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Produce prescription programs can benefit both individuals and health systems; however, best practices for integrating such programs into the Australian health system are yet unknown. This study explored stakeholders' perspectives on the acceptability, potential design and integration of produce prescription programs for adults with type 2 diabetes in Australia. Purposive sampling was used to recruit 22 participants for an online workshop, representing six stakeholder groups (government, healthcare service, clinician, food retailer, consumer, non-government organisation). Participant responses were gathered through workshop discussions and a virtual collaboration tool (Mural). The workshop was video-recorded and transcribed verbatim, and thematic analysis was conducted using a deductive-inductive approach. Stakeholders recognised produce prescription as an acceptable intervention; however, they identified challenges to implementation related to contextuality, accessibility, and sustainability. Stakeholders were vocal about the approach (e.g., community-led) and infrastructure (e.g., screening tools) needed to support program design and implementation but expressed diverse views about potential funding models, indicating a need for further investigation. Aligning evaluation outcomes with existing measures in local, State and Federal initiatives was recommended, and entry points for integration were identified within and outside of the Australian health sector. Our findings provide clear considerations for future produce prescription interventions for people with type 2 diabetes.

Vaccine hesitancy is one of the top ten threats to global health. Artificial intelligence-driven chatbots and motivational interviewing skills show promise in addressing vaccine hesitancy. This study aimed to develop and validate an artificial intelligence-driven motivational digital assistant in decreasing COVID-19 vaccine hesitancy among Hong Kong adults. The intervention development and validation were guided by the Medical Research Council's framework with four major steps: logic model development based on theory and qualitative interviews (n = 15), digital assistant development, expert evaluation (n = 5), and a pilot test (n = 12). The Vaccine Hesitancy Matrix model and qualitative findings guided the development of the intervention logic model and content with five web-based modules. An artificial intelligence-driven chatbot tailored to each module was embedded in the website to motivate vaccination intention using motivational interviewing skills. The content validity index from expert evaluation was 0.85. The pilot test showed significant improvements in vaccine-related health literacy ( p = 0.021) and vaccine confidence ( p = 0.027). This digital assistant is effective in improving COVID-19 vaccine literacy and confidence through valid educational content and motivational conversations. The intervention is ready for testing in a randomized controlled trial and has high potential to be a useful toolkit for addressing ambivalence and facilitating informed decision making regarding vaccination.

Background: 'Food is medicine' strategies aim to integrate food-based nutrition interventions into healthcare systems and are of growing interest to healthcare providers and policy makers. 'Medically Tailored Meals' (MTM) is one such intervention, which involves the 'prescription' by healthcare providers of subsidized, pre-prepared meals for individuals to prevent or manage chronic conditions, combined with nutrition education., Objective: This study will test the efficacy of an MTM program in Australia among participants with type 2 diabetes (T2D) and hyperglycemia, who experience difficulties accessing and eating nutritious food., Methods: This study will be a two-arm parallel trial (goal n = 212) with individuals randomized in a 1:1 ratio to a MTM intervention group or a control group (106 per arm). Over 26 weeks, the intervention group will be prescribed 20 MTM per fortnight and up to 3 sessions with an accredited dietitian. Controls will continue with their usual care. The primary outcome is glycated hemoglobin (HbA1c, %) and secondary outcomes include differences in blood pressure, blood lipids and weight, all measured at 26 weeks. Process and economic data will be analyzed to assess the feasibility, acceptability, scalability, and cost-effectiveness of the intervention. Recruitment commenced in the first quarter of 2023, with analyses and results anticipated to be available by March 2025., Discussion: Few randomized controlled trials have assessed the impact of MTM on clinical outcomes. This Australian-first trial will generate robust data to inform the case for sustained, large-scale implementation of MTM to improve the management of T2D among vulnerable populations., Anzctr: ACTRN12622000852752., Protocol Version: Version 1.1, July 2023., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Mozaffarian reports research funding from the National Institutes of Health, The Gates Foundation, The Rockefeller Foundation, Vail Innovative Global Research, and the Kaiser Permanente Fund; personal fees from Acasti Pharma and Barilla; scientific advisory board, Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc., and Perfect Day (ended: Day Two, Season Health, and Tiny Organics); stock ownership in Calibrate and HumanCo; and chapter royalties from UpToDate. All other co-authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

