Development of a Bamlanivimab Infusion Process in the Emergency Department for Outpatient COVID-19 Patients

The coronavirus disease 2019 (COVID-19) pandemic has prompted the creation of new therapies to help fight against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bamlanivimab is a SARS-CoV-2 monoclonal antibody that is administered as an intravenous infusion to ambulatory patients with mild or moderate COVID-19, but a concern that arose was deciding the optimal location for patients to receive the medication. This report describes the development and implementation of a bamlanivimab infusion center in the emergency department of three hospitals in Orange County, California, shortly after bamlanivimab received emergency use authorization. As a result, a total of 601 patients received bamlanivimab in one of these three emergency departments between December 2020 to April 2021. The emergency department was shown to be an optimal setting for administration of bamlanivimab due to its convenience, accessibility, and capabilities for monitoring patients

Exact Results for the BTZ Black Hole

In this review, we summarize exact results for the three-dimensional BTZ black hole. We use rigorous mathematical results to clarify the general structure and properties of this black hole spacetime and its microscopic description. In particular, we study the formation of the black hole by point particle collisions, leading to an exact analytic determination of the Choptuik scaling parameter. We also show that a `No Hair Theorem' follows immediately from a mathematical theorem of hyperbolic geometry, due to Sullivan. A microscopic understanding of the Bekenstein-Hawking entropy, and decay rate for massless scalars, is shown to follow from standard results of conformal field theory.Comment: 24 pages, Latex, Review article to appear in Int. J. Mod. Phys. D, v2 additional reference

Intravascular ultrasound scanning improves long-term patency of iliac lesions treated with balloon angioplasty and primary stenting

AbstractPurpose: Underdeployment of an intravascular stent has been identified as a cause of restenosis or occlusion of a treated arterial lesion. Intravascular ultrasound (IVUS) has been shown to initially improve the anatomic and clinical stenting. The purpose of this study was to determine whether the use of IVUS increased long-term patency of this intervention. Methods: Between March 1992 and October 1995, 71 limbs (52 patients) with symptomatic aortoiliac occlusive disease underwent balloon angioplasty with primary stenting. IVUS and arteriography were used in 49 limbs (36 patients) to evaluate stent deployment. Arteriography alone was used in 22 limbs (16 patients) to evaluate stent deployment. Patients were captured prospectively in a vascular registry and retrospectively reviewed. Results: Mean age of patients treated with IVUS was 61.1 ± 9.0 years (range, 38-85) versus 70.0 ± 10.1 years (range, 57-87) in patients treated without IVUS (P <.01). There was no difference between the groups with respect to preoperative comorbidities, ankle-brachial indices, or number of stents per limb. Mean follow-up for IVUS patients was 62.1 ± 7.3 months (range, 15-81) and 57.9 ± 8.7 months (range, 8-80) for patients treated without IVUS (P = not significant). In 40% (20/49) of limbs, IVUS demonstrated inadequate stent deployment at the time of the original procedure. Kaplan-Meier 3- and 6-year primary patency estimates were 100% and 100% in the IVUS group and 82% and 69%, respectively, in limbs treated without IVUS (P <.001). There have been no secondary procedures performed in limbs treated with IVUS and a 23% (5/22) secondary intervention rate in the non-IVUS group (P <.05). Overall Kaplan-Meier survival estimates at 3 and 6 years for all patients were 84% and 67%, respectively. Conclusion: Balloon angioplasty and primary stenting of symptomatic aortoiliac occlusive lesions is a durable treatment option. Long-term follow-up of treated patients shows outcomes that are comparable with direct surgical intervention. IVUS significantly improved the long-term patency of iliac arterial lesions treated with balloon angioplasty and stenting by defining the appropriate angioplasty diameter endpoint and adequacy of stent deployment. (J Vasc Surg 2002;35:316-23.

Measuring the Hubble Constant Near and Far in the Era of ELT's

Many of the fundamental physical constants in Physics, as a discipline, are measured to exquisite levels of precision. The fundamental constants that define Cosmology, however, are largely determined via a handful of independent techniques that are applied to even fewer datasets. The history of the measurement of the Hubble Constant (H0), which serves to anchor the expansion history of the Universe to its current value, is an exemplar of the difficulties of cosmological measurement; indeed, as we approach the centennial of its first measurement, the quest for H0 still consumes a great number of resources. In this white paper, we demonstrate how the approaching era of Extremely Large Telescopes (ELTs) will transform the astrophysical measure of H0 from the limited and few into a fundamentally new regime where (i) multiple, independent techniques are employed with modest use of large aperture facilities and (ii) 1% or better precision is readily attainable. This quantum leap in how we approach H0 is due to the unparalleled sensitivity and spatial resolution of ELT's and the ability to use integral field observations for simultaneous spectroscopy and photometry, which together permit both familiar and new techniques to effectively by-pass the conventional 'ladder' framework to minimize total uncertainty. Three independent techniques are discussed -- (i) standard candles via a two-step distance ladder applied to metal, poor stellar populations, (ii) standard clocks via gravitational lens cosmography, and (iii) standard sirens via gravitational wave sources -- each of which can reach 1% with relatively modest investment from 30-m class facilities.Comment: Submitted as an Astro2020 White Paper. Please send comments to both Rachael Beaton & Simon Birrer. Development of this paper occurred as part of the The US Extremely Large Telescope Program Workshop in Oct 2018. We wish to acknowledge NOAO for bringing the co-authors together, in particular the enthusiasm and tireless leadership of Mark Dickinso

Perfusion Assessment in Laparoscopic Left-Sided/Anterior Resection (PILLAR II): A Multi-Institutional Study

BackgroundOur primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.Study DesignThis is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.ResultsA total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.ConclusionsPINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA

Substrate binding disrupts dimerization and induces nucleotide exchange of the chloroplast GTPase Toc33

GTPases act as molecular switches to control many cellular processes, including signalling, protein translation and targeting. Switch activity can be regulated by external effector proteins or intrinsic properties, such as dimerization. The recognition and translocation of pre-proteins into chloroplasts [via the TOC/TIC (translocator at the outer envelope membrane of chloroplasts/inner envelope membrane of chloroplasts)] is controlled by two homologous receptor GTPases, Toc33 and Toc159, whose reversible dimerization is proposed to regulate translocation of incoming proteins in a GTP-dependent manner. Toc33 is a homodimerizing GTPase. Functional analysis suggests that homodimerization is a key step in the translocation process, the molecular functions of which, as well as the elements regulating this event, are largely unknown. In the present study, we show that homodimerization reduces the rate of nucleotide exchange, which is consistent with the observed orientation of the monomers in the crystal structure. Pre-protein binding induces a dissociation of the Toc33 homodimer and results in the exchange of GDP for GTP. Thus homodimerization does not serve to activate the GTPase activity as discussed many times previously, but to control the nucleotide-loading state. We discuss this novel regulatory mode and its impact on the current models of protein import into the chloroplast