Healthcare professional experiences and attitudes on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To investigate the knowledge and views of a range of healthcare professionals (consultant paediatricians, general practitioners (GPs), community pharmacists and paediatric nurses) regarding the use of unlicensed/off-label medicines in children and the participation of children in clinical trials.

Methods: A regional study in which a survey instrument with 39 items was issued to 500 randomly selected GPs, all community pharmacists (n?=?512), 50 hospital consultants and 150 paediatric nurses in Northern Ireland.

Results: Approximately half (46.5%) of the 1,212 healthcare professionals approached responded to the questionnaire. The majority of respondents indicated their familiarity with the term unlicensed (82.9%) or off-label (58.6%) prescribing with the most frequently quoted reason for such prescribing being younger age (33.6%). Apart from community pharmacists, most respondents reported having gained their knowledge through personal experience. Even though a large percentage of respondents expressed concerns about the safety (77.8%) or efficacy (87.9%) of unlicensed/off-label prescribing in children, only 30.7% reported informing parents/guardians of these concerns on the use of such medicines in children. In addition, only 56% of respondents believed that unlicensed/off-label medicines should undergo clinical trials in children. Overall, 28.4% of respondents (20.1% of GPs, 41.4% of community pharmacists, 27.7% of paediatric nurses and 94% of consultant paediatricians) indicated their willingness to be actively involved in, and recruit their patients for paediatric clinical research.

Conclusion: The use of unlicensed and off-label medicines remains a major issue in paediatric medicine. Until such times as more licensed medicines are available for children, clear guidance should be developed to allow consistency in practice across the spectrum of healthcare professionals who are involved with such medicines in their routine practice.

BYPASSING STATE INITIALIZATION IN HAMILTONIAN TOMOGRAPHY ON SPIN-CHAINS

We provide an extensive discussion on a scheme for Hamiltonian tomography of a spin-chain model that does not require state initialization [Phys. Rev. Lett. 102 ( 2009) 187203]. The method has spurred the attention of the physics community interested in indirect acquisition of information on the dynamics of quantum many-body systems and represents a genuine instance of a control-limited quantum protocol.

Memory-keeping effects and forgetfulness in the dynamics of a qubit coupled to a spin chain

Using recently proposed measures for non-Markovianity [H.-P. Breuer, E. M. Laine, and J. Piilo, Phys. Rev. Lett. 103, 210401 (2009)], we study the dynamics of a qubit coupled to a spin environment via an energy-exchange mechanism. We show the existence of a point, in the parameter space of the system, where the qubit dynamics is effectively Markovian and that such a point separates two regions with completely different dynamical behaviors. Indeed, our study demonstrates that the qubit evolution can in principle be tuned from a perfectly forgetful one to a deep non-Markovian regime where the qubit is strongly affected by the dynamical backaction of the environmental spins. By means of a theoretical quantum process tomography analysis, we provide a complete and intuitive characterization of the qubit channel.

Multipartite nonlocality in a thermalized Ising spin chain

We study multipartite correlations and nonlocality in an isotropic Ising ring under transverse magnetic field at both zero and finite temperature. We highlight parity-induced differences between the multipartite Bell-like functions used in order to quantify the degree of nonlocality within a ring state and reveal a mechanism for the passive protection of multipartite quantum correlations against thermal spoiling effects that is clearly related to the macroscopic properties of the ring model.

Phase diagram of spin-1 bosons on one-dimensional lattices

Spinor Bose condensates loaded in optical lattices have a rich phase diagram characterized by different magnetic order. Here we apply the density matrix renormalization group to accurately determine the phase diagram for spin-1 bosons loaded on a one-dimensional lattice. The Mott lobes present an even or odd asymmetry associated to the boson filling. We show that for odd fillings the insulating phase is always in a dimerized state. The results obtained in this work are also relevant for the determination of the ground state phase diagram of the S=1 Heisenberg model with biquadratic interaction.

From perfect to fractal transmission in spin chains

Perfect state transfer is possible in modulated spin chains [Phys. Rev. Lett. 92, 187902 (2004)], imperfections, however, are likely to corrupt the state transfer. We study the robustness of this quantum communication protocol in the presence of disorder both in the exchange couplings between the spins and in the local magnetic field. The degradation of the fidelity can be suitably expressed, as a function of the level of imperfection and the length of the chain, in a scaling form. In addition the time signal of fidelity becomes fractal. We further characterize the state transfer by analyzing the spectral properties of the Hamiltonian of the spin chain.

Cloning transformations in spin networks without external control

In this paper we present an approach to quantum cloning with unmodulated spin networks. The cloner is realized by a proper design of the network and a choice of the coupling between the qubits. We show that in the case of phase covariant cloner the XY coupling gives the best results. In the 1 -> 2 cloning we find that the value for the fidelity of the optimal cloner is achieved, and values comparable to the optimal ones in the general N -> M case can be attained. If a suitable set of network symmetries are satisfied, the output fidelity of the clones does not depend on the specific choice of the graph. We show that spin network cloning is robust against the presence of static imperfections. Moreover, in the presence of noise, it outperforms the conventional approach. In this case the fidelity exceeds the corresponding value obtained by quantum gates even for a very small amount of noise. Furthermore, we show how to use this method to clone qutrits and qudits. By means of the Heisenberg coupling it is also possible to implement the universal cloner although in this case the fidelity is 10% off that of the optimal cloner.

