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Deterministic coupling between photonic nodes in a quantum network is an essential step toward implementing various quantum technologies. The omnidirectionality of free-standing emitters, however, makes this coupling highly inefficient, in particular if the distant nodes are coupled via low numerical aperture (NA) channels such as optical fibers. This limitation requires placing quantum emitters in nanoantennas that can direct the photons into the channels with very high efficiency. Moreover, to be able to scale such technologies to a large number of channels, the placing of the emitters should be deterministic. In this work, we present a method for directly locating single free-standing quantum emitters with high spatial accuracy at the center of highly directional bullseye metal–dielectric nanoantennas. We further employ non-blinking, high quantum yield colloidal quantum dots for on-demand single-photon emission that is uncompromised by instabilities or non-radiative exciton recombination processes. Taken together, this approach results in a record-high collection efficiency of 85% of the single photons into a low NA of 0.5, setting the stage for efficient coupling between on-chip, room temperature nanoantenna-emitter devices and a fiber or a remote free-space node without the need for additional optics.

IntroductionMultiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model.MethodsWe randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold.ResultsThe proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44–99.99), weighted F1-score of 98.46 (90–100), AUC of 98.99 (96.89–100), sensitivity (SE) of 96.97 (82.54–99.89), and specificity (SP) of 100 (62.97–100).ConclusionsThe proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies.

Background Immune checkpoint inhibitors (ICIs) are being used after allogeneic hematopoietic stem cell transplantation (alloHCT) to reverse immune dysfunction. However, a major concern for the use of ICIs after alloHCT is the increased risk of graft-versus-host disease (GVHD). We analyzed the association between GVHD prophylaxis and frequency of GVHD in patients who had received ICI therapy after alloHCT.Methods A retrospective study was performed in 21 patients with acute myeloid leukemia (n=16) or myelodysplastic syndromes (n=5) who were treated with antiprogrammed cell death protein 1 (16 patients) or anticytotoxic T lymphocyte-associated antigen 4 (5 patients) therapy for disease relapse after alloHCT. Associations between the type of GVHD prophylaxis and incidence of GVHD were analyzed.Results Four patients (19%) developed acute GVHD. The incidence of acute GVHD was associated only with the type of post-transplantation GVHD prophylaxis; none of the other variables included (stem cell source, donor type, age at alloHCT, conditioning regimen and prior history of GVHD) were associated with the frequency of acute GVHD. Twelve patients received post-transplantation cyclophosphamide (PTCy) for GVHD prophylaxis. Patients who received PTCy had a significantly shorter median time to initiation of ICI therapy after alloHCT compared with patients who did not receive PTCy (median 5.1 months compared with 26.6 months). Despite early ICI therapy initiation, patients who received PTCy had a lower observed cumulative incidence of grades 2–4 acute GVHD compared with patients who did not receive PTCy (16% compared with 22%; p=0.7). After controlling for comorbidities and time from alloHCT to ICI therapy initiation, the analysis showed that PTCy was associated with a 90% reduced risk of acute GVHD (HR 0.1, 95% CI 0.02 to 0.6, p=0.01).Conclusions ICI therapy for relapsed acute myeloid leukemia/myelodysplastic syndromes after alloHCT may be a safe and feasible option. PTCy appears to decrease the incidence of acute GVHD in this cohort of patients.

Acute tubular interstitial nephritis (ATIN) is the most frequently reported pathology in patients with checkpoint inhibitor (CPI) induced acute kidney injury (AKI). Glucocorticoid (GC) therapy and discontinuation of CPI are the mainstay of treatment to prevent permanent renal dysfunction and dialysis. However, less than 50% of patients have complete kidney recovery and relapse of ATIN can occur. Infliximab is effective in treating other immune-related adverse events but its use for the treatment of CPI-ATIN is not well established. We report the first retrospective study examining the steroid-sparing potential of infliximab in achieving durable and complete renal recovery for patients with CPI-ATIN. Data were collected from medical records of patients diagnosed with CPI-AKI with a kidney biopsy or clinical diagnosis of ATIN that was managed with GC and infliximab. Infliximab-containing regimens were used to treat 10 patients with CPI-ATIN. Four patients relapsing after GC therapy achieved durable and complete renal recovery, four patients experienced partial renal recovery, and two patients showed no improvement in kidney function. This is the first study evaluating clinical outcomes using an infliximab-containing regimen for treatment of relapsed CPI-ATIN in patients or patients failing to achieve complete response after primary therapy. Our data suggest that infliximab may be a treatment option for achieving durable and complete renal recovery in this patient population and represents a potential steroid-sparing strategy in challenging cases of CPI-ATIN. Rigorous clinical studies are warranted to evaluate the risk-benefit analysis for infliximab usage in CPI-ATIN patients.

