Association Between COVID-19 and Delirium Development in the General Medical Units at an Academic Medical Center

INTRODUCTION

Evidence suggests that inpatients who develop delirium experience worse outcomes. Although there is reason to believe that COVID-positive patients may be at a higher risk for developing delirium, little is known about the association between COVID-19 and delirium among hospitalized patients outside the intensive care unit (ICU). This study aimed to examine (1) the independent association between COVID-19 infection and the development of delirium among all non-ICU patients and (2) the risk factors associated with developing delirium among patients admitted with COVID-19, with a special focus on presenting symptoms.

METHODS

Using electronic health record (EHR) data of adults admitted to any general medical unit at a large academic medical center from July 2020 through February 2021, we used a cross-sectional multivariable logistic regression to estimate the associations, while adjusting for patients' sociodemographic, clinical characteristics, delirium-free length of stay, as well as time fixed effects.

RESULTS

Multivariable regression estimates applied to 20 509 patients hospitalized during the study period indicate that COVID-19-positive patients had 72% higher relative risk (odds ratio 1.72; 95% CI, 1.31 - 2.26; P < 0.001) of developing delirium than the COVID-19-negative patients. However, among the subset of patients admitted with COVID-19, having any COVID-19-specific symptoms was not associated with elevated odds of developing delirium compared to those who were asymptomatic, after controlling for potential confounders.

CONCLUSIONS

COVID-19 positivity was associated with higher odds of developing delirium among patients during their non-ICU hospitalization. These findings may be helpful in targeting the use of delirium prevention strategies among non-ICU patients.

Efficacy of a Digital Intervention to Increase Annual Wellness Visit Scheduling Amid COVID-19 Backlog

BACKGROUND

The Medicare Annual Wellness Visit is a preventive visit that is largely underutilized, a problem further compounded by the COVID-19 pandemic.

METHODS

We implemented a digital outreach intervention to improve Annual Wellness Visit scheduling in our health system. Using a bulk outreach functionality in the electronic medical record, we sent a message to patients due for an Annual Wellness Visit and analyzed the efficacy of this message on scheduling rates while also assessing its impact by race.

RESULTS

Patients who read the message were 40% more likely to schedule an Annual Wellness Visit (OR 1.42; 95% CI, 1.34 - 1.50) compared to those who did not read the message.

DISCUSSION

After this intervention, Annual Wellness Visit scheduling rates increased by 50% for White patients and 325% for Black patients versus prepandemic rates in 2019.

Effect of Implementing a Commercial Electronic Early Warning System on Outcomes of Hospitalized Patients

Despite the widespread adoption of early warning systems (EWSs), it is uncertain if their implementation improves patient outcomes. The authors report a pre-post quasi-experimental evaluation of a commercially available EWS on patient outcomes at a 700-bed academic medical center. The EWS risk scores were visible in the electronic medical record by bedside clinicians. The EWS risk scores were also monitored remotely 24/7 by critical care trained nurses who actively contacted bedside nurses when a patient's risk levels increased. The primary outcome was inpatient mortality. Secondary outcomes were rapid response team calls and activation of cardiopulmonary arrest (code-4) response teams. The study team conducted a regression discontinuity analysis adjusting for age, gender, insurance, severity of illness, risk of mortality, and hospital occupancy at admission. The analysis included 53,229 hospitalizations. Adjusted analysis showed no significant change in inpatient mortality, rapid response team call, or code-4 activations after implementing the EWS. This study confirms the continued uncertainty in the effectiveness of EWSs and the need for further rigorous examinations of EWSs.

Ancient Roots of Today's Emerging Renaissance in Psychedelic Medicine

An international ban on psychedelics initiated by the United Nations' Convention on Psychotropic Substances in 1971 restricted the clinical use of these ancient psychoactive substances. Yet, in an era marked by rising mental health concerns and a growing "Deaths of Despair" epidemic (i.e., excess mortality and morbidity from suicide, drug overdose, and alcoholism), the structured psychedelic use that has long been a part of ritual healing experiences for human societies is slowly regaining credibility in Western medicine for its potential to treat various mental health conditions. We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a "psychedelic renaissance" anchored in the lessons of antiquity can potentially help shift healthcare systems-and perhaps the broader society-towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.

Real-world implementation evaluation of an electronic health record-integrated consumer informatics tool that collects patient-generated contextual data

OBJECTIVE

Use the RE-AIM framework to examine the implementation of a patient contextual data (PCD) Tool designed to share patients' needs, values, and preferences with care teams ahead of clinical encounters.

MATERIALS & METHODS

Observational study that follows initial PCD Tool scaling across primary care at a Midwestern academic health network. Program invitations, enrollment, patient submissions, and clinician views were tracked over a 1-year study period. Logistic regression modeled the likelihood of using the PCD Tool, accounting for patient covariates.

RESULTS

Of 58,874 patients who could be contacted by email, 9,183 (15.6%) became PCD Tool users. Overall, 76% of primary care providers had patients who used the PCD Tool. Older age, female gender, non-minority race, patient portal activation, and Medicare coverage were significantly associated with increased likelihood of use. Number of office visits, medical issues, and behavioral health conditions also associated with use. Primary care staff viewed 18.7% of available PCD Tool summaries, 1.1% to 57.6% per clinic.

DISCUSSION

The intervention mainly reached non-minority patients and patients who used more health services. Given the requirement for an email address on file, some patients may have been underrepresented. Overall, patient reach and adoption and clinician adoption, implementation, and maintenance of this Tool were modest but stable, consistent with a non-directive approach to fostering adoption by introducing the Tool in the absence of clear expectations for use.

CONCLUSION

Healthcare organizations must implement effective methods to increase the reach, adoption, implementation, and maintenance of PCD tools across all patient populations. Assisting people, particularly racial minorities, with PCD Tool registration and actively supporting clinician use are critical steps in implementing technology that facilitates care.

