Gestational dating by metabolic profile at birth: a California cohort study.

BackgroundAccurate gestational dating is a critical component of obstetric and newborn care. In the absence of early ultrasound, many clinicians rely on less accurate measures, such as last menstrual period or symphysis-fundal height during pregnancy, or Dubowitz scoring or the Ballard (or New Ballard) method at birth. These measures often underestimate or overestimate gestational age and can lead to misclassification of babies as born preterm, which has both short- and long-term clinical care and public health implications.ObjectiveWe sought to evaluate whether metabolic markers in newborns measured as part of routine screening for treatable inborn errors of metabolism can be used to develop a population-level metabolic gestational dating algorithm that is robust despite intrauterine growth restriction and can be used when fetal ultrasound dating is not available. We focused specifically on the ability of these markers to differentiate preterm births (PTBs) (<37 weeks) from term births and to assign a specific gestational age in the PTB group.Study designWe evaluated a cohort of 729,503 singleton newborns with a California birth in 2005 through 2011 who had routine newborn metabolic screening and fetal ultrasound dating at 11-20 weeks' gestation. Using training and testing subsets (divided in a ratio of 3:1) we evaluated the association among PTB, target newborn characteristics, acylcarnitines, amino acids, thyroid-stimulating hormone, 17-hydroxyprogesterone, and galactose-1-phosphate-uridyl-transferase. We used multivariate backward stepwise regression to test for associations and linear discriminate analyses to create a linear function for PTB and to assign a specific week of gestation. We used sensitivity, specificity, and positive predictive value to evaluate the performance of linear functions.ResultsAlong with birthweight and infant age at test, we included 35 of the 51 metabolic markers measured in the final multivariate model comparing PTBs and term births. Using a linear discriminate analyses-derived linear function, we were able to sort PTBs and term births accurately with sensitivities and specificities of ≥95% in both the training and testing subsets. Assignment of a specific week of gestation in those identified as PTBs resulted in the correct assignment of week ±2 weeks in 89.8% of all newborns in the training and 91.7% of those in the testing subset. When PTB rates were modeled using the metabolic dating algorithm compared to fetal ultrasound, PTB rates were 7.15% vs 6.11% in the training subset and 7.31% vs 6.25% in the testing subset.ConclusionWhen considered in combination with birthweight and hours of age at test, metabolic profile evaluated within 8 days of birth appears to be a useful measure of PTB and, among those born preterm, of specific week of gestation ±2 weeks. Dating by metabolic profile may be useful in instances where there is no fetal ultrasound due to lack of availability or late entry into care

Fly-by-light flight control system technology development plan

The results of a four-month, phased effort to develop a Fly-by-Light Technology Development Plan are documented. The technical shortfalls for each phase were identified and a development plan to bridge the technical gap was developed. The production configuration was defined for a 757-type airplane, but it is suggested that the demonstration flight be conducted on the NASA Transport Systems Research Vehicle. The modifications required and verification and validation issues are delineated in this report. A detailed schedule for the phased introduction of fly-by-light system components has been generated. It is concluded that a fiber-optics program would contribute significantly toward developing the required state of readiness that will make a fly-by-light control system not only cost effective but reliable without mitigating the weight and high-energy radio frequency related benefits

On the Meaning of the Principle of General Covariance

We present a definite formulation of the Principle of General Covariance (GCP) as a Principle of General Relativity with physical content and thus susceptible of verification or contradiction. To that end it is useful to introduce a kind of coordinates, that we call quasi-Minkowskian coordinates (QMC), as an empirical extension of the Minkowskian coordinates employed by the inertial observers in flat space-time to general observers in the curved situations in presence of gravitation. The QMC are operationally defined by some of the operational protocols through which the inertial observers determine their Minkowskian coordinates and may be mathematically characterized in a neighbourhood of the world-line of the corresponding observer. It is taken care of the fact that the set of all the operational protocols which are equivalent to measure a quantity in flat space-time split into inequivalent subsets of operational prescriptions under the presence of a gravitational field or when the observer is not inertial. We deal with the Hole Argument by resorting to de idea of the QMC and show how it is the metric field that supplies the physical meaning of coordinates and individuates point-events in regions of space-time where no other fields exist. Because of that the GCP has also value as a guiding principle supporting Einstein's appreciation of its heuristic worth in his reply to Kretschmann in 1918

TransverseDiff gravity is to scalar-tensor as unimodular gravity is to General Relativity

Transverse Diffeomorphism (TDiff) theories are well-motivated theories of gravity from the quantum perspective, which are based upon a gauge symmetry principle. The main contribution of this work is to firmly establish a correspondence between TransverseDiff and the better-known scalar-tensor gravity --- in its more general form ---, a relation which is completely analogous to that between unimodular gravity and General Relativity. We then comment on observational aspects of TDiff. In connection with this proof, we derive a very general rule that determines under what conditions the procedure of fixing a gauge symmetry can be equivalently applied before the variational principle leading to the equations of motion, as opposed to the standard procedure, which takes place afterwards; this rule applies to gauge-fixing terms without derivatives.Comment: 10 pages; amsart style; v3: version as appeared in JCAP, redaction improve

Remission vs low disease activity: function, quality of life and structural outcomes in the Early Rheumatoid Arthritis Study and Network

Objectives To examine associations between function, quality of life and structural outcomes in patients achieving remission vs low disease activity in early RA. Methods Demographic, clinical and radiographic variables were collected at baseline and then annually from the Early Rheumatoid Arthritis Study (ERAS) and Early Rheumatoid Arthritis Network (ERAN) inception cohorts in routine care from 1986 to 2012. Disease activity was categorized: mean DAS28 score between years 1 and 5: remission [mean remission DAS (mRDAS) <2.6] or low [mean low DAS (mLDAS) 2.6–3.2]; sustained low/remission DAS28 (sLDAS/sRDAS) at years 1 and 2; and sustained Boolean remission (sBR) at years 1 and 2. Changes in HAQ and Short Form 36 Health Survey Questionnaire [SF-36; physical (PCS) and mental (MCS) component score]) and total Sharp van der Heijde (SvdH) scores for each disease activity category were modelled using multi-level models. Covariates included year of onset, age, gender and DMARD use at first visit. Results Of 2701 patients, 562 (21%) were categorized mRDAS, 330 (12%) mLDAS, 279 (10%) sRDAS, 203 (7.5%) sLDAS and 93 (3%) sBR. Patients categorized as mRDAS had increasingly divergent improved HAQ, SF-36 PCS, MCS and total SvdH scores compared with mLDAS (P-values 0.001 to <0.0001, all time points). Patients categorized as sRDAS had better HAQ, SF-36 PCS and MCS scores (P-values 0.05 to <0.0001, all time points) and SvdH scores (P = 0.05, years 3–5) over sLDAS. sBR was associated with better HAQ, and SF-36 PCS and MCS scores over sLDAS (P-values 0.002 to <0.0001, all time points). Conclusion These findings from routine care support ACR/EULAR guidelines that remission is a preferable goal over low disease activity in early RA.Peer reviewedFinal Published versio

Functional correlates of optic flow motion processing in Parkinson’s disease

The visual input created by the relative motion between an individual and the environment, also called optic flow, influences the sense of self-motion, postural orientation, veering of gait, and visuospatial cognition. An optic flow network comprising visual motion areas V6, V3A, and MT+, as well as visuo-vestibular areas including posterior insula vestibular cortex (PIVC) and cingulate sulcus visual area (CSv), has been described as uniquely selective for parsing egomotion depth cues in humans. Individuals with Parkinson’s disease (PD) have known behavioral deficits in optic flow perception and visuospatial cognition compared to age- and education-matched control adults (MC). The present study used functional magnetic resonance imaging (fMRI) to investigate neural correlates related to impaired optic flow perception in PD. We conducted fMRI on 40 non-demented participants (23 PD and 17 MC) during passive viewing of simulated optic flow motion and random motion. We hypothesized that compared to the MC group, PD participants would show abnormal neural activity in regions comprising this optic flow network. MC participants showed robust activation across all regions in the optic flow network, consistent with studies in young adults, suggesting intact optic flow perception at the neural level in healthy aging. PD participants showed diminished activity compared to MC particularly within visual motion area MT+ and the visuo-vestibular region CSv. Further, activation in visuo-vestibular region CSv was associated with disease severity. These findings suggest that behavioral reports of impaired optic flow perception and visuospatial performance may be a result of impaired neural processing within visual motion and visuo-vestibular regions in PD.Published versio

Gap maps and intrinsic diffraction losses in one-dimensional photonic crystal slabs

A theoretical study of photonic bands for one-dimensional (1D) lattices embedded in planar waveguides with strong refractive index contrast is presented. The approach relies on expanding the electromagnetic field on the basis of guided modes of an effective waveguide, and on treating the coupling to radiative modes by perturbation theory. Photonic mode dispersion, gap maps, and intrinsic diffraction losses of quasi-guided modes are calculated for the case of self-standing membranes as well as for Silicon-on-Insulator structures. Photonic band gaps in a waveguide are found to depend strongly on the core thickness and on polarization, so that the gaps for transverse electric and transverse magnetic modes most often do not overlap. Radiative losses of quasi-guided modes above the light line depend in a nontrivial way on structure parameters, mode index and wavevector. The results of this study may be useful for the design of integrated 1D photonic structures with low radiative losses.Comment: 9 pages, 8 figures, submitted to Physical Review

On the injectivity of the circular Radon transform arising in thermoacoustic tomography

The circular Radon transform integrates a function over the set of all spheres with a given set of centers. The problem of injectivity of this transform (as well as inversion formulas, range descriptions, etc.) arises in many fields from approximation theory to integral geometry, to inverse problems for PDEs, and recently to newly developing types of tomography. The article discusses known and provides new results that one can obtain by methods that essentially involve only the finite speed of propagation and domain dependence for the wave equation.Comment: To appear in Inverse Problem