Phonon downconversion to suppress correlated errors in superconducting qubits

Quantum error correction can preserve quantum information in the presence of local errors, but correlated errors are fatal. For superconducting qubits, high-energy particle impacts from background radioactivity produce energetic phonons that travel throughout the substrate and create excitations above the superconducting ground state, known as quasiparticles, which can poison all qubits on the chip. We use normal metal reservoirs on the chip back side to downconvert phonons to low energies where they can no longer poison qubits. We introduce a pump-probe scheme involving controlled injection of pair-breaking phonons into the qubit chips. We examine quasiparticle poisoning on chips with and without back-side metallization and demonstrate a reduction in the flux of pair-breaking phonons by over a factor of 20. We use a Ramsey interferometer scheme to simultaneously monitor quasiparticle parity on three qubits for each chip and observe a two-order of magnitude reduction in correlated poisoning due to background radiation.

232 WORKING-UP DEMENTIA, A RETROSPECTIVE COHORT STUDY OF REFERRALS TO A SPECIALIST DEMENTIA SERVICE

Background

Rates of dementia in Ireland are rapidly increasing in line with our ageing population. Cases are predicted to more than double in the next 30 years from a prevalence of 55,000 in 2018, to 141,000 in 2050. Dementia services will be placed under significant pressure. It is essential that patients referred to specialist memory services are appropriately worked-up prior to referral, to ensure efficiency and optimise the running of these services, and also to improve patient experience.

Methods

We carried out a retrospective review of patients referred to the Psychiatry of Later Life Team for specialist dementia care by General Practitioners. We obtained date of referral to the service, and carried out an electronic chart review to evaluate the work-up performed prior to referral. Our standard work-up criteria consisted of neuroimaging (CT brain or MRI brain), and blood tests including B12, folate, and thyroid function tests within 12-months. Results were analysed descriptively.

Results

104 patients were included in the study, from referrals dated Nov 2014-June 2019. Neuroimaging had been performed in 79.8% (n=83) prior to referral- 89.1% CT, 9.6% MRI, 1.2% both CT and MRI. Of those who had neuroimaging, n=37 had been performed in the previous 12-months, representing 35.6% of overall cohort. In terms of blood work-up, 23.1% (n=24) had bloods performed in the 12 months prior to referral- 70.8% B12, folate and thyroid function tests; 20.8% TFTS only; 8.3% B12 and folate levels only).

Conclusion

Referrals to specialist memory services by General Practice often lack the appropriate first line investigations, which introduces delay in review and the need for further assessment once baseline investigations have been done. There is a need for a standardised work-up prior to referral for optimum running of such services.

A systematic review of the effectiveness of community interventions to improve parent health literacy

Background

Many community-based interventions have been developed to increase parent/caregiver health literacy, yet no systematic review of their effectiveness has been published. Therefore, the aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents/caregivers.

Methods

A systematic review of six databases; MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source were conducted to identify relevant articles. Risk of bias were assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane Collaboration Risk of Bias in Non-Randomised Studies of Interventions. The study findings were grouped and synthesised following the Synthesis Without Meta-analysis framework.

Results

Eleven community-based health literacy interventions for parents/caregivers were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. The risk of bias was high in over half the studies (n = 7) Studies were heterogeneous preventing a meta-analysis.

Discussion

Although no definitive conclusion of the effectiveness of community-based interventions can be drawn there are suggestions of improvement in many of the studies included in this review. The review has brought into question whether the health literacy measurement tools used met the needs of assessing the interventions outcomes. When comparing the cost and resources needed for digital with in person interventions, the findings of this review have implications for both practise and research.

Key messages

Leptin receptor co-expression gene network moderates the effect of early life adversity on eating behavior in children