Assessment of oral and overall health parameters using the SillHa Oral Wellness System

OBJECTIVE

The study evaluated use of a multipoint saliva analyzer to assess patient wellness in a contemporary dental practice setting.

STUDY DESIGN

Unstimulated saliva from a diverse 104 patient cohort was analyzed using the SillHa Oral Wellness System. The device measures the following 7 analytes present in the patient's oral rinse: cariogenic bacteria, acidity, buffer capacity, blood, leukocytes, protein, and ammonia. Data obtained were compared with validated clinical assessment data independently provided by credentialed dental professionals.

RESULTS

Measured leukocyte and protein levels were higher in patients with periodontal disease and/or deep gingival pockets. Patients with a history of cancer and/or diabetes presented with higher ammonia and lower leukocyte levels. Acidity levels were higher in patients using multiple xerogenic medications and lower in patients with a history of sleep apnea. Sex differences showed female patients exhibiting higher acidity, lower buffer capacity, and lower ammonia than male patients. Increasing age is associated with elevated buffer capacity.

CONCLUSIONS

Multipoint saliva analyzers such as the one used in this study, along with clinical practice examination and medical history, can provide rapid salivary component analysis that augments treatment planning. A follow-up multisite study would provide the opportunity to test this analyzer in clinical sites with different practice workflows.

Qubit teleportation between non-neighbouring nodes in a quantum network

Future quantum internet applications will derive their power from the ability to share quantum information across the network^1,2. Quantum teleportation allows for the reliable transfer of quantum information between distant nodes, even in the presence of highly lossy network connections³. Although many experimental demonstrations have been performed on different quantum network platforms^4-10, moving beyond directly connected nodes has, so far, been hindered by the demanding requirements on the pre-shared remote entanglement, joint qubit readout and coherence times. Here we realize quantum teleportation between remote, non-neighbouring nodes in a quantum network. The network uses three optically connected nodes based on solid-state spin qubits. The teleporter is prepared by establishing remote entanglement on the two links, followed by entanglement swapping on the middle node and storage in a memory qubit. We demonstrate that, once successful preparation of the teleporter is heralded, arbitrary qubit states can be teleported with fidelity above the classical bound, even with unit efficiency. These results are enabled by key innovations in the qubit readout procedure, active memory qubit protection during entanglement generation and tailored heralding that reduces remote entanglement infidelities. Our work demonstrates a prime building block for future quantum networks and opens the door to exploring teleportation-based multi-node protocols and applications^2,11-13.

Association Between Nonsurgical Weight Loss From Body Mass Index >40 to Body Mass Index <40 and Complications and Readmissions Following Total Hip Arthroplasty

BACKGROUND

Elevated body mass index (BMI) is a risk factor for adverse outcomes following total hip arthroplasty (THA). It is unknown if preoperative weight loss to a BMI <40 kg/m² is associated with reduced risk of adverse outcomes.

METHODS

We retrospectively reviewed elective, primary THA performed at an academic center from 2015 to 2019. Patients were split into groups based on their BMI trajectory prior to THA: BMI consistently <40 ("BMI <40"); BMI >40 at the time of surgery ("BMI >40"); and BMI >40 within 2 years preoperatively, but <40 at the time of surgery ("Weight Loss"). Length of stay (LOS), 30-day readmissions, and complications as defined by Centers for Medicare and Medicaid Services were compared between groups using parsimonious regression models and Fisher's exact testing. Adjusted analyses controlled for sex, age, and American Society of Anesthesiologists class.

RESULTS

In total, 1589 patients were included (BMI <40: 1387, BMI >40: 96, Weight Loss: 106). The rate of complications in each group was 3.5%, 6.3%, and 8.5% and the rate of 30-day readmissions was 3.0%, 4.2%, and 7.5%, respectively. Compared to the BMI <40 group, the weight loss group had a significantly higher risk of 30-day readmission (odds ratio [OR] 2.70, 95% confidence interval [CI] 1.19-6.17, P = .02), higher risk of any complication (OR 2.47, 95% CI 1.09-5.59, P = .03), higher risk of mechanical complications (OR 3.07, 95% CI 1.14-8.25, P = .03), and longer median LOS (16% increase, P = .002). The BMI >40 group had increased median LOS (10% increase, P = .03), but no difference in readmission or complications (P > .05) compared to BMI <40.

CONCLUSION

Weight loss from BMI >40 to BMI <40 prior to THA was associated with increased risk of readmission and complications compared to BMI <40, whereas BMI >40 was not.

LEVEL OF EVIDENCE

Level III - Retrospective Cohort Study.

IgE-Based Therapeutic Combination Enhances Antitumor Response in Preclinical Models of Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) represents 3% of all cancer cases and 7% of all cancer deaths in the United States. Late diagnosis and inadequate response to standard chemotherapies contribute to an unfavorable prognosis and an overall 5-year survival rate of less than 10% in PDAC. Despite recent advances in tumor immunology, tumor-induced immunosuppression attenuates the immunotherapy response in PDAC. To date, studies have focused on IgG-based therapeutic strategies in PDAC. With the recent interest in IgE-based therapies in multiple solid tumors, we explored the MUC1-targeted IgE potential against pancreatic cancer. Our study demonstrates the notable expression of FceRI (receptor for IgE antibody) in tumors from PDAC patients. Our study showed that administration of MUC1 targeted-IgE (mouse/human chimeric anti-MUC1.IgE) antibody at intermittent levels in combination with checkpoint inhibitor (anti-PD-L1) and TLR3 agonist (PolyICLC) induces a robust antitumor response that is dependent on NK and CD8 T cells in pancreatic tumor-bearing mice. Subsequently, our study showed that the antigen specificity of the IgE antibody plays a vital role in executing the antitumor response as nonspecific IgE, induced by ovalbumin (OVA), failed to restrict tumor growth in pancreatic tumor-bearing mice. Utilizing the OVA-induced allergic asthma-PDAC model, we demonstrate that allergic phenotype induced by OVA cannot restrain pancreatic tumor growth in orthotopic tumor-bearing mice. Together, our data demonstrate the novel tumor protective benefits of tumor antigen-specific IgE-based therapeutics in a preclinical model of pancreatic cancer, which can open new avenues for future clinical interventions.

