Accountable Care Organization Leader Perspectives on the Medicare Shared Savings Program: A Qualitative Study.

Importance: The Medicare Shared Savings Program (MSSP) includes more than 400 accountable care organizations (ACOs) and is among the largest and longest running value-based payment efforts in the US. However, given recent program reforms and other changes in the health care system, the experiences and perspectives of ACO leaders remain incompletely characterized. Objective: To understand the priorities, strategies, and challenges of ACO leaders in MSSP. Design, Setting, and Participants: In this qualitative study, interviews were conducted with leaders of 49 ACOs of differing sizes, leadership structures, and geographies from MSSP between September 29 and December 29, 2022. Participants were asked about their clinical and care management efforts; how they engaged frontline clinicians; the process by which they distributed shared savings and added or removed practices; and other factors that they believed influenced their success or failure in the program. Main Outcomes and Measures: Leader perspectives on major themes related to ACO initiatives, performance improvement, and the recruitment, engagement, and retention of clinicians. Results: Of the 49 ACOs interviewed, 34 were hospital-associated ACOs (69%), 35 were medium or large (>10 000 attributed beneficiaries) (71%), and 17 were rural (35%). The ACOs had a mean (SD) tenure of 8.1 (2.1) years in MSSP. Five major themes emerged: (1) ACO leaders reported a focus on annual wellness visits, coding practices, and care transitions; (2) leaders used both relationship-based and metrics-based strategies to promote clinician engagement; (3) ACOs generally distributed half or more of shared savings to participating practices; (4) ACO recruitment and retention efforts were increasingly influenced by market competition; and (5) some hospital-associated ACOs faced misaligned incentives. Conclusions and Relevance: In this study, the ACO leaders reported varied approaches to promoting clinician alignment with ACO goals, an emphasis on increasing annual wellness visits, and new pressures related to growth of other care models. Policymakers hoping to modify or expand the program may wish to incorporate these perspectives into future reforms.

All-Optical Noise Spectroscopy of a Solid-State Spin.

Noise spectroscopy elucidates the fundamental noise sources in spin systems, thereby serving as an essential tool toward developing spin qubits with long coherence times for quantum information processing, communication, and sensing. But existing techniques for noise spectroscopy that rely on microwave fields become infeasible when the microwave power is too weak to generate Rabi rotations of the spin. Here, we demonstrate an alternative all-optical approach to performing noise spectroscopy. Our approach utilizes coherent Raman rotations of the spin state with controlled timing and phase to implement Carr-Purcell-Meiboom-Gill pulse sequences. Analyzing the spin dynamics under these sequences enables us to extract the noise spectrum of a dense ensemble of nuclear spins interacting with a single spin in a quantum dot, which has thus far been modeled only theoretically. By providing spectral bandwidths of over 100 MHz, our approach enables studies of spin dynamics and decoherence for a broad range of solid-state spin qubits.

Psychedelics promote neuroplasticity through the activation of intracellular 5-HT2A receptors.

Decreased dendritic spine density in the cortex is a hallmark of several neuropsychiatric diseases, and the ability to promote cortical neuron growth has been hypothesized to underlie the rapid and sustained therapeutic effects of psychedelics. Activation of 5-hydroxytryptamine (serotonin) 2A receptors (5-HT2ARs) is essential for psychedelic-induced cortical plasticity, but it is currently unclear why some 5-HT2AR agonists promote neuroplasticity, whereas others do not. We used molecular and genetic tools to demonstrate that intracellular 5-HT2ARs mediate the plasticity-promoting properties of psychedelics; these results explain why serotonin does not engage similar plasticity mechanisms. This work emphasizes the role of location bias in 5-HT2AR signaling, identifies intracellular 5-HT2ARs as a therapeutic target, and raises the intriguing possibility that serotonin might not be the endogenous ligand for intracellular 5-HT2ARs in the cortex.

Lobbying Expenditures in the US Health Care Sector, 2000-2020.

This cross-sectional study uses publicly available, nonpartisan data to evaluate trends in lobbying expenditures across health care industries.

