Emerging Strategies for the Prevention of Immune Toxicities Associated with T cell-Engaging Cancer Therapies

SUMMARY

Immune-related toxicities including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common side effects of bispecific antibody and chimeric antigen receptor (CAR) T-cell therapies of hematologic malignancies. As anti-inflammatory therapy (the standard of care) is variably effective in mitigating these toxicities after onset, here we discuss emerging evidence for shifting the strategy from mitigation to prevention.

Genomic and immune signatures predict clinical outcome in newly diagnosed multiple myeloma treated with immunotherapy regimens

Despite improving outcomes, 40% of patients with newly diagnosed multiple myeloma treated with regimens containing daratumumab, a CD38-targeted monoclonal antibody, progress prematurely. By integrating tumor whole-genome and microenvironment single-cell RNA sequencing from upfront phase 2 trials using carfilzomib, lenalidomide and dexamethasone with daratumumab ( NCT03290950 ), we show how distinct genomic drivers including high APOBEC mutational activity, IKZF3 and RPL5 deletions and 8q gain affect clinical outcomes. Furthermore, evaluation of paired bone marrow profiles, taken before and after eight cycles of carfilzomib, lenalidomide and dexamethasone with daratumumab, shows that numbers of natural killer cells before treatment, high T cell receptor diversity before treatment, the disappearance of sustained immune activation (that is, B cells and T cells) and monocyte expansion over time are all predictive of sustained minimal residual disease negativity. Overall, this study provides strong evidence of a complex interplay between tumor cells and the immune microenvironment that is predictive of clinical outcome and depth of treatment response in patients with newly diagnosed multiple myeloma treated with highly effective combinations containing anti-CD38 antibodies.

Safety and Efficacy of Traditional Heart Failure Therapies in Patients With Cardiac Amyloidosis and Heart Failure

Randomized controlled trials have demonstrated mortality benefits for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction (EF). However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. our study aimed to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF (HFmrEF). We conducted a single-center retrospective study. Patients were included if they were diagnosed with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF between January 2012 and 2022. The primary outcomes of interest were medication use patterns (for β blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], angiotensin receptor blockers [ARBs], angiotensin receptor neprilysin inhibitors [ARNI], and mineralocorticoid receptor antagonists [MRAs]); potential medication side effects (symptomatic bradycardia, fatigue, hypotension, lightheadedness, and syncope); hospitalization; and death. The associations of BB, ACEI/ARB/ARNI, and MRA use with clinical outcomes were evaluated using Kaplan-Meier and Cox proportional hazards regression. A total of 82 patients met study criteria. At time of cardiac amyloidosis diagnosis, 63.4% were on a BB, 51.2% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. At last follow-up, 51.2% were on a BB, 35.4% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. There were no statistically significant differences in rates of potential medication side effects in patients on the medication class compared with those who were not. There was no association with hospitalization or mortality for baseline or follow-up BB, ACEI/ARB/ARNI, or MRA use. In conclusion, BBs, ACEI/ARB/ARNIs, and MRAs may be safely used in this population. However, their use does not appear to improve mortality or hospitalization.

Long-term survival in people with transthyretin amyloid cardiomyopathy who took tafamidis: A Plain Language Summary

WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT?

This summary presents the results from an ongoing, long-term extension study that followed an earlier study called ATTR-ACT. People who took part in this extension study and ATTR-ACT have a type of heart disease known as transthyretin amyloid cardiomyopathy (ATTR-CM for short), which causes heart failure and death. In ATTR-ACT, people took either a medicine called tafamidis or a placebo (a pill that looks like the study drug but does not contain any active ingredients) for up to 2½ years. So far, in the long-term extension study, people have continued taking tafamidis, or switched from taking a placebo to tafamidis, for another 2½ years. Researchers looked at how many people died in ATTR-ACT and the extension study. The long-term extension study is expected to end in 2027, so these are interim (not final) results.

WHAT DID RESEARCHERS FIND OUT?

In the extension study of ATTR-ACT, the risk of dying was lower in people who took tafamidis continuously throughout ATTR-ACT and the extension study than in people who took placebo in ATTR-ACT and switched to tafamidis in the extension study.

WHAT DO THE RESULTS MEAN?

Taking tafamidis increases how long people with ATTR-CM live. People with ATTR-CM who take tafamidis early and continuously are more likely to live longer than those who do not. These results highlight the importance of early detection and treatment in people with ATTR-CM. Clinical Trial Registration: NCT01994889 (ClinicalTrials.gov) Clinical Trial Registration: NCT02791230 (ClinicalTrials.gov).

How did transthyretin amyloid cardiomyopathy progress in patients who took placebo in the study ATTR-ACT? A plain language summary

WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT?

This plain language summary describes some results of a study called ATTR-ACT. This was the first large study to include people with wild-type and hereditary transthyretin amyloid cardiomyopathy (ATTR-CM for short). ATTR-CM is a type of heart disease that happens when abnormal clumps of protein build up in the heart. This build-up prevents the heart from working properly, causing a condition called heart failure. Wild-type ATTR-CM happens for unknown reasons in some people as they get older. Hereditary ATTR-CM can happen because of changes in people's genes (known as gene variants or mutations).

