A Randomized Trial of Choice Architecture and Mailed Colorectal Cancer Screening Outreach in a Community Health Setting.

BACKGROUND & AIMS: Mailed outreach for colorectal cancer (CRC) screening increases uptake but it is unclear how to offer the choice of testing. We evaluated if the active choice between colonoscopy and fecal immunochemical test (FIT), or FIT alone, increased response compared with colonoscopy alone. METHODS: This pragmatic, randomized, controlled trial at a community health center included patients between ages 50 and 74 who were not up to date with CRC screening. Patients were randomized 1:1:1 to the following: (1) colonoscopy only, (2) active choice of colonoscopy or FIT, or (3) FIT only. Patients received an outreach letter with instructions for testing (colonoscopy referral and/or an enclosed FIT kit), a reminder letter at 2 months, and another reminder at 3 to 5 months via text message or automated voice recording. The primary outcome was CRC screening completion within 6 months. RESULTS: Among 738 patients in the final analysis, the mean age was 58.7 years (SD, 6.2 y); 48.6% were insured by Medicaid and 24.3% were insured by Medicare; and 71.7% were White, 16.9% were Black, and 7.3% were Hispanic/Latino. At 6 months, 5.6% (95% CI, 2.8-8.5) completed screening in the colonoscopy-only arm, 12.8% (95% CI, 8.6-17.0) in the active-choice arm, and 11.3% (95% CI, 7.4-15.3) in the FIT-only arm. Compared with colonoscopy only, there was a significant increase in screening in active choice (absolute difference, 7.1%; 95% CI, 2.0-12.2; P = .006) and FIT only (absolute difference, 5.7%; 95% CI, 0.8-10.6; P = .02). CONCLUSIONS: Both choice of testing and FIT alone increased response and may align with patient preferences. TRIAL REGISTRATION: clinicaltrials.gov NCT04711473.

Massively parallel FMCW lidar with cm range resolution using an electro-optic frequency comb.

Frequency-modulated continuous wave (FMCW) light detection and ranging (lidar) is a promising solution for three-dimensional (3D) imaging and autonomous driving. This technique maps range and velocity measurement to frequency counting via coherent detection. Compared with single-channel FMCW lidar, multi-channel FMCW lidar can greatly improve the measurement rate. A chip-scale soliton micro-comb is currently used in FMCW lidar to enable multi-channel parallel ranging and significantly increase the measurement rate. However, its range resolution is limited due to the soliton comb having only a few-GHz frequency sweep bandwidth. To overcome this limitation, we propose using a cascaded modulator electro-optic (EO) frequency comb for massively parallel FMCW lidar. We demonstrate a 31-channel FMCW lidar with a bulk EO frequency comb and a 19-channel FMCW lidar using an integrated thin-film lithium niobate (TFLN) EO frequency comb. Both systems have a sweep bandwidth of up to 15 GHz for each channel, corresponding to a 1-cm range resolution. We also analyze the limiting factors of the sweep bandwidth in 3D imaging and perform 3D imaging for a specific target. The measurement rate achieved is over 12 megapixels per second, which verifies its feasibility for massively parallel ranging. Our approach has the potential to greatly benefit 3D imaging in fields where high range resolution is required, such as in criminal investigation and precision machining.

High-fidelity sub-petabit-per-second self-homodyne fronthaul using broadband electro-optic combs.

With the exponential growth in data density and user ends of wireless networks, fronthaul is tasked with supporting aggregate bandwidths exceeding thousands of gigahertz while accommodating high-order modulation formats. However, it must address the bandwidth and noise limitations imposed by optical links and devices in a cost-efficient manner. Here we demonstrate a high-fidelity fronthaul system enabled by self-homodyne digital-analog radio-over-fiber superchannels, using a broadband electro-optic comb and uncoupled multicore fiber. This self-homodyne superchannel architecture not only offers capacity boosting but also supports carrier-recovery-free reception. Our approach achieves a record-breaking 15,000 GHz aggregated wireless bandwidth, corresponding to a 0.879 Pb/s common public radio interface (CPRI) equivalent data rate. Higher-order formats up to 1,048,576 quadrature-amplitude-modulated (QAM) are showcased at a 100 Tb/s class data rate. Furthermore, we employ a packaged on-chip electro-optic comb as the sole optical source to reduce the cost, supporting a data rate of 100.5 Tb/s with the 1024-QAM format. These demonstrations propel fronthaul into the era of Pb/s-level capacity and exhibit the promising potential of integrated-photonics implementation, pushing the boundaries to new heights in terms of capacity, fidelity, and cost.