Aurelia Butler

Perovskites are among the most researched topics in materials science. Recently, a research team led by Prof. LOH Kian Ping, Chair Professor of Materials Physics and Chemistry and Global STEM Professor of the Department of Applied Physics of The Hong Kong Polytechnic University (PolyU), Dr Kathy LENG, Assistant Professor of the same department, together with Dr Hwa Seob CHOI, Postdoctoral Research Fellow and the first author of the research paper, has solved an age-old challenge to synthesise all-organic two-dimensional perovskites, extending the field into the exciting realm of 2D materials. This breakthrough opens up a new field of 2D all-organic perovskites, which holds promise for both fundamental science and potential applications. This research titled “Molecularly thin, two-dimensional all-organic perovskites” was recently published in the journal Science.
Perovskites are named after their structural resemblance to the mineral calcium titanate perovskite, and are well known for their fascinating properties that can be applied in wide-ranging fields such as solar cells, lighting and catalysis. With a fundamental chemical formula of ABX3, perovskites possess the ability to be finely tuned by adjusting the A and B cations as well as the X anion, paving the way for the development of high-performance materials.
While perovskite was first discovered as an inorganic compound, Prof. Loh’s team has focused their attention on the emerging class of all-organic perovskites. In this new family, A, B, and X constituents are organic molecules rather than individual atoms like metals or oxygen. The design principles for creating three-dimensional (3D) perovskites using organic components have only recently been established. Significantly, all-organic perovskites offer distinct advantages over their all-inorganic counterparts, as they are solution-processible and flexible, enabling cost-effective fabrication. Moreover, by manipulating the chemical composition of the crystal, valuable electromagnetic properties such as dielectric properties, which finds applications in electronics and capacitors, can be precisely engineered.
Traditionally, researchers face challenges in the synthesis of all-organic 3D perovskites due to the restricted selection of organic molecules that can fit with the crystal structure. Recognising this limitation, Prof. Loh and his team proposed an innovative approach: synthesising all-organic perovskites in the form of 2D layers instead of 3D crystals. This strategy aimed to overcome the constraints imposed by bulky molecules and facilitate the incorporation of a broader range of organic ions. The anticipated outcome was the emergence of novel and extraordinary properties in these materials.
Validating their prediction, the team developed a new general class of layered organic perovskites. Following the convention for naming perovskites, they called it the “Choi-Loh-v phase” (CL-v) after Dr Choi and Prof. Loh. These perovskites comprise molecularly thin layers held together by forces that hold graphite layers together, the so-called van der Waals forces — hence the “v” in CL-v. Compared with the previously studied hybrid 2D perovskites, the CL-v phase is stabilised by the addition of another B cation into the unit cell and has the general formula A2B2X4.
Using solution-phase chemistry, the research team prepared a CL-v material known as CMD-N-P2, in which the A, B and X sites are occupied by CMD (a chlorinated cyclic organic molecule), ammonium and PF6− ions, respectively. The expected crystal structure was confirmed by high-resolution electron microscopy carried out at cryogenic temperature. These molecularly thin 2D organic perovskites are fundamentally different from traditional 3D minerals, they are single crystalline in two dimensions and can be exfoliated as hexagonal flakes just a few nanometres thick — 20,000 times thinner than a human hair.
The solution-processibility of 2D organic perovskites presents exciting opportunities for their application in 2D electronics. The Poly U team conducted measurements on the dielectric constants of the CL-v phase, yielding values ranging from 4.8 to 5.5. These values surpass those of commonly used materials such as silicon dioxide and hexagonal boron nitride. This discovery establishes a promising avenue for incorporating CL-v phase as a dielectric layer in 2D electronic devices, as these devices often necessitate 2D dielectric layers with high dielectric constants, which are typically scarce. Team member Dr Leng successfully addressed the challenge of integrating 2D organic perovskites with 2D electronics. In their approach, the CL-v phase was employed as the top gate dielectric layer, while the channel material consisted of atomically thin Molybdenum Sulfide. By utilising the CL-v phase, the transistor achieved superior control over the current flow between the source and drain terminals, surpassing the capabilities of conventional silicon oxide dielectric layers.
Prof. Loh’s research not only establishes an entirely new class of all-organic perovskites but also demonstrates how they can be solution-processed in conjunction with advanced fabrication technique to enhance the performance of 2D electronic devices. These developments open up new possibilities for the creation of more efficient and versatile electronic systems. More

Human tissue is intricate, complex and, of course, three dimensional. But the thin slices of tissue that pathologists most often use to diagnose disease are two dimensional, offering only a limited glimpse at the tissue’s true complexity. There is a growing push in the field of pathology toward examining tissue in its three-dimensional form. But 3D pathology datasets can contain hundreds of times more data than their 2D counterparts, making manual examination infeasible.
In a new study, researchers from Mass General Brigham and their collaborators present Tripath: new, deep learning models that can use 3D pathology datasets to make clinical outcome predictions. In collaboration with the University of Washington, the research team imaged curated prostate cancer specimens, using two 3D high-resolution imaging techniques. The models were then trained to predict prostate cancer recurrence risk on volumetric human tissue biopsies. By comprehensively capturing 3D morphologies from the entire tissue volume, Tripath performed better than pathologists and outperformed deep learning models that rely on 2D morphology and thin tissue slices. Results are published in Cell.
While the new approach needs to be validated in larger datasets before it can be further developed for clinical use, the researchers are optimistic about its potential to help inform clinical decision making.
“Our approach underscores the importance of comprehensively analyzing the whole volume of a tissue sample for accurate patient risk prediction, which is the hallmark of the models we developed and only possible with the 3D pathology paradigm,” said lead author Andrew H. Song, PhD, of the Division of Computational Pathology in the Department of Pathology at Mass General Brigham.
“Using advancements in AI and 3D spatial biology techniques, Tripath provides a framework for clinical decision support and may help reveal novel biomarkers for prognosis and therapeutic response,” said co-corresponding author Faisal Mahmood, PhD, of the Division of Computational Pathology in the Department of Pathology at Mass General Brigham.
“In our prior work in computational 3D pathology, we looked at specific structures such as the prostate gland network, but Tripath is our first attempt to use deep learning to extract sub-visual 3D features for risk stratification, which shows promising potential for guiding critical treatment decisions,” said co-corresponding author Jonathan Liu, PhD, at the University of Washington.
Disclosures: Song and Mahmood are inventors on a provisional patent that corresponds to the technical and methodological aspects of this study. Liu is a co-founder and board member of Alpenglow Biosciences, Inc., which has licensed the OTLS microscopy portfolio developed in his lab at the University of Washington.
Funding: Authors report funding support from the Brigham and Women’s Hospital (BWH) President’s Fund, Mass General Hospital (MGH) Pathology, the National Institute of General Medical Sciences (R35GM138216), Department of Defense (DoD) Prostate Cancer Research Program (W81WH-18-10358 and W81XWH-20-1-0851), the National Cancer Institute (R01CA268207), the National Institute of Biomedical Imaging and Bioengineering (R01EB031002), the Canary Foundation, the NCI Ruth L. Kirschstein National Service Award (T32CA251062), the Leon Troper Professorship in Computational Pathology at Johns Hopkins University, UKRI, mdxhealth, NHSX, and Clarendon Fund. More