IMPORTANT INFORMATION ABOUT ATTR-ACT

In this study, 441 people with ATTR-CM took either a medicine called tafamidis or a placebo (a capsule that looked like tafamidis but didn't contain any active medicine) by mouth for 30 months, once a day. The researchers' main aim was to find out how tafamidis treatment affected the risk of people dying or being admitted to the hospital for heart problems. They found that tafamidis lowered these risks by about one-third compared with placebo.

WHAT ELSE DID RESEARCHERS FIND OUT IN ATTR-ACT?

As described in this summary, after ATTR-ACT was completed, researchers looked back at the results from people who took placebo to learn how ATTR-CM progressed without treatment. The researchers found that about 4 in 10 people with wild-type ATTR-CM who took placebo died and 6 in 10 were admitted to the hospital because of heart problems over 30 months. People who took placebo also could not walk as far at the end of the study as they did at the start because their heart function worsened over time.

WHY ARE THESE RESULTS IMPORTANT?

By showing how ATTR-CM affects people's health when they do not take treatment, these results highlight the benefits of early diagnosis and treatment of ATTR-CM. ClinicalTrials.gov NCT number: NCT01994889.

Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy

Background:

Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial).

Methods:

Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE.

Results:

Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44–0.79]; P<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33–0.99]; P=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43–0.87]; P=0.006); and baseline New York Heart Association class I and II (0.56 [0.38–0.82]; P=0.003) and class III (0.65 [0.41–1.01]; P=0.06).

Conclusions:

In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01994889 and NCT02791230.

Quality of life analyses in patients with multiple myeloma: results from the Selinexor (KPT-330) Treatment of Refractory Myeloma (STORM) phase 2b study

BACKGROUND

Selinexor is an oral, selective nuclear export inhibitor. STORM was a phase 2b, single-arm, open-label, multicenter trial of selinexor with low dose dexamethasone in patients with penta-exposed relapsed/refractory multiple myeloma (RRMM) that met its primary endpoint, with overall response of 26% (95% confidence interval [CI], 19 to 35%). Health-related quality of life (HRQoL) was a secondary endpoint measured using the Functional Assessment of Cancer Therapy - Multiple Myeloma (FACT-MM). This study examines impact of selinexor treatment on HRQoL of patients treated in STORM and reports two approaches to calculate minimal clinically important differences for the FACT-MM.

METHODS

FACT-MM data were collected at baseline, on day 1 of each 4-week treatment cycle, and at end of treatment (EOT). Changes from baseline were analyzed for the FACT-MM total score, FACT-trial outcome index (TOI), FACT-General (FACT-G), and the MM-specific domain using mixed-effects regression models. Two approaches for evaluating minimal clinically important differences were explored: the first defined as 10% of the instrument range, and the second based on estimated mean baseline differences between Eastern Cooperative Oncology Group performance status (ECOG PS) scores. Post-hoc difference analysis compared change in scores from baseline to EOT for treatment responders and non-responders.

RESULTS

Eighty patients were included in the analysis; the mean number of prior therapies was 7.9 (standard deviation [SD] 3.1), and mean duration of myeloma was 7.6 years (SD 3.4). Each exploratory minimal clinically important difference threshold yielded consistent results whereby most patients did not experience HRQoL decline during the first six cycles of treatment (range: 53.9 to 75.7% for the first approach; range: 52.6 to 72.9% for the second). Treatment responders experienced less decline in HRQoL from baseline to EOT than non-responders, which was significant for the FACT-G, but not for other scores.

CONCLUSION

The majority of patients did not experience decline in HRQoL based on minimal clinically important differences during early cycles of treatment with selinexor and dexamethasone in the STORM trial. An anchor-based approach utilizing patient-level data (ECOG PS score) to define minimal clinically important differences for the FACT-MM gave consistent results with a distribution-based approach.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov under the trial-ID NCT02336815 on January 8, 2015.

Natural history and progression of transthyretin amyloid cardiomyopathy: insights from ATTR-ACT

Aims

Transthyretin amyloid cardiomyopathy (ATTR‐CM) is a progressive, fatal disorder that remains underdiagnosed. The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR‐ACT) was the first large clinical trial to include both wild‐type (ATTRwt) and hereditary (ATTRv) patients. A description of the natural history of ATTR‐CM, utilizing data from placebo‐treated patients in ATTR‐ACT, will provide a greater understanding of presentation and progression of ATTR‐CM and may aid in disease awareness, earlier diagnosis and treatment monitoring.

Methods and results

Changes in clinical endpoints (mortality, cardiovascular [CV]‐related hospitalizations, 6‐min walk test [6MWT] distance and Kansas City Cardiomyopathy Questionnaire Overall Summary [KCCQ‐OS] score) from baseline to Month 30 in the 177 patients (134 ATTRwt, 43 ATTRv) who received placebo in ATTR‐ACT were assessed. ATTRwt patients tended to have less severe disease at baseline. Over the duration of ATTR‐ACT, there were 76 (42.9%) all‐cause deaths, and 107 (60.5%) patients had a CV‐related hospitalization. There was a lower proportion of all‐cause deaths in ATTRwt (49, 36.6%) than ATTRv (27, 62.8%). There was a similar, steady decline in mean (SD) 6MWT distance from baseline to Month 30 in ATTRwt (93.9 [93.7] m) and ATTRv (89.1 [107.2] m) patients. The decline in mean (SD) KCCQ‐OS score was less severe in ATTRwt (13.8 [20.7]) than ATTRv (21.0 [26.4]) patients.