SARS-CoV-2 Cycle Thresholds, Poverty, Race, and Clinical Outcomes

BACKGROUND

Poverty and high viral load are associated with worse outcomes among COVID-19 patients.

METHODS

We included patients admitted to Froedtert Health between March 16 and June 1, 2020. SARS-CoV-2 viral load was proxied by cycle-threshold values. To measure poverty, we used Medicaid or uninsured status and residence in socially disadvantaged areas. We assessed the association between viral load and length of stay and discharge disposition, while controlling for demographics and confounders.

RESULTS

Higher viral load was associated with longer length of stay (coefficient -0.02; 95% CI, -0.04 to 0.01; P = 0.006) and higher likelihood of death (coefficient -0.11; 95% CI, -0.17 to -0.06; P < 0.001). Poverty, residence in disadvantaged areas, and race were not.

DISCUSSION

This study confirms a relationship of viral load with in-hospital death, even after controlling for race and poverty.

Validity of claims-based algorithms to identify neurodevelopmental disorders in children

PURPOSE

To validate healthcare claim-based algorithms for neurodevelopmental disorders (NDD) in children using medical records as the reference.

METHODS

Using a clinical data warehouse of patients receiving outpatient or inpatient care at two hospitals in Boston, we identified children (≤14 years between 2010 and 2014) with at least one of the following NDDs according to claims-based algorithms: autism spectrum disorder/pervasive developmental disorder (ASD), attention deficit disorder/other hyperkinetic syndromes of childhood (ADHD), learning disability, speech/language disorder, developmental coordination disorder (DCD), intellectual disability, and behavioral disorder. Fifty cases per outcome were randomly sampled and their medical records were independently reviewed by two physicians to adjudicate the outcome presence. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated.

RESULTS

PPVs were 94% (95% CI, 83%-99%) for ASD, 88% (76%-95%) for ADHD, 98% (89%-100%) for learning disability, 98% (89%-100%) for speech/language disorder, 82% (69%-91%) for intellectual disability, and 92% (81%-98%) for behavioral disorder. A total of 19 of the 50 algorithm-based cases of DCD were confirmed as severe coordination disorders with functional impairment, with a PPV of 38% (25%-53%). Among the 31 false-positive cases of DCD were 7 children with coordination deficits that did not persist throughout childhood, 7 with visual-motor integration deficits, 12 with coordination issues due to an underlying medical condition and 5 with ADHD and at least one other severe NDD.

CONCLUSIONS

PPVs were generally high (range: 82%-98%), suggesting that claims-based algorithms can be used to study NDDs. For DCD, additional criteria are needed to improve the classification of true cases.

Puerperium Stroke and Subsequent Tissue-Type Plasminogen Activator-Induced Hemorrhage: A Case Report

We report a case of ischemic stroke in an apparently healthy 35-year-old gravida 2 para 1 who was treated with tissue-type plasminogen activator (tPA) 9 hours after vaginal delivery that resulted in severe hemorrhage. Limited data suggest use of thrombolytics in pregnancy is safe, but there is a paucity of evidence assessing their use immediately postpartum. We describe successful combination of tPA with endovascular mechanical thrombectomy (EMT) for treatment of postpartum stroke, which was followed by extensive uterine bleeding.

Transmission Dynamics of Clostridioides difficile in 2 High-Acuity Hospital Units

BACKGROUND

The key epidemiological drivers of Clostridioides difficile transmission are not well understood. We estimated epidemiological parameters to characterize variation in C. difficile transmission, while accounting for the imperfect nature of surveillance tests.

METHODS

We conducted a retrospective analysis of C. difficile surveillance tests for patients admitted to a bone marrow transplant (BMT) unit or a solid tumor unit (STU) in a 565-bed tertiary hospital. We constructed a transmission model for estimating key parameters, including admission prevalence, transmission rate, and duration of colonization to understand the potential variation in C. difficile dynamics between these 2 units.

RESULTS

A combined 2425 patients had 5491 admissions into 1 of the 2 units. A total of 3559 surveillance tests were collected from 1394 patients, with 11% of the surveillance tests being positive for C. difficile. We estimate that the transmission rate in the BMT unit was nearly 3-fold higher at 0.29 acquisitions per percentage colonized per 1000 days, compared to our estimate in the STU (0.10). Our model suggests that 20% of individuals admitted into either the STU or BMT unit were colonized with C. difficile at the time of admission. In contrast, the percentage of surveillance tests that were positive within 1 day of admission to either unit for C. difficile was 13.4%, with 15.4% in the STU and 11.6% in the BMT unit.

CONCLUSIONS

Although prevalence was similar between the units, there were important differences in the rates of transmission and clearance. Influential factors may include antimicrobial exposure or other patient-care factors.

Realization of a multinode quantum network of remote solid-state qubits

The distribution of entangled states across the nodes of a future quantum internet will unlock fundamentally new technologies. Here, we report on the realization of a three-node entanglement-based quantum network. We combine remote quantum nodes based on diamond communication qubits into a scalable phase-stabilized architecture, supplemented with a robust memory qubit and local quantum logic. In addition, we achieve real-time communication and feed-forward gate operations across the network. We demonstrate two quantum network protocols without postselection: the distribution of genuine multipartite entangled states across the three nodes and entanglement swapping through an intermediary node. Our work establishes a key platform for exploring, testing, and developing multinode quantum network protocols and a quantum network control stack.

