Implementing and Enhancing Social and Economic Needs Screening at a Federally Qualified Health Center.

BACKGROUND: Programs to screen for social and economic needs (SENs) are challenging to implement. AIM: To describe implementation of an SEN screening program for patients obtaining care at a federally qualified health center (FQHC). SETTING: Large Chicago-area FQHC where many patients are Hispanic/Latino and insured through Medicaid. PROGRAM DESCRIPTION: In the program's phase 1 (beginning April 2020), a prescreening question asked about patients' interest in receiving community resources; staff then called interested patients. After several refinements (e.g., increased staffing, tailored reductions in screening frequency) to address challenges such as a large screening backlog, program phase 2 began in February 2021. In phase 2, a second prescreening question asked about patients' preferred modality to learn about community resources (text/email versus phone calls). PROGRAM EVALUATION: During phase 1, 8925 of 29,861 patients (30%) expressed interest in community resources. Only 40% of interested patients were successfully contacted and screened. In phase 2, 5781 of 21,737 patients (27%) expressed interest in resources; 84% of interested patients were successfully contacted by either text/email (43%) or phone (41%). DISCUSSION: Under one-third of patients obtaining care at an FQHC expressed interest in community resources for SENs. After program refinements, rates of follow-up with interested patients substantially increased.

Seeing green in conference season.

Researchers and scientific organizations are becoming aware of the greenhouse-gas emissions and waste associated with attending scientific conferences. Fledgling efforts are now underway to address this problem by offering carbon offsets, recycling at conferences, reducing conference travel, or replacing meetings with teleconferences.

The impact of telecom industry employees' stress perception on job burnout: moderated mediation model.

BACKGROUND: The rapid development of the telecommunications industry in the post-COVID-19 era has brought tremendous pressure to employees making them a high-risk group for job burnout. However, prior research paid less attention to the burnout of employees. Furthermore, social support and gender have separate effects on job burnout. This study explores the mechanism of stress perception on job burnout and examines the roles of social support and gender amid it. METHOD: This cross-sectional study was conducted from June 2023 to August 2023 in mainland China. A total of 39,507 were recruited by random sampling and online questionnaires, and 28,204 valid questionnaires were retained. SPSS (version 26.0) and PROCESS (Model 4 & 7) were used for correlation analysis, mediation analysis, and mediated moderation analysis. RESULT: Stress perception can positively predict the level of job burnout of employees in the telecommunications industry, and social support plays a partial mediating role, accounts for 8.01% of the total effect, gender moderates the first half of the path in this mediation model. At the same pressure level, female can perceive more social support than male. CONCLUSIONS: Under high pressure background, employees' job burnout varies depending on gender and the perception of social support. Therefore, telecommunications industry managers should adopt decompression measures and targeted social support resources for different groups.

Monitoring the COVID-19 epidemic with nationwide telecommunication data.

In response to the novel coronavirus disease (COVID-19), governments have introduced severe policy measures with substantial effects on human behavior. Here, we perform a large-scale, spatiotemporal analysis of human mobility during the COVID-19 epidemic. We derive human mobility from anonymized, aggregated telecommunication data in a nationwide setting (Switzerland; 10 February to 26 April 2020), consisting of ∼1.5 billion trips. In comparison to the same time period from 2019, human movement in Switzerland dropped by 49.1%. The strongest reduction is linked to bans on gatherings of more than five people, which are estimated to have decreased mobility by 24.9%, followed by venue closures (stores, restaurants, and bars) and school closures. As such, human mobility at a given day predicts reported cases 7 to 13 d ahead. A 1% reduction in human mobility predicts a 0.88 to 1.11% reduction in daily reported COVID-19 cases. When managing epidemics, monitoring human mobility via telecommunication data can support public decision makers in two ways. First, it helps in assessing policy impact; second, it provides a scalable tool for near real-time epidemic surveillance, thereby enabling evidence-based policies.

The role of information industry convergence in energy transition.

To cope with global climate risks, promoting energy transformation has become a global consensus. China issued a reform policy in 2010 to promote the convergence of the three major information industries, namely broadcasting and television networks, telecommunications networks and the Internet (TPR policy). However, is the convergence of information industries able to promote energy transition? This study constructs a quasi-natural experimental framework using China's TPR policy as a representative case of industrial convergence. Using city-level panel data between 2003 and 2016 in China and a multi-period difference-in-differences model, this study examines the impact of TPR policy on energy transition. The results show that TPR policy positively contributes to energy transition at a 1% significance level. Extensive robustness tests support this finding. This positive effect is particularly evident in regions with less developed communications infrastructure and stricter environmental regulations. Mechanism analysis suggests that TPR policy promotes energy transition by improving the level of information networks, promoting technological innovation, and optimizing industrial structure. The findings of this paper emphasize the importance of information industry convergence in facilitating energy transformation.

