Effectiveness of an Immersive Telemedicine Platform for Delivering Diabetes Medical Group Visits for African American, Black and Hispanic, or Latina Women With Uncontrolled Diabetes: The Women in Control 2.0 Noninferiority Randomized Clinical Trial.

BACKGROUND: Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. OBJECTIVE: The purpose of this study was to compare the effectiveness of diabetes medical group visits (DMGVs) delivered in an immersive telemedicine platform versus an in-person (IP) setting and establish the noninferiority of the technology-enabled approach for changes in hemoglobin A1c (HbA1c) and physical activity (measured in metabolic equivalent of task [MET]) at 6 months. METHODS: This study is a noninferiority randomized controlled trial conducted from February 2017 to December 2019 at an urban safety net health system and community health center. We enrolled adult women (aged ≥18 years) who self-reported African American or Black race or Hispanic or Latina ethnicity and had type 2 diabetes mellitus and HbA1c ≥8%. Participants attended 8 weekly DMGVs, which included diabetes self-management education, peer support, and clinician counseling using a culturally adapted curriculum in English or Spanish. In-person participants convened in clinical settings, while virtual world (VW) participants met remotely via an avatar-driven, 3D VW linked to video teleconferencing. Follow-up occurred 6 months post enrollment. Primary outcomes were mean changes in HbA1c and physical activity at 6 months, with noninferiority margins of 0.7% and 12 MET-hours, respectively. Secondary outcomes included changes in diabetes distress and depressive symptoms. RESULTS: Of 309 female participants (mean age 55, SD 10.6 years; n=195, 63% African American or Black; n=105, 34% Hispanic or Latina; n=151 IP; and n=158 in VW), 207 (67%) met per-protocol criteria. In the intention-to-treat analysis, we confirmed noninferiority for primary outcomes. We found similar improvements in mean HbA1c by group at 6 months (IP: -0.8%, SD 1.9%; VW: -0.5%, SD 1.8%; mean difference 0.3, 97.5% CI -∞ to 0.3; P<.001). However, there were no detectable improvements in physical activity (IP: -6.5, SD 43.6; VW: -9.6, SD 44.8 MET-hours; mean difference -3.1, 97.5% CI -6.9 to ∞; P=.02). The proportion of participants with significant diabetes distress and depressive symptoms at 6 months decreased in both groups. CONCLUSIONS: In this noninferiority randomized controlled trial, immersive telemedicine was a noninferior platform for delivering diabetes care, eliciting comparable glycemic control improvement, and enhancing patient engagement, compared to IP DMGVs. TRIAL REGISTRATION: ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/ct2/show/NCT02726425.

Indigenous Community-Directed Needs Assessment for Rehabilitation Therapy Services.

The eleven Indigenous communities served by the File Hills Qu'Appelle Tribal Council (FHQTC) in Saskatchewan, Canada have experienced a progressive reduction in access to physical and occupational therapy services. A community-directed needs assessment facilitated by FHQTC Health Services was undertaken in the summer of 2021 to identify experiences and barriers of community members in accessing rehabilitation services. Sharing circles were conducted according to FHQTC COVID-19 policies; researchers connected to community members via Webex virtual conferencing software. Community stories and experiences were collected via sharing circles and semi-structured interviews. Data was analysed using an iterative thematic analysis approach with NVIVO qualitative analysis software. An overarching theme of culture contextualised five primary themes: 1) Barriers to Rehabilitation Care, 2) Impacts on Family and Quality of Life, 3) Calls for Services, 4) Strength Based Supports, and 5) What Care Should Look Like. Each theme is comprised of numerous subthemes amassed by stories from community members. Five recommendations were developed to enhance culturally responsive access to local services in FHQTC communities: 1) Rehabilitation Staffing Requirements, 2) Integration with Cultural Care, 3) Practitioner Education and Awareness, 4) Patient and Community-Centered Care, and 5) Feedback and Ongoing Evaluation.

Pixel super-resolution with spatially entangled photons.

Pixelation occurs in many imaging systems and limits the spatial resolution of the acquired images. This effect is notably present in quantum imaging experiments with correlated photons in which the number of pixels used to detect coincidences is often limited by the sensor technology or the acquisition speed. Here, we introduce a pixel super-resolution technique based on measuring the full spatially-resolved joint probability distribution (JPD) of spatially-entangled photons. Without shifting optical elements or using prior information, our technique increases the pixel resolution of the imaging system by a factor two and enables retrieval of spatial information lost due to undersampling. We demonstrate its use in various quantum imaging protocols using photon pairs, including quantum illumination, entanglement-enabled quantum holography, and in a full-field version of N00N-state quantum holography. The JPD pixel super-resolution technique can benefit any full-field imaging system limited by the sensor spatial resolution, including all already established and future photon-correlation-based quantum imaging schemes, bringing these techniques closer to real-world applications.

Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial.

PURPOSE: To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS: This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge. RESULTS: We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes. CONCLUSIONS: Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.

Transient mid-IR nonlinear refraction in air.

We use the polarization-sensitive, time-resolved Beam-Deflection technique to measure the nonlinear refraction of air, exciting in both the near and mid-IR and probing in the mid-IR. This gives us the first measurements for air using both excitation and probe in the mid-IR, and we find no dispersion of the bound-electronic nonlinear refractive index, n2,el(λp;λe), assuming, as has been shown earlier, that the nuclear rotational nonlinear refraction is nearly dispersionless. From these data, we can model the pulsewidth dependence of the effective nonlinear refractive index, n2,eff, i.e., as would be measured by a single beam. Interestingly, n2,eff is maximized for a pulsewidth of approximately 0.5 ps. The position of this maximum is nearly independent of pressure while its magnitude decreases with increasing pressure and temperature. From the measurements and modeling, we predict the nonlinear refraction in the atmosphere at different altitudes.

Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial.

BACKGROUND: Preconception care focuses on improving women's health before pregnancy as a means to improve their health and future pregnancy outcomes. How to effectively deliver such care is unknown. The aim of this research was to assess the impact of an embodied conversational agent system on preconception risks among African American and Black women. METHODS: We did an open-label, randomised controlled trial of women aged 18-34 years, self-identified as African American or Black, or both, and not pregnant, recruited from 35 states in the USA. Sealed allocation envelopes (in permuted blocks of six and eight, prepared using a random number generator) were opened after enrolment. Intervention participants received an online conversational agent called Gabby that assessed 102 preconception risks and delivered 12 months of tailored dialogue using synthesised speech, non-verbal behaviour, visual aids, and health behaviour change techniques such as motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk with a clinician. The primary outcome was the proportion of identified risks at the action or maintenance stage of change at months 6 and 12. The study is registered with ClinicalTrials.gov, NCT01827215. FINDINGS: From March 11, 2014, through July 8, 2018, 528 women recruited from 35 states and 242 cities across the USA received the Gabby intervention (n=262) or were assigned to the control group (n=266). Participants identified a mean of 21 preconception risks per woman (SD 9·9). In the intention-to-treat analysis, at 6 months, intervention women reported reaching the action or maintenance stage of change for 50·0% (SD 28·9) of those preconception risks identified compared with 42·7% (28·3) in the control group (incidence rate ratio 1·16, 95% CI 1·07-1·26; p=0·0004). This result persisted at 12 months. INTERPRETATION: The Gabby system has the potential to improve women's preconception health. Further research is needed to determine if improving preconception risks impacts outcomes such as preterm delivery. FUNDING: National Institute for Minority Health and Health Disparities.

Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women.

BACKGROUND: Improving the health of women before pregnancy and throughout a woman's lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S. METHODS: This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25-50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change. DISCUSSION: This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04514224 . Date of registration: August 14, 2020. Retrospectively Registered.

Promotion of Preconception Care Among Adolescents and Young Adults by Conversational Agent.

PURPOSE: Preconception care is important for all women to improve infant and maternal health outcomes and may be especially important for adolescents and young adults. This study assesses the acceptance, usability, and use of an automated intervention to screen women on 108 preconception care risks and address them over the course of a year via a Web-based virtual animated health counselor and compares these measures for the adolescent and young adult users aged 18-25 years with those of users aged 26-34 years. We hypothesize that the younger cohort will have significantly greater use of and satisfaction with the online intervention. METHODS: A randomized controlled trial involving a national sample of 528 women was conducted. We present a secondary data analysis on the system use and self-reported usability and satisfaction of the 79 women aged 18-25 years randomized to the intervention group, compared with the 183 women aged 26-34 years in the intervention group. Participants were required to self-identify as female, black or African American, aged 18-34 years, not pregnant, and English-speaking and were recruited through a variety of advertisements and outreach activities. RESULTS: Of the adolescent and young adult participants (aged 18-25 years) enrolled and randomized to the intervention, 20.25% of participants accessed the system 0 times; 29.11%, 1-3 times; and 50.63%, >3 times over the course of a year. At the end of the year, almost all (96.4%) indicated they had either acted on recommendations made by the agent or planned to. Most (75.0%) said they would recommend the system to someone they knew. There were no significant differences between the two age groups on intervention use or satisfaction. CONCLUSIONS: Web-based conversational agents are a viable medium for delivering longitudinal preconception care counseling to adolescents and young adults.

Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period.

Importance: Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. Methods: We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. Interventions: An online conversational agent, called "Gabby", assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. Results: After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). Conclusion: The scalability of Gabby has the potential to improve women's nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01827215.

Quantum image distillation.

Imaging with quantum states of light promises advantages over classical approaches in terms of resolution, signal-to-noise ratio, and sensitivity. However, quantum detectors are particularly sensitive sources of classical noise that can reduce or cancel any quantum advantage in the final result. Without operating in the single-photon counting regime, we experimentally demonstrate distillation of a quantum image from measured data composed of a superposition of both quantum and classical light. We measure the image of an object formed under quantum illumination (correlated photons) that is mixed with another image produced by classical light (uncorrelated photons) with the same spectrum and polarization, and we demonstrate near-perfect separation of the two superimposed images by intensity correlation measurements. This work provides a method to mix and distinguish information carried by quantum and classical light, which may be useful for quantum imaging, communications, and security.

Adaptive Quantum Optics with Spatially Entangled Photon Pairs.

Light shaping facilitates the preparation and detection of optical states and underlies many applications in communications, computing, and imaging. In this Letter, we generalize light shaping to the quantum domain. We show that patterns of phase modulation for classical laser light can also shape higher orders of spatial coherence, allowing deterministic tailoring of high-dimensional quantum entanglement. By modulating spatially entangled photon pairs, we create periodic, topological, and random patterns of quantum illumination, without effect on intensity. We then structure the quantum illumination to simultaneously compensate for entanglement that has been randomized by a scattering medium and to characterize the medium's properties via a quantum measurement of the optical memory effect. The results demonstrate fundamental aspects of spatial coherence and open the field of adaptive quantum optics.

General Model of Photon-Pair Detection with an Image Sensor.

We develop an analytic model that relates intensity correlation measurements performed by an image sensor to the properties of photon pairs illuminating it. Experiments using an effective single-photon counting camera, a linear electron-multiplying charge-coupled device camera, and a standard CCD camera confirm the model. The results open the field of quantum optical sensing using conventional detectors.

Massively Parallel Coincidence Counting of High-Dimensional Entangled States.

Entangled states of light are essential for quantum technologies and fundamental tests of physics. Current systems rely on entanglement in 2D degrees of freedom, e.g., polarization states. Increasing the dimensionality provides exponential speed-up of quantum computation, enhances the channel capacity and security of quantum communication protocols, and enables quantum imaging; unfortunately, characterizing high-dimensional entanglement of even bipartite quantum states remains prohibitively time-consuming. Here, we develop and experimentally demonstrate a new theory of camera detection that leverages the massive parallelization inherent in an array of pixels. We show that a megapixel array, for example, can measure a joint Hilbert space of 1012 dimensions, with a speed-up of nearly four orders-of-magnitude over traditional methods. The technique uses standard geometry with existing technology, thus removing barriers of entry to quantum imaging experiments, generalizes readily to arbitrary numbers of entangled photons, and opens previously inaccessible regimes of high-dimensional quantum optics.

Dispersion of nondegenerate nonlinear refraction in semiconductors.

We use our recently developed beam-deflection technique to measure the dispersion of the nondegenerate nonlinear refraction (NLR) of direct-gap semiconductors. The magnitude and sign of the NLR coefficient n2(ωa; ωb) are determined over a broad spectral range for different values of nondegeneracy. In the extremely nondegenerate case, n2(ωa; ωb) is positively enhanced near the two-photon absorption (2PA) edge and is significantly larger than its degenerate counterpart, suggesting applications for nondegenerate all-optical switching. At higher photon energies within the 2PA regime, n2(ωa; ωb) switches sign to negative over a narrow wavelength range. This strong anomalous nonlinear dispersion provides large phase modulation of a femtosecond pulse with bandwidth centered near the zero-crossing frequency. The measured nondegenerate dispersion closely follows our earlier predictions based on nonlinear Kramers-Kronig relations [Sheik-Bahae et. al, IEEE J. Quant. Electron. 30, 249 (1994)].

Observation of Nondegenerate Two-Photon Gain in GaAs.

Two-photon lasers require materials with large two-photon gain (2PG) coefficients and low linear and nonlinear losses. Our previous demonstration of large enhancement of two-photon absorption in semiconductors for very different photon energies translates directly into enhancement of 2PG. We experimentally demonstrate nondegenerate 2PG in optically excited bulk GaAs via femtosecond pump-probe measurements. 2PG is isolated from other pump induced effects through the difference between measurements performed with parallel and perpendicular polarizations of pump and probe. An enhancement in the 2PG coefficient of nearly 2 orders of magnitude is reported. The results point a possible way toward two-photon semiconductor lasers.

