Quantum transport of high-dimensional spatial information with a nonlinear detector.

Information exchange between two distant parties, where information is shared without physically transporting it, is a crucial resource in future quantum networks. Doing so with high-dimensional states offers the promise of higher information capacity and improved resilience to noise, but progress to date has been limited. Here we demonstrate how a nonlinear parametric process allows for arbitrary high-dimensional state projections in the spatial degree of freedom, where a strong coherent field enhances the probability of the process. This allows us to experimentally realise quantum transport of high-dimensional spatial information facilitated by a quantum channel with a single entangled pair and a nonlinear spatial mode detector. Using sum frequency generation we upconvert one of the photons from an entangled pair resulting in high-dimensional spatial information transported to the other. We realise a d = 15 quantum channel for arbitrary photonic spatial modes which we demonstrate by faithfully transferring information encoded into orbital angular momentum, Hermite-Gaussian and arbitrary spatial mode superpositions, without requiring knowledge of the state to be sent. Our demonstration merges the nascent fields of nonlinear control of structured light with quantum processes, offering a new approach to harnessing high-dimensional quantum states, and may be extended to other degrees of freedom too.

Design and Evaluation of an Interprofessional Preceptor Development Mini-Fellowship Program.

INTRODUCTION: Health professions preceptors require skills and knowledge to effectively meet the educational needs of interprofessional students in clinical environments. We implemented a mini-fellowship program to enhance the knowledge, skills, and self-efficacy of preceptors teaching students and applying quality improvement (QI) methods across disciplines and patient care settings. METHOD: The design, implementation, and evaluation of the program were informed by the faculty development literature, principles of adult learning, and preceptor needs. The 3-day program included workshops on curriculum design, clinical teaching methods, QI, social determinants of health, cultural humility, and interprofessional teamwork. Quantitative and qualitative evaluation methods were used including preprogram and postprogram knowledge and self-efficacy surveys, along with end-of-session and program evaluations. RESULTS: Five annual cohorts involving 41 preceptors with varied demographics, professions, and clinical practices completed the mini-fellowship program. Participants' percentage of items answered correctly on a QI knowledge test increased from 79.2% (pretest) to 85.5% (post-test), a gain of 6.3% (90% CI: 2.9-9.7%; P < .003). The average QI self-efficacy scores improved from 2.64 to 3.82, a gain of 1.18 points on a five-point scale (P < .001). The average education/teaching self-efficacy increased from 2.79 to 3.80 on a five-point scale (P < .001). Ultimately, 94% would recommend the program to other preceptors. DISCUSSION: An interprofessional preceptor development program designed to train clinicians to effectively teach in the clinical setting and to conduct QI projects with students was achievable and effective. This program can serve as a model for academic centers charged with training future health care workers and supporting their community-based preceptors' training needs.

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic.

OBJECTIVES: The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC). METHODS: In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices. RESULTS: Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily. CONCLUSIONS: The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians' mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians' work, job, and mental health needs now and before the next pandemic.

Overall Work and Practice Satisfaction of Licensed Clinical Social Workers in the National Health Service Corps Loan Repayment Program.

Little is known about the job satisfaction of licensed clinical social workers (LCSWs) participating in the National Health Service Corps (NHSC) federal Loan Repayment Program (LRP). Employee satisfaction in organizations is important for organizational well-being and to decrease turnover. A satisfied NHSC LCSW workforce is also important given the array of services it provides, especially in rural and underserved areas. This study examined the work satisfaction of 386 LCSWs participating in the NHSC LRP in 21 states. Rural upbringing, being older than 40 years, and a higher salary were significantly associated with overall work and practice satisfaction. In addition, satisfaction with administration, staff and the practices' linkages to other health providers, the mission of the practice, and connection with patients were strongly associated with overall work and practice satisfaction. To our knowledge, this is the first study to examine the work and practice satisfaction of LCSWs participating in the NHSC LRP, and our findings have the potential to inform the NHSC's strategies in managing and retaining LCSWs.

Serum sclerostin and glucose homeostasis: No association in healthy men. Cross-sectional and prospective data from the EGIR-RISC study.