Addressing depression and behavioral health needs through a digital program at scale

Depression and anxiety disorders are prevalent mental health conditions; yet they are often unrecognized, under-addressed and/or under-treated, and specialty treatment for these conditions is oftentimes difficult to access. By acting either as a bridge to therapy or as a form of therapy, digital tools, such as those that provide internet-based cognitive behavioral therapy (iCBT), may help clinicians support their patients' mental health needs. At one academic health system, a digital mental health program was deployed in primary care and outpatient behavioral health programs to help patients meet needs identified through screening or clinical visits. Over the first two years of operation, 138 clinicians (40% of eligible clinicians) prescribed the program to 2,228 unique patients, from which 1,117 (48.9%) enrolled. Patients who enrolled tended to be younger and healthier than non-enrollees. On average, enrolled patients spent 114.6 minutes within the iCBT program. Clinical improvement was assessed using pre- and post PHQ-9 and GAD-7 scores for depression and anxiety, respectively. Pre/Post scores were compared using Wilcoxon Rank Sum test. Patients with at least moderate depression had an average 23% reduction in PHQ-9 scores (median change -3(interquartile range 7), p<0.001) and those with at least moderate anxiety had a 26% reduction in GAD-7 scores (-4(7), p<0.001). Improvements were clinically and statistically significant. Future steps include performing a cost analysis to understand whether models utilizing iCBT are net cost-saving for health systems.

Decrease in Positivity Rate of Influenza Tests Coinciding With Outbreak of SARS-CoV-2: Data From a Southeastern Wisconsin Laboratory

BACKGROUND

The SARS-CoV-2 outbreak prompted public health interventions and changes in public behavior that may have affected the 2019-2020 influenza season.

METHODS

Using data from a laboratory in southeastern Wisconsin, we compared the number of weekly influenza tests and their positivity rates during the 2019-2020 influenza season with the previous 4 seasons.

RESULTS

The number of influenza tests per week at the outset of the SARS-CoV-2 outbreak was higher than the average the previous 4 years, and positivity rates declined to 0% earlier than any of the previous 4 seasons.

CONCLUSION

The testing trajectory and positivity rate for influenza differed during the part of the 2019-2020 season coinciding with the SARS-CoV-2 outbreak as compared to similar periods during the previous 4 seasons.

Orbital and Spin Dynamics of Single Neutrally-Charged Nitrogen-Vacancy Centers in Diamond

The neutral charge state plays an important role in quantum information and sensing applications based on nitrogen-vacancy centers. However, the orbital and spin dynamics remain unexplored. Here, we use resonant excitation of single centers to directly reveal the fine structure, enabling selective addressing of spin-orbit states. Through pump-probe experiments, we find the orbital relaxation time (430 ns at 4.7 K) and measure its temperature dependence up to 11.8 K. Finally, we reveal the spin relaxation time (1.5 s) and realize projective high-fidelity single-shot readout of the spin state (≥98%).

Racial Disparities in Incidence and Outcomes Among Patients With COVID-19

IMPORTANCE

Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19).

OBJECTIVE

To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds).

EXPOSURES

Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown).

MAIN OUTCOMES AND MEASURES

Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

RESULTS

A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.

Location as Destiny: Identifying Geospatial Disparities in Radiation Treatment Interruption by Neighborhood, Race, and Insurance

PURPOSE

Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities.

METHODS AND MATERIALS

All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant.

RESULTS

Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions.

CONCLUSIONS

Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.

Abstract A124: Neighborhood, race and insurance predict for hospital admission during radiation therapy

Background: Hospital admission during radiotherapy (ADRT) is associated with increased cost, interrupted treatment, and inferior outcomes. The purpose of this study was to benchmark patient ADRT rates, define socioeconomic predictors for ADRT, and geographically map ADRT rates on the neighborhood level across a large Mid-Southern catchment region served by a single academic cancer referral center. Methods: Demographic, clinical and treatment information were collected for all patients treated with radiation therapy (RT) at our center from January 1, 2015 to December 31, 2017. Occurrence of ADRT included inpatient and emergency room admissions. ADRT was categorized as causing “minor interruption” if ADRT was associated with postponement in 1-4 RT treatments. “Major interruption” was defined as postponement in 5 or more treatments. Patients with Medicaid or no insurance were categorized as “At-Risk”. Patient predicted income (PPI) was modeled using 2017 US Census data for annual household income by patient residence census tract, categorized into low (&lt;$34k), middle, and high (&gt;$67k) thirds. ADRT rates were compared across variables, analyzed using Pearson’s Chi square testing, and geomapped by patient residence at the neighborhood (census tract) level. Results: 3,729 patients were included. 2,032 (54.5%) were Caucasian, 1,577 African American (42.3%), and 120 (3.2%) other. Insurance status was defined as Commercial, Medicare, or At Risk in 1,794 (48.1%), 1,503 (40.3%), and 432 (11.6%) patients. The mean PPI was $49,951 (range $10,871-$177,857). A total of 83,306 fractions (median 24, IQR 11-30) were delivered with 7,107 (8.5%) total interruptions. 727 interruptions (mean 0.19, range 0-21) were due to ADRT in 197 patients (5.3%). Minor interruption rates were significantly elevated in At Risk patients v. those with Commercial or Medicare insurance (7.4% v 3.5% p=&lt;0.0001; OR 2.21 [95%CI 1.47-3.31]), African American v. Caucasian patients (5.1% v 3.1% p=0.002; OR 1.66 [95%CI 1.19-2.32]), and low PPI v. high PPI patients (5.2% v 2.5% p=&lt;0.0005; OR 2.17 [95%CI 1.39-3.39]). Major interruption rates were similar across all groups: At Risk v. Commercial or Medicare insurance (1.6% v 1.2% p=0.591; OR 1.25 [95%CI 0.55-2.79]), African American v. Caucasian ([1.3% v 1.4% p=0.74; OR 0.91 [95%CI 0.51-1.61]), and low PPI v. high PPI (1.4% v 1.3% p=0.93; OR 1.03 [95%CI 0.52-2.05]). Elevated minor interruption rates were geographically associated with low income, predominately African American neighborhoods across our treatment region. Conclusion: At our high-volume academic radiotherapy practice, hospital admission during RT correlated significantly with uninsured or Medicaid coverage status, African American race, and low predicted income and mapped to low income neighborhoods, suggesting limited care access for these populations. Major hotspot locations have been identified, setting the stage for targeted studies to close gaps in RT quality.