Background: The incidence of renal immune-related adverse events (irAEs) is reported to be 3.8%, with varied definitions of acute kidney injury (AKI). This study reports a 10-year experience at MD Anderson Cancer Center of patients diagnosed with melanoma and treated with immune checkpoint inhibitors (ICIs) and evaluated the incidence of AKI, associated factors, and its association with overall survival. Methods: A retrospective chart review (2010–2019) of all patients with melanoma treated with ipilimumab, nivolumab, pembrolizumab, or atezolizumab was performed. All available serum creatinine data were extracted and used to calculate the estimated GFR (eGFR) using the CKD Epi equation, and to diagnose AKI using the two KDIGO (Kidney Disease: Improving Global Outcomes) criteria for defining stage I AKI in 1664 unique patients. Cumulative incidence rates of AKI after initiation of ICIs were calculated in the presence of death as a competing risk. The effects of covariates on the cumulative incidence function of AKI were evaluated in a univariant and multivariable analysis. Overall survival was estimated by Kaplan–Meier method in accordance to the occurrence of AKI. Results: The incidence of AKI by definitions 1a and 1b were 3.49% and 3.33%, respectively. After adjudication, AKI attributable to ICI was 58% and 65% of the overall incidence of AKI in each definition respectively. Increasing age was associated with decreased risk of AKI. Asian race was associated with a higher risk of AKI. Comorbidities were not associated with increased risk of AKI while use of proton pump inhibitors (PPI), ipilimumab or ICI combinations were significantly associated with AKI. AKI was not significantly associated with overall survival. Immune-related adverse events (irAEs) occurred in 30% of patients with AKI but their incidence was not different in patients with AKI attributable to ICI versus other AKI. Conclusions: In a large population of patients with melanoma treated with ICIs, an accurate documentation of AKI in setting of ICI use and predictors associated is presented. AKI following ICI use is infrequent, not associated with mortality, and associated with the use of ipilimumab, ICI combinations and PPIs.

The percentage of patients with cancer eligible for checkpoint inhibitor (CPI) therapy has increased rapidly over the past few years and approaches 45%. As a result, more cases of CPI-related nephrotoxicity, including a rare subset with vasculitis, are being reported. To elucidate the clinical presentation of CPI-associated renal vasculitis and its possible mechanisms, treatment options and prognosis, we describe cases from a comprehensive cancer center and reviewed the literature for similar cases. We retrospectively reviewed the charts of all patients with cancer from 2014 to 2020 who were diagnosed with CPI-related nephrotoxicity and underwent a kidney biopsy. We identified five cases of renal vasculitis: three patients were diagnosed with seronegative antineutrophil cytoplasm antibody (ANCA)-associated vasculitis, one case with seropositive ANCA-associated vasculitis and one case was diagnosed with IgA vasculitis. Of these cases, four patients were receiving nivolumab, and one patient was receiving tremelimumab. All patients had microscopic hematuria, four out of five patients had negative ANCA serology, one patient had concurrent lung involvement and positive ANCA serology, and all had severe acute kidney injury with creatinine >4.50 mg/dL on diagnosis. All patients were treated by discontinuing CPI and initiating corticosteroids and rituximab. Three patients received plasmapheresis; two of these required renal replacement therapy including the patient with lung involvement. All patients after rituximab had a partial or complete renal response. Two patients died within 8 months of diagnosis due to malignancy progression. None of the patients had a relapse of vasculitis. We demonstrated that CPI can be associated with different types of renal vasculitis that are predominantly ANCA negative and manifest as severe acute kidney injury. Despite the lack of strong evidence, treatment similar to treatment of primary seropositive ANCA-associated vasculitis with corticosteroids and rituximab is well tolerated with favorable renal outcomes.

The same mechanisms that mediate antitumor immunity from checkpoint inhibitors (CPIs) can also lead to unintended targeting of normal tissues, characterized as immune-related adverse events (irAEs). Those with pre-existing autoimmune disease are believed to be particularly vulnerable for exacerbating underlying autoimmunity or inducing severe irAEs. We report the first case of CPI-associated reactivation of primary membranous nephropathy (MN) in a patient with pleural mesothelioma responding to immunotherapy. Due to its specificity in targeting B-lymphocytes, rituximab was used to treat primary MN with the expectation that this would not interfere with the benefits gained from T cell-mediated antitumor immunity. Rituximab was effective in treating CPI-associated reactivation of MN, and the patient was successfully rechallenged with nivolumab and maintained stable kidney function and sustained clinical antitumor effect. While exacerbation of pre-existing autoimmune diseases from CPIs is common, therapy for autoimmune reactivation can be rationally directed by an understanding of the immunosuppressive mechanism with goals of cancer treatment.