Conclusions

Patients with ATTR‐CM experience a severe, progressive disease. In ATTR‐ACT, placebo‐treated patients with ATTRv, compared with ATTRwt, had more severe disease at baseline, and their disease progressed more rapidly as shown by mortality, hospitalizations and quality of life over time.

Searching for emotional salience

In the emotion induced blindness (EIB) paradigm, participants search for a single target picture embedded in a rapidly presented sequence of "background" pictures. When the sequence also contains a task-irrelevant, emotional distractor appearing shortly before the target, awareness for the target is severely impaired (Most, Chun, Widders, & Zald, 2005). This temporary "blindness" for the target is thought to reflect attention capture by the emotionally salient distractor which blocks the target's access to the attention system. However, there are also reasons to suspect that physical salience may play an important role in the initial attention capture process. The emotional pictures consist of close-ups of people and animals while the background pictures are wide-angle views of landscapes and cityscapes. These physical differences might result in pop-out of the distractor picture that is at least partially based on physical and not emotional salience. We investigated the role of physical salience in emotional capture by comparing the typical EIB paradigm, which uses dissimilar distractors, with one in which the background pictures consist of people and animals in non-emotional settings (similar distractors). If emotional salience is the basis of attention capture in EIB, we should see similar amounts of target suppression in both conditions. Instead, we found that the EIB effect was reduced and possibly eliminated in the similar background condition. A control experiment revealed that emotional information was still available in the similar background condition because the blink was restored when the emotional picture was designated for report by a salient cue. These findings are clearly inconsistent with current theories of EIB (e.g., McHugo, Olatunji, & Zald, 2013) which assume that initial attention capture is driven by emotional not physical salience.

Systemic Amyloidosis Caused by Monoclonal Immunoglobulins: Soft Tissue and Vascular Involvement

Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very important for the diagnosis and early intervention on the underlying plasma cell disease.

High-grade B-cell lymphoma with MYC and BCL6 rearrangements presenting as a cervical mass

Lymphoid malignancies represent 0. 008% of all cervical tumours. While uncommon, lymphoid malignancies of the gynaecological tract require careful diagnosis and classification to ensure appropriate treatment. We present a case of a 54-year-old woman with HIV who presented with urinary and faecal incontinence for 2 weeks, associated with the feeling of a mass in her vagina. A smooth flesh-coloured pelvic mass was seen on physical examination, and a transvaginal biopsy revealed infiltration of atypical lymphoid cells with fluorescence in situ hybridisation positive for MYC and BCL6, and negative for IGH/BCL2. Bone marrow and cerebral spinal fluid analysis also showed involvement by atypical lymphocytes. She was diagnosed with stage IV high-grade B-cells lymphoma (HGBLs) with MYC and BCL6 rearrangements. She was given R-CODOX-M plus IVAC with no evidence of disease at 4-month follow-up. To our knowledge, this is the first literature report of a HGBL with MYC and BCL6 rearrangement presenting as a cervical mass.

Liver failure due to relapsed myeloma and hepatic iron overload

Multiple myeloma is a hematologic malignancy that classically manifests with hypercalcaemia, renal insufficiency, anaemia and lytic bone lesions. Liver dysfunction in multiple myeloma is a lesser known complication that occurs through biliary obstruction, liver infiltration by plasma cells, amyloid/light chain deposition or due to liver injury from medications. Although transfusion-related hepatic iron overload—leading to significant liver disease—is a recognised complication in certain hematologic malignancies, little is known about transfusional iron overload in patients with multiple myeloma. We present a case of a 49-year-old female with relapsed/refractory multiple myeloma who presented with rapid onset liver failure, due to both iron deposition and malignant plasma cell infiltration of the liver as a terminal event. A review of the literature on hepatic complications in multiple myeloma patients is presented.

1169Interim analysis of data from a long-term, extension trial of tafamidis meglumine in patients with transthyretin amyloid cardiomyopathy

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM), is an underdiagnosed, fatal disease caused by the deposition of transthyretin amyloid fibrils in the heart leading to heart failure. The Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), an international, multi-center, double-blind, placebo-controlled, randomized study, demonstrated the efficacy and safety of tafamidis treatment for patients with ATTR-CM due to variant (ATTRm) or wild-type (ATTRwt) TTR.

Purpose

This is a pooled analysis of data from ATTR-ACT and interim data from the ongoing, long-term, extension study to evaluate longer term data on the efficacy of tafamidis in patients with ATTR-CM.

