The Scope of Practice of an Embedded Pediatric Palliative Oncology Clinic.

CONTEXT: Pediatric palliative care (PPC) improves end-of-life (EOL) outcomes for children with cancer. Though PPC visits are the 'intervention' in studies focused on EOL care, the content of PPC visits within pediatric oncology is poorly understood. OBJECTIVES: This study aimed to understand the scope of PPC practice during visits for children with cancer and their families. METHODS: This was a retrospective cohort study of patients 0-27 years with cancer seen in PPC clinic within an academic pediatric oncology center between 2017 and 2022. During each PPC visit, documenting providers chose the domains discussed or managed (goals of care, symptom management, and care coordination with respective subdomains). Data was abstracted from the electronic health record, PPC clinic database, and Cancer Registry. The differences in frequency and addressed domains were analyzed by demographics, visit type, diagnosis group, and proximity to EOL. RESULTS: Across 351 patients, 1919 outpatient PPC visits occurred. Median domains were higher in visits <90 days vs. 91+ days from EOL (12.0 vs. 10.0; p < 0.0001); pain and hospice collaboration were particularly discussed closer to EOL. Psychological symptoms like anxiety (30.7% vs. 21.1%; p < 0.001) were addressed more in follow-ups than initial visits. Compared to brain tumor or leukemia/lymphoma visits, solid tumor visits addressed more symptom management subdomains, especially pain (79.9%; p < 0.0001). CONCLUSION: The scope of PPC practice is broad and varied. Each visit encompasses many subdomains, the most common being care coordination with oncology teams and helping patients/families cope with the disease. More domains were addressed in solid tumor visits and near EOL.

Association of Severe Acute Respiratory Syndrome Coronavirus 2 Infection With Early Breastfeeding.

OBJECTIVE: The association of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status before delivery with breastfeeding is unknown. This study compares breastfeeding initiation, exclusivity, and duration between SARS-CoV-2-positive (+) and SARS-CoV-2-negative (-) mothers during the first 2 months of their newborns' lives. METHODS: A single center, retrospective cohort study of pediatric contacts during the first 2 months in a diverse mother-infant population (n = 285) compared breastfeeding outcomes by maternal SARS-CoV-2 status during a pandemic surge. Infants of SARS-CoV-2 positive mothers were also tested before discharge. Comparison of maternal demographics (age, race, ethnicity), maternal/infant characteristics (parity, insurance, delivery mode, infant sex, hospital length of stay), and pediatric contacts by maternal SARS-CoV-2 status included Fisher's exact and Wilcoxon tests and Poisson regression for count outcomes. Logistic regression compared breastfeeding outcomes between the 2 groups, adjusting for potential confounders and effect modifiers. RESULTS: Maternal demographics and maternal/infant characteristics were similar. While 19% of mothers tested positive for SARS-CoV-2 (n = 54), their infants were all negative. SARS-CoV-2 positive mothers had fewer in-person, but more virtual pediatric contacts. After controlling for the above variables, SARS-CoV-2 positive mothers had lower odds of breastfeeding initiation within 1 to 7 days of life (78% vs 88%; adjusted odds ratio [aOR] = 0.40, 95% confidence interval [CI]: 0.17, 0.96) and of any breastfeeding during month 2 (54% vs 76%; aOR = 0.37, 95% CI: 0.16, 0.86) compared with SARS-CoV-2 negative mothers. CONCLUSIONS: Maternal SARS-CoV-2 positivity at delivery was independently associated with less initiation and shorter duration of any breastfeeding during month 2. SARS-CoV-2 positive women would likely benefit from additional breastfeeding support during pandemic surges.

Quantum State Learning via Single-Shot Measurements.

A novel machine-learning algorithm based on single-shot measurements, named single-shot measurement learning, is demonstrated achieving the theoretical optimal accuracy. The method is at least as efficient as existing tomographic schemes and computationally much less demanding. The merits are attributed to the inclusion of weighted randomness in the learning rule governing the exploration of diverse learning routes. These advantages are explored experimentally by a linear-optical setup that is designed to draw the fullest potential of the proposed method. The experimental results show an unprecedented high level of accuracy for qubit-state learning and reproduction exhibiting (nearly) optimal infidelity scaling, O(N^{-0.983}), for the number N of unknown state copies, down to <10^{-5} without any compensation for experimental nonidealities. Extension to high dimensions is discussed with simulation results.

