IMPLEMENTATION OF A GOLDEN HOUR PROTOCOL FOR EXTREMELY PREMATURE INFANTS

ABSTRACT Sarah E. W. Croop: Implementation of a Golden Hour Protocol for Extremely Premature Infants (Under the direction of Suzanne Thoyre) Extremely premature (EP) infants are fragile, susceptible to rapidly developing hypothermia and hypoglycemia, and face substantial risk of long-term morbidity and mortality. Golden Hour protocols (GHP) bundle and standardize evidence-based practices for care of these vulnerable infants during the first 60 minutes of life and are reported to decrease short-term and potentially decrease long-term morbidity and mortality. The purpose of the study was to examine short- and long-term outcomes in EP infants following implementation of a GHP in one neonatal intensive care unit. Cyclical plan-do-study-act quality improvement (QI) methodology was utilized. Data were collected on inborn infants < 27 weeks’ gestation (2012-2017) over 3 phases; pre-GHP (n = 80), Phase I (n = 42), and Phase II (n = 92). There were no statistically significant differences in infant characteristics. A systematic approach to care of EP infants in the first hour of life resulted in improved short-term outcomes. Significant differences were observed in minutes to completion of GHP care [median (Q1,Q3) 110 (89,138) vs 111 (94,135) vs 92(74,129) respectively p = 0.0035], abnormal temperature (59% vs 26% vs 38%; p = 0.001) and hypoglycemia (18% vs 7% vs 4%; p = 0.012). Evaluation of long-term morbidity and mortality did not reveal significant differences. However, there was an increase in the number of infants resuscitated and admitted at the cusp of viability (22 and 23 weeks gestation) over the three phases of the study (16%, 16%, 29%) similar to national trends of providing more aggressive care at earlier gestational ages. Although significant improvements in long-term outcomes were not observed, the lack of significant differences may represent a protective effect of GHP as the highest risks of morbidity and mortality are associated with the most premature infants. Additional studies, larger sample sizes, and consistent analysis of long-term morbidities would provide greater insight into the impact of GHP. Ongoing QI should focus on sustaining achieved improvements, continuing to improve time to completion of care, and seeking additional, meaningful short-term outcome measures. Keywords: extremely premature, infant, golden hour, neonatal intensive care unit, quality improvemen

Measurements of few-mode fiber photonic lanterns in emulated atmospheric conditions for a low earth orbit space to ground optical communication receiver application

Photonic lanterns are being evaluated as a component of a scalable photon counting real-time optical ground receiver for space-to-ground photon-starved communication applications. The function of the lantern as a component of a receiver is to efficiently couple and deliver light from the atmospherically distorted focal spot formed behind a telescope to multiple small-core fiber-coupled single-element super-conducting nanowire detectors. This architecture solution is being compared to a multimode fiber coupled to a multi-element detector array. This paper presents a set of measurements that begins this comparison. This first set of measurements are a comparison of the throughput coupling loss at emulated atmospheric conditions for the case of a 60 cm diameter telescope receiving light from a low earth orbit satellite. The atmospheric conditions are numerically simulated at a range of turbulence levels using a beam propagation method and are physically emulated with a spatial light modulator. The results show that for the same number of output legs as the single-mode fiber lantern, the few-mode fiber lantern increases the power throughput up to 3.92 dB at the worst emulated atmospheric conditions tested of D/r(sub 0)=8.6. Furthermore, the coupling loss of the few-mode fiber lantern approaches the capability of a 30 micron graded index multimode fiber chosen for coupling to a 16 element detector array

P-glycoproteins encoded by mdr 1b in murine gravid uterus and multidrug resistant tumor cell lines are differentially glycosylated

AbstractThere are 3 members of the multidrug-resitance gene family expressed in mouse. Only one of these, mdr lb, and its gene product P-glycoprotein are induced to high levels in the mouse endometrium during pregnancy. It is shown here that P-glycoprotein in the gravid uterus is significantly larger (Mr 155000) compared to P-glycoprotein encoded by mdr lb in a murine multidrug-resistant cell line (Mr 140000). However, both species co-migrate after enzymatic removal of N-linked sugars (Mr 125000). These results demonstrate that differential glycosylation of the mdr lb gene product contributes to molecular heterogeneity found in P-glycoprotein from normal and multidrug-resistant cells

Evidence for BCR/ABL1‐positive T‐cell acute lymphoblastic leukemia arising in an early lymphoid progenitor cell

BCR‐ABL1‐positive leukemias have historically been classified as either chronic myelogenous leukemia or Ph+ acute lymphoblastic leukemia. Recent analyses suggest there may be a wider range of subtypes. We report a patient with BCR‐ABL1 fusion positive T‐cell ALL with a previously undescribed cell distribution of the fusion gene. The examination of sorted cells by fluorescence in situ hybridization showed the BCR‐ABL1 fusion in the malignant T cells and a subpopulation of the nonmalignant B cells, but not nonmalignant T cells or myeloid or CD34+ progenitor cells providing evidence that the fusion may have occurred in an early lymphoid progenitor