Leptin influences eating behavior. Exposure to early adversity is associated with eating behaviour disorders and metabolic syndrome, but the role of the leptin receptor on this relationship is poorly explored. We investigated whether individual differences in brain region specific leptin receptor (LepR) gene networks could moderate the effects of early adversity on eating behavior and metabolism. We created an expression-based polygenic risk score (ePRS) reflecting variations in the function of LepR gene network in prefrontal cortex and hypothalamus to investigate the interactions between a cumulative index of postnatal adversity on eating behavior in two independent birth cohorts (MAVAN and GUSTO). To explore whether variations in the prefrontal cortex or hypothalamic genetic scores could be associated with metabolic measurements, we also assessed the relationship between LepR-ePRS and fasting blood glucose and leptin levels in a third independent cohort (ALSPAC). We identified significant interaction effects between postnatal adversity and prefrontal-based LepR-ePRS on the Child Eating Behavior Questionnaire scores. In MAVAN, we observed a significant interaction effect on food enjoyment at 48 months (β = 61.58, p = 0.015) and 72 months (β = 97.78, p = 0.001); food responsiveness at 48 months (β = 83.79, p = 0.009) satiety at 48 months (β = −43.63, p = 0.047). Similar results were observed in the GUSTO cohort, with a significant interaction effect on food enjoyment (β = 30.48, p = 0.006) food fussiness score (β = −24.07, p = 0.02) and satiety score at 60 months (β = −17.00, p = 0.037). No effects were found when focusing on the hypothalamus-based LepR-ePRS on eating behavior in MAVAN and GUSTO cohorts, and there was no effect of hypothalamus and prefrontal cortex based ePRSs on metabolic measures in ALSPAC. Our study indicated that exposure to postnatal adversity interacts with prefrontal cortex LepR-ePRS to moderate eating behavior, suggesting a neurobiological mechanism associated with the development of eating behavior problems in response to early adversity. The knowledge of these mechanisms may guide the understanding of eating patterns associated with risk for obesity in response to fluctuations in stress exposure early in life.

An expression-based polygenic risk score analysis of leptin receptor (LepR) genes suggests that LepR-specific genes co-expressed in the prefrontal cortex interact with exposure to postnatal adversity, potentially modulating eating behavior in children.

Lipoprotein(a), cardiovascular events, and benefit of P2Y12 inhibition: insights from the PEGASUS-TIMI 54 trial

Background

Lp(a) plays a causal role in atherogenesis and may exert pro-thrombotic effects by inhibiting fibrinolysis owing to its structural homology with plasminogen. Patients with higher Lp(a) concentrations may derive greater benefit from anti-thrombotic therapy.

Purpose

We assessed whether patients with higher Lp(a) derive greater risk reduction from P2Y12 inhibition with ticagrelor vs. placebo on a background of aspirin therapy.

Methods

Lp(a) concentration was measured (Randox) in a prospective nested cohort of 8,967 pts enrolled in PEGASUS-TIMI 54, a randomized trial of ticagrelor vs. placebo in patients 1–3 years post MI (median follow-up: 2.7 y). Lp(a) was dichotomized at 200 nmol/L as an established threshold of risk. The prespecified MACE endpoint was CV death, MI or stroke, with KM rates reported at 3y. Cox proportional hazards were used to assess the relationship between Lp(a), MACE and treatment benefit. Models were adjusted for relevant baseline characteristics including apolipoprotein B.

Results

The median Lp(a) was 29 (25th-75th percentile: 12–137) nmol/L. A total of 1,053 pts (11.7%) had a high Lp(a) (≥200 nmol/L). In the pooled trial population, high Lp(a) concentration was associated with a 29% higher risk of MACE (9.1% vs 7.6%; adjusted hazard ratio [adj HR] 1.29, 95% confidence interval [CI] 1.02–1.62; p=0.03), including a 37% higher risk of MI (6.9% vs. 5.3%; adj HR 1.37, 95% CI 1.05–1.79; p=0.02). The hazard ratios for MACE with ticagrelor vs. placebo were 0.73 (95% CI 0.48–1.11) for patients with higher Lp(a) and 0.88 (95% CI 0.74–1.05) for patients with lower Lp(a) (p-interaction=0.41; Figure 1). The absolute risk reductions were 2.4% and 1.2%, respectively.

Conclusion

Lp(a) above 200 nmol/L identifies patients with prior MI at increased risk of MACE who may derive greater absolute risk reduction from treatment with ticagrelor. These exploratory observations provide insights for therapeutics that are evaluating the clinical benefit of Lp(a) reduction.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The PEGASUS-TIMI 54 trial was funded by AstraZeneca

High-resolution fiber imaging for pulsed power experiments

This work presents a novel approach for imaging the visible emissions from plasmas in pulsed power experiments using high-resolution plastic optical fibers. The diagnostic consists of a 2 mm diameter core commercial cable constructed of 13 000 individual acrylic fibers. The fibers are fused together to create a single high-resolution bundle. Different designs were investigated to cover a wide range of resolutions and fields of view (3-700 µm and 0.05-45 mm, respectively). The system was tested on the 1-MA Mykonos accelerator at Sandia National Laboratories and successfully imaged visible emission from a hybrid x-pinch target. Diagnostic development and preliminary results are presented.