Deterministic Secure Quantum Communication on the BB84 System.

In this paper, we propose a deterministic secure quantum communication (DSQC) protocol based on the BB84 system. We developed this protocol to include quantum entity authentication in the DSQC procedure. By first performing quantum entity authentication, it was possible to prevent third-party intervention. We demonstrate the security of the proposed protocol against the intercept-and-re-send attack and the entanglement-and-measure attack. Implementation of this protocol was demonstrated for quantum channels of various lengths. Especially, we propose the use of the multiple generation and shuffling method to prevent a loss of message in the experiment.

Vaccine Development: From Laboratory to Policy.

Vaccines are one of the greatest public health achievements, protecting children and adults against numerous infectious diseases; however, the complex, rigorous process of vaccine development is unknown to many. A candidate vaccine undergoes extensive evaluation of safety and efficacy to meet licensure requirements before recommendations for use become policy. This time-consuming process involves an intricate collaboration among academia, public and private organizations, and federal agencies to ensure that safety is prioritized in every step. Vaccine safety continues to be monitored after licensure through a robust system. Yet, vaccine hesitancy remains a major challenge, especially now with the coronavirus disease 2019 (COVID-19) pandemic and concerns about the speed with which candidate vaccines are being developed. This article reviews the vaccine development process and the systems in place to ensure safety and effectiveness. A better understanding of these topics is necessary to address concerns and improve public acceptance of all vaccines, particularly COVID-19 vaccines. [Pediatr Ann. 2020;49(12):e509-e515.].

Quantum Teleportation of Shared Quantum Secret.

Quantum teleportation is a fundamental building block of quantum communications and quantum computations, transferring quantum states between distant physical entities. In the context of quantum secret sharing, the teleportation of quantum information shared by multiple parties without concentrating the information at any place is essential, and this cannot be realized by any previous scheme. We propose and experimentally demonstrate a novel teleportation protocol that enables one to perform this task. It is jointly performed by distributed participants, while none of them can fully access the information. Our scheme can be extended to arbitrary numbers of senders and receivers and to fault-tolerant quantum networks by incorporating error-correction codes.

Measurement of bending-induced birefringence in a hollow-core photonic crystal fiber.

We report the measurement of bending-induced birefringence in the presence of large intrinsic birefringence in a hollow-core photonic crystal fiber (HC-PCF). The fast axis of bending-induced birefringence was found to be normal to the bending plane, in contrast to the conventional fiber case. The dependence of the induced birefringence on the bending radius was also different from the typical inverse square law. Possibilities and design criteria for polarization controllers using bending-induced birefringence in HC-PCFs are presented.

Relative time multiplexing of heralded telecom-band single-photon sources using switchable optical fiber delays.

We experimentally demonstrate a time-multiplexing method for pulse-pumped heralded single-photon sources using switchable optical fiber delay lines. The optical fibers constitute a 32-channel binary-division photon buffer that can multiplex time slots into single temporal mode to enhance single-photon generation rate without increasing multi-photon noise. Relative time multiplexing using the same actively controlled variable delay realizes Hong-Ou-Mandel interferometry by two photons produced in arbitrary two time-bins. The interference dip depth in good agreement with theory verifies path length matching within the photonic coherence length and dispersion compensation of the optical fiber delay sections. We independently confirm by low-coherence interferometry that the internal optical path lengths of the optical switches are constant during the switching operations.

Urinary neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury in sepsis patients in the emergency department.

BACKGROUND: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for predicting acute kidney injury (AKI). The purpose of this study was to evaluate the diagnostic performance of urinary NGAL in predicting AKI in sepsis patients in the emergency department. METHODS: A total of 140 patients were enrolled. We compared serum procalcitonin and urinary NGAL concentrations between patients with local infection, sepsis, and septic shock, and between patients who did and did not develop AKI with sepsis. Receiver-operating characteristic curve analysis was used to evaluate the ability to predict AKI in sepsis patients. RESULTS: Both serum procalcitonin and urinary NGAL concentrations were significantly higher in the sepsis and septic shock groups than in the local infection group (both p < 0.001). In sepsis patients, serum procalcitonin and urinary NGAL concentrations were higher in AKI patients than in those without AKI (p = 0.006, p < 0.001, respectively). The area under the curve for predicting of AKI was higher for a urinary NGAL of 0.820 (95% confidence interval (CI) 0.721-0.895) than for a serum procalcitonin concentration of 0.76 (95% CI 0.597-0.800). CONCLUSION: Urinary NGAL concentration may predict AKI in patients with sepsis in the emergency department.