Vehicle Systems Panel deliberations

The Vehicle Systems Panel addressed materials and structures technology issues related to launch and space vehicle systems not directly associated with the propulsion or entry systems. The Vehicle Systems Panel was comprised of two subpanels - Expendable Launch Vehicles & Cryotanks (ELVC) and Reusable Vehicles (RV). Tom Bales, LaRC, and Tom Modlin, JSC, chaired the expendable and reusable vehicles subpanels, respectively, and co-chaired the Vehicle Systems Panel. The following four papers are discussed in this section: (1) Net Section components for Weldalite Cryogenic Tanks, by Don Bolstad; (2) Build-up Structures for Cryogenic Tanks and Dry Bay Structural Applications, by Barry Lisagor; (3) Composite Materials Program, by Robert Van Siclen; (4) Shuttle Technology (and M&S Lessons Learned), by Stan Greenberg

Human Model Reaching, Grasping, Looking and Sitting Using Smart Objects

Manually creating convincing animated human motion in a 3D ergonomic test environment is tedious and time consuming. However, procedural motion generators help animators efficiently produce complex and realistic motions. Using the concept of a Human Modeling Software Testbed (HMST), we created novel procedural methods for animating reaching, grasping, looking, and sitting using the environmental context of ‘smart’ objects that parametrically guide human model ergonomic motions. This approach enabled complicated procedures such as collision-free leg reach and contextual sitting motion generation. By procedurally adding small secondary details to the animation, such as head/eye vision constraints and prehensile grasps, the animated motions look more natural with minimal animator input. A ‘smart’ object in the scene graph provides specific parameters to produce proper motions and final positions. These parameters are applied to the desired figure procedurally to create any secondary motions, and further generalize to any environment. Our system allows users to proceed with any required ergonomic analyses with confidence in the visual validity of the automated motions

A phase 1, first-in-child, multicenter study to evaluate the safety and efficacy of the oncolytic herpes virus talimogene laherparepvec in pediatric patients with advanced solid tumors

Immunotherapy; Oncolytic herpes virus; Pediatric solid tumorInmunoterapia; Virus del herpes oncolítico; Tumor sólido pediátricoImmunoteràpia; Virus de l'herpes oncolític; Tumor sòlid pediàtricBackground: The survival rates for pediatric patients with relapsed and refractory tumors are poor. Successful treatment strategies are currently lacking and there remains an unmet need for novel therapies for these patients. We report here the results of a phase 1 study of talimogene laherparepvec (T-VEC) and explore the safety of this oncolytic immunotherapy for the treatment of pediatric patients with advanced non–central nervous system tumors. Methods: T-VEC was delivered by intralesional injection at 106 plaque-forming units (PFU)/ml on the first day, followed by 108 PFU/ml on the first day of week 4 and every 2 weeks thereafter. The primary objective was to evaluate the safety and tolerability as assessed by the incidence of dose-limiting toxicities (DLTs). Secondary objectives included efficacy indicated by response and survival per modified immune-related response criteria simulating the Response Evaluation Criteria in Solid Tumors (irRC-RECIST). Results: Fifteen patients were enrolled into two cohorts based on age: cohort A1 (n = 13) 12 to ≤21 years old (soft-tissue sarcoma, n = 7; bone sarcoma, n = 3; neuroblastoma, n = 1; nasopharyngeal carcinoma, n = 1; and melanoma, n = 1) and cohort B1 (n = 2) 2 to <12 years old (melanoma, n = 2). Overall, patients received treatment for a median (range) of 5.1 (0.1, 39.4) weeks. No DLTs were observed during the evaluation period. All patients experienced at least one treatment-emergent adverse event (TEAE), and 53.3% of patients reported grade ≥3 TEAEs. Overall, 86.7% of patients reported treatment-related TEAEs. No complete or partial responses were observed, and three patients (20%) overall exhibited stable disease as the best response. Conclusions: T-VEC was tolerable as assessed by the observation of no DLTs. The safety data were consistent with the patients' underlying cancer and the known safety profile of T-VEC from studies in the adult population. No objective responses were observed.This study received funding from Amgen Inc. The funder was involved in the study design; collection, analysis, and interpretation of data; the writing of this article; and the decision to submit it for publication

Measurements of Few-Mode Fiber Photonic Lanterns in Emulated Atmospheric Conditions for a Low Earth Orbit Space to Ground Optical Communication Receiver Application

Photonic lanterns are being evaluated as a component of a scalable photon counting real-time optical ground receiver for space-to-ground photon-starved communication applications. The function of the lantern as a component of a receiver is to efficiently couple and deliver light from the atmospherically distorted focal spot formed behind a telescope to multiple small-core fiber-coupled single-element super-conducting nanowire detectors. This architecture solution is being compared to a multimode fiber coupled to a multi-element detector array. This paper presents a set of measurements that begins this comparison. This first set of measurements are a comparison of the throughput coupling loss at emulated atmospheric conditions for the case of a 60 cm diameter telescope receiving light from a low earth orbit satellite. The atmospheric conditions are numerically simulated at a range of turbulence levels using a beam propagation method and are physically emulated with a spatial light modulator. The results show that for the same number of output legs as the single-mode fiber lantern, the few mode fiber lantern increases the power throughput up to 3.92 dB at the worst emulated atmospheric conditions tested of D/r0=8.6. Furthermore, the coupling loss of the few mode fiber lantern approaches the capability of a 30 micron graded index multimode fiber chosen for coupling to a 16 element detector array