Citation Format: Daniel V Wakefield, Matthew Carnell, Bo Jiang, Austin Dove, Wesley Garner, Drucilla Edmonston, Adam Hubler, Esra Ozdenerol, Ryan Hanson, Maria Pisu, David L Schwartz, David L Schwarts. Neighborhood, race and insurance predict for hospital admission during radiation therapy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A124.

Association Between Environmental Factors and Toxigenic Clostridioides difficile Carriage at Hospital Admission

IMPORTANCE

Clostridioides difficile infection is the most frequent health care-associated infection in the United States. However, exposure to this organism might occur outside the health care setting.

OBJECTIVE

To examine whether exposure to environmental factors, such as livestock farms, is associated with a higher probability of being colonized with C difficile at hospital admission.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study was conducted from May 1, 2017, to June 30, 2018, at a teaching-affiliated hospital in Milwaukee, Wisconsin. All consecutive patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. Data analyses were performed from July 2018 to October 2019.

EXPOSURES

The distances from patient residence to the nearest livestock farms, meat processing plants, raw materials services, and sewage facilities were measured in addition to risk factors previously evaluated in other studies.

MAIN OUTCOMES AND MEASURES

The main outcome was a positive result on C difficile screening tests performed within 72 hours of hospital admission.

RESULTS

A total of 3043 patients admitted to the hospital were included in the final analysis. Of those, 1564 (51.4%) were women and 2074 (68.9%) were white, with a mean (SD) age of 62.0 (15.9) years; 978 patients (32.1%) were admitted to hematology-oncology units. At first admission, 318 patients (10.4%) were detected through testing as C difficile carriers. Multivariable logistic regression analyses were performed on a stratified sample of patients based on hematology-oncology admission status. These analyses indicated that although patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, no significant association existed between their sociodemographic and economic characteristics or health care and environmental exposures and the likelihood of a positive C difficile test result. In contrast, among patients admitted to non-hematology-oncology units, comorbidities increased the likelihood for colonization by more than 4 times; women had 60% greater colonization than men, and a history of recent hospitalization (ie, within the preceding 6 months) increased the likelihood of colonization by 70%. Residential proximity to livestock farms were all significantly associated with a higher likelihood of a positive C difficile test result. Residential proximity to livestock farms more than doubled the probability of C difficile colonization in patients admitted to non-hematology-oncology units.

CONCLUSIONS AND RELEVANCE

A shorter distance between residence and livestock farms was associated with C difficile colonization. Knowledge of the epidemiology of C difficile in the community surrounding the hospital is important, as it has potential implications for the incidence of hospital-onset C difficile infection.

MSTO1 mutations cause mtDNA depletion, manifesting as muscular dystrophy with cerebellar involvement

MSTO1 encodes a cytosolic mitochondrial fusion protein, misato homolog 1 or MSTO1. While the full genotype–phenotype spectrum remains to be explored, pathogenic variants in MSTO1 have recently been reported in a small number of patients presenting with a phenotype of cerebellar ataxia, congenital muscle involvement with histologic findings ranging from myopathic to dystrophic and pigmentary retinopathy. The proposed underlying pathogenic mechanism of MSTO1-related disease is suggestive of impaired mitochondrial fusion secondary to a loss of function of MSTO1. Disorders of mitochondrial fusion and fission have been shown to also lead to mitochondrial DNA (mtDNA) depletion, linking them to the mtDNA depletion syndromes, a clinically and genetically diverse class of mitochondrial diseases characterized by a reduction of cellular mtDNA content. However, the consequences of pathogenic variants in MSTO1 on mtDNA maintenance remain poorly understood. We present extensive phenotypic and genetic data from 12 independent families, including 15 new patients harbouring a broad array of bi-allelic MSTO1 pathogenic variants, and we provide functional characterization from seven MSTO1-related disease patient fibroblasts. Bi-allelic loss-of-function variants in MSTO1 manifest clinically with a remarkably consistent phenotype of childhood-onset muscular dystrophy, corticospinal tract dysfunction and early-onset non-progressive cerebellar atrophy. MSTO1 protein was not detectable in the cultured fibroblasts of all seven patients evaluated, suggesting that pathogenic variants result in a loss of protein expression and/or affect protein stability. Consistent with impaired mitochondrial fusion, mitochondrial networks in fibroblasts were found to be fragmented. Furthermore, all fibroblasts were found to have depletion of mtDNA ranging from 30 to 70% along with alterations to mtDNA nucleoids. Our data corroborate the role of MSTO1 as a mitochondrial fusion protein and highlight a previously unrecognized link to mtDNA regulation. As impaired mitochondrial fusion is a recognized cause of mtDNA depletion syndromes, this novel link to mtDNA depletion in patient fibroblasts suggests that MSTO1-deficiency should also be considered a mtDNA depletion syndrome. Thus, we provide mechanistic insight into the disease pathogenesis associated with MSTO1 mutations and further define the clinical spectrum and the natural history of MSTO1-related disease.

Multipartite Entanglement Generation and Contextuality Tests Using Nondestructive Three-Qubit Parity Measurements

We report on the realization and application of nondestructive three-qubit parity measurements on nuclear spin qubits in diamond. We use high-fidelity quantum logic to map the parity of the joint state of three nuclear spin qubits onto an electronic spin qubit that acts as an ancilla, followed by a single-shot nondestructive readout of the ancilla combined with an electron spin echo to ensure outcome-independent evolution of the nuclear spins. Through the sequential application of three such parity measurements, we demonstrate the generation of genuine multipartite entangled states out of the maximally mixed state. Furthermore, we implement a single-shot version of the Greenberger-Horne-Zeilinger experiment that can generate a quantum versus classical contradiction in each run. Finally, we test a state-independent noncontextuality inequality in eight dimensions. The techniques and insights developed are relevant for fundamental tests as well as for quantum information protocols such as quantum error correction.