Optical Transparency Induced by a Largely Purcell Enhanced Quantum Dot in a Polarization-Degenerate Cavity.

Optically active spin systems coupled to photonic cavities with high cooperativity can generate strong light-matter interactions, a key ingredient in quantum networks. However, obtaining high cooperativities for quantum information processing often involves the use of photonic crystal cavities that feature a poor optical access from the free space, especially to circularly polarized light required for the coherent control of the spin. Here, we demonstrate coupling with a cooperativity as high as 8 of an InAs/GaAs quantum dot to a fabricated bullseye cavity that provides nearly degenerate and Gaussian polarization modes for efficient optical accessing. We observe spontaneous emission lifetimes of the quantum dot as short as 80 ps (an ∼15 Purcell enhancement) and a ∼80% transparency of light reflected from the cavity. Leveraging the induced transparency for photon switching while coherently controlling the quantum dot spin could contribute to ongoing efforts of establishing quantum networks.

A biomimetic multilayered polymeric material designed for heart valve repair and replacement.

Materials currently used to repair or replace a heart valve are not durable. Their limited durability related to structural degeneration or thrombus formation is attributed to their inadequate mechanical properties and biocompatibility profiles. Our hypothesis is that a biostable material that mimics the structure, mechanical and biological properties of native tissue will improve the durability of these leaflets substitutes and in fine improve the patient outcome. Here, we report the development, optimization, and testing of a biomimetic, multilayered material (BMM), designed to replicate the native valve leaflets. Polycarbonate urethane and polycaprolactone have been processed as film, foam, and aligned fibers to replicate the leaflet's architecture and anisotropy, through solution casting, lyophilization, and electrospinning. Compared to the commercialized materials, our BMMs exhibited an anisotropic behavior and a closer mechanical performance to the aortic leaflets. The material exhibited superior biostability in an accelerated oxidization environment. It also displayed better resistance to protein adsorption and calcification in vitro and in vivo. These results will pave the way for a new class of advanced synthetic material with long-term durability for surgical valve repair or replacement.

Enhanced Spin Coherence of a Self-Assembled Quantum Dot Molecule at the Optimal Electrical Bias.

A pair of coupled dots with one electron in each dot can provide improvements in spin coherence, particularly at an electrical bias called the "sweet spot," but few measurements have been performed on self-assembled dots in this regime. Here, we directly measure the T_{2}^{*} coherence time of the singlet-triplet states in this system as a function of bias and magnetic field, obtaining a maximum T_{2}^{*} of 60 ns, more than an order of magnitude higher than an electron spin in a single quantum dot. Our results uncover two main dephasing mechanisms: electrical noise away from the sweet spot, and a magnetic field dependent interaction with nuclear spins due to a difference in g factors.

Coherent Population Trapping Combined with Cycling Transitions for Quantum Dot Hole Spins Using Triplet Trion States.

Optical spin rotations and cycling transitions for measurement are normally incompatible in quantum dots, presenting a fundamental problem for quantum information applications. Here we show that for a hole spin this problem can be addressed using a trion with one hole in an excited orbital, where strong spin-orbit interaction tilts the spin. Then, a particular trion triplet forms a double Λ system, even in a Faraday magnetic field, which we use to demonstrate fast hole spin initialization and coherent population trapping. The lowest trion transitions still strongly preserve spin, thus combining fast optical spin control with cycling transitions for spin readout.

Arrays of Si vacancies in 4H-SiC produced by focused Li ion beam implantation.