Simple polarization-insensitive coherent RoF link with increased capacity.

A simple polarization-insensitive coherent radio-over-fiber (RoF) link with increased spectrum efficiency and transmission capacity is proposed and demonstrated. Instead of using two polarization splitters (PBSs), two 90° hybrids, and four pairs of balanced photodetectors (PDs) in a conventional polarization-diversity coherent receiver (PDCR), a simplified PDCR with only one PBS, one optical coupler (OC), and two PDs is employed in the coherent RoF link. At the simplified receiver, a novel, to the best of our knowledge, digital signal processing (DSP) algorithm is proposed to achieve polarization-insensitive detection and demultiplexing of two spectrally overlapping microwave vector signals as well as the elimination of the joint phase noise originating from the transmitter and the local oscillator (LO) laser sources. An experiment is performed. The transmission and detection of two independent 16QAM microwave vector signals at identical microwave carrier frequencies of 3 GHz with a symbol rate of 0.5 GSym/s over a 25-km single-mode fiber (SMF) is demonstrated. Thanks to the spectrum superposition of the two microwave vector signals, the spectral efficiency as well as the data transmission capacity is increased.

Reaching Ambulatory Older Adults with Educational Tools: Comparative Efficacy and Cost of Varied Outreach Modalities in Primary Care.

BACKGROUND: Providing patients with access to health information that can be obtained outside of an office visit is an important part of education, yet little is known about the effectiveness of outreach modalities to connect older adults to online educational tools. The objective was to identify the effectiveness and cost of outreach modalities providing online information about advance care planning (ACP) for older adults. METHODS: Six different outreach modalities were utilized to connect patients to online educational tools (ACP video decision aids). Participants were 13,582 patients aged 65 and older of 185 primary care providers with appointments over a 30-month period within a large health system in the greater New York City area. Main outcome measures were number of online video views and costs per outreach for each modality. KEY RESULTS: There were 1150 video views for 21,407 remote outreach events. Text messages, sent to the largest volume of patients (8869), had the highest outcome rate (9.6%) and were the most economical ($0.09). Characterization of phone calls demonstrated 21.7% engagement in the topic of ACP but resulted in minimal video views (<1%) and incurred the highest cost per outreach ($2.88). In-office handouts had negligible results (<1%). CONCLUSIONS: Text was the most cost-effective modality to connect older adults to an online educational tool in this pragmatic trial, though overall efficacy of all modalities was low.

The Support, Educate, Empower personalized glaucoma coaching trial design.

BACKGROUND: Glaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program. METHODS/DESIGN: This study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure. DISCUSSION: The personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes.

BACKGROUND: The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. OBJECTIVE: This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. METHODS: A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. RESULTS: Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. CONCLUSIONS: The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review.

BACKGROUND: Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities. AIM AND METHODS: In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period. FINDINGS: The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions. CONCLUSIONS: Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.

Human Exposure to Non-Ionizing Radiation from Indoor Distributed Antenna System: Shopping Mall Measurement Analysis.

It is crucial to monitor the levels of Non-Ionizing Radiation (NIR) to which the general population may be exposed and compare them to the limits defined in the current standards, in view of the rapid rise of communication services and the prospects of a connected society. A high number of people visits shopping malls and since these locations usually have several indoor antennas close to the public, it is therefore a kind of place that must be evaluated. Thus, this work presents measurements of the electric field in a shopping mall located in Natal, Brazil. We proposed a set of six measurement points, following two criteria: places with great the flow of people and the presence of one or more Distributed Antenna System (DAS), co-sited or not with WiFi access points. Results are presented and discussed in terms of the distance to DAS (conditions: near and far) and flow density of people in the mall (scenarios: low and high number of people). The highest peaks of electric field measured were 1.96 and 3.26 V/m, respectively corresponding to 5% and 8% of the limits defined by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and the Brazilian National Telecommunication Agency (ANATEL).

Two-Channel OTDM System for Data-Center Interconnects: A Review.