Entanglement distillation between solid-state quantum network nodes

The impact of future quantum networks hinges on high-quality quantum entanglement shared between network nodes. Unavoidable imperfections necessitate a means to improve remote entanglement by local quantum operations. We realize entanglement distillation on a quantum network primitive of distant electron-nuclear two-qubit nodes. The heralded generation of two copies of a remote entangled state is demonstrated through single-photon-mediated entangling of the electrons and robust storage in the nuclear spins. After applying local two-qubit gates, single-shot measurements herald the distillation of an entangled state with increased fidelity that is available for further use. The key combination of generating, storing, and processing entangled states should enable the exploration of multiparticle entanglement on an extended quantum network.

Experimental creation of quantum Zeno subspaces by repeated multi-spin projections in diamond

Repeated observations inhibit the coherent evolution of quantum states through the quantum Zeno effect. In multi-qubit systems this effect provides opportunities to control complex quantum states. Here, we experimentally demonstrate that repeatedly projecting joint observables of multiple spins creates quantum Zeno subspaces and simultaneously suppresses the dephasing caused by a quasi-static environment. We encode up to two logical qubits in these subspaces and show that the enhancement of the dephasing time with increasing number of projections follows a scaling law that is independent of the number of spins involved. These results provide experimental insight into the interplay between frequent multi-spin measurements and slowly varying noise and pave the way for tailoring the dynamics of multi-qubit systems through repeated projections.

Repeated observations of quantum states inhibit coherent evolution through the Zeno effect, providing opportunities for controlling multi-qubit systems. Here the authors demonstrate that projecting joint observables of three spins in diamond creates quantum Zeno subspaces that suppress dephasing.

Optimized quantum sensing with a single electron spin using real-time adaptive measurements

Quantum sensors based on single solid-state spins promise a unique combination of sensitivity and spatial resolution. The key challenge in sensing is to achieve minimum estimation uncertainty within a given time and with high dynamic range. Adaptive strategies have been proposed to achieve optimal performance, but their implementation in solid-state systems has been hindered by the demanding experimental requirements. Here, we realize adaptive d.c. sensing by combining single-shot readout of an electron spin in diamond with fast feedback. By adapting the spin readout basis in real time based on previous outcomes, we demonstrate a sensitivity in Ramsey interferometry surpassing the standard measurement limit. Furthermore, we find by simulations and experiments that adaptive protocols offer a distinctive advantage over the best known non-adaptive protocols when overhead and limited estimation time are taken into account. Using an optimized adaptive protocol we achieve a magnetic field sensitivity of 6.1 ± 1.7 nT Hz(-1/2) over a wide range of 1.78 mT. These results open up a new class of experiments for solid-state sensors in which real-time knowledge of the measurement history is exploited to obtain optimal performance.

An assessment of the ship drag penalty arising from light calcareous tubeworm fouling

A test coupon coated with light calcareous tubeworm fouling was scanned, scaled and reproduced for wind-tunnel testing to determine the equivalent sand grain roughness ks. It was found that this surface had a ks = 0.325 mm, substantially less than the previously reported values for light calcareous fouling. This result was used to predict the drag on a fouled full scale ship. To achieve this, a modified method for predicting the total drag of a spatially developing turbulent boundary layer (TBL), such as that on the hull of a ship, is presented. The method numerically integrates the skin friction over the length of the boundary layer, assuming an analytical form for the mean velocity profile of the TBL. The velocity profile contains the roughness (fouling) information, such that the prediction requires only an input of ks, the free-stream velocity (ship speed), the kinematic viscosity and the length of the boundary layer (the hull length). Using the equivalent sandgrain roughness height determined from experiments, a FFG-7 Oliver Perry class frigate is predicted to experience a 23% increase in total resistance at cruise, if its hull is coated in light calcareous tubeworm fouling. A similarly fouled very large crude carrier would experience a 34% increase in total resistance at cruise.

Word structures of Granada Spanish-speaking preschoolers with typical versus protracted phonological development

BACKGROUND

Research on children's word structure development is limited. Yet, phonological intervention aims to accelerate the acquisition of both speech-sounds and word structure, such as word length, stress or shapes in CV sequences. Until normative studies and meta-analyses provide in-depth information on this topic, smaller investigations can provide initial benchmarks for clinical purposes.

AIMS

To provide preliminary reference data for word structure development in a variety of Spanish with highly restricted coda use: Granada Spanish (similar to many Hispano-American varieties). To be clinically applicable, such data would need to show differences by age, developmental typicality and word structure complexity. Thus, older typically developing (TD) children were expected to show higher accuracy than younger children and those with protracted phonological development (PPD). Complex or phonologically marked forms (e.g. multisyllabic words, clusters) were expected to be late developing.

METHODS & PROCEDURES

Participants were 59 children aged 3-5 years in Granada, Spain: 30 TD children, and 29 with PPD and no additional language impairments. Single words were digitally recorded by a native Spanish speaker using a 103-word list and transcribed by native Spanish speakers, with confirmation by a second transcriber team and acoustic analysis. The program Phon 1.5 provided quantitative data.

OUTCOMES & RESULTS

In accordance with expectations, the TD and older age groups had better-established word structures than the younger children and those with PPD. Complexity was also relevant: more structural mismatches occurred in multisyllabic words, initial unstressed syllables and clusters. Heterosyllabic consonant sequences were more accurate than syllable-initial sequences. The most common structural mismatch pattern overall was consonant deletion, with syllable deletion most common in 3-year-olds and children with PPD.

CONCLUSIONS & IMPLICATIONS

The current study provides preliminary reference data for word structure development in a Spanish variety with restricted coda use, both by age and types of word structures. Between ages 3 and 5 years, global measures (whole word match, word shape match) distinguished children with typical versus protracted phonological development. By age 4, children with typical development showed near-mastery of word structures, whereas 4- and 5-year-olds with PPD continued to show syllable deletion and cluster reduction, especially in multisyllabic words. The results underline the relevance of multisyllabic words and words with clusters in Spanish phonological assessment and the utility of word structure data for identification of protracted phonological development.