INTRODUCTION: Sclerostin, an inhibitor of bone formation, has emerged as a potential negative regulator of glucose homeostasis. We aimed to investigate if serum sclerostin associates with insulin sensitivity, beta cell function, prediabetes or metabolic syndrome in healthy men. MATERIALS AND METHODS: Serum sclerostin was measured in basal and insulin-stimulated samples from 526 men without diabetes from the RISC cohort study. An OGTT was performed at baseline and after 3 years. An IVGTT and a hyperinsulinaemic-euglycaemic clamp were performed at baseline. Insulin sensitivity was estimated by the oral glucose sensitivity index (OGIS) and the M-value relative to insulin levels. Beta cell function was assessed by the acute and total insulin secretion (ISRtot) and by beta cell glucose sensitivity. RESULTS: Serum sclerostin levels correlated positively with age but were similar in individuals with (n = 69) and without (n = 457) prediabetes or the metabolic syndrome. Serum sclerostin was associated with measures of neither insulin sensitivity nor beta cell function at baseline in age-adjusted analyses including all participants. However, baseline serum sclerostin correlated inversely with OGIS at follow-up in men without prediabetes (B: -0.29 (-0.57, -0.01) p = 0.045), and inversely with beta cell glucose sensitivity in men with prediabetes (B: -13.3 (-26.3, -0.2) p = 0.046). Associations between serum sclerostin and 3-year changes in measures of glucose homeostasis were not observed. Acute hyperinsulinemia suppressed serum sclerostin (p = 0.02), and this reduction correlated with OGIS and ISRtot. CONCLUSIONS: Overall, serum sclerostin was not associated with prediabetes, insulin sensitivity or insulin secretion in healthy men. The inverse relationship between serum sclerostin and insulin sensitivity at follow-up was weak and likely not of clinical relevance. The ability of insulin to reduce sclerostin, possibly promoting bone formation, needs to be clarified.

Circulating palmitoleic acid is an independent determinant of insulin sensitivity, beta cell function and glucose tolerance in non-diabetic individuals: a longitudinal analysis.

AIMS/HYPOTHESIS: Experimental studies suggest that the fatty acid palmitoleate may act as an adipocyte-derived lipid hormone (or 'lipokine') to regulate systemic metabolism. We investigated the relationship of circulating palmitoleate with insulin sensitivity, beta cell function and glucose tolerance in humans. METHODS: Plasma NEFA concentration and composition were determined in non-diabetic individuals from the Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study cohort at baseline (n = 1234) and after a 3 year follow-up (n = 924). Glucose tolerance, insulin secretion and beta cell function were assessed during an OGTT. Whole-body insulin sensitivity was measured by a hyperinsulinaemic-euglycaemic clamp (M/I) and OGTT (oral glucose insulin sensitivity index [OGIS]). The liver insulin resistance index was calculated using clinical and biochemical data. Body composition including fat mass was determined by bioelectrical impedance. RESULTS: Circulating palmitoleate was proportional to fat mass (r = 0.21, p < 0.0001) and total NEFA levels (r = 0.19, p < 0.0001). It correlated with whole-body insulin sensitivity (M/I: standardised regression coefficient [std. ß] = 0.16, p < 0.0001), liver insulin resistance (std. ß = -0.14, p < 0.0001), beta cell function (potentiation: std. ß = 0.08, p = 0.045) and glucose tolerance (2 h glucose: std. ß = -0.24, p < 0.0001) after adjustment for age, sex, BMI, adiposity and other NEFA. High palmitoleate concentrations prevented the decrease in insulin sensitivity associated with excess palmitate (p = 0.0001). In a longitudinal analysis, a positive independent relationship was observed between changes in palmitoleate and insulin sensitivity over time (std. ß = 0.07, p = 0.04). CONCLUSIONS/INTERPRETATION: We demonstrated that plasma palmitoleate is an independent determinant of insulin sensitivity, beta cell function and glucose tolerance in non-diabetic individuals. These results support the role of palmitoleate as a beneficial lipokine released by adipose tissue to prevent the negative effects of adiposity and excess NEFA on systemic glucose metabolism.

Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults.

Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.

Satisfaction of the Primary Care, Mental Health, and Dental Health Clinicians of the National Health Service Corps Loan Repayment Program.