Methods

Patients who completed ATTR-ACT (which had a duration of 30 months) were eligible to be enrolled in a long-term, extension study in which patients either continued to receive tafamidis meglumine at the same dose (the tafamidis/tafamidis [T/T] group) or, for patients previously treated with placebo, were randomised (in a 1:2 ratio) to tafamidis meglumine 20 mg or 80 mg (the placebo/tafamidis [P/T] group) for up to 60 months. The primary efficacy outcome was all-cause mortality. This analysis combined data from the completed ATTR-ACT with interim data from the extension study (cut-off date: 15 Feb, 2018), and included patients treated with tafamidis meglumine across the two studies with a median follow up of 36 months.

Results

All-cause mortality was significantly lower in the T/T group (n=264; 88 events, 33.3%) compared with the P/T group (n=177; 88 events, 50.3%); hazard ratio (95% CI), 0.64 (0.47, 0.85); P=0.001. In the subgroup of ATTRwt patients, all-cause mortality was significantly reduced in the T/T group (55/201; 27.4%) compared with the P/T group (60/134; 44.8%); 0.64 (0.44, 0.92); P=0.002. In the 106 (24.0%) ATTRm patients, there was a trend towards a reduction in all-cause mortality in the T/T group (33/63; 52.4%) compared with the P/T group (29/43; 67.4%); 0.66 (0.39, 1.09); P=0.17. In patients who were NYHA Class I or II at baseline, all-cause mortality was significantly reduced in the T/T group (38/186; 20.4%) compared with the P/T group (45/114; 39.5%); 0.49 (0.32, 0.75); P=0.001. In those patients with more severe symptoms at baseline (NYHA Class III), there were fewer deaths in the T/T group (50/78; 64.1%) compared with the P/T group (44/63; 69.8%); 0.80 (0.53, 1.21), but this difference was not statistically significant (P=0.50).

Conclusions

In ATTR-ACT, tafamidis was shown to significantly improve survival, functional capacity, and quality of life in patients with ATTR-CM. This pooled analysis with data from the ongoing extension study further supports the efficacy of tafamidis in patients over a longer period of time and the importance of early diagnosis and treatment.

Acknowledgement/Funding

This study was sponsored by Pfizer.

Oral Selinexor-Dexamethasone for Triple-Class Refractory Multiple Myeloma

BACKGROUND

Selinexor, a selective inhibitor of nuclear export compound that blocks exportin 1 (XPO1) and forces nuclear accumulation and activation of tumor suppressor proteins, inhibits nuclear factor κB, and reduces oncoprotein messenger RNA translation, is a potential novel treatment for myeloma that is refractory to current therapeutic options.

METHODS

We administered oral selinexor (80 mg) plus dexamethasone (20 mg) twice weekly to patients with myeloma who had previous exposure to bortezomib, carfilzomib, lenalidomide, pomalidomide, daratumumab, and an alkylating agent and had disease refractory to at least one proteasome inhibitor, one immunomodulatory agent, and daratumumab (triple-class refractory). The primary end point was overall response, defined as a partial response or better, with response assessed by an independent review committee. Clinical benefit, defined as a minimal response or better, was a secondary end point.

RESULTS

A total of 122 patients in the United States and Europe were included in the modified intention-to-treat population (primary analysis), and 123 were included in the safety population. The median age was 65 years, and the median number of previous regimens was 7; a total of 53% of the patients had high-risk cytogenetic abnormalities. A partial response or better was observed in 26% of patients (95% confidence interval, 19 to 35), including two stringent complete responses; 39% of patients had a minimal response or better. The median duration of response was 4.4 months, median progression-free survival was 3.7 months, and median overall survival was 8.6 months. Fatigue, nausea, and decreased appetite were common and were typically grade 1 or 2 (grade 3 events were noted in up to 25% of patients, and no grade 4 events were reported). Thrombocytopenia occurred in 73% of the patients (grade 3 in 25% and grade 4 in 33%). Thrombocytopenia led to bleeding events of grade 3 or higher in 6 patients.

CONCLUSIONS

Selinexor-dexamethasone resulted in objective treatment responses in patients with myeloma refractory to currently available therapies. (Funded by Karyopharm Therapeutics; STORM ClinicalTrials.gov number, NCT02336815.).

Selective Inhibition of Nuclear Export With Oral Selinexor for Treatment of Relapsed or Refractory Multiple Myeloma

Purpose Selinexor, a first-in-class, oral, selective exportin 1 (XPO1) inhibitor, induces apoptosis in cancer cells through nuclear retention of tumor suppressor proteins and the glucocorticoid receptor, along with inhibition of translation of oncoprotein mRNAs. We studied selinexor in combination with low-dose dexamethasone in patients with multiple myeloma refractory to the most active available agents. Patients and Methods This phase II trial evaluated selinexor 80 mg and dexamethasone 20 mg, both orally and twice weekly, in patients with myeloma refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide (quad-refractory disease), with a subset also refractory to an anti-CD38 antibody (penta-refractory disease). The primary end point was overall response rate (ORR). Results Of 79 patients, 48 had quad-refractory and 31 had penta-refractory myeloma. Patients had received a median of seven prior regimens. The ORR was 21% and was similar for patients with quad-refractory (21%) and penta-refractory (20%) disease. Among patients with high-risk cytogenetics, including t(4;14), t(14;16), and del(17p), the ORR was 35% (six of 17 patients). The median duration of response was 5 months, and 65% of responding patients were alive at 12 months. The most common grade ≥ 3 adverse events were thrombocytopenia (59%), anemia (28%), neutropenia (23%), hyponatremia (22%), leukopenia (15%), and fatigue (15%). Dose interruptions for adverse events occurred in 41 patients (52%), dose reductions occurred in 29 patients (37%), and treatment discontinuation occurred in 14 patients (18%). Conclusion The combination of selinexor and dexamethasone has an ORR of 21% in patients with heavily pretreated, refractory myeloma with limited therapeutic options.