Targeting MPS1 Enhances Radiosensitization of Human Glioblastoma by Modulating DNA Repair Proteins

To ensure faithful chromosome segregation, cells use the spindle assembly checkpoint (SAC), which can be activated in aneuploid cancer cells. Targeting the components of SAC machinery required for the growth of aneuploid cells may offer a cancer cell-specific therapeutic approach. In this study, the effects of inhibiting Monopolar spindle 1, MPS1 (TTK), an essential SAC kinase, on the radiosensitization of glioblastoma (GBM) cells were analyzed. Clonogenic survival was used to determine the effects of the MPS1 inhibitor NMS-P715 on radiosensitivity in multiple model systems, including GBM cell lines, a normal astrocyte, and a normal fibroblast cell line. DNA double-strand breaks (DSB) were evaluated using γH2AX foci, and cell death was measured by mitotic catastrophe evaluation. Transcriptome analysis was performed via unbiased microarray expression profiling. Tumor xenografts grown from GBM cells were used in tumor growth delay studies. Inhibition of MPS1 activity resulted in reduced GBM cell proliferation. Furthermore, NMS-P715 enhanced the radiosensitivity of GBM cells by decreased repair of DSBs and induction of postradiation mitotic catastrophe. NMS-P715 in combination with fractionated doses of radiation significantly enhanced the tumor growth delay. Molecular profiling of MPS1-silenced GBM cells showed an altered expression of transcripts associated with DNA damage, repair, and replication, including the DNA-dependent protein kinase (PRKDC/DNAPK). Next, inhibition of MPS1 blocked two important DNA repair pathways. In conclusion, these results not only highlight a role for MPS1 kinase in DNA repair and as prognostic marker but also indicate it as a viable option in glioblastoma therapy.

IMPLICATIONS

Inhibition of MPS1 kinase in combination with radiation represents a promising new approach for glioblastoma and for other cancer therapies.

Towards quantum networks of single spins: analysis of a quantum memory with an optical interface in diamond

Single defect centers in diamond have emerged as a powerful platform for quantum optics experiments and quantum information processing tasks. Connecting spatially separated nodes via optical photons into a quantum network will enable distributed quantum computing and long-range quantum communication. Initial experiments on trapped atoms and ions as well as defects in diamond have demonstrated entanglement between two nodes over several meters. To realize multi-node networks, additional quantum bit systems that store quantum states while new entanglement links are established are highly desirable. Such memories allow for entanglement distillation, purification and quantum repeater protocols that extend the size, speed and distance of the network. However, to be effective, the memory must be robust against the entanglement generation protocol, which typically must be repeated many times. Here we evaluate the prospects of using carbon nuclear spins in diamond as quantum memories that are compatible with quantum networks based on single nitrogen vacancy (NV) defects in diamond. We present a theoretical framework to describe the dephasing of the nuclear spins under repeated generation of NV spin-photon entanglement and show that quantum states can be stored during hundreds of repetitions using typical experimental coupling parameters. This result demonstrates that nuclear spins with weak hyperfine couplings are promising quantum memories for quantum networks.

A Growing Opportunity: Community Gardens Affiliated with US Hospitals and Academic Health Centers

Background

Community gardens can reduce public health disparities through promoting physical activity and healthy eating, growing food for underserved populations, and accelerating healing from injury or disease. Despite their potential to contribute to comprehensive patient care, no prior studies have investigated the prevalence of community gardens affiliated with US healthcare institutions, and the demographic characteristics of communities served by these gardens.

Methods

In 2013, national community garden databases, scientific abstracts, and public search engines (e.g., Google Scholar) were used to identify gardens. Outcomes included the prevalence of hospital-based community gardens by US regions, and demographic characteristics (age, race/ethnicity, education, household income, and obesity rates) of communities served by gardens.

Results

There were 110 healthcare-based gardens, with 39 in the Midwest, 25 in the South, 24 in the Northeast, and 22 in the West. Compared to US population averages, communities served by healthcare-based gardens had similar demographic characteristics, but significantly lower rates of obesity (27% versus 34%, P < .001).

Conclusions

Healthcare-based gardens are located in regions that are demographically representative of the US population, and are associated with lower rates of obesity in communities they serve.

•

Community gardens may offer diverse public health benefits.

•

We identified 110 gardens that are operating in partnership with hospitals.

•

Communities served by hospital gardens may have lower obesity than US average.

Quantum information. Unconditional quantum teleportation between distant solid-state quantum bits

Realizing robust quantum information transfer between long-lived qubit registers is a key challenge for quantum information science and technology. Here we demonstrate unconditional teleportation of arbitrary quantum states between diamond spin qubits separated by 3 meters. We prepare the teleporter through photon-mediated heralded entanglement between two distant electron spins and subsequently encode the source qubit in a single nuclear spin. By realizing a fully deterministic Bell-state measurement combined with real-time feed-forward, quantum teleportation is achieved upon each attempt with an average state fidelity exceeding the classical limit. These results establish diamond spin qubits as a prime candidate for the realization of quantum networks for quantum communication and network-based quantum computing.

Universal control and error correction in multi-qubit spin registers in diamond

Quantum registers of nuclear spins coupled to electron spins of individual solid-state defects are a promising platform for quantum information processing. Pioneering experiments selected defects with favourably located nuclear spins with particularly strong hyperfine couplings. To progress towards large-scale applications, larger and deterministically available nuclear registers are highly desirable. Here, we realize universal control over multi-qubit spin registers by harnessing abundant weakly coupled nuclear spins. We use the electron spin of a nitrogen-vacancy centre in diamond to selectively initialize, control and read out carbon-13 spins in the surrounding spin bath and construct high-fidelity single- and two-qubit gates. We exploit these new capabilities to implement a three-qubit quantum-error-correction protocol and demonstrate the robustness of the encoded state against applied errors. These results transform weakly coupled nuclear spins from a source of decoherence into a reliable resource, paving the way towards extended quantum networks and surface-code quantum computing based on multi-qubit nodes.