University food environments have a strong influence on the dietary choices of students and staff. The aim of this study was to assess the food environment at a large university in Sydney, Australia. Data were collected between March and July 2022 from 27 fixed food outlets and 24 vending machines. The healthiness of the food environment was evaluated using the Healthy Food and Drink in NSW Health Facilities for Staff and Visitors Framework ('Framework'), which assesses food environment parameters including the availability, placement, and promotion of 'Everyday' (healthy) and 'Occasional' (less healthy) products. Each parameter was evaluated overall and across each food outlet type. Across all outlets, Everyday foods and drinks made up 43.9% of all products. Only two outlets met the Framework's product availability benchmark of ≥75% Everyday foods and drinks. A total of 43 outlets (84.3%) sold sugary drinks as part of their product range. Occasional products made up 68.4%, 53.3%, and 59.9% of all items for sale at checkout areas, countertops, and eye-level shelves, respectively. Finally, 79.7% of meal deals included Occasional products. Our findings highlight the need to improve the availability, placement, and promotion of foods and drinks sold at a major university campus in Sydney, Australia.

Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people's efforts to manage their weight, depending on availability of nutritious and nutrient-poor 'discretionary' foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. The MAST is a desk-based tool designed to objectively assess availability of nutrient-poor and absence of nutritious food and beverages on food service menus. A risk assessment approach was applied, using the best available evidence in an iterative way. MAST scores for 30 food service outlets in one Local Government Authority in Perth, Western Australia highlight opportunities for improvements. MAST is the first tool of its kind in Australia to assess the nutritional quality of food service menus. It was practical and feasible to use by public health nutritionists/dietitians and can be adapted to suit other settings or countries.

Purpose: Although it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS., Methods: Participants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC)., Results: Fifty-nine patients with AIS were recruited. Regarding the trunk flexion-extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59)., Conclusion: This is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability., (© 2022. The Author(s).)

Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. 'Kids' Menus' are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids' Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids' Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids' Menu. The validated Kids' Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids' Menus. Almost all Kids' Menus (99%) were rated 'unhealthy' using KIMEHS. The mean KIMEHS score for all restaurants and cafés was -8.5 (range -14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean -3.5, range -6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids' Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making.

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers' experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

Background: Recently, new evidence from large scale trials and updated guidelines have emerged on the risks and benefits of extended dual antiplatelet therapy (DAPT) for patients with acute coronary syndrome (ACS)., Aims: To discuss, clarify and advise on the application of the evidences and guidelines on individual patient selection for extended DAPT, with regard to balancing risk factors, particularly in Asian populations., Methods: A total of 14 local cardiologists from Hong Kong with extensive experience in cardiology and cardiac interventions convened in a series of 3 advisory board meetings from October 2016 to September 2017, which included reviews of new evidence in the literature and discussions of the latest clinical trends, using an anonymous, electronic voting system for arriving at consensuses., Results: Recommendations were produced for the following nine risk factors: old age (>65), chronic kidney disease (CKD), diabetes mellitus (DM), recurrent myocardial infarction (MI), multi-vessel disease (MVD), multiple stents, bioresorbable vascular scaffold (BVS) stent, left main stenting and peripheral artery disease (PAD). Strong ischaemic risk factors include DM, recurrent MI, MVD and/or >3 stents; less-strong ischaemic factors include CKD, left main stenting, BVS stent and PAD. Old age can be an unclear risk factor due to variations in physical fitness even among patients of identical age., Discussion: The strengths and limitations of the results were acknowledged., Conclusion: ACS patients with ischaemic risk factors could be considered for extended DAPT beyond 12 months, while balancing the risk of bleeding., (© 2019 Royal Australasian College of Physicians.)

