only a few cycles in duration and have Rabi frequencies of the order of the carrier frequency. The phase difference between the carrier and the envelope of the pulses has a significant effect on the excitation of atomic coherence and population transfer. We provide a theoretical description of this phenomenon using density matrix equations. We discuss the implications and possible applications of our results.

Heterodyne coherent anti-Stokes Raman scattering for spectral phase retrieval and signal amplification.

We study interference between a local oscillator and coherent anti-Stokes Raman scattering signal fields by controlling their relative phase and amplitude. This control allows direct observation of the real and imaginary components of the third-order nonlinear susceptibility (chi((3))) of the sample. In addition, we demonstrate that the heterodyne method can be used to amplify the signal.

Controlled parametric generation in a double-ladder system via all-resonant four-wave mixing.

We demonstrate parametric generation of a new coherent field with a polarization orthogonal to the signal field via an all-resonant four-wave mixing process in a double-ladder system. We show that the generation of the coherent field is an efficient resonantly enhanced process that can be realized with a fairly dilute medium and relatively weak drive fields. The large parameter domain that exists in this system provides good control for both the weak probe and the generated field. Potential applications in optical communication are outlined.

An analysis of risk factors associated with failure of below knee amputations.

BACKGROUND: Below knee amputation (BKA) is often required in patients with critical limb ischemia. When such a procedure fails, an above knee revision (AKA) is required. This can cause further complications in this group of patients, who already have a high incidence of medical co-morbidities. METHODS: Case records of 47 patients (51 procedures performed) with BKA for peripheral vascular diseases during a 4-year period were reviewed. Clinical factors were analyzed using bi- and multi-variate analysis against the procedure outcome. Degree of social deprivation was evaluated with DEPCAT score in relation to amputation failure. Each arterial segment of the pre-operative arteriograms was scored based on a 3-point scoring system (0=normal, 1=stenosis, and 2=cclusion). With the assignment of an arbitrary weight for each segment, a total arterial score (TAS) was derived for each patient. RESULTS: Eighteen percent of BKA (n=9) failed. Absence of popliteal pulse (failure vs. success: 100% vs. 63%, P=0.04), calf rest pain (67% vs. 20%, P=0.01), combination of calf rest pain and feet tissue loss (CRPFTL; 67% vs. 3%, P=0.00), postoperative stump trauma (44% vs. 10%, P=0.03), and wound infection (WI; 89% vs. 26%, P=0.00) were factors associated with the failure of a BKA in bivariate analysis. Using multiple logistic regression, WI (OR=14) and CRPFTL (OR=47) were found to be independent predictors for the outcome of BKA. No statistical significance was found between the DEPCAT score and the failure rate. TAS was significantly higher in the failure group (median=17 vs. 9; P=0.00). CONCLUSIONS: This study suggests that CRPFTL and postoperative WI are predictor variables for the failure of a BKA. In addition, there is the potential role of arteriogram scoring in predicting the outcome of a BKA.

Visible and UV coherent Raman spectroscopy of dipicolinic acid.

We use time-resolved coherent Raman spectroscopy to obtain molecule-specific signals from dipicolinic acid (DPA), which is a marker molecule for bacterial spores. We use femtosecond laser pulses in both visible and UV spectral regions and compare experimental results with theoretical predictions. By exciting vibrational coherence on more than one mode simultaneously, we observe a quantum beat signal that can be used to extract the parameters of molecular motion in DPA. The signal is enhanced when an UV probe pulse is used, because its frequency is near-resonant to the first excited electronic state of the molecule. The capability for unambiguous identification of DPA molecules will lead to a technique for real-time detection of spores.