Targeting High Mobility Group Box-1 (HMGB1) Promotes Cell Death in Myelodysplastic Syndrome.

PURPOSE: Myelodysplastic syndrome (MDS) is associated with a dysregulated innate immune system. The purpose of this study was to determine whether modulation of the innate immune system via high mobility group box-1 (HMGB1) could reduce cell viability in MDS. EXPERIMENTAL DESIGN: We quantified HMGB1 in an MDS cell line MDS-L and in primary MDS cells compared with nonmalignant hematopoietic cells. We performed loss-of-function studies of HMGB1 using pooled siRNAs and a small-molecule inhibitor sivelestat compared with standard chemotherapy. We measured levels of engraftment of MDS-L cells in NOD-scidIL2Rgnull (NSG) mice following treatment with sivelestat. Mechanistically, we interrogated cell survival pathways and 45 targets within the NFκB pathway using both protein analysis and a proteome profiler array. RESULTS: We discovered that HMGB1 had increased expression in both MDS-L cells and in primary CD34+ MDS cells compared with healthy CD34+ hematopoietic cells. Sivelestat impaired MDS cell expansion, increased cellular death, and spared healthy hematopoietic cells. MDS-L marrow engraftment is reduced significantly at 17 weeks following treatment with sivelestat compared with control mice. Treatment of CD34+ MDS cells with sivelestat and azacitidine or decitabine was additive to increase apoptotic cell death compared with chemotherapy alone. Sivelestat promoted apoptosis with increased expression of PUMA, activated caspase 3, and increased DNA double-strand breaks. Inhibition of HMGB1 reduced levels of Toll-like receptors (TLR) and suppressed activation of NFκB in MDS-L cells. CONCLUSIONS: Inhibition of HMGB1 could promote MDS cell death and alter innate immune responses via suppression of NFκB pathways.

Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial.

BACKGROUND: Effortful swallowing training (EST) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient. AIMS: To investigate the effects of EST on tongue strength and swallowing function in patients with stroke. METHODS & PROCEDURES: Stroke patients with dysphagia were randomly assigned to one of two groups: an experimental group (n = 12) and a control group (n = 12). The experimental group underwent EST, while the control group performed saliva swallowing. Training was conducted 5 days per week for 4 weeks. Both groups underwent conventional dysphagia treatment for 30 min/day, 5 days/week for 4 weeks. OUTCOMES & RESULTS: Tongue strength was assessed using the Iowa Oral Performance Instrument. The Videofluoroscopic Dysphagia Scale (VDS), based on a videofluoroscopic swallowing study, was used to analyze oropharyngeal swallowing function. The experimental group showed greater improvements in anterior and posterior tongue strength compared with the control group (p = 0.046 and 0.042, respectively), and greater improvement in the oral phases of the VDS (p = 0.017). CONCLUSIONS & IMPLICATIONS: We recommend EST as a remedial strategy for improving tongue strength and oral swallowing function in patients with stroke.

Efficient High-Dimensional Quantum Key Distribution with Hybrid Encoding.

We propose a schematic setup of quantum key distribution (QKD) with an improved secret key rate based on high-dimensional quantum states. Two degrees-of-freedom of a single photon, orbital angular momentum modes, and multi-path modes, are used to encode secret key information. Its practical implementation consists of optical elements that are within the reach of current technologies such as a multiport interferometer. We show that the proposed feasible protocol has improved the secret key rate with much sophistication compared to the previous 2-dimensional protocol known as the detector-device-independent QKD.

Comparison of orbicularis oris muscle strength and endurance in young and elderly adults.

[Purpose] The purpose of this study was to compare the strength and endurance of the orbicularis oris muscle in healthy Korean (young vs. elderly adults). [Participants and Methods] A total of 60 participants (30 young adults and 30 elderly adults) were recruited. The Iowa Oral Performance Instrument was used to measure orbicularis oris muscle maximal strength and endurance. [Results] Elderly adults showed significantly lower orbicularis oris muscle strength and endurance than younger adults. [Conclusion] This study confirmed a significant age-related decrease in orbicularis oris muscle strength and endurance. The data collected will be useful as a basis for future on speech and swallowing therapy.