BackgroundRapid and extensive testing of large parts of the population and specific subgroups is crucial for proper management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decision-making in times of a pandemic outbreak. However, point-of-care (POC) testing in places such as emergency units, outpatient clinics, airport security points or the entrance of any public building is a major challenge. The need for thermal cycling and nucleic acid isolation hampers the use of standard PCR-based methods for this purpose.MethodsTo avoid these obstacles, we tested PCR-independent methods for the detection of SARS-CoV-2 RNA from primary material (nasopharyngeal swabs) including reverse transcription loop-mediated isothermal amplification (RT-LAMP) and specific high-sensitivity enzymatic reporter unlocking (SHERLOCK).ResultsWhilst specificity of standard RT-LAMP assays appears to be satisfactory, sensitivity does not reach the current gold-standard quantitative real-time polymerase chain reaction (qPCR) assays yet. We describe a novel multiplexed RT-LAMP approach and validate its sensitivity on primary samples. This approach allows for fast and reliable identification of infected individuals. Primer optimization and multiplexing helps to increase sensitivity significantly. In addition, we directly compare and combine our novel RT-LAMP assays with SHERLOCK.ConclusionIn summary, this approach reveals one-step multiplexed RT-LAMP assays as a prime-option for the development of easy and cheap POC test kits.

Construction-oriented quantity take-off (QTO) refers to the process of determining the quantities for construction items or work packages in accordance with their descriptions. However, the current construction-oriented QTO practice relies on estimators’ manual interpretation of work descriptions and manual processes to look up proper building objects for quantity calculation. Hence, this research aims to develop natural language processing (NLP) and rule-based algorithms to automate the information extraction (IE) from work descriptions for QTO in building construction. Specifically, several named entity recognition (NER) models, including Hidden Markov Model (HMM), Conditional Random Field (CRF), Bidirectional-Long Short-Term Memory (Bi-LSTM), and Bi-LSTM+CRF, were developed to identify construction activities, material, building component, product features, measurement unit, and additional information (e.g., work scope) from work descriptions. Cost items in the RSMeans database are used to evaluate the developed models in terms of F1 scores. HMM was found to achieve a 5% higher F1 score in the NER than the other three algorithms. Then, labeling rules and active learning strategies were applied along with the HMM model, which improved F1 score by 3% and reduced the labeling efforts by 26%. The results showed that the proposed IE method successfully interprets the desired information from the work description for QTO. This research contributed to the body of knowledge by the NLP-based information extraction model integrating HMM and formalized labeling rules that automatically process work descriptions and lay a foundation for automated QTO and cost estimation.

A rigorous understanding of off-target effects is necessary for SaCas9 to be used in therapeutic genome editing. Here the authors measure SaCas9 mismatch tolerance across a pairwise library screen of 88,000 guides and targets in human cells and develop a model which ranks off-target sites.

Car dependence is a trend brought about by the desire for comfortable transportation, in many countries around the world. After the invention and acceptance of automobiles, cities were designed with layouts that favored automobiles at the expense of other forms of transportation. However, the situation has changed with research and execution of plans for smart cities, with smart mobility transition taking centre stage. The purpose of this research is to highlight the need for transition to smart mobility, provide detailed description of various aspects of smart mobility and analyse the challenges and opportunities associated with the transition to smart mobility in car-dependent countries. A thorough and critical review of the literature has been done to achieve the aim of this study. Previous research efforts indicated that car-dependent cities have experienced several challenges in their transition to smart mobility, including inadequate infrastructure, low acceptance of new technological solutions, inadequate knowledge and framework for big data, financial constraints, data quality management, integration of data from different sources, privacy issues, and development of appropriate of government policies. There are several promising recommendations, which implementation is expected to help car-dependent countries overcome the above challenges and open opportunities for a successful transition. These recommendations include implementation of aggressive government policies, practicing greater inclusivity, and planning for the future of smart mobility by investing in Internet of Things (IoT) applications and reliable infrastructure. To facilitate the decision makers, challenges have been mapped with recommendations for transition to smart mobility, in light of the review findings. [ABSTRACT FROM AUTHOR]

In recent years, the implementation of digital twin (DT) technology has gained significant attention in various industries. However, the fire safety management (FSM) sector has been relatively slow in adopting this technology compared to other major industries. Therefore, this study aims to explore the limitations, opportunities, and challenges associated with adopting DT technology in the FSM sector and further develop a DT-based FSM framework towards smart facility management (FM). To achieve this objective, this research started by reviewing several promising DTs for FSM, including building information modeling (BIM), the Internet of Things (IoT), artificial intelligence (AI), and augmented reality (AR). On this basis, a conceptual framework was synthesized in consideration of the benefits of each technology. A questionnaire was conducted for FM professionals to evaluate the proposed framework and identify the challenges of adopting DT in the FSM sector. The survey results reveal that the proposed framework can assist decision makers in obtaining comprehensive information about facilities' communication among stakeholders. The survey results validate the potential of the adoption of DTs toward smart FM practices in FSM. The survey results provide insights into the perception of DT technology among FM practitioners and identify the current state of DT technology in the FSM sector, its expected benefits, and its potential challenges. The main barriers to adopting DTs in FSM are a lack of knowledge about DTs, their initial costs, user acceptance, difficulties in systems integration, education training costs, a lack of competence, development complexity, difficulties in data management, and a lack of trust in data security. [ABSTRACT FROM AUTHOR]