Beam deflection measurement of bound-electronic and rotational nonlinear refraction in molecular gases: erratum.

We provide an updated comparison of second hyperpolazability of carbon disulfide reported in [Opt. Express23(17), 22224 (2015)10.1364/OE.23.022224Optica3(6), 657 (2016)10.1364/OPTICA.3.000657].

Measurements of Submicron Particle Adsorption and Particle Film Elasticity at Oil-Water Interfaces.

The influence of particle adsorption on liquid/liquid interfacial tension is not well understood, and much previous research has suggested conflicting behaviors. In this paper we investigate the surface activity and adsorption kinetics of charge stabilized and pH-responsive polymer stabilized colloids at oil/water interfaces using two tensiometry techniques: (i) pendant drop and (ii) microtensiometer. We found, using both techniques, that charge stabilized particles had little or no influence on the (dynamic) interfacial tension, although dense silica particles affected the "apparent" measured tension in the pendent drop, due to gravity driven elongation of the droplet profile. Nevertheless, this apparent change additionally allowed the study of adsorption kinetics, which was related qualitatively between particle systems by estimated diffusion coefficients. Significant and real interfacial tension responses were measured using ∼53 nm core-shell latex particles with a pH-responsive polymer stabilizer of poly(methyl methacrylate)-b-poly(2-(dimethylamino)ethyl methacrylate) (pMMA-b-pDMAEMA) diblock copolymer. At pH 2, where the polymer is strongly charged, behavior was similar to that of the bare charge-stabilized particles, showing little change in the interfacial tension. At pH 10, where the polymer is discharged and poorly soluble in water, a significant decrease in the measured interfacial tension commensurate with strong adsorption at the oil-water interface was seen, which was similar in magnitude to the surface activity of the free polymer. These results were both confirmed through droplet profile and microtensiometry experiments. Dilational elasticity measurements were also performed by oscillation of the droplet; again, changes in interfacial tension with droplet oscillation were only seen with the responsive particles at pH 10. Frequency sweeps were performed to ascertain the dilational elasticity modulus, with measured values being significantly higher than previously reported for nanoparticle and surfactant systems, and similar in magnitude to protein stabilized droplets.

Three-dimensional IR imaging with uncooled GaN photodiodes using nondegenerate two-photon absorption.

We utilize the recently demonstrated orders of magnitude enhancement of extremely nondegenerate two-photon absorption in direct-gap semiconductor photodiodes to perform scanned imaging of three-dimensional (3D) structures using IR femtosecond illumination pulses (1.6 µm and 4.93 µm) gated on the GaN detector by sub-gap, femtosecond pulses. While transverse resolution is limited by the usual imaging criteria, the longitudinal or depth resolution can be less than a wavelength, dependent on the pulsewidths in this nonlinear interaction within the detector element. The imaging system can accommodate a wide range of wavelengths in the mid-IR and near-IR without the need to modify the detection and imaging systems.

Beam deflection measurement of bound-electronic and rotational nonlinear refraction in molecular gases.

A polarization-resolved beam deflection technique is used to separate the bound-electronic and molecular rotational components of nonlinear refractive transients of molecular gases. Coherent rotational revivals from N(2), O(2), and two isotopologues of carbon disulfide (CS(2)), are identified in gaseous mixtures. Dephasing rates, rotational and centrifugal distortion constants of each species are measured. Polarization at the magic angle allows unambiguous measurement of the bound-electronic nonlinear refractive index of air and second hyperpolarizability of CS(2). Agreement between gas and liquid phase second hyperpolarizability measurements is found using the Lorentz-Lorenz local field correction.

Coalescence behavior of oil droplets coated in irreversibly-adsorbed surfactant layers.

Coalescence between oil caps with irreversibly adsorbed layers of nonionic surfactant is characterized in deionized water and electrolyte solution. The coalescence is characterized using a modified capillary tensiometer allowing for accurate measurement of the coalescence time. Results suggest two types of coalescence behavior, fast coalescence at low surface coverages that are independent of ionic strength and slow coalescence at high coverage. These slow coalescence events (orders of magnitude slower) are argued to be due to electric double layer forces or more complicated stabilization mechanisms arising from interfacial deformation and surface forces. A simple film drainage model is used in combination with measured values for interfacial properties to quantify the interaction potential between the two interfaces. Since this approach allows the two caps to have the same history, interfacial coverage and curvature, the results offer a tool to better understand a mechanism that is important to emulsion stability.