Background: Etiologies of pediatric intensive care unit (PICU) mortality are diverse. This study aimed to investigate the pattern of PICU mortality in a regional trauma center, and explore factors associated with prolonged non-survival., Methods: Demographic data of all PICU deaths in a regional trauma center were analyzed. Factors associated with prolonged nonsurvival (length of stay) were investigated with univariate log rank and multivariate Cox-Regression forward stepwise tests., Results: There were 88 deaths (males 61%; infants 23%) over 10 years (median PICU stay = 3.5 days, interquartile range: 1 and 11 days). The mean annual mortality rate of PICU admissions was 5.8%. Septicemia with gram positive, gram negative and fungal pathogens were present in 13 (16%), 13 (16%) and 4 (5%) of these patients, respectively. Viruses were isolated in 25 patients (28%). Ninety percent of these 88 patients were ventilated, 75% required inotropes, 92% received broad spectrum antibiotic coverage, 32% received systemic corticosteroids, 56% required blood transfusion and 39% received anticonvulsants. Thirty nine patients (44%) had a DNAR (Do-Not-Attempt-Resuscitation) order with their deaths at the PICU. Comparing with non-trauma category, trauma patients had higher mortality score, no premorbid disease, suffered asystole preceding PICU admission and subsequent brain death. Oncologic conditions were the most prevalent diagnosis in the non-trauma category. There was no gunshot or asthma death in this series. Prolonged non-survival was significantly associated with DNAR, fungal infections, and mechanical ventilation but negatively associated with bacteremia., Conclusions: Death in the PICU is a heterogeneous event that involves infants and children. Resuscitation was not attempted at the time of their deaths in nearly half of the patients in honor of parents' wishes. Parents often make DNAR decision when medical futility becomes evident. They could be reassured that DNAR did not mean "abandoning" care. Instead, DNAR patients had prolonged PICU stay and received the same level of PICU supports as patients who did not respond to cardiopulmonary resuscitation.

Graded Hedgehog (Hh) signaling governs the balance of Gli transcriptional activators and repressors to specify diverse ventral cell fates in the spinal cord. It remains unclear how distinct intracellular Gli activity is generated. Here, we demonstrate that Sufu acts universally as a negative regulator of Hh signaling, whereas Kif7 inhibits Gli activity in cooperation with, and independent of, Sufu. Together, they deter naïve precursors from acquiring increasingly ventral identity. We show that Kif7 is also required to establish high intracellular Gli activity by antagonizing the Sufu-inhibition of Gli2. Strikingly, by abolishing the negative regulatory action of Sufu, diverse ventral cell fates can be specified in the absence of extracellular Hh signaling. These data suggest that Sufu is the primary regulator of graded Hh signaling and establish that the antagonistic and cooperative actions of Kif7 and Sufu are responsible for setting up distinct Gli activity in ventral cell fate specification.

Purpose: To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption., Methods: 57 men and 8 women aged 20 to 56 (mean, 39) years who had a more than 3-month history of low back pain and were unresponsive to more than 6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared., Results: Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function., Conclusion: This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.

A central question in Hedgehog (Hh) signaling is how evolutionarily conserved components of the pathway might use the primary cilium in mammals but not fly. We focus on Suppressor of fused (Sufu), a major Hh regulator in mammals, and reveal that Sufu controls protein levels of full-length Gli transcription factors, thus affecting the production of Gli activators and repressors essential for graded Hh responses. Surprisingly, despite ciliary localization of most Hh pathway components, regulation of Gli protein levels by Sufu is cilium-independent. We propose that Sufu-dependent processes in Hh signaling are evolutionarily conserved. Consistent with this, Sufu regulates Gli protein levels by antagonizing the activity of Spop, a conserved Gli-degrading factor. Furthermore, addition of zebrafish or fly Sufu restores Gli protein function in Sufu-deficient mammalian cells. In contrast, fly Smo is unable to translocate to the primary cilium and activate the mammalian Hh pathway. We also uncover a novel positive role of Sufu in regulating Hh signaling, resulting from its control of both Gli activator and repressor function. Taken together, these studies delineate important aspects of cilium-dependent and cilium-independent Hh signal transduction and provide significant mechanistic insight into Hh signaling in diverse species.