Visual attention is required for multiple object tracking

In the multiple object tracking task, participants attempt to keep track of a moving set of target objects embedded in an identical set of moving distractors. Depending on several display parameters, observers are usually only able to accurately track 3 to 4 objects. Various proposals attribute this limit to a fixed number of discrete indexes (Pylyshyn, 1989), limits in visual attention (Cavanagh & Alvarez, 2005), or "architectural limits" in visual cortical areas (Franconeri, 2013). The present set of experiments examined the specific role of visual attention in tracking using a dual-task methodology in which participants tracked objects while identifying letter probes appearing on the tracked objects and distractors. As predicted by the visual attention model, probe identification was faster and/or more accurate when probes appeared on tracked objects. This was the case even when probes were more than twice as likely to appear on distractors suggesting that some minimum amount of attention is required to maintain accurate tracking performance. When the need to protect tracking accuracy was relaxed, participants were able to allocate more attention to distractors when probes were likely to appear there but only at the expense of large reductions in tracking accuracy. A final experiment showed that people attend to tracked objects even when letters appearing on them are task-irrelevant, suggesting that allocation of attention to tracked objects is an obligatory process. These results support the claim that visual attention is required for tracking objects. (PsycINFO Database Record

Acoustic buffeting by infrasound in a low vibration facility

Measurement instruments and fabrication tools with spatial resolution on the atomic scale require facilities that mitigate the impact of vibration sources in the environment. One approach to protection from vibration in a building's foundation is to place the instrument on a massive inertia block, supported on pneumatic isolators. This opens the questions of whether or not a massive floating block is susceptible to acoustic forces, and how to mitigate the effects of any such acoustic buffeting. Here this is investigated with quantitative measurements of vibrations and sound pressure, together with finite element modeling. It is shown that a particular concern, even in a facility with multiple acoustic enclosures, is the excitation of the lowest fundamental acoustic modes of the room by infrasound in the low tens of Hz range, and the efficient coupling of the fundamental room modes to a large inertia block centered in the room.

Intermodal energy transfer in a tapered optical fiber: optimizing transmission

We present an experimental and theoretical study of the energy transfer between modes during the tapering process of an optical nanofiber through spectrogram analysis. The results allow optimization of the tapering process, and we measure transmission in excess of 99.95% for the fundamental mode. We quantify the adiabaticity condition through calculations and place an upper bound on the amount of energy transferred to other modes at each step of the tapering, giving practical limits to the tapering angle.

A low-loss photonic silica nanofiber for higher-order modes

Optical nanofibers confine light to subwavelength scales, and are of interest for the design, integration, and interconnection of nanophotonic devices. Here we demonstrate high transmission (> 97%) of the first family of excited modes through a 350 nm radius fiber, by appropriate choice of the fiber and precise control of the taper geometry. We can design the nanofibers so that these modes propagate with most of their energy outside the waist region. We also present an optical setup for selectively launching these modes with less than 1% fundamental mode contamination. Our experimental results are in good agreement with simulations of the propagation. Multimode optical nanofibers expand the photonic toolbox, and may aid in the realization of a fully integrated nanoscale device for communication science, laser science or other sensing applications.

Small Subitizing Range in People with Williams syndrome

Recent evidence suggests that the rapid apprehension of small numbers of objects-- often called subitizing-- engages a system which allows representation of up to 4 objects but is distinct from other aspects of numerical processing. We examined subitizing by studying people with Williams syndrome (WS), a genetic deficit characterized by severe visuospatial impairments, and normally developing children (4-6.5 years old). In Experiment 1, participants first explicitly counted displays of 1 to 8 squares that appeared for 5 s and reported "how many". They then reported "how many" for the same displays shown for 250 ms, a duration too brief to allow explicit counting, but sufficient for subitizing. All groups were highly accurate up to 8 objects when they explicitly counted. With the brief duration, people with WS showed almost perfect accuracy up to a limit of 3 objects, comparable to 4 year-olds but fewer than either 5 or 6.5 year-old children. In Experiment 2, participants were asked to report "how many" for displays that were presented for an unlimited duration, as rapidly as they could while remaining accurate. Individuals with WS responded as rapidly as 6.5 year-olds, and more rapidly than 4 year-olds. However, their accuracy was as in Experiment 1, comparable to 4 year-olds, and lower than older children. These results are consistent with previous results indicating that people with WS can simultaneously represent multiple objects, but that they have a smaller capacity than older children, on par with 4 year-olds. This pattern is discussed in the context of normal and abnormal development of visuospatial skills, in particular those linked to the representation of numerosity.

