A case for the resuscitation of infants born at less than 24 weeks gestation

Despite improvements in survival of extremely preterm infants, the decision whether to begin intensive care for infants at borderline viability is controversial. A great deal of this controversy focuses on concerns of survival, cost and neurodevelopmental outcome. Why are these concerns more emphasized in discussions of prematurity than other areas of medicine

Hyperglycemia as a risk factor for the development of retinopathy of prematurity

BACKGROUND: Hyperglycemia has recently been described as a risk factor for the development of retinopathy of prematurity (ROP), a proliferative vascular disease of the retina that primarily affects premature infants. This study was to evaluate the relationship of hyperglycemia and the development of ROP in premature infants less than 32 weeks gestation. METHODS: This was a retrospective cohort study of all infants less than 32 weeks gestation from 2003–2007 who survived to discharge in our NICU. Demographic data including birthweight, gestational age, Apgar scores, method of delivery, antenatal steroid use, neonatal steroid use, and size for gestational age was collected for each infant. Episodes of sepsis, grade of intraventricular hemorrhage, presence of a patent ductus arteriosus, number of days on the ventilator, and stage of necrotizing enterocolitis were assessed as well as days of hyperglycemia, defined as number of days with whole blood glucose > 150 mg/dl. In addition, the highest stage of ROP was recorded for each infant. A Student’s two tailed t-test or Fisher’s exact test was performed to identify significant clinical risk factors associated with the development of ROP. From this univariate analysis, a multiple logistic regression was performed to determine the effect of hyperglycemia on the development of ROP, adjusting for significant clinical risk factors. Statistical analysis was performed using SAS v.9.2. RESULTS: Univariate analysis demonstrated that infants with ROP were of lower birthweight and gestational age, and were affected by a patent ductus arteriosus, neonatal sepsis, intraventricular hemorrhage, have significant lung disease and received postnatal glucocorticoid therapy. Infants with ROP experienced more days with hyperglycemia (7 vs. 2, p = < 0.0001). Using multiple logistic regression analysis to compare no ROP vs. all stages of ROP, gestational age (OR 0.745, 95% CI [0.634, 0.877], p = 0.0004), mean days of hyperglycemia (OR 1.073, 95% CI [1.004, 1.146], p = 0.04), and mean days receiving mechanical ventilation (OR 1.012, 95% CI [1.000, 1.025], p = 0.05) remained significantly associated with ROP after adjusting for other risk factors. CONCLUSION: Our data suggests that hyperglycemia is associated with the development of ROP in premature infants

PdZnAl Catalysts for the Reactions of Water-Gas-Shift, Methanol Steam Reforming, and Reverse-Water-Gas-Shift

Pd/ZnO/Al2O3 catalysts were studied for water-gas-shift (WGS), methanol steam reforming, and reverse-water-gas-shift (RWGS) reactions. WGS activity was found to be dependent on the Pd:Zn ratio with a maximum activity obtained at approximately 0.50, which was comparable to that of a commercial Pt-based catalyst. The catalyst stability was demonstrated for 100 hours time-on-stream at a temperature of 360ºC without evidence of metal sintering. WGS reaction rates were approximately 1st order with respect to CO concentration, and kinetic parameters were determined to be Ea = 58.3 kJ mol-1 and k0 = 6.1x107 min-1. During methanol steam reforming, the CO selectivities were observed to be lower than the calculated equilibrium values over a range of temperatures and steam/carbon ratios studied while the reaction rate constants were approximately of the same magnitude for both WGS and methanol steam reforming. These results indicate that although Pd/ZnO/Al2O3 are active WGS catalysts, WGS is not involved in methanol steam reforming. RWGS rate constants are on the order of about 20 times lower than that of methanol steam reforming, suggesting that RWGS reaction could be one of the sources for small amount of CO formation in methanol steam reforming