It has been proposed to implement the >100 Gb/s data-center interconnects using a two-channel optical time-division multiplexed system with multilevel pulse-amplitude modulation. Unlike the conventional four-channel optical time-division multiplexed system which requires an expensive narrow pulse, the two-channel system can be implemented cost-effectively using a wide pulse (which can be simply generated using a single modulator). The two-channel system is expected to be practically available using an integrated transmitter in a chip due to the recent advances in photonics-integrated circuits. This paper reviews the current stage of research on a two-channel optical time-division multiplexed system and discusses possible research directions. Furthermore, it has been demonstrated that 200 Gb/s signals can be generated by using modulators with only 17.2 GHz bandwidth. Therefore, the use of the phase-alternating pulse can make the multiplexed signal robust to chromatic dispersion, enabling the 200 Gb/s 4-level pulse-amplitude-modulated signal to be transmitted over 1.9 km of standard single-mode fiber.

Region Anomaly Detection via Spatial and Semantic Attributed Graph in Human Monitoring.

This paper proposes a graph-based deep framework for detecting anomalous image regions in human monitoring. The most relevant previous methods, which adopt deep models to obtain salient regions with captions, focus on discovering anomalous single regions and anomalous region pairs. However, they cannot detect an anomaly involving more than two regions and have deficiencies in capturing interactions among humans and objects scattered in multiple regions. For instance, the region of a man making a phone call is normal when it is located close to a kitchen sink and a soap bottle, as they are in a resting area, but abnormal when close to a bookshelf and a notebook PC, as they are in a working area. To overcome this limitation, we propose a spatial and semantic attributed graph and develop a Spatial and Semantic Graph Auto-Encoder (SSGAE). Specifically, the proposed graph models the "context" of a region in an image by considering other regions with spatial relations, e.g., a man sitting on a chair is adjacent to a white desk, as well as other region captions with high semantic similarities, e.g., "a man in a kitchen" is semantically similar to "a white chair in the kitchen". In this way, a region and its context are represented by a node and its neighbors, respectively, in the spatial and semantic attributed graph. Subsequently, SSGAE is devised to reconstruct the proposed graph to detect abnormal nodes. Extensive experimental results indicate that the AUC scores of SSGAE improve from 0.79 to 0.83, 0.83 to 0.87, and 0.91 to 0.93 compared with the best baselines on three real-world datasets.

Waveguide-Integrated PdSe2 Photodetector over a Broad Infrared Wavelength Range.

Hybrid integration of van der Waals materials on a photonic platform enables diverse exploration of novel active functions and significant improvement in device performance for next-generation integrated photonic circuits, but developing waveguide-integrated photodetectors based on conventionally investigated transition metal dichalcogenide materials at the full optical telecommunication bands and mid-infrared range is still a challenge. Here, we integrate PdSe2 with silicon waveguide for on-chip photodetection with a high responsivity from 1260 to 1565 nm, a low noise-equivalent power of 4.0 pW·Hz-0.5, a 3-dB bandwidth of 1.5 GHz, and a measured data rate of 2.5 Gbit·s-1. The achieved PdSe2 photodetectors provide new insights to explore the integration of novel van der Waals materials with integrated photonic platforms and exhibit great potential for diverse applications over a broad infrared range of wavelengths, such as on-chip sensing and spectroscopy.

Rural-Urban Differences in Telehealth Utilization and Delayed Care During the COVID-19 Pandemic.

Purpose: Use of telehealth among older adults increased during the COVID-19 pandemic, but patterns and correlates of its use are poorly understood. The present study uses a representative sample of Medicare beneficiaries to examine rural-urban differences in telehealth utilization during the pandemic and to investigate the associations between the number and type of telehealth services utilized and delayed in-person care. Methods: The study sample (N = 3,257) came from Round 10 of the National Health and Aging Trends Study. Telehealth was measured in three modalities: phone calls, e-mails or portal messages, and video calls. Multivariable Poisson and logistic regressions were performed to test the study aims, adjusting for sociodemographic and health controls. Analytic weights and survey design factors were incorporated to generate population estimates. Findings: Results show that rurality is associated with lower rates (incidence rate ratio = 0.78, p < 0.001) and lower odds of telehealth use compared with urban older adults. Specifically, rural older adults were less likely to use e-mail or portal messages (adjusted odds ratio [AOR] = 0.43, p < 0.001) and video calls (AOR = 0.57, p = 0.004) to communicate with their usual health care provider. Use of any 2 forms of telehealth was associated with greatest increased odds of delayed in-person care among rural and urban populations during the pandemic. Conclusions: Future efforts are needed to expand the utilization of e-mail/portal messages and video call telehealth services among rural older adults. Telehealth may be an important mechanism to support care continuity during and beyond the COVID-19 pandemic for both urban and rural older adults when in-person modalities of care are not feasible.

Comprehensive characterization and environmental implications of spent telecommunication printed circuit boards: Towards a cleaner and sustainable environment.