Abstract 1584: Targeting the mitotic checkpoint with inhibition of MPS1 kinase enhances radiosensitivity of glioblastoma cancer cells

During the cell cycle, genomic stability requires accurate chromosome segregation. Errors in this process can cause aneuploidy and lead to tumorigenesis. To ensure faithful chromosome segregation, cells develop a mechanism called the spindle assembly checkpoint (SAC). Cancer cells are addicted to the components of SAC machinery for a faithful entry of the cell into anaphase. Thus, targeting the molecular mechanisms required for the growth of aneuploid cells may be a more cancer cell specific therapeutic approach applicable to broader tumor histologies. Previously, using a siRNA based RNAi screen we identified MPS1 kinase, (also known as TTK) as an important kinase for GBM cell survival. MPS1 is an essential SAC enzyme aberrantly overexpressed in a wide range of tumors and necessary for tumor cell proliferation.

We observed inhibition of GBM cell growth when MPS1 was downregulated by number of MPS1 specific siRNAs. This was further validated using a selective and orally bioavailable MPS1 inhibitor NMS-P715 in various in-vitro cell assays. The inhibition of cell death was induced partly by apoptosis; however, the major mechanism was mitotic catastrophe. Cells treated with NMS-P715 showed an increase in cells in G2-M phase of cell cycle compared to control cells followed by mitotic catastrophe. Moreover, inhibition of MPS1 resulted in radiosensitization of GBM cells. We observed decrease in DNA damage repair and significant retention of γH2AX foci after combination of radiation (RT) with NMS-P715 compared to individual treatments. Next, radiation in combination with NMS-P715 inhibited cell survival ability of GBM cells in a colony formation assay. Further, NMS-P715 could inhibit GBM tumor growth in an orthotopic brain tumor model. Finally, in order to determine MPS1 associated molecular pathways, we compared gene expression profile in MPS1 knockdown cells compared to the control by microarray analysis. Ingenuity pathway and Gene Set Enrichment Analysis were used to investigate the biological relevance of the MPS1 modulated genes. We identified genes important in cell assembly, cell organization, DNA repair and cell death pathways. Thus, inhibiting MPS1 kinase in combination with radiation could represent a promising new approach to GBM therapy.

Citation Format: Anita T. Tandle, Ryan Hanson, Uday B. Maachani, Tamalee Meushaw, Shuping Zhao, Uma Shankavaram, Philip Tofilon, Natasha J. Caplen, Kevin Camphausen. Targeting the mitotic checkpoint with inhibition of MPS1 kinase enhances radiosensitivity of glioblastoma cancer cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1584. doi:10.1158/1538-7445.AM2013-1584

Probing dynamics of an electron-spin ensemble via a superconducting resonator

We study spin relaxation and diffusion in an electron-spin ensemble of nitrogen impurities in diamond at low temperature (0.25-1.2 K) and polarizing magnetic field (80-300 mT). Measurements exploit field-controlled coupling of the ensemble to two modes of a transmission-line resonator. The observed temperature-independent spin relaxation time indicates that spin outdiffusion across the mode volume dominates over spin-lattice relaxation. Depolarization of one hyperfine-split subensemble by pumping of another indicates fast cross relaxation, with implications for the use of subensembles as independent quantum memories.

Detection and control of individual nuclear spins using a weakly coupled electron spin

We experimentally isolate, characterize, and coherently control up to six individual nuclear spins that are weakly coupled to an electron spin in diamond. Our method employs multipulse sequences on the electron spin that resonantly amplify the interaction with a selected nuclear spin and at the same time dynamically suppress decoherence caused by the rest of the spin bath. We are able to address nuclear spins with interaction strengths that are an order of magnitude smaller than the electron spin dephasing rate. Our results provide a route towards tomography with single-nuclear-spin sensitivity and greatly extend the number of available quantum bits for quantum information processing in diamond.

A phase 2 study of pegylated interferon α-2b (PEG-Intron(®)) in children with diffuse intrinsic pontine glioma

BACKGROUND

Interferon-α is a cytokine that has demonstrated activity in patients with supratentorial gliomas, but its ideal dose and schedule of administration is unknown. Studies suggest that low-dose, continuous exposure is more efficacious than intermittent, high doses. The authors performed a phase 2 study of recombinant interferon α-2b with monomethoxy polyethylene glycol (PEG-Intron(®)) in children with diffuse intrinsic pontine glioma (DIPG), a population with dismal survival despite decades of clinical investigation. The primary objective was to compare 2-year survival with a historic cohort that received radiation therapy alone.

METHODS

Patients received weekly subcutaneous PEG-Intron(®) at a dose of 0.3 μg/kg beginning 2 to 10 weeks after the completion of radiation therapy until they developed disease progression. Patients were evaluated clinically and radiographically at regular intervals. Serum and urine were assayed for biomarkers before each cycle. Quality-of-life (QOL) evaluations were administered at baseline and before every other cycle of therapy to the parents of patients ages 6 to 18 years.

RESULTS

Thirty-two patients (median age, 5.3 years; range, 1.8-14.8 years) were enrolled and received a median of 7 cycles of therapy (range, from 1 cycle to ≥70 cycles). PEG-Intron(®) was well tolerated, and no decrease in QOL scores was noted in the subset of patients tested. The 2-year survival rate was 14%, which was not significantly improved compared with the historic cohort. However, the median time to progression was 7.8 months, which compared favorably with recent trials reporting a time to progression of 5 months in a similar population.

CONCLUSIONS

Although low-dose PEG-Intron(®) therapy did not significantly improve 2-year survival in children with DIPG compared with an historic control population, it did delay the time to progression.