Developmental profiles for multiple object tracking and spatial memory: typically developing preschoolers and people with Williams syndrome

The ability to track moving objects, a crucial skill for mature performance on everyday spatial tasks, has been hypothesized to require a specialized mechanism that may be available in infancy (i.e. indexes). Consistent with the idea of specialization, our previous work showed that object tracking was more impaired than a matched spatial memory task in individuals with Williams syndrome (WS), a genetic disorder characterized by severe visuo-spatial impairment. We now ask whether this unusual pattern of performance is a reflection of general immaturity or of true abnormality, possibly reflecting the atypical brain development in WS. To examine these two possibilities, we tested typically developing 3- and 4-year-olds and people with WS on multiple object tracking (MOT) and memory for static spatial location. The maximum number of objects that could be correctly tracked or remembered (estimated from the k-statistic) showed similar developmental profiles in typically developing 3- and 4-year-old children, but the WS profile differed from either age group. People with WS could track more objects than 3-year-olds, and the same number as 4-year-olds, but they could remember the locations of more static objects than both 3- and 4-year-olds. Combining these data with those from our previous studies, we found that typically developing children show increases in the number of objects they can track or remember between the ages of 3 and 6, and these increases grow in parallel across the two tasks. In contrast, object tracking in older children and adults with WS remains at the level of 4-year-olds, whereas the ability to remember multiple locations of static objects develops further. As a whole, the evidence suggests that MOT and memory for static location develop in tandem typically, but not in WS. Atypical development of the parietal lobe in people with WS could play a causal role in the abnormal, uneven pattern of performance in WS. This interpretation is consistent with the idea that multiple object tracking engages different mechanisms from those involved in memory for static object location, and that the former can be particularly disrupted by atypical development.

Scanning tunneling spectroscopy and vortex imaging in the iron pnictide superconductor BaFe1.8Co0.2As2

We present an atomic resolution scanning tunneling spectroscopy study of superconducting BaFe1.8Co0.2As2 single crystals in magnetic fields up to 9 T. At zero field, a single gap with coherence peaks at Delta=6.25 meV is observed in the density of states. At 9 and 6 T, we image a disordered vortex lattice, consistent with isotropic, single flux quantum vortices. Vortex locations are uncorrelated with strong-scattering surface impurities, demonstrating bulk pinning. The vortex-induced subgap density of states fits an exponential decay from the vortex center, from which we extract a coherence length xi=27.6+/-2.9 A, corresponding to an upper critical field Hc2=43 T.

Object substitution masking interferes with semantic processing: evidence from event-related potentials

Object substitution masking (OSM) refers to impaired target identification caused by common onset, but delayed offset, of a surrounding dot mask. This effect has been hypothesized to reflect reentrant processes that result in the mask replacing the target representation. However, little is known about the depth of processing associated with masked targets in this paradigm. We investigated this issue by examining the effect of OSM on the N400 component of the event-related potential, which reflects the degree of semantic mismatch between a target and its context. Participants read a context word followed by a semantically related or unrelated target word surrounded by dots. As expected, delayed dot offset significantly reduced accuracy in identifying the target. The N400 amplitude was also diminished by OSM. These findings offer the first evidence that substitution interferes with target processing prior to semantic analysis, demonstrating an important difference between OSM and other visual phenomena, such as the attentional blink, in which semantic processing is independent of awareness.

More than meets the eye: The effect of planned fixations on scene representation

Scene memory frequently includes a swath of unseen layout beyond a photograph's boundaries (boundary extension [BE]; Intraub and Richardson, 1989). Might it be affected by the viewer's plan to shift fixation near a view boundary? When photographs were centrally fixated (500 msec), BE occurred following a 2-sec masked interval (Experiment 1). In Experiments 2-4, a cue during the first fixation signaled viewers to fixate an object near the left or right boundary. The picture was masked before the eyes landed. BE occurred on the cued side and on the top and bottom, but not on the uncued side. This relatively accurate performance on the uncued side suggests that inhibition of a movement to one side (in a competitive task) may also inhibit extrapolation of layout. BE on the to-be-fixated side, however, supports the idea that anticipatory representation of layout is an adaptive error that may aid the spatial integration of successive views.

Object recognition with severe spatial deficits in Williams syndrome: sparing and breakdown

Williams syndrome (WS) is a rare genetic disorder that results in severe visual-spatial cognitive deficits coupled with relative sparing in language, face recognition, and certain aspects of motion processing. Here, we look for evidence for sparing or impairment in another cognitive system-object recognition. Children with WS, normal mental-age (MA) and chronological age-matched (CA) children, and normal adults viewed pictures of a large range of objects briefly presented under various conditions of degradation, including canonical and unusual orientations, and clear or blurred contours. Objects were shown as either full-color views (Experiment 1) or line drawings (Experiment 2). Across both experiments, WS and MA children performed similarly in all conditions while CA children performed better than both WS group and MA groups with unusual views. This advantage, however, was eliminated when images were also blurred. The error types and relative difficulty of different objects were similar across all participant groups. The results indicate selective sparing of basic mechanisms of object recognition in WS, together with developmental delay or arrest in recognition of objects from unusual viewpoints. These findings are consistent with the growing literature on brain abnormalities in WS which points to selective impairment in the parietal areas of the brain. As a whole, the results lend further support to the growing literature on the functional separability of object recognition mechanisms from other spatial functions, and raise intriguing questions about the link between genetic deficits and cognition.