Point defects in SiC are an attractive platform for quantum information and sensing applications because they provide relatively long spin coherence times, optical spin initialization, and spin-dependent fluorescence readout in a fabrication-friendly semiconductor. The ability to precisely place these defects at the optimal location in a host material with nano-scale accuracy is desirable for integration of these quantum systems with traditional electronic and photonic structures. Here, we demonstrate the precise spatial patterning of arrays of silicon vacancy ([Formula: see text]) emitters in an epitaxial 4H-SiC (0001) layer through mask-less focused ion beam implantation of Li+. We characterize these arrays with high-resolution scanning confocal fluorescence microscopy on the Si-face, observing sharp emission lines primarily coming from the [Formula: see text] zero-phonon line (ZPL). The implantation dose is varied over 3 orders of magnitude, leading to [Formula: see text] densities from a few per implantation spot to thousands per spot, with a linear dependence between ZPL emission and implantation dose. Optically-detected magnetic resonance (ODMR) is also performed, confirming the presence of V2 [Formula: see text]. Our investigation reveals scalable and reproducible defect generation.

Circulating and tissue matricellular RNA and protein expression in calcific aortic valve disease.

Aortic valve sclerosis is a highly prevalent, poorly characterized asymptomatic manifestation of calcific aortic valve disease and may represent a therapeutic target for disease mitigation. Human aortic valve cusps and blood were obtained from 333 patients undergoing cardiac surgery (n = 236 for severe aortic stenosis, n = 35 for asymptomatic aortic valve sclerosis, n = 62 for no valvular disease), and a multiplex assay was used to evaluate protein expression across the spectrum of calcific aortic valve disease. A subset of six valvular tissue samples (n = 3 for asymptomatic aortic valve sclerosis, n = 3 for severe aortic stenosis) was used to create RNA sequencing profiles, which were subsequently organized into clinically relevant gene modules. RNA sequencing identified 182 protein-encoding, differentially expressed genes in aortic valve sclerosis vs. aortic stenosis; 85% and 89% of expressed genes overlapped in aortic stenosis and aortic valve sclerosis, respectively, which decreased to 55% and 84% when we targeted highly expressed genes. Bioinformatic analyses identified six differentially expressed genes encoding key extracellular matrix regulators: TBHS2, SPARC, COL1A2, COL1A1, SPP1, and CTGF. Differential expression of key circulating biomarkers of extracellular matrix reorganization was observed in control vs. aortic valve sclerosis (osteopontin), control vs. aortic stenosis (osteoprotegerin), and aortic valve sclerosis vs. aortic stenosis groups (MMP-2), which corresponded to valvular mRNA expression. We demonstrate distinct mRNA and protein expression underlying aortic valve sclerosis and aortic stenosis. We anticipate that extracellular matrix regulators can serve as circulating biomarkers of early calcific aortic valve disease and as novel targets for early disease mitigation, pending prospective clinical investigations.

Enabling remote quantum emission in 2D semiconductors via porous metallic networks.

Here we report how two-dimensional crystal (2DC) overlayers influence the recrystallization of relatively thick metal films and the subsequent synergetic benefits this provides for coupling surface plasmon-polaritons (SPPs) to photon emission in 2D semiconductors. We show that annealing 2DC/Au films on SiO2 results in a reverse epitaxial process where initially nanocrystalline Au films gain texture, crystallographically orient with the 2D crystal overlayer, and form an oriented porous metallic network (OPEN) structure in which the 2DC can suspend above or coat the inside of the metal pores. Both laser excitation and exciton recombination in the 2DC semiconductor launch propagating SPPs in the OPEN film. Energy in-/out- coupling occurs at metal pore sites, alleviating the need for dielectric spacers between the metal and 2DC layer. At low temperatures, single-photon emitters (SPEs) are present across an OPEN-WSe2 film, and we demonstrate remote SPP-mediated excitation of SPEs at a distance of 17 µm.

A Spin-Photon Interface Using Charge-Tunable Quantum Dots Strongly Coupled to a Cavity.

Charged quantum dots containing an electron or hole spin are bright solid-state qubits suitable for quantum networks and distributed quantum computing. Incorporating such quantum dot spin into a photonic crystal cavity creates a strong spin-photon interface in which the spin can control a photon by modulating the cavity reflection coefficient. However, previous demonstrations of such spin-photon interfaces have relied on quantum dots that are charged randomly by nearby impurities, leading to instability in the charge state, which causes poor contrast in the cavity reflectivity. Here we demonstrate a strong spin-photon interface using a quantum dot that is charged deterministically with a diode structure. By incorporating this actively charged quantum dot in a photonic crystal cavity, we achieve strong coupling between the cavity mode and the negatively charged state of the dot. Furthermore, by initializing the spin through optical pumping, we show strong spin-dependent modulation of the cavity reflectivity, corresponding to a cooperativity of 12. This spin-dependent reflectivity is important for mediating entanglement between spins using photons, as well as generating strong photon-photon interactions for applications in quantum networking and distributed quantum computing.