Longitudinal monitoring of prefrontal cortical ensemble dynamics reveals new insights into stress habituation

The prefrontal cortex is highly susceptible to the detrimental effects of stress and has been implicated in the pathogenesis of stress-related psychiatric disorders. It is not well understood, however, how stress is represented at the neuronal level in the prefrontal cortical neuronal ensembles. Even less understood is how the representation of stress changes over time with repeated exposure. Here we show that the prelimbic prefrontal neuronal ensemble representation of foot shock stress exhibits rapid spatial drift within and between sessions. Despite this rapid spatial drift of the ensemble, the representation of the stressor itself stabilizes over days. Our results suggest that stress is represented by rapidly drifting ensembles and despite this rapid drift, important features of the neuronal representation are stabilized, suggesting a neural correlate of stress habituation is present within prefrontal cortical neuron populations.

Unique collateralisation between the left internal thoracic artery and the coeliac artery

Collateralisation around stenotic or occlusive arterial disease is a commonly observed adaptation for maintenance of arterial perfusion. It occurs through pathways of well-understood embryological origin. Examples include Winslow's pathway (internal thoracic artery to iliac artery via the epigastric arteries) and the arc of Riolan (between superior and inferior mesenteric arteries). In this article, we describe a pathway of collateralisation around stenotic disease of the coeliac and superior mesenteric arteries in a 76-year-old man with an abdominal aortic aneurysm. The collateral pathway was identified on computed tomography angiography between the left internal thoracic artery in the thorax and the coeliac artery in the abdomen via the left inferior phrenic artery. This has implications for routine cardiac surgery, such that left internal thoracic artery harvest during coronary artery bypass surgery would likely result in acute ischaemia of the abdominal viscera.

491 Improving the Return Rate of the 6 Week Post Procedure Forms at King's College Hospital Tongue Tie Clinic

Aim

The aim of the audit was to assess, and improve, the return yield of feedback forms from parents using the King's College Hospital tongue-tie service. In a procedure that's primary objective is to improve the mother and baby experience of breast-feeding, it is vital that we are aware of maternal perceptions on any improvements that the procedure conveys.

Method

Baseline return yields were initially collected and assessed using clinic and feedback data from January 2020. A focus group was held with the tongue-tie MDT to ascertain current procedures for feedback collection. During this it was identified that parents were never reminded to return the feedback form. Change was instigated in December 2020 with “Envoy Patient Messenger”, a software employed to send a text reminder to parents 5 days before feedback forms were due. January 2021 was used as a comparable month to analyse the effectiveness of the change.

Results

In January 2020, 4 (6.15%) parent feedback forms were returned out of the 65 babies undergoing tongue-tie procedures. Following initiation of the text reminder service, in January 2021, 15 (33.3%) of parent feedback forms were returned out of a possible 45, giving a 5.41x increase in return yield.

Conclusions

This audit demonstrated that simple measures such a text reminder service significantly increased the return yield of parent feedback forms following tongue-tie procedure. Work is ongoing with Patient Outcomes team regarding the introduction of an online feedback form.

483 Surgical Virtual Clinic: A Safe and Effective Alternative to Acute Surgical Clinics for Semi-Urgent, Ambulatory Patients

Introduction

Many ‘Hot Clinics’ deal with ambulatory patients only requiring semi-urgent investigation and treatment, potentially avoiding hospital admission. These clinics often use the same staff and resources being utilised for acute surgical admission and treatment. We present data showing that “Virtual Clinics” (VC) are safe alternatives to this system, improving patient service and relieving a significant burden on the acute surgical units.

Method

78 patients who came through the established VC between 23/12/2020 and 19/01/2021 (4 weeks), were assessed for delays in scan date, call-backs, diagnosis, referral patterns, readmission rates and eventual outcomes for those who needed surgical interventions.

Results

83% of patients had their scans within the set-out time of 72 hours. 89.7% of scans were reported on the same day. Only 18% of the patients had a surgical diagnosis. 51% had no diagnosis at all and were discharged safely from the clinic. 16.7% were still symptomatic at the time of the VC with 3.8% of these having a surgical pathology. 22% were referred to other specialities. 2 patients were referred to MDT.

In total, 6 patients were re-admitted to the hospital (7.6%). 4 patients were listed for surgery following the VC.

Conclusions

The VC proves to be a safe and effective system for semi-urgent, ambulatory patients. Re-admission rates are low, justifying the discharge of these patients from the acute surgical assessment unit to a virtual follow up environment.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Heparin desensitisation prior to cardiopulmonary bypass in a patient with alpha-gal allergy

This case report describes the implementation of a heparin desensitisation strategy for a patient with confirmed galactose-alpha-1,3-galactose (alpha-gal) allergy, prior to cardiac surgery. We describe the pre-, intra- and postoperative management. We believe this report can enhance the limited data currently in existence on alternative strategies for heparin utilisation in cardiopulmonary bypass in a previously intolerant patient population.