The National Health Service Corps (NHSC) aims to foster a positive service experience for its clinicians to promote long-term retention. We assess the satisfaction of primary care, dental, and mental health clinicians in the NHSC's Loan Repayment Program (LRP). Survey data are from 1,193 clinicians (72.4% response) who completed NHSC LRP contracts in 16 states from July 2015 through December 2016. Eighty-one percent reported overall satisfaction with their work and practice, without differences across disciplines. Nearly 95% were satisfied with the mission and patients of their practices. Fewer clinicians were satisfied with compensation (51%) and time demands of work (36%). Ninety-four percent reported the NHSC experience met or exceeded their expectations, and 94% recommend the NHSC LRP to others. In summary, the NHSC LRP experience is generally positive for clinicians of all disciplines. Clinicians' issues with their incomes and with the time demands of their work deserve attention from the NHSC.

A versatile quantum walk resonator with bright classical light.

In a Quantum Walk (QW) the "walker" follows all possible paths at once through the principle of quantum superposition, differentiating itself from classical random walks where one random path is taken at a time. This facilitates the searching of problem solution spaces faster than with classical random walks, and holds promise for advances in dynamical quantum simulation, biological process modelling and quantum computation. Here we employ a versatile and scalable resonator configuration to realise quantum walks with bright classical light. We experimentally demonstrate the versatility of our approach by implementing a variety of QWs, all with the same experimental platform, while the use of a resonator allows for an arbitrary number of steps without scaling the number of optics. This paves the way for future QW implementations with spatial modes of light in free-space that are both versatile and scalable.

Spatial mode detection by frequency upconversion.

The efficient creation and detection of spatial modes of light has become topical of late, driven by the need to increase photon bit-rates in classical and quantum communications. Such mode creation/detection is traditionally achieved with tools based on linear optics. Here we put forward a new spatial mode detection technique based on the nonlinear optical process of sum-frequency generation. We outline the concept theoretically and demonstrate it experimentally with intense laser beams carrying orbital angular momentum and Hermite-Gaussian modes. Finally, we show that the method can be used to transfer an image from the infrared band to the visible, which implies the efficient conversion of many spatial modes.

Pathophysiological Characteristics Underlying Different Glucose Response Curves: A Latent Class Trajectory Analysis From the Prospective EGIR-RISC Study.

OBJECTIVE: Glucose measurements during an oral glucose tolerance test (OGTT) are useful in predicting diabetes and its complications. However, knowledge of the pathophysiology underlying differences in glucose curve shapes is sparse. We examined the pathophysiological characteristics that create different glucose curve patterns and studied their stability and reproducibility over 3 years of follow-up. RESEARCH DESIGN AND METHODS: We analyzed data from participants without diabetes from the observational cohort from the European Group for the Study of Insulin Resistance: Relationship between Insulin Sensitivity and Cardiovascular Disease study; participants had a five-time point OGTT at baseline (n = 1,443) and after 3 years (n = 1,045). Measures of insulin sensitivity and secretion were assessed at baseline with a euglycemic-hyperinsulinemic clamp and intravenous glucose tolerance test. Heterogeneous glucose response patterns during the OGTT were identified using latent class trajectory analysis at baseline and at follow-up. Transitions between classes were analyzed with multinomial logistic regression models. RESULTS: We identified four different glucose response patterns, which differed with regard to insulin sensitivity and acute insulin response, obesity, and plasma levels of lipids and inflammatory markers. Some of these associations were confirmed prospectively. Time to glucose peak was driven mainly by insulin sensitivity, whereas glucose peak size was related to both insulin sensitivity and secretion. The glucose patterns identified at follow-up were similar to those at baseline, suggesting that the latent class method is robust. We integrated our classification model into an easy-to-use online application that facilitates the assessment of glucose curve patterns for other studies. CONCLUSIONS: The latent class analysis approach is a pathophysiologically insightful way to classify individuals without diabetes based on their response to glucose during an OGTT.

The relationship between bone turnover and insulin sensitivity and secretion: Cross-sectional and prospective data from the RISC cohort study.