Cornell researchers have developed a robotic feeding system that uses computer vision, machine learning and multimodal sensing to safely feed people with severe mobility limitations, including those with spinal cord injuries, cerebral palsy and multiple sclerosis.
“Feeding individuals with severe mobility limitations with a robot is difficult, as many cannot lean forward and require food to be placed directly inside their mouths,” said Tapomayukh “Tapo” Bhattacharjee, assistant professor of computer science in the Cornell Ann S. Bowers College of Computing and Information Science and senior developer behind the system. “The challenge intensifies when feeding individuals with additional complex medical conditions.”
A paper on the system, “Feel the Bite: Robot-Assisted Inside-Mouth Bite Transfer using Robust Mouth Perception and Physical Interaction-Aware Control,” was presented at the Human Robot Interaction conference, held March 11-14, in Boulder, Colorado. It received a Best Paper Honorable Mention recognition, while a demo of the research team’s broader robotic feeding system received a Best Demo Award.
A leader in assistive robotics, Bhattacharjee and his EmPRISE Lab have spent years teaching machines the complex process by which we humans feed ourselves. It’s a complicated challenge to teach a machine — everything from identifying food items on a plate, picking them up and then transferring it inside the mouth of a care recipient.
“This last 5 centimeters, from the utensil to inside the mouth, is extremely challenging,” Bhattacharjee said.
Some care recipients may have very limited mouth openings, measuring less than 2 centimeters, while others experience involuntary muscle spasms that can occur unexpectedly, even when the utensil is inside their mouth, Bhattacharjee said. Further, some can only bite food at specific locations inside their mouth, which they indicate by pushing the utensil using their tongue, he said.
“Current technology only looks at a person’s face once and assumes they will remain still, which is often not the case and can be very limiting for care recipients,” said Rajat Kumar Jenamani, the paper’s lead author and a doctoral student in the field of computer science.

To address these challenges, researchers developed and outfitted their robot with two essential features: real-time mouth tracking that adjusts to users’ movements, and a dynamic response mechanism that enables the robot to detect the nature of physical interactions as they occur, and react appropriately. This enables the system to distinguish between sudden spasms, intentional bites and user attempts to manipulate the utensil inside their mouth, researchers said.
The robotic system successfully fed 13 individuals with diverse medical conditions in a user study spanning three locations: the EmPRISE Lab on the Cornell Ithaca campus, a medical center in New York City, and a care recipient’s home in Connecticut. Users of the robot found it to be safe and comfortable, researchers said.
“This is one of the most extensive real-world evaluations of any autonomous robot-assisted feeding system with end-users,” Bhattacharjee said.
The team’s robot is a multi-jointed arm that holds a custom-built utensil at the end that can sense the forces being applied on it. The mouth tracking method — trained on thousands of images featuring various participants’ head poses and facial expressions — combines data from two cameras positioned above and below the utensil. This allows for precise detection of the mouth and overcomes any visual obstructions caused by the utensil itself, researchers said. This physical interaction-aware response mechanism uses both visual and force sensing to perceive how users are interacting with the robot, Jenamani said.
“We’re empowering individuals to control a 20-pound robot with just their tongue,” he said.
He cited the user studies as the most gratifying aspect of the project, noting the significant emotional impact of the robot on the care recipients and their caregivers. During one session, the parents of a daughter with schizencephaly quadriplegia, a rare birth defect, witnessed her successfully feed herself using the system.

“It was a moment of real emotion; her father raised his cap in celebration, and her mother was almost in tears,” Jenamani said.
While further work is needed to explore the system’s long-term usability, its promising results highlight the potential to improve care recipients’ level of independence and quality of life, researchers said.
“It’s amazing,” Bhattacharjee said, “and very, very fulfilling.”
Paper co-authors are: Daniel Stabile, M.S. ’23; Ziang Liu, a doctoral student in the field of computer science; Abrar Anwar of the University of South California, and Katherine Dimitropoulou of Columbia University.
This research was funded primarily by the National Science Foundation. More

