Mentored implementation to initiate a diabetes program in an underserved community: a pilot study

IntroductionCommunity clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic.Research design and methodsParticipants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.ResultsPhase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: −0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (p<0.001–0.002). Phase II: participants had significant reductions in HbA1c (mean change: −0.78%, p=0.006), diastolic blood pressure (p=0.004), body mass index (0.012), weight (p=0.010), medication non-adherence (p<0.001), and six ADA measures (p=0.007–0.005). Phase I intervention versus phase II outcomes were comparable. CHWs improved knowledge from pre-test to post-tests (p<0.001).ConclusionsA novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.

The Quantum Kerr Nonlinear Coupler: The Analytical Versus Phase-Space Method

The generation of squeezed states of light in a two-mode Kerr nonlinear directional coupler (NLDC) was investigated using two different methods in quantum mechanics. First, the analytical method, a Heisenberg-picture-based method where the operators are evolving in time but the state vectors are time-independent. In this method, an analytical solution to the coupled Heisenberg equations of motion for the propagating modes was proposed based on Baker–Hausdorff (BH) formula. Second, the phase space method, a Schrödinger-picture based method in which the operators are constant and the density matrix evolves in time. In this method, the quantum mechanical master equation of the density matrix was converted to a corresponding classical Fokker-Planck (FP) equation in positive-P representation. Then, the FP equation was converted to a set of stochastic differential equations using Ito rules. The strength and weaknesses of each method are discussed. A good agreement between both methods was achieved, especially at early evolution stages and lower values of linear coupling coefficient. On one side, the analytical method seems insensitive to higher values of nonlinear coupling coefficients. Nevertheless, it demonstrated better numerical stability. On the other side, the solution of the stochastic equations resulting from the phase space method is numerically expensive as it requires averaging over thousands of trajectories. Besides, numerically unstable trajectories appear with positive-P representation at higher values of nonlinearity.

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P &lt; 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

CYLINDRICAL CONFINEMENT OF SOLUTIONS CONTAINING SEMIFLEXIBLE MACROMOLECULES: SURFACE-INDUCED NEMATIC ORDER VERSUS PHASE SEPARATION

Solutions of semiflexible polymers confined in cylindrical pores with repulsive walls are studied by Molecular Dynamics simulations for a wide range of polymer concentrations. Both the case where both lengths...

Radiation in Materials

The interaction of electromagnetic radiation and matter is examined, specifically electric and magnetic fields in materials with real and imaginary responses: under certain conditions the fields move through the material as a wave and under others they diffuse. The movement of a pulse of radiation in dispersive materials is described in which there are two wave velocities: group versus phase. The reflection of light from a sharp interface is analyzed and the Fresnel reflection/transmission equations derived. The response of materials to applied electric and magnetic fields in the time domain are correlated to their frequency response of the material’s polarization. The generalized Kramers–Kronig equations are derived and their applicability as a fundamental relationship between the real and imaginary parts of any material’s polarizability is discussed in detail. Finally, practical measurement techniques for extracting the real and imaginary components of a material’s index of refraction are introduced.

Group versus Phase Velocity of Shear Waves in Soft Tissues

Across the varieties of waves that have been studied in physics, it is well established that group velocities can be significantly greater than or less than phase velocities measured within comparable frequency bands, depending on the particular mechanisms involved. The distinction between group and phase velocities is important in elastography, because diagnoses are made based on shear wave speed estimations from a variety of techniques. We review the general definitions of group and phase velocity and examine their specific relations within an important general class of rheological models. For the class of tissues and materials exhibiting power law dispersion, group velocity is significantly greater than phase velocity, and simple expressions are shown to interrelate the commonly measured parameters. Examples are given from phantoms and tissues.