Tunable Coupling of a Double Quantum Dot Spin System to a Mechanical Resonator.

The interaction of quantum systems with mechanical resonators is of practical interest for applications in quantum information and sensing and also of fundamental interest as hybrid quantum systems. Achieving a large and tunable interaction strength is of great importance in this field as it enables controlled access to the quantum limit of motion and coherent interactions between different quantum systems. This has been challenging with solid state spins, where typically the coupling is weak and cannot be tuned. Here we use pairs of coupled quantum dots embedded within cantilevers to achieve a high coupling strength of the singlet-triplet spin system to mechanical motion through strain. Two methods of achieving strong, tunable coupling are demonstrated. The first is through different strain-induced energy shifts for the two QDs when the cantilever vibrates, resulting in changes to the exchange interaction. The second is through a laser-driven AC Stark shift that is sensitive to strain-induced shifts of the optical transitions. Both of these mechanisms can be tuned to zero with electrical bias or laser power, respectively, and give large spin-mechanical coupling strengths.

Scalable in operando strain tuning in nanophotonic waveguides enabling three-quantum-dot superradiance.

The quest for an integrated quantum optics platform has motivated the field of semiconductor quantum dot research for two decades. Demonstrations of quantum light sources, single photon switches, transistors and spin-photon interfaces have become very advanced. Yet the fundamental problem that every quantum dot is different prevents integration and scaling beyond a few quantum dots. Here, we address this challenge by patterning strain via local phase transitions to selectively tune individual quantum dots that are embedded in a photonic architecture. The patterning is implemented with in operando laser crystallization of a thin HfO2 film 'sheath' on the surface of a GaAs waveguide. Using this approach, we tune InAs quantum dot emission energies over the full inhomogeneous distribution with a step size down to the homogeneous linewidth and a spatial resolution better than 1 µm. Using these capabilities, we tune multiple quantum dots into resonance within the same waveguide and demonstrate a quantum interaction via superradiant emission from three quantum dots.

Spin-cavity interactions between a quantum dot molecule and a photonic crystal cavity.

The integration of InAs/GaAs quantum dots into nanophotonic cavities has led to impressive demonstrations of cavity quantum electrodynamics. However, these demonstrations are primarily based on two-level excitonic systems. Efforts to couple long-lived quantum dot electron spin states with a cavity are only now succeeding. Here we report a two-spin-cavity system, achieved by embedding an InAs quantum dot molecule within a photonic crystal cavity. With this system we obtain a spin singlet-triplet Λ-system where the ground-state spin splitting exceeds the cavity linewidth by an order of magnitude. This allows us to observe cavity-stimulated Raman emission that is highly spin-selective. Moreover, we demonstrate the first cases of cavity-enhanced optical nonlinearities in a solid-state Λ-system. This provides an all-optical, local method to control the spin exchange splitting. Incorporation of a highly engineerable quantum dot molecule into the photonic crystal architecture advances prospects for a quantum network.

Leveraging crystal anisotropy for deterministic growth of InAs quantum dots with narrow optical linewidths.

Crystal growth anisotropy in molecular beam epitaxy usually prevents deterministic nucleation of individual quantum dots when a thick GaAs buffer is grown over a nanopatterned substrate. Here, we demonstrate how this anisotropy can actually be used to mold nucleation sites for single dots on a much thicker buffer than has been achieved by conventional techniques. This approach greatly suppresses the problem of defect-induced line broadening for single quantum dots in a charge-tunable device, giving state-of-the-art optical linewidths for a system widely studied as a spin qubit for quantum information.