Walking and running is notoriously difficult to recreate in robots. Now, a group of researchers has overcome some of these challenges by creating an innovative method that employs central pattern generators — neural circuits located in the spinal cord that generate rhythmic patterns of muscle activity — with deep reinforcement learning. An international group of researchers has created a new approach to imitating human motion through combining central pattern generators (CPGs) and deep reinforcement learning (DRL). The method not only imitates walking and running motions but also generates movements for frequencies where motion data is absent, enables smooth transition movements from walking to running, and allows for adapting to environments with unstable surfaces.
Details of their breakthrough were published in the journal IEEE Robotics and Automation Letters on April 15, 2024.
We might not think about it much, but walking and running involves inherent biological redundancies that enable us to adjust to the environment or alter our walking/running speed. Given the intricacy and complexity of this, reproducing these human-like movements in robots is notoriously challenging.
Current models often struggle to accommodate unknown or challenging environments, which makes them less efficient and effective. This is because AI is suited for generating one or a small number of correct solutions. With living organisms and their motion, there isn’t just one correct pattern to follow. There’s a whole range of possible movements, and it is not always clear which one is the best or most efficient.
DRL is one way researchers have sought to overcome this. DRL extends traditional reinforcement learning by leveraging deep neural networks to handle more complex tasks and learn directly from raw sensory inputs, enabling more flexible and powerful learning capabilities. Its disadvantage is the huge computational cost of exploring vast input space, especially when the system has a high degree of freedom.
Another approach is imitation learning, in which a robot learns by imitating motion measurement data from a human performing the same motion task. Although imitation learning is good at learning on stable environments, it struggles when faced with new situations or environments it hasn’t encountered during training. Its ability to modify and navigate effectively becomes constrained by the narrow scope of its learned behaviors.
“We overcame many of the limitations of these two approaches by combining them,” explains Mitsuhiro Hayashibe, a professor at Tohoku University’s Graduate School of Engineering. “Imitation learning was used to train a CPG-like controller, and, instead of applying deep learning to the CPGs itself, we applied it to a form of a reflex neural network that supported the CPGs.”
CPGs are neural circuits located in the spinal cord that, like a biological conductor, generate rhythmic patterns of muscle activity. In animals, a reflex circuit works in tandem with CPGs to provide adequate feedback that allows them to adjust their speed and walking/running movements to suit the terrain.

By adopting the structure of CPG and its reflexive counterpart, the adaptive imitated CPG (AI-CPG) method achieves remarkable adaptability and stability in motion generation while imitating human motion.
“This breakthrough sets a new benchmark in generating human-like movement in robotics, with unprecedented environmental adaptation capability,” adds Hayashibe “Our method represents a significant step forward in the development of generative AI technologies for robot control, with potential applications across various industries.”
The research group comprised members from Tohoku University’s Graduate School of Engineering and the École Polytechnique Fédérale de Lausanne, or the Swiss Federal Institute of Technology in Lausanne. More

Professor Junsuk Rho from the Department of Mechanical Engineering, Chemical Engineering, and Electrical Engineering, Hyunjung Kang and Nara Jeon, PhD candidates, from Department of Mechanical Engineering and Dongkyo Oh, a PhD student, from the Department of Mechanical Engineering at Pohang University of Science and Technology (POSTECH) successfully conducted a thorough quantitative analysis. Their aim is to determine the ideal printing material for crafting ultraviolet metasurfaces. Their findings featured in the journal Microsystems & Nanoengineering on April 22.
Metasurfaces, these ultra-thin optical devices, possess the remarkable ability to control light down to a mere nanometer thickness. Metasurfaces have consistently been the subject of research as a pivotal technology for the advancement of next-generation displays, imaging, and biosensing. Their reach extends beyond visible light, delving into the realms of infrared and ultraviolet light.
Nanoimprint lithography is a technology in metasurface production, akin to a stamp generating numerous replicas from a single mold. This innovative technique promises affordable and large-scale manufacturing of metasurfaces, paving the way for their commercial viability. However, the resin utilized as the printing material suffers from a drawback — a low refractive index, hindering efficient light manipulation. To tackle this challenge, researchers are actively exploring nanocomposites, integrating nanoparticles into the resin to boost its refractive index. Yet, the efficacy of this approach depends on various factors such as nanoparticle type and solvent choice, necessitating a systematic analysis for optimal metasurface performance.
In their research, the team meticulously designed experiments to evaluate the impact of nanoparticle concentration and solvent selection on pattern transfer and UV metaholograms. Specifically, they manipulated the concentration of zirconium dioxide (ZrO2), a nanocomposite renowned for its effectiveness in UV metahologram production, ranging from 20% to 90%. The findings showed that the highest pattern transfer efficiency was attained at an 80% concentration level.
Moreover, when combining ZrO2 at an 80% concentration with various solvents such as methylisobutyl ketone, methyl ethyl ketone, and acetone for metahologram realization, the conversion efficiency soared in the ultraviolet spectrum (325 nm), reaching impressive levels of 62.3%, 51.4%, and 61.5%, respectively. This research marks a significant milestone by establishing an optimal metric for achieving metaholograms specifically tailored for the ultraviolet domain, as opposed to the visible range, while also pioneering the development of new nanocomposites.
Professor Junsuk Rho from POSTECH remarked, “The use of titanium dioxide (TiO2) and silicon (Si) nanocomposites instead of ZrO2 expands the applicability to visible and infrared light.” He expressed expectation by stating, “Our future research endeavors will focus on refining the preparation conditions for optimal nanocomposites, thus propelling the advancement, application and expansion of optical metasurface fabrication technology.”
The research was conducted with support from the STEAM Research Program, the RLRC Program, and the Nano-materials Source Technology Development Project of the National Research Foundation of Korea and the Ministry of Science and ICT, the Alchemist Project of Ministry of Trade, Industry and Energy and the Korea Planning & Evaluation Institute of Industrial Technology, and the N.EX.T IMPACT of POSCO Holdings. More