Bone metabolism appears to influence insulin secretion and sensitivity, and insulin promotes bone formation in animals, but similar evidence in humans is limited. The objectives of this study are to explore if bone turnover markers were associated with insulin secretion and sensitivity and to determine if bone turnover markers predict changes in insulin secretion and sensitivity. The study population encompassed 576 non-diabetic adult men with normal glucose tolerance (NGT; n=503) or impaired glucose regulation (IGR; n=73). Baseline markers of bone resorption (CTX) and formation (P1NP) were determined in the fasting state and after a 2-h hyperinsulinaemic, euglycaemic clamp. An intravenous glucose tolerance test (IVGTT) and a 2-h oral glucose tolerance test (OGTT) were performed at baseline, and the OGTT was repeated after 3years. There were no differences in bone turnover marker levels between NGT and IGR. CTX and P1NP levels decreased by 8.0% (p<0.001) and 1.9% (p<0.01) between baseline and steady-state during the clamp. Fasting plasma glucose was inversely associated with CTX and P1NP both before and after adjustment for recruitment centre, age, BMI, smoking and physical activity. However, baseline bone turnover markers were neither associated with insulin sensitivity (assessed using hyperinsulinaemic euglycaemic clamp and OGTT) nor with insulin secretion capacity (based on IVGTT and OGTT) at baseline or at follow-up. Although inverse associations between fasting glucose and markers of bone turnover were identified, this study cannot support an association between insulin secretion and sensitivity in healthy, non-diabetic men.

A deterministic detector for vector vortex states.

Encoding information in high-dimensional degrees of freedom of photons has led to new avenues in various quantum protocols such as communication and information processing. Yet to fully benefit from the increase in dimension requires a deterministic detection system, e.g., to reduce dimension dependent photon loss in quantum key distribution. Recently, there has been a growing interest in using vector vortex modes, spatial modes of light with entangled degrees of freedom, as a basis for encoding information. However, there is at present no method to detect these non-separable states in a deterministic manner, negating the benefit of the larger state space. Here we present a method to deterministically detect single photon states in a four dimensional space spanned by vector vortex modes with entangled polarisation and orbital angular momentum degrees of freedom. We demonstrate our detection system with vector vortex modes from the |[Formula: see text]| = 1 and |[Formula: see text]| = 10 subspaces using classical and weak coherent states and find excellent detection fidelities for both pure and superposition vector states. This work opens the possibility to increase the dimensionality of the state-space used for encoding information while maintaining deterministic detection and will be invaluable for long distance classical and quantum communication.

Simultaneous entanglement swapping of multiple orbital angular momentum states of light.

High-bit-rate long-distance quantum communication is a proposed technology for future communication networks and relies on high-dimensional quantum entanglement as a core resource. While it is known that spatial modes of light provide an avenue for high-dimensional entanglement, the ability to transport such quantum states robustly over long distances remains challenging. To overcome this, entanglement swapping may be used to generate remote quantum correlations between particles that have not interacted; this is the core ingredient of a quantum repeater, akin to repeaters in optical fibre networks. Here we demonstrate entanglement swapping of multiple orbital angular momentum states of light. Our approach does not distinguish between different anti-symmetric states, and thus entanglement swapping occurs for several thousand pairs of spatial light modes simultaneously. This work represents the first step towards a quantum network for high-dimensional entangled states and provides a test bed for fundamental tests of quantum science.Entanglement swapping in high dimensions requires large numbers of entangled photons and consequently suffers from low photon flux. Here the authors demonstrate entanglement swapping of multiple spatial modes of light simultaneously, without the need for increasing the photon numbers with dimension.

The Association Between Sleep Duration, Insulin Sensitivity, and ß-Cell Function: The EGIR-RISC Study.

CONTEXT: In the past decade, over 3 dozen studies reported a relationship between self-reported short sleep and disturbed glucose metabolism. A study with insulin sensitivity assessed according to the gold standard hyperinsulinemic-euglycemic clamp is, however, still missing. OBJECTIVE: To evaluate the cross-sectional association of sleep duration with insulin sensitivity and ß-cell function in the European group for the study of insulin resistance (EGIR-RISC) study cohort. DESIGN, SETTING, PARTICIPANTS, AND MEASURES: We used data from the baseline measurements of the European, multicentre EGIR-RISC study that included 1319 clinically healthy participants. Sleep and physical activity were measured using a single-axis accelerometer. Insulin sensitivity and ß-cell function were estimated by hyperinsulinemic-euglycemic clamp and from the oral glucose insulin sensitivity index model, using an oral glucose tolerance test. Associations of sleep duration with insulin sensitivity and ß-cell function were analyzed by multiple linear regression, stratified by sex. RESULTS: In our current analysis, we included 788 participants (57% women, age 44 ± 8 y), who had an average sleep duration of 7.3 ± 1.5 hours. In men, we observed an inverted U-shaped association between sleep duration categorized per hour and M/I (in µmol/min per kgFFM/nM per hour) (ß-estimate [95% confidence intervals] 41 [2, 80]; P = .04 and ß(2)-estimate -3 [-6, -0.2], P = .04) as well as a trend for the oral glucose insulin sensitivity index (in mL/min per kgFFM) (ß-estimate [95% confidence intervals] 0.8 [-0.4, 2]; P = .17). In women, we observed a U-shaped association between sleep duration and ß-cell function (in pmol/min per m(2)/mM per hour) (ß-estimate -45 [-86, -3]; P = .04 and ß(2)-estimate 3 [0.2, 6]; P = .04). CONCLUSIONS: Sleep duration is associated with insulin sensitivity and ß-cell function in a sex-specific manner in clinically healthy people.