Geomagnetic Storms and Long-Term Impacts on Power Systems

Pacific Northwest National Laboratory was commissioned to study the potential impact of a severe GIC event on the western U.S.-Canada power grid (referred to as the Western Interconnection). The study identified long transmission lines (length exceeding 150 miles) that did not include series capacitors. The basic assumption for the study is that a GIC is more likely to couple to long transmission lines, and that series capacitors would block the flow of the induced DC GIC. Power system simulations were conducted to evaluate impacts to the bulk power system if transformers on either end of these lines failed. The study results indicated that the Western Interconnection was not substantially at risk to GIC because of the relatively small number of transmission lines that met this criterion. This report also provides a summary of the Hydro-Québec blackout on March 13, 1989, which was caused by a GIC. This case study delves into the failure mechanisms of that event, lessons learned, and preventive measures that have been implemented to minimize the likelihood of its reoccurrence. Finally, the report recommends that the electric power industry consider the adoption of new protective relaying approaches that will prevent severe GIC events from catastrophically damaging transformers. The resulting changes may increase the likelihood of smaller disruptions but should prevent an unlikely yet catastrophic national-level event

Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants

RATIONALE: Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. OBJECTIVES: To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. METHODS: Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. MEASUREMENTS AND MAIN RESULTS: After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. CONCLUSIONS: We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth

MANGO ? Modal Analysis for Grid Operation: A Method for Damping Improvement through Operating Point Adjustment

Small signal stability problems are one of the major threats to grid stability and reliability in the U.S. power grid. An undamped mode can cause large-amplitude oscillations and may result in system breakups and large-scale blackouts. There have been several incidents of system-wide oscillations. Of those incidents, the most notable is the August 10, 1996 western system breakup, a result of undamped system-wide oscillations. Significant efforts have been devoted to monitoring system oscillatory behaviors from measurements in the past 20 years. The deployment of phasor measurement units (PMU) provides high-precision, time-synchronized data needed for detecting oscillation modes. Measurement-based modal analysis, also known as ModeMeter, uses real-time phasor measurements to identify system oscillation modes and their damping. Low damping indicates potential system stability issues. Modal analysis has been demonstrated with phasor measurements to have the capability of estimating system modes from both oscillation signals and ambient data. With more and more phasor measurements available and ModeMeter techniques maturing, there is yet a need for methods to bring modal analysis from monitoring to actions. The methods should be able to associate low damping with grid operating conditions, so operators or automated operation schemes can respond when low damping is observed. The work presented in this report aims to develop such a method and establish a Modal Analysis for Grid Operation (MANGO) procedure to aid grid operation decision making to increase inter-area modal damping. The procedure can provide operation suggestions (such as increasing generation or decreasing load) for mitigating inter-area oscillations

Sequence variants in oxytocin pathway genes and preterm birth: a candidate gene association study

Peer reviewe

Oligonucleotide-based strategies to reduce gene expression

Abstract Research on embryonic development and differentiation provides a sensitive, but challenging opportunity to use a variety of techniques designed to modulate gene expression. Changes in the expression of a single gene can alter levels of other genes and provide information on developmentally regulated gene expression pathways. The morphological consequences of altered gene expression can link gene expression to developmental fate. Oligonucleotide-based approaches offer a variety of means to potentially disrupt normal gene expression. The basis for some of these approaches is presented in this review

Consortium for Electric Reliability Technology Solutions Grid of the Future White Paper on Review of Recent Reliability Issues and Systems Events

This report is one of six reports developed under the U.S. Department of Energy (DOE) program in Power System Integration and Reliability (PSIR). The objective of this report is to review, analyze, and evaluate critical reliability issues demonstrated by recent disturbance events in the North America power system. Eleven major disturbances are examined, most occurring in this decade. The strategic challenge is that the pattern of technical need has persisted for a long period of time. For more than a decade, anticipation of market deregulation has been a major disincentive to new investments in system capacity. It has also inspired reduced maintenance of existing assets. A massive infusion of better technology is emerging as the final option to continue reliable electrical services. If an investment in better technology will not be made in a timely manner, then North America should plan its adjustments to a very different level of electrical service. It is apparent that technical operations staff among the utilities can be very effective at marshaling their forces in the immediate aftermath of a system emergency, and that serious disturbances often lead to improved mechanisms for coordinated operation. It is not at all apparent that such efforts can be sustained through voluntary reliability organizations in which utility personnel external to those organizations do most of the technical work. The eastern interconnection shows several situations in which much of the technical support has migrated from the utilities to the Independent System Operator (ISO), and the ISO staffs or shares staff with the regional reliability council. This process may be a natural and very positive consequence of utility restructuring. If so, the process should be expedited in regions where it is less advanced