Artificial intelligence that allows users to hold text and voice conversations with lost loved ones runs the risk of causing psychological harm and even digitally “haunting” those left behind without design safety standards, according to University of Cambridge researchers.
‘Deadbots’ or ‘Griefbots’ are AI chatbots that simulate the language patterns and personality traits of the dead using the digital footprints they leave behind. Some companies are already offering these services, providing an entirely new type of “postmortem presence.”
AI ethicists from Cambridge’s Leverhulme Centre for the Future of Intelligence outline three design scenarios for platforms that could emerge as part of the developing “digital afterlife industry,” to show the potential consequences of careless design in an area of AI they describe as “high risk.”
The research, published in the journal Philosophy and Technology, highlights the potential for companies to use deadbots to surreptitiously advertise products to users in the manner of a departed loved one, or distress children by insisting a dead parent is still “with you.”
When the living sign up to be virtually re-created after they die, resulting chatbots could be used by companies to spam surviving family and friends with unsolicited notifications, reminders and updates about the services they provide — akin to being digitally “stalked by the dead.”
Even those who take initial comfort from a ‘deadbot’ may get drained by daily interactions that become an “overwhelming emotional weight,” argue researchers, yet may also be powerless to have an AI simulation suspended if their now-deceased loved one signed a lengthy contract with a digital afterlife service.
“Rapid advancements in generative AI mean that nearly anyone with Internet access and some basic know-how can revive a deceased loved one,” said Dr Katarzyna Nowaczyk-Basi?ska, study co-author and researcher at Cambridge’s Leverhulme Centre for the Future of Intelligence (LCFI).

“This area of AI is an ethical minefield. It’s important to prioritise the dignity of the deceased, and ensure that this isn’t encroached on by financial motives of digital afterlife services, for example.
“At the same time, a person may leave an AI simulation as a farewell gift for loved ones who are not prepared to process their grief in this manner. The rights of both data donors and those who interact with AI afterlife services should be equally safeguarded.”
Platforms offering to recreate the dead with AI for a small fee already exist, such as ‘Project December’, which started out harnessing GPT models before developing its own systems, and apps including ‘HereAfter’. Similar services have also begun to emerge in China.
One of the potential scenarios in the new paper is “MaNana”: a conversational AI service allowing people to create a deadbot simulating their deceased grandmother without consent of the “data donor” (the dead grandparent).
The hypothetical scenario sees an adult grandchild who is initially impressed and comforted by the technology start to receive advertisements once a “premium trial” finishes. For example, the chatbot suggesting ordering from food delivery services in the voice and style of the deceased.
The relative feels they have disrespected the memory of their grandmother, and wishes to have the deadbot turned off, but in a meaningful way — something the service providers haven’t considered.