From insects to humans, the Hedgehog (Hh) signaling pathway has conserved roles in embryonic development and tissue homeostasis. However, it has been suggested that the lack of mammalian equivalents of Costal2 (Cos2) contributes to a divergence between the mechanism of Drosophila and mammalian Hh signal transduction. Here, we challenge this view by showing that the kinesin protein Kif7 is a critical regulator of Hh signaling in mice. Similar to Cos2, Kif7 physically interacted with Gli transcription factors and controlled their proteolysis and stability, and acted both positively and negatively in Hh signaling. Thus, Kif7 is a missing component of the mammalian Hh signaling machinery, implying a greater commonality between the Drosophila and mammalian system than the prevailing view suggests.

Background: Direct-current cardioversion (DCCV) of atrial fibrillation and atrial flutter commonly causes post-DCCV left atrial (LA) stunning (LAS), which may potentiate thromboembolic complications. Data on LAS determinants are inconclusive., Methods: We prospectively evaluated LA and LA appendage function before and immediately after DCCV of atrial fibrillation and atrial flutter in 59 consecutive patients undergoing transesophageal echocardiographically guided DCCV to determine predictors of post-DCCV LAS., Results: After exclusion of patients with pre-DCCV LAS (LA appendage emptying velocity <20 cm/s), post-DCCV LAS was observed in 32 of 45 patients (71%). Only precardioversion mitral E-wave deceleration time significantly correlated with post-DCCV LAS (142 +/- 46 vs 170 +/- 360 milliseconds; P = .04). At 3.3 years, there was a trend toward a higher arrhythmia recurrence rate in patients with LAS compared with those without (86% vs 53%; P = .063)., Conclusion: Only mitral E-wave deceleration time was predictive of post-DCCV LAS, which may be a marker of atrial fibrillation and atrial flutter recurrence.

The mixed Lagrange time-delay estimation autoregressive (MLTDEAR) model is proposed as a solution to estimate image noise variance. The only information available to the proposed estimator is a corrupted image and the nature of additive white noise. The image autocorrelation function is calculated and used to obtain the MLTDEAR model coefficients; the relationship between the MLTDEAR and linear prediction models is utilized to estimate the model coefficients. The forward-backward prediction is then used to obtain the predictor coefficients; the MLTDEAR model coefficients and prior samples of zero-offset autocorrelation values are next used to predict the power of the noise-free image. Furthermore, the fundamental performance limit of the signal and noise estimation, as derived from the Cramer-Rao inequality, is presented., ((c) 2008 Wiley-Liss, Inc.)

AMP-activated protein kinase (AMPK) is the downstream component of a kinase cascade that plays a pivotal role in energy homeostasis. AMPK has recently emerged as an attractive and novel target for inflammatory disorders. Thus, the aim of this study was to assess the role of AMPKalpha in the anti-inflammatory effect of nicotine in carrageenan-induced rat paw edema model and to evaluate the mechanism of nicotine-induced AMPKalpha phosphorylation in RAW 264.7 cells. The results indicate that nicotine alleviated paw edema and the activation of AMPKalpha involved in the anti-inflammatory effect of nicotine in vivo. In addition, nicotine was able to activate AMPKalpha phosphorylation in macrophages and this effect was mediated through nicotinic acetylcholine receptors. Furthermore, nicotine significantly induced the phosphorylation of Akt and the Ca(2+)/calmodulin-dependent protein kinase kinase (CaMKK) protein expression in macrophages. Wortmannin, a specific inhibitor of phosphotidylinositol 3-kinase (PI3K), suppressed nicotine-induced Akt and AMPKalpha phosphorylation. STO-609, a CaMKK inhibitor, not only inhibited the activation of AMPKalpha but also suppressed the phosphorylation of Akt induced by nicotine. In conclusion, both of CaMKK and PI3K/Akt pathways are involved in the nicotine-induced AMPKalpha phosphorylation in macrophages, and the interaction of CaMKK and Akt may exist. AMPKalpha is a novel and critical component of anti-inflammatory effect of nicotine.

A new filter is developed for the enhancement of scanning electron microscope (SEM) images. A mixed Lagrange time delay estimation auto-regression (MLTDEAR)-based interpolator is used to provide an estimate of noise variance to a standard Wiener filter. A variety of images are captured and the performance of the filter is shown to surpass the conventional noise filters. As all the information required for processing is extracted from a single image, this method is not constrained by image registration requirements and thus can be applied in real-time in cases where specimen drift is presented in the SEM image.