Engineering two-photon high-dimensional states through quantum interference.

Many protocols in quantum science, for example, linear optical quantum computing, require access to large-scale entangled quantum states. Such systems can be realized through many-particle qubits, but this approach often suffers from scalability problems. An alternative strategy is to consider a lesser number of particles that exist in high-dimensional states. The spatial modes of light are one such candidate that provides access to high-dimensional quantum states, and thus they increase the storage and processing potential of quantum information systems. We demonstrate the controlled engineering of two-photon high-dimensional states entangled in their orbital angular momentum through Hong-Ou-Mandel interference. We prepare a large range of high-dimensional entangled states and implement precise quantum state filtering. We characterize the full quantum state before and after the filter, and are thus able to determine that only the antisymmetric component of the initial state remains. This work paves the way for high-dimensional processing and communication of multiphoton quantum states, for example, in teleportation beyond qubits.

Physician assistants and nurse practitioners in the National Health Service Corps.

OBJECTIVES: This study describes the experiences of physician assistants (PAs) and nurse practitioners (NPs) in the National Health Service Corps' (NHSC) loan repayment program in 2010. METHODS: In 2011, a stratified random sample of NHSC clinicians was surveyed. Data from the 148 PA and 137 NP respondents were analyzed (52.4% response rate). RESULTS: PAs were younger than NPs (mean age 31 versus 35 years), less often female (68% versus 91%), and more often carried educational debt over $100,000 (56% versus 24%). Both groups were serving in states familiar to them and within communities where they felt accepted. The groups were generally satisfied on most measures of work, with PAs more satisfied than NPs on some measures. CONCLUSION: The NHSC's PAs and NPs are well matched to communities and satisfied with their work. Maximizing their NHSC experiences and retention requires recognizing their differences in demographics, debt, and areas of job satisfaction.

An evaluation of state-based support-for-service programs targeting nurse faculty.

AIM: The aim of the study was to assess how state-based support-for-service (SFS) programs are used by deans and directors of nursing programs and to evaluate their perceived impact. BACKGROUND: Given projected nurse faculty shortages, stakeholders are looking for ways to address the maldistribution and shortage of nurse faculty. One state-level strategy is the implementation of loan repayment and scholarship programs, which incentivize individuals with, or currently pursuing, graduate degrees to become or remain nurse faculty. METHOD: This study used a mixed-method and multilevel approach to assess the impact of SFS programs in seven states. RESULTS: Programs are perceived to affect both recruitment and retention of faculty and play a role in increasing the educational qualifications of current nurse faculty. CONCLUSION: Nurse educators need to be aware of SFS programs and how best to use them to support nurse faculty.

Qudit-teleportation for photons with linear optics.

Quantum Teleportation, the transfer of the state of one quantum system to another without direct interaction between both systems, is an important way to transmit information encoded in quantum states and to generate quantum correlations (entanglement) between remote quantum systems. So far, for photons, only superpositions of two distinguishable states (one "qubit") could be teleported. Here we show how to teleport a "qudit", i.e. a superposition of an arbitrary number d of distinguishable states present in the orbital angular momentum of a single photon using d beam splitters and d additional entangled photons. The same entanglement resource might also be employed to collectively teleport the state of d/2 photons at the cost of one additional entangled photon per qubit. This is superior to existing schemes for photonic qubits, which require an additional pair of entangled photons per qubit.