The management and prevention of environmental risks associated with spent telecommunications printed circuit boards (STPCBs) is a concerning issue worldwide. Recycling might be proposed as a proper method to overcome this issue. Despite knowing that, choosing a sustainable method is challenging because of STPCBs complexity. This problem was overcome by analyzing STPCBs using different analytical methods and metal speciation. Understanding these data is essential in selection strategies to maximize selective recycling of metals and to minimize environmental impact. This research focused on characterizing STPCBs based on their structural, morphological, physiochemical, surface, and thermal properties. The accurate measurement of metal contents, indicating 187,900 mg kg-1 Cu, 22,540 mg kg-1 Pb, 1320 mg kg-1 Ag, and 205 mg kg-1 Au elements, plus other base metals, revealed a remarkable potential value in STPCBs. The results of structural analyses indicated that the powder has a crystalline structure and consists of Cu, Sn and Pb phases as well as different functional groups. In addition, after evaluating the zeta potential of the sample, the isoelectric pH of the sample was observed to be 5.6, which indicates that the powder particles have a negative surface in an environment with a pH higher than this value. Further, the metal speciation via sequential extraction procedure was performed, which showed that a unique harsh recycling strategy is required due to the stable structure of STPCBs. According to the results of this analysis, the global contamination factor (GCF) value was 83.48, which indicates STPCBs have a high degree of contamination. Leaching tests and environmental criteria were also conducted on this waste. The findings suggest that STPCBs needs pretreatments before landfilling to lower the concentration of toxic metals. Also, waste extraction test was the most aggressive procedure to assess mobility. Achieving this information is considered an essential step to choosing the most efficient recycling methods that minimize environmental impact while maximizing selective recycling of metals.

Shaping Communications: The Development of the National Telegraph Network in Ireland, 1850-70.

Despite Ireland's centrality to transatlantic telegraphic communication and as an integral part of the United Kingdom, telegraphy on the island is often merely a footnote in the scholarship. Yet telegraphy had a significant impact in Ireland, accelerating internal and external communication times. This article provides the first comprehensive study of telegraphy's expansion, from its arrival in Ireland in the 1850s until the eve of nationalization in 1870. It shows how Ireland's geographical position as a telegraphic gateway to North America, the heavy integration of Ireland's economy into Britain after 1853, and the relationship between telegraphy and the rail network shaped Irish telegraphy in unique ways.

Indoor optical fiber eavesdropping approach and its avoidance.

The optical fiber network has become a worldwide infrastructure. In addition to the basic functions in telecommunication, its sensing ability has attracted more and more attention. In this paper, we discuss the risk of household fiber being used for eavesdropping and demonstrate its performance in the lab. Using a 3-meter tail fiber in front of the household optical modem, voices of normal human speech can be eavesdropped by a laser interferometer and recovered 1.1 km away. The detection distance limit and system noise are analyzed quantitatively. We also give some practical ways to prevent eavesdropping through household fiber.

Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study.

BACKGROUND: Electronic health records are now the norm in US healthcare. Bidirectional patient portals allow frequent communication between patients and their healthcare team. Many studies have examined the importance of patient engagement and trust between patients and their healthcare team, typically in the context of face-to-face interactions. Little is known about how patient trust and engagement are built or enhanced through electronic communications. COVID-19 provided a unique time in history for this novel exploration. OBJECTIVE: Our objective was to learn how patients experience trust formation through electronic communication (patient messaging and video visits) with their healthcare team. DESIGN: Our research was guided by grounded theory methodology. Qualitative interviews were conducted between February and December 2020 with patients or their caregivers from an internal medicine clinic in Colorado. PARTICIPANTS: Fifty-one participants were recruited by age group and gender to represent the clinic's adult ambulatory care demographics. Seven were patients' caregivers who were purposefully recruited. Average age was 53 with an educated, middle class, and largely white predominance in our eventual sample. APPROACH: Thirty-minute semi-structured interviews were conducted using an interview guide informed by a validated physician-patient trust scale. Interviews were conducted by telephone, recorded via Zoom, and transcribed. Results were analyzed and coded in ATLAS.ti utilizing the constant comparative method, with two coders. KEY RESULTS: Patients experienced enhanced trust in their healthcare team through electronic communications. Interpersonal and system factors contributed to trust formation. Promptness of reply was the most salient factor in trust formation with a majority desiring same day response. CONCLUSIONS: Patients now rely on electronic communication with their healthcare team. Opportunities exist to leverage this to improve health outcomes. Important research in expanded demographic groups, along with ambulatory healthcare redesign, will be necessary to optimize benefits of electronic communication with patients and meet patient expectations.