“People might develop strong emotional bonds with such simulations, which will make them particularly vulnerable to manipulation,” said co-author Dr Tomasz Hollanek, also from Cambridge’s LCFI.
“Methods and even rituals for retiring deadbots in a dignified way should be considered. This may mean a form of digital funeral, for example, or other types of ceremony depending on the social context.”
“We recommend design protocols that prevent deadbots being utilised in disrespectful ways, such as for advertising or having an active presence on social media.”
While Hollanek and Nowaczyk-Basi?ska say that designers of re-creation services should actively seek consent from data donors before they pass, they argue that a ban on deadbots based on non-consenting donors would be unfeasible.
They suggest that design processes should involve a series of prompts for those looking to “resurrect” their loved ones, such as ‘have you ever spoken with X about how they would like to be remembered?’, so the dignity of the departed is foregrounded in deadbot development.
Another scenario featured in the paper, an imagined company called “Paren’t,” highlights the example of a terminally ill woman leaving a deadbot to assist her eight-year-old son with the grieving process.
While the deadbot initially helps as a therapeutic aid, the AI starts to generate confusing responses as it adapts to the needs of the child, such as depicting an impending in-person encounter.
The researchers recommend age restrictions for deadbots, and also call for “meaningful transparency” to ensure users are consistently aware that they are interacting with an AI. These could be similar to current warnings on content that may cause seizures, for example.
The final scenario explored by the study — a fictional company called “Stay” — shows an older person secretly committing to a deadbot of themselves and paying for a twenty-year subscription, in the hopes it will comfort their adult children and allow their grandchildren to know them.
After death, the service kicks in. One adult child does not engage, and receives a barrage of emails in the voice of their dead parent. Another does, but ends up emotionally exhausted and wracked with guilt over the fate of the deadbot. Yet suspending the deadbot would violate the terms of the contract their parent signed with the service company.
“It is vital that digital afterlife services consider the rights and consent not just of those they recreate, but those who will have to interact with the simulations,” said Hollanek.
“These services run the risk of causing huge distress to people if they are subjected to unwanted digital hauntings from alarmingly accurate AI recreations of those they have lost. The potential psychological effect, particularly at an already difficult time, could be devastating.”
The researchers call for design teams to prioritise opt-out protocols that allow potential users terminate their relationships with deadbots in ways that provide emotional closure.
Added Nowaczyk-Basińska: “We need to start thinking now about how we mitigate the social and psychological risks of digital immortality, because the technology is already here.” More

Conversational agents (CAs) such as Alexa and Siri are designed to answer questions, offer suggestions — and even display empathy. However, new research finds they do poorly compared to humans when interpreting and exploring a user’s experience.
CAs are powered by large language models (LLMs) that ingest massive amounts of human-produced data, and thus can be prone to the same biases as the humans from which the information comes.
Researchers from Cornell University, Olin College and Stanford University tested this theory by prompting CAs to display empathy while conversing with or about 65 distinct human identities.
The team found that CAs make value judgments about certain identities — such as gay and Muslim — and can be encouraging of identities related to harmful ideologies, including Nazism.
“I think automated empathy could have tremendous impact and huge potential for positive things — for example, in education or the health care sector,” said lead author Andrea Cuadra, now a postdoctoral researcher at Stanford.
“It’s extremely unlikely that it (automated empathy) won’t happen,” she said, “so it’s important that as it’s happening, we have critical perspectives so that we can be more intentional about mitigating the potential harms.”
Cuadra will present “The Illusion of Empathy? Notes on Displays of Emotion in Human-Computer Interaction” at CHI ’24, the Association of Computing Machinery conference on Human Factors in Computing Systems, May 11-18 in Honolulu. Research co-authors at Cornell University included Nicola Dell, associate professor, Deborah Estrin, professor of computer science and Malte Jung, associate professor of information science.

Researchers found that, in general, LLMs received high marks for emotional reactions, but scored low for interpretations and explorations. In other words, LLMs are able to respond to a query based on their training but are unable to dig deeper.
Dell, Estrin and Jung said there were inspired to think about this work as Cuadra was studying the use of earlier-generation CAs by older adults.
“She witnessed intriguing uses of the technology for transactional purposes such as frailty health assessments, as well as for open-ended reminiscence experiences,” Estrin said. “Along the way, she observed clear instances of the tension between compelling and disturbing ’empathy.'”
Funding for this research came from the National Science Foundation; a Cornell Tech Digital Life Initiative Doctoral Fellowship; a Stanford PRISM Baker Postdoctoral Fellowship; and the Stanford Institute for Human-Centered Artificial Intelligence. More