Multiple object tracking in people with Williams syndrome and in normally developing children

Multiple object tracking is hypothesized to utilize visual indexes, which may provide rapid, parallel access to a limited number of visual objects, thereby supporting a variety of spatial tasks. We examined whether faulty indexing might play a role in the severe visuospatial deficits found in Williams syndrome. We asked observers to track from one to four targets in a display of eight identical objects. Objects remained stationary (static condition) or moved randomly and independently (moving condition) for 6 s, after which observers pointed to the objects they thought were targets. People with Williams syndrome were impaired in the moving condition, but not the static condition, compared with mental-age-matched control participants. Normal children who were younger than the mental-age-matched control children did not show the same profile as individuals with Williams syndrome, which suggests that the difference between the tasks in Williams syndrome did not reflect simple developmental immaturity. Error analysis revealed that all groups had "slippery" indexes, falsely identifying target neighbors, and further suggested that people with Williams syndrome deploy fewer indexes than do people without this disorder.

Motion processing specialization in Williams syndrome

Williams syndrome (WS) is a rare genetic disorder characterized by severe spatial deficits and relatively spared language. Although initial research suggested that WS entails a generalized motion processing deficit, later work demonstrated intact biological motion perception in people with WS, reflecting a sparing of a specific motion perception system. The present study examined whether this sparing is unique to biological motion, or extends to other motion tasks as well. WS children and adults and normal controls were tested to examine developmental changes across a variety of motion tasks. Results indicated that WS individuals performed at normal levels for motion coherence and biological motion tasks but had elevated thresholds for the 2-D form-from-motion task, a profile that extended into adulthood. These findings provide evidence that a genetic impairment can lead to a selective motion processing deficit and argue against characterizing WS as including a general motion processing impairment. The nature of the motion deficit is considered, including the implications for WS dorsal/ventral processing.

Coincidence of checkerboard charge order and antinodal state decoherence in strongly underdoped superconducting Bi2Sr2CaCu2O8 + delta)

The doping dependence of nanoscale electronic structure in superconducting Bi(2)Sr(2)CaCu(2)O(8 + delta) is studied by scanning tunneling microscopy. At all dopings, the low energy density-of-states modulations are analyzed according to a simple model of quasiparticle interference and found to be consistent with Fermi-arc superconductivity. The superconducting coherence peaks, ubiquitous in near-optimal tunneling spectra, are destroyed with strong underdoping and a new spectral type appears. Exclusively in regions exhibiting this new spectrum, we find local "checkerboard" charge ordering of high energy states, with a wave vector of Q = (+/- 2pi/4.5a(0),0); (0, +/- 2pi/4.5a(0)) +/- 15%. Surprisingly, this spatial ordering of high energy states coexists harmoniously with the low energy Bogoliubov quasiparticle states.

Spatial breakdown in spatial construction: evidence from eye fixations in children with Williams syndrome

We investigated the role of executive and spatial representational processes in impaired performance of block construction tasks by children with Williams syndrome (WS), a rare genetic defect that results in severely impaired spatial cognition. In Experiment 1, we examined performance in two kinds of block construction tasks, Simple Puzzles, in which block faces contained a single color, and Complex, in which some block faces contained an arrangement of two colors. WS and control children were comparable in their ability to solve simple puzzles, and showed similar eye-fixation patterns, suggesting that basic executive processes were intact. However, WS children were severely impaired in their ability to solve complex puzzles. In these puzzles, WS children fixated the complex puzzle models and checked their partial solutions less often than normal children, but they were comparable in their ability to detect errors in their copies and almost exclusively made repairs to copies that were, in fact, incorrect. We conjecture that the abnormal fixation patterns were a consequence of impoverished spatial representations, rather than a cause of it. This conjecture was tested in Experiment 2, where we examined children's capacity to match and place individual blocks without engaging the complex executive processes required to carry out a complete puzzle solution. We found serious deficiency among WS children in both aspects of spatial representation. Moreover, estimates of the errors in representing the identity and location of model blocks derived from Experiment 2 provided a good account of the observed errors in the block construction task of Experiment 1.

Relating atomic-scale electronic phenomena to wave-like quasiparticle states in superconducting Bi2Sr2CaCu2O8+delta

The electronic structure of simple crystalline solids can be completely described in terms either of local quantum states in real space (r-space), or of wave-like states defined in momentum-space (k-space). However, in the copper oxide superconductors, neither of these descriptions alone may be sufficient. Indeed, comparisons between r-space and k-space studies of Bi2Sr2CaCu2O8+delta (Bi-2212) reveal numerous unexplained phenomena and apparent contradictions. Here, to explore these issues, we report Fourier transform studies of atomic-scale spatial modulations in the Bi-2212 density of states. When analysed as arising from quasiparticle interference, the modulations yield elements of the Fermi-surface and energy gap in agreement with photoemission experiments. The consistency of numerous sets of dispersing modulations with the quasiparticle interference model shows that no additional order parameter is required. We also explore the momentum-space structure of the unoccupied states that are inaccessible to photoemission, and find strong similarities to the structure of the occupied states. The copper oxide quasiparticles therefore apparently exhibit particle-hole mixing similar to that of conventional superconductors. Near the energy gap maximum, the modulations become intense, commensurate with the crystal, and bounded by nanometre-scale domains. Scattering of the antinodal quasiparticles is therefore strongly influenced by nanometre-scale disorder.