Effect of orbicularis oris muscle training on muscle strength and lip closure function in patients with stroke and swallowing disorder.

[Purpose] We aimed to investigate the effect of resistance training of the orbicularis oris muscles on lip muscle strength and closure function in patients with swallowing disorder with facial palsy after stroke. [Participants and Methods] This study recruited 10 patients with swallowing disorder and facial palsy after stroke. All the participants received orbicularis oris muscle training at an intensity of 70% of 1 repetition maximum by using an Iowa oral performance instrument. Muscle strength and lip closure function were evaluated after orbicularis oris muscle training. [Results] After the intervention, the orbicularis oris muscle strength showed a statistically significant increase from 20.5 ± 5.15 to 25.3 ± 4.2 kilopascal. Lip closure function showed a statistically significant improvement from 2.6 ± 1.5 to 1.2 ± 1.0. [Conclusion] This study recommends to train at an intensity of 70% of 1 repetition maximum for 4 weeks to increase theorbicularis oris muscle strength and improve lip closure function.

Experimental Demonstration of Four-Dimensional Photonic Spatial Entanglement between Multi-core Optical Fibres.

Fibre transport of multi-dimensional photonic quantum states promises high information capacity per photon without space restriction. This work experimentally demonstrates transmission of spatial ququarts through multi-core optical fibres and measurement of the entanglement between two fibres with quantum state analyzers, each composed of a spatial light modulator and a single-mode fibre. Quantum state tomography reconstructs the four-dimension entangled state that verifies the nonlocality through concurrences in two-dimensional subspaces, a lower bound of four-dimensional concurrence and a Bell-type CGLMP inequality.

Effect of mirror therapy and electrical stimulation on upper extremity function in stroke with hemiplegic patient: a pilot study.

[Purpose] This study investigated the effects of mirror therapy and neuromuscular electrical stimulation on upper extremity function in stroke patients. [Subjects and Methods] This study recruited 8 stroke patients. All patients were treated with mirror therapy and neuromuscular electrical stimulation five times per week for 4 weeks. Upper limb function evaluation was performed using upper extremity part of fugl meyer assessment. [Results] Before and after intervention, fugl meyer assessment showed significant improvement. [Conclusion] In this study, mirror therapy and neuromuscular electrical stimulation are effective methods for upper extremity function recovery in stroke patients.

Multi-core fiber interferometer using spatial light modulators for measurement of the inter-core group index differences.

We demonstrate an experimental technique to generate and measure arbitrary superpositions of core modes in a multi-core fiber. Two spatial light modulators couple the fundamental mode of a single-mode fiber with multiple-core modes of the MCF to constitute a Mach-Zehnder-type multi-path interferometer. The phase tunability of each path is verified by comparing two-, three-, and four-path interference patterns with the theory. Interference fringes in the wavelength domain estimates the inter-core group index differences with a resolution of 10(-5) using a fiber length of 1 m.

Acousto-optic resonant coupling of three spatial modes in an optical fiber.

A fiber-optic analogue to an externally driven three-level quantum state is demonstrated by acousto-optic coupling of the spatial modes in a few-mode fiber. Under the condition analogous to electromagnetically induced transparency, a narrow-bandwidth transmission within an absorption band for the fundamental mode is demonstrated. The presented structure is an efficient converter between the fundamental mode and the higher-order modes that cannot be easily addressed by previous techniques, therefore can play a significant role in the next-generation space-division multiplexing communications as an arbitrarily mode-selectable router.

Experimental direct estimation of nonlinear functionals of photonic quantum states via interferometry with a controlled-swap operation.

We propose a multi-photon interferometer with a generalized C-SWAP operation that can estimate Tr[ρ(1)ρ(2)···ρ(n)], a nonlinear functional of n photonic density matrices. The scheme is demonstrated for three single-photon states whose overlap is experimentally measured as the interference visibility of a control qubit encoded into photonic paths. The validity of this method is verified by comparing the visibility with the results of Hong-Ou-Mandel experiments.

Measurement of the entanglement between photonic spatial modes in optical fibers.

We experimentally demonstrate the entanglement of spatial modes between two photons propagating through separate few-mode optical fibers. Quantum states over the two lowest-order spatial modes are measured with highly efficient spatial-mode analyzers based on acousto-optics. Quantum state tomography verifies the entanglement of the spatial-domain Bell state.