We report a case of restrictive cardiomyopathy in which a distinct endothelial thickening of the atrial wall and pulmonary vein orifices was noted on transesophageal echocardiography. Echocardiographically guided endomyocardial biopsy of the thickening revealed an inflammatory infiltrate that was rich in giant cells and provided important clues about an underlying immune mechanism for the pathogenesis. Positive results from the antineutrophil cytoplasmic autoantibody assay supported the diagnosis of Wegener's granulomatosis. After immunosuppressive therapy, the endomyocardial thickening completely resolved, but the restrictive cardiomyopathy did not reverse.

The aim of the study was to formulate normative data for the lifting capacities of a normal Chinese population, in order to establish a basic foundation for further studies and to investigate the relationship between individual attributes including age, gender, height, weight, job physical demand and each type of lifting capacity. Isokinetic and isometric lifting strength at low, waist and shoulder assessment levels were measured using the LIDO Workset II based on a sample of 93 normal Chinese adults (63 men and 30 women) between the ages of 21-51. The 50th percentile score for adult Chinese female's lifting strength was 17.71% lower than the American female while the adult Chinese male's lifting strength was 14.94% lower than the American male. Lifting forces were higher in the 20-40 year age group. The isometric work mode had considerable impact on the lifting capacities, with shoulder level having the highest lifting capacities. The gender and body weight had a significant positive correlation to lifting capacity while job physical demand had a moderate correlation. Age and body heights were weakly correlated to lifting capacity., (Copyright 2003 Elsevier Science Ltd.)

The present study examined the relationship between promotion, perceived instrumentality of organizational citizenship behavior (OCB) for promotion, and employees' OCB before and after promotion. A field quasi-experiment involving 293 tellers of a multinational bank was conducted. Both supervisors and employees provided OCB ratings 3 months before and 3 months after the promotion decision was announced. The authors found employees who perceived OCB as instrumental to their promotion and who were promoted were more likely to decline in their OCB after the promotion.

I present a theoretical analysis and study of a compound Fabry-Perot resonator consisting of two coupled Fabry-Perot étalons. The coupled resonator configuration studied contains a passive and nonabsorptive Fabry-Perot cavity coupled to an active Fabry-Perot cavity, the absorption of which can be adjusted. Mathematical relationships useful in the design and optimization of the structures with prescribed properties for device applications are given.

Strong excitonic nonlinearity in the photoconductive response of a P-I-N photodiode incorporating narrow asymmetric coupled quantum wells has been observed at 78 K. When the P-I-N photodiode is overbiased, the heavyhole energy levels in the two coupled quantum wells are moved toward the resonance by increasing the laser intensity. Also, both the light-hole and the heavy-hole excitonic transitions undergo intensity-dependent shifts. Both these effects indicate intrinsic change of bias due to redistribution of photogenerated carriers and, therefore, the existence of an intrinsic feedback mechanism. The magnitude of the blue shift of the heavy-hole excitonic transitions significantly increases when the laser intensity is changed from 9.2 to ~270 mW/cm(2).

Promising approaches for achieving optically addressed spatial light modulators (O-SLMs) are investigated based on combining nipi and multiple quantum well structures. Theoretical aspects of photooptic effects achievable in such structures are treated. Test structures are grown by molecular beam epitaxy using two material systems, (In,Ga)As/GaAs and (Al,Ga)As/GaAs. Experiments show large optically controlled modulation of the absorption coefficient in the quantum well layers ( approximately 10(4) cm(-1)), a log power dependence on the control signal, millisecond and shorter time response, and generally predictable behavior. The results are encouraging for several different O-SLM device structures proposed.

An optically controlled reflection modulator has been demonstrated that consists of a combination of a GaAs-AlGaAs n-i-p-i doping structure with a multiple-quantum-well structure on top of a distributed Bragg reflector, all grown by molecular-beam epitaxy. A modulation of approximately 60% is obtained on our test structure, corresponding to a differential change of absorption coefficient in the quantum wells of approximately 7500/cm. Changes in reflectance can be observed with a control beam power as low as 1.5 microW. This device structure has the potential of being developed as an optically addressed spatial light modulator for optical information processing.