Quantum cloning in spin networks

We introduce an approach to quantum cloning based on spin networks and we demonstrate that phase covariant cloning can be realized using no external control but only with a proper design of the Hamiltonian of the system. In the 1-->2 cloning we find that the XY model saturates the value for the fidelity of the optimal cloner and gives values comparable to it in the general N-->M case. We finally discuss the effect of external noise. Our protocol is much more robust to decoherence than a conventional procedure based on quantum gates.

Berry phase for a spin 1/2 particle in a classical fluctuating field

The effect of fluctuations in the classical control parameters on the Berry phase of a spin 1/2 interacting with an adiabatically cyclically varying magnetic field is analyzed. It is explicitly shown that in the adiabatic limit dephasing is due to fluctuations of the dynamical phase.

Ramsey interferometry with a spin embedded in a Coulomb chain

We show that the statistical properties of a Coulomb crystal can be measured by means of a standard interferometric procedure performed on the spin of one ion in the chain. The ion spin, constituted by two internal levels of the ion, couples to the crystal modes via spatial displacement induced by photon absorption. The loss of contrast in the interferometric signal allows one to measure the autocorrelation function of the crystal observables. Close to the critical point, where the chain undergoes a second-order phase transition to a zigzag structure, the signal gives the behavior of the correlation function at the critical point.

Electronic states and spin-forbidden cooling transitions of AlH and AlF

The feasibility of laser cooling AlH and AlF is investigated using ab initio quantum chemistry. All the electronic states corresponding to the ground and lowest two excited states of the Al atom are calculated using multi-reference configuration interaction (MRCI) and the large AV6Z basis set for AlH. The smaller AVQZ basis set is used to calculate the valence electronic states of AlF. Theoretical Franck-Condon factors are determined for the A(1)Pi -> X(1)Sigma(+) transitions in both radicals and found to agree with the highly diagonal factors found experimentally, suggesting computational chemistry is an effective method for screening suitable laser cooling candidates. AlH does not appear to have a transition quite as diagonal as that in SrF (which has been laser cooled) but the A(1)Pi -> X(1)Sigma(+) transition transition of AlF is a strong candidate for cooling with just a single laser, though the cooling frequency is deep in the UV. Furthermore, the a (3)Pi -> X(1)Sigma(+) transitions are also strongly diagonal and in AlF is a practical method for obtaining very low final temperatures around 3 mu K.

Extent and nature of unlicensed and off-label medicine use in hospitalised children in Palestine

Objective of the study: To determine the extent and nature of unlicensed/off-label prescribing patterns in hospitalised children in Palestine. Setting: Four paediatric wards in two public health system hospitals in Palestine [Caritas children’s hospital (Medical and neonatal intensive care units) and Rafidia general hospital (Medical and surgical units)]. Method: A prospective survey of drugs administered to infants and children <18 years old was carried out over a five-week period in the four paediatric wards. Main outcome measure: Drug-licensing status of all prescriptions was determined according to the Palestinian Registered Product List and the Physician’s Desk Reference. Results: Overall, 917 drug prescriptions were administered to 387 children. Of all drug prescriptions, 528 (57.5%) were licensed for use in children; 65 (7.1%) were unlicensed; and 324 (35.3%) were used off-label. Of all children, 49.6% received off-label prescriptions, 10.1% received unlicensed medications and 8.2% received both. Seventy-two percent of off-label drugs and 66% of unlicensed drugs were prescribed for children <2 years. Multivariate analysis showed that patients who were admitted to the neonatal intensive care unit and infants aged 0–1 years were most likely to receive a greater number of off-label or unlicensed medications (OR 1.80; 95% CI 1.03–3.59 and OR 1.99; 95% CI 0.88–3.73, respectively). Conclusion: The present findings confirmed the elevated prevalence of unlicensed and off-label paediatric drugs use in Palestine and strongly support the need to perform well designed clinical studies in children.

Children’s views on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To explore the views and perspectives of children on the unlicensed/off-label use of medicines in children and on the participation of children in clinical trials. Methods: Focus-group discussions, involving school children, were carried out in a range of primary and secondary schools in Northern Ireland. A purposeful sample was chosen to facilitate representation of various socioeconomic groupings. Results: A total of 123 pupils, aged from 10 to 16 years, from six schools, participated in 16 focus groups. In general, pupils viewed the unlicensed/off-label use of medicines in children as unsafe and unethical and felt it is necessary to test medicines in children to improve the availability of licensed products. The majority felt that older children should be told, and that parents should be told, about the unlicensed/off-label use of medicines in children, yet they recognised some implications of this, such as potential medication non-adherence. Conclusions: This is the first study to explore the views of healthy children on unlicensed medicine use in children. Children were able to recognise potential risks associated with the unlicensed use of medicines and felt it is necessary to test and license more medicines in children. Practice implications Health care professionals should consider the views of children in decisions that affect their health.

DNA Reorientation on Au Nanoparticles: Label-Free Detection of Hybridization by Surface Enhanced Raman Spectroscopy

DNA sequences attached to Au nanoparticles via thiol linkers stand up from the surface, giving preferential enhancement of the adenine ring breathing SERS band. Non-specific binding via the nucleobases reorients the DNA, reducing this effect. This change in intensity on reorientation was utilised for label-free detection of hybridization of a molecular beacon.