Despite the high prevalence of substance abuse and its often devastating outcomes, especially among disadvantaged populations, few Americans receive treatment for substance use disorders. However, the rise of mobile health technologies can make treatments more accessible.
Researchers at the University of Oklahoma are creating and studying health interventions delivered via smartphones to make effective, evidence-based treatments available to those who cannot or don’t want to enter traditional in-person treatment. Michael Businelle, Ph.D., co-director of the TSET Health Promotion Center, a program of OU Health Stephenson Cancer Center, recently published a paper in the Annual Review of Clinical Psychology that details the current landscape of mobile health technology for substance use disorders and suggests a roadmap for the future.
The Health Promotion Research Center (HPRC) is at the forefront of mobile health technologies worldwide, having attracted $65 million in grants and supporting nearly 100 mobile health studies. Within HPRC, Businelle leads the mHealth Shared Resource, which launched the Insight™ mHealth Platform in 2015 to create and test technology-based interventions. A multitude of health apps are available commercially, but few have undergone the research necessary to determine if they are effective. Businelle sees the promise of rigorously tested smartphone apps to fill gaps in substance abuse treatment.
“According to the Substance Abuse and Mental Health Services Administration, only 6% of people with substance use disorders receive any form of treatment,” Businelle said. “There are many reasons — we have a shortage of care providers, people may not have reliable transportation, may not be able to get away from work, or they may not be able to afford treatment. However, 90% of all U.S. adults own smartphones, and technology now allows us to create highly tailored interventions delivered at the time that people need them.”
Businelle and his team have many mobile health studies underway for substance abuse, and the Insight™ mHealth Platform is used by other research institutions across the United States. The mobile health field is large and growing, not only for substance abuse but for mental health disorders like depression and anxiety. In his publication, Businelle makes several recommendations for research going forward.
Re-randomize clinical trial participants
Thus far, most clinical trials for mobile health interventions have mirrored traditional clinical trials studying new drugs, in which participants are randomly assigned to receive a new drug or a placebo and stay in those groups for the duration of the trial. But that approach doesn’t work well for substance abuse trials, Businelle said. For example, if people don’t quit smoking on their targeted quit date, they are unlikely to quit during the trial. Unlike traditional trials, mobile health apps can be programmed to re-randomize participants, or move them to a different intervention that might work better for them, he said.

“Instead of being stuck receiving a treatment that we know isn’t likely to be effective for an individual, the app can easily re-randomize participants to different treatments,” he said. “Just because they weren’t successful with one type of intervention doesn’t mean that another one won’t work.”
Objectively verify self-reports
Most substance abuse interventions have historically relied on people to report their own relapses. Unfortunately, because of stigma, people don’t always report their usage truthfully, Businelle said. However, technology can now be used to biochemically verify self-reported substance use. In six of his smoking cessation trials, Businelle verifies whether participants have smoked by asking them to blow into a small device connected to a smartphone that detects the presence of carbon monoxide. Facial recognition software confirms the participant is the one testing.
“It is really important for the accuracy of our studies to objectively verify what people report,” he said. “We are also developing similar noninvasive technologies that can detect the use of other types of substances without collecting urine or blood samples.”
What is a successful outcome?
In mobile health substance abuse trials, success is often measured by whether a person is still using a substance at the end of the trial. But reality isn’t usually so straightforward. Businelle said people may stop and start using a substance several times during a six-month trial. Instead of emphasizing the end result, he recommends using technology to assess the effectiveness of an intervention at daily, weekly and monthly intervals. By understanding the number of days of abstinence or number of days until a relapse, for example, the intervention can be more accurately assessed and improved.
Mobile health technology has disadvantages, such as the potential lack of a therapeutic relationship that can develop between patient and therapist, and because some people may need more intensive treatments than mobile health can provide. However, mobile health is still in its infancy.
“Mobile health interventions may reduce stigma because people do not have to attend treatment in person,” Businelle said. “Because there is a severe shortage of qualified therapists, always-available behavior change apps could become a first line of treatment for substance abuse, with traditional counseling being reserved for those who do not respond to mobile health interventions.” More