Imaging quasiparticle interference in Bi2Sr2CaCu2O8+delta

Scanning tunneling spectroscopy of the high-Tc superconductor Bi2Sr2CaCu2O8+delta reveals weak, incommensurate, spatial modulations in the tunneling conductance. Images of these energy-dependent modulations are Fourier analyzed to yield the dispersion of their wavevectors. Comparison of the dispersions with photoemission spectroscopy data indicates that quasiparticle interference, due to elastic scattering between characteristic regions of momentum-space, provides a consistent explanation for the conductance modulations, without appeal to another order parameter. These results refocus attention on quasiparticle scattering processes as potential explanations for other incommensurate phenomena in the cuprates. The momentum-resolved tunneling spectroscopy demonstrated here also provides a new technique with which to study quasiparticles in correlated materials.

Intact perception of biological motion in the face of profound spatial deficits: Williams syndrome

Williams syndrome (WS) is a rare genetic disorder that results in profound spatial cognitive deficits. We examined whether individuals with WS have intact perception of biological motion, which requires global spatial integration of local motion signals into a unitary percept of a human form. Children with WS, normal mental-age-matched children, and normal adults viewed point-light-walker (PLW) displays portraying a human figure walking to the left or right. Children with WS were as good as or better than control children in their ability to judge the walker's direction, even when it was masked with dynamic noise that mimicked the local motion of the PLW lights. These results show that mechanisms underlying the perception of at least some kinds of biological motion are unimpaired in children with WS. They provide the first evidence of selective sparing of a specialized spatial system in individuals with a known genetic impairment.

Imaging the granular structure of high-Tc superconductivity in underdoped Bi2Sr2CaCu2O8+delta

Granular superconductivity occurs when microscopic superconducting grains are separated by non-superconducting regions; Josephson tunnelling between the grains establishes the macroscopic superconducting state. Although crystals of the copper oxide high-transition-temperature (high-Tc) superconductors are not granular in a structural sense, theory suggests that at low levels of hole doping the holes can become concentrated at certain locations resulting in hole-rich superconducting domains. Granular superconductivity arising from tunnelling between such domains would represent a new view of the underdoped copper oxide superconductors. Here we report scanning tunnelling microscope studies of underdoped Bi2Sr2CaCu2O8+delta that reveal an apparent segregation of the electronic structure into superconducting domains that are approximately 3 nm in size (and local energy gap <50 meV), located in an electronically distinct background. We used scattering resonances at Ni impurity atoms as 'markers' for local superconductivity; no Ni resonances were detected in any region where the local energy gap Delta > 50 +/- 2.5 meV. These observations suggest that underdoped Bi2Sr2CaCu2O8+delta is a mixture of two different short-range electronic orders with the long-range characteristics of a granular superconductor.

A four unit cell periodic pattern of quasi-particle states surrounding vortex cores in Bi2Sr2CaCu2O8+delta

Scanning tunneling microscopy is used to image the additional quasi-particle states generated by quantized vortices in the high critical temperature superconductor Bi2Sr2CaCu2O8+delta. They exhibit a copper-oxygen bond-oriented "checkerboard" pattern, with four unit cell (4a0) periodicity and a approximately 30 angstrom decay length. These electronic modulations may be related to the magnetic field-induced, 8a0 periodic, spin density modulations with decay length of approximately 70 angstroms recently discovered in La1.84Sr0.16CuO4. The proposed explanation is a spin density wave localized surrounding each vortex core. General theoretical principles predict that, in the cuprates, a localized spin modulation of wavelength lambda should be associated with a corresponding electronic modulation of wavelength lambda/2, in good agreement with our observations.

Chondrocyte death precedes structural damage in blunt impact trauma

Joint impact trauma has been shown to cause fissures, fibrillation, and other structural damage of the cartilage or subchondral bone. Previous studies used impact energies sufficient to fracture the underlying bone. Under these circumstances, the initial influence of impact trauma on cellular components and cartilage structure is unknown. The goal of this study was to determine whether an impact trauma first causes cellular or structural damage to a cartilage layer. Such damage might be the starting point of degenerative changes found in osteoarthrosis. Porcine patellas (n = 12) were subjected to standardized low-impact loading of three magnitudes with a spherical impactor attached to a drop tower device (0.06, 0.1, and 0.2 J). India ink staining and scanning electron microscopic analysis were used for analysis and showed no evidence of gross structural disruption. Chondrocyte viability assessed with thiazole blue staining and propidium iodide counterstaining was reduced significantly in the tangential and middle zones with increasing impact energy. These results indicate that chondrocyte death may precede excessive structural damage reported in earlier studies and might be a crucial factor in posttraumatic osteoarthrosis.