Discussion required for correct interpretation

Thank you for the opportunity to comment on the editorial by Romero and colleagues [1], which raises a number of important and interesting questions. Such discussion is mandatory if results of scientific techniques such as gene array are to be correctly interpreted and used as the basis for future improvements in patient care

Precision Linear Actuator for Space Interferometry Mission (SIM) Siderostat Pointing

'SIM PlanetQuest will exploit the classical measuring tool of astrometry (interferometry) with unprecedented precision to make dramatic advances in many areas of astronomy and astrophysics'(1). In order to obtain interferometric data two large steerable mirrors, or Siderostats, are used to direct starlight into the interferometer. A gimbaled mechanism actuated by linear actuators is chosen to meet the unprecedented pointing and angle tracking requirements of SIM. A group of JPL engineers designed, built, and tested a linear ballscrew actuator capable of performing submicron incremental steps for 10 years of continuous operation. Precise, zero backlash, closed loop pointing control requirements, lead the team to implement a ballscrew actuator with a direct drive DC motor and a precision piezo brake. Motor control commutation using feedback from a precision linear encoder on the ballscrew output produced an unexpected incremental step size of 20 nm over a range of 120 mm, yielding a dynamic range of 6,000,000:1. The results prove linear nanometer positioning requires no gears, levers, or hydraulic converters. Along the way many lessons have been learned and will subsequently be shared

Linear Actuator Has Long Stroke and High Resolution

The term precision linear actuator, direct drive ( PLADD ) refers to a robust linear actuator designed to be capable of repeatedly performing, over a lifetime of the order of 5 to 10 years, positioning maneuvers that include, variously, submicron increments or slews of the order of a centimeter. The PLADD is capable of both long stroke (120 mm) and high resolution (repeatable increments of 20 nm). Unlike precise linear actuators of prior design, the PLADD contains no gears, levers, or hydraulic converters. The PLADD, now at the prototype stage of development, is intended for original use as a coarse-positioning actuator in a spaceborne interferometer. The PLADD could also be adapted to terrestrial applications in which there are requirements for long stroke and high resolution: potential applications include medical imaging and fabrication of semiconductor devices. The PLADD (see figure) includes a commercially available ball-screw actuator driven directly by a commercially available three-phase brushless DC motor. The ball-screw actuator comprises a spring-preloaded ball nut on a ball screw that is restrained against rotation as described below. The motor is coupled directly (that is, without an intervening gear train) to a drive link that, in turn, is coupled to the ball nut. By eliminating the gear train, the direct-drive design eliminates the complexity, backlash, and potential for misalignment associated with a gear train. To prevent inadvertent movement, there is a brake that includes flexured levers compressed against the drive link by preload springs. This is a power-off brake: There are also piezoelectric stacks that can be activated to oppose the springs and push the levers away from the drive link. Hence, power must be applied to the piezoelectric stacks to release the drive link from braking. To help ensure long operational life, all of the mechanical drive components are immersed in an oil bath within hermetically sealed bellows. The outer end of the bellows holds the outer end of the ball screw, thereby preventing rotation of the ball screw. Positioning is controlled by an electronic control system that includes digital and analog subsystems that interact with the motor and brake and with two sensor/encoder units: a Hall-effect-sensor rotation encoder and a linear glass-scale encoder. This system implements a proportional + integral + derivative control algorithm that results in variation of voltage commands to each of the three pairs of windings of the brushless DC motor. In one of two alternative control modes, the voltages are applied to the windings in a trapezoidal commutation scheme on the basis of timing signals obtained from the Hall-effect sensors; this scheme yields relatively coarse positioning - 24 steps per motor revolution. The second control mode involves a sinusoidal commutation scheme in which the output of the linear glass-scale encoder is transposed to rotational increments to yield much finer position feedback - more than 400,000 steps per revolution

Ondansetron Exposure Changes in a Pregnant Woman

Pregnancy results in many physiologic changes that can alter the pharmacokinetic profiles of medications used during pregnancy. One of the primary factors leading to these pharmacokinetic changes is altered activity of drug-metabolizing enzymes. Ondansetron is a substrate of cytochrome P450 (CYP) 3A4 (primary metabolic pathway), 2D6, and 1A2, all of which are altered during pregnancy. We evaluated the pharmacokinetics of ondansetron at three different gestational time points in a 26-year-old, pregnant, Caucasian woman with normal liver and kidney function, who was maintained on ondansetron 8 mg administered orally 3 times/day throughout her pregnancy. Serial plasma samples were collected from the subject over one 8-hour dosing interval at 14, 24, and 35 weeks’ gestation (representing early-, mid-, and late-pregnancy time points, respectively). Ondansetron plasma concentrations were determined using liquid chromatography-tandem mass spectrometry. Ondansetron area under the plasma concentration–time curve decreased progressively across gestation (634 ng hr/ml in early pregnancy, 553 ng hr/ml in mid-pregnancy, and 387 ng hr/ml in late pregnancy), with a corresponding increase in apparent oral clearance (12.6 L/hr in early-pregnancy, 14.5 L/hr in midpregnancy, and 20.7 L/hr in late-pregnancy). The decreased area under the plasma concentration–time curve and exposure to ondansetron across gestation is likely due to increased activity of CYP3A4 and CYP2D6 during pregnancy. We were not able to study this patient during the postpartum period; however, as with other CYP3A4 and CYP2D6 substrates, the apparent activities of these isoenzymes are likely return to baseline. To our knowledge, this is the first report to describe ondansetron pharmacokinetics across gestation. Additional pharmacokinetic and pharmacodynamic data are needed to confirm our results and to evaluate clinical impact; however, in the meantime, clinicians should be aware of these pharmacokinetic changes in ondansetron exposure during pregnancy

Effect of Magnesium Sulfate Administration for Neuroprotection on Latency in Women with Preterm Premature Rupture of Membranes

To evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes between 24 and 31 6/7 weeks' gestation

The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles

To determine whether an individualized growth standard (IS) improves identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death

Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort

Although preterm birth less than 37 weeks gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates

Defining failed induction of labor

BACKGROUND: While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. OBJECTIVE: The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction. METHODS: This study is based on data from an obstetric cohort of women delivering at 25 U.S. hospitals from 2008-2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated and rupture of membranes (ROM) had occurred, and was determined to end once 5 cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (e.g., cesarean delivery, postpartum hemorrhage, chorioamnionitis) and perinatal outcomes (e.g., a composite frequency of either seizures, sepsis, bone or nerve injury, encephalopathy, or death), were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments). RESULTS: A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman's latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P<0.001, for time both as a continuous and categorical independent variable), although more than forty percent of women whose latent phase lasted for 18 or more hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < 0.001) and chorioamnionitis (P < 0.001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time. CONCLUSION: The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress

A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy