Recommendations for phototherapy during the COVID-19 pandemicEnd of Life Considerations in the ECMO Patient - A Case Presentation

Background: Extracorporeal membrane oxygenation (ECMO) is an emerging life-sustaining intervention for patients experiencing critical cardiopulmonary compromise. Despite the promises of this therapy, studies have shown that over 40% of patients receiving ECMO do not survive their hospitalization.1 In light of this, existing research and protocols for weaning ECMO in the setting of medical futility is extremely limited.2,4 Additionally, research suggests that medications may work differently for patients receiving ECMO3, raising questions about the development of future protocols in this patient population. Case Description: Patient is a 60 year-old female with a history of pulmonary sarcoidosis who was hospitalized for acute-on-chronic hypoxic respiratory failure, complicated by in-hospital cardiac arrest. She was ultimately resuscitated and placed on VA-ECMO as a bridge to lung transplantation. She maintained intact neurologic function after several weeks during her hospitalization, however she developed a retroperitoneal hemorrhage and was subsequently informed that she was no longer a candidate for transplantation. The patient and her family made the decision to discontinue life sustaining therapies, including ECMO. Prior to ECMO wean, she received boluses of IV morphine and ativan, and a morphine infusion was initiated. Her ECMO was weaned to 50% settings, and then discontinued altogether as medications were titrated. Despite this, the patient was noted to have evidence of respiratory distress including accessory muscle use. She died approximately 20 minutes after discontinuation of ECMO. Conclusion: ECMO is an emerging life-sustaining therapy for some of the most critically ill patients. Despite the high need for palliative care in this patient population, there exists minimal evidence for protocolization of terminal ECMO weans. This presentation will review clinical challenges in delivering palliative care to an awake patient undergoing a terminal ECMO wean, and aims to identify areas of future research, including relief of symptom burden, and minimizing patient/family distress.https://scholarlycommons.henryford.com/merf2020caserpt/1010/thumbnail.jp

Expression and Purification of Calmodulin and its Interaction with the SK peptide

Calmodulin (CaM) is a highly conserved protein that has been observed to regulate ion channels. Calcium (Ca2+) binds to Calmodulin in order to activate Ca2+ activated Potassium channels (SK Channels). Calmodulin is known to responsible for gating the SK channel; however, the mechanism in which it does this is unclear. In order to study this interaction, wild-type CaM, single lobe or half CaM, double lobe CaM, and a SK channel peptide (SKp) were all purified. Purification of proteins was done through high performance liquid chromatography (HPLC) and verified with SDS gels. The CaM-SKp complex was analyzed through CG-MALS (composition gradient multi-angle light scattering). CG-MALS can be used to determine the molar mass of complexes formed. Stoichiometry can be determined if molar mass of the proteins complexing are known. Results from CG-MALS show the formation of stoichiometries that have not been observed before. The introduction of these new stoichiometries adds complexity to the SKp-CaM interaction and require more testing in order to fully elucidate the mechanism of SK channel gating.Biochemistr

Implications of the Measured Image Size for the Radio Afterglow of GRB 030329

We use data on the image size of the radio afterglow of GRB 030329 (Taylor et al. 2004) to constrain the physical parameters of this explosion. Together with the observed broad band spectrum, this data over-constrains the physical parameters, thus enabling to test different GRB jet models for consistency. We consider two extreme models for the lateral spreading of the jet: model 1 with relativistic expansion in the local rest frame, and model 2 with little lateral expansion as long as the jet is highly relativistic. We find that both models are consistent with the data for a uniform external medium, while for a stellar wind environment model 1 is consistent with the data but model 2 is disfavored by the data. Our derivations can be used to place tighter constraints on the dynamics and structure of GRB jets in future afterglows, following a denser monitoring campaign for the temporal evolution of their image size.Comment: 12 pages, 6 figues; submitted to Ap

The Sheinbein Case and the Israeli-American Extradition Experience: A Need for Compromise

This Article will examine the political ramifications of the extradition process and the need for compromise to prevent domestic politics from undermining the ends of law enforcement. This Article will also suggest possible measures to ease the complications that extradition poses to international law enforcement cooperation. Part II of this Article will examine the facts of the most recent and dramatic example of the politics of extradition as played out in the Sheinbein case. Part III will analyze other issues which have placed obstacles in the path of practical law enforcement and international relations, and the way that the United States has reacted to each issue. Special emphasis will be placed on U.S.-Israeli extradition problems. Finally, Part IV will discuss compromises which might be made by the United States and other nations such as Israel to ease the extradition process, particularly in cases involving a national of the asylum state, without sacrificing national sovereignty

The Post-Sheinbein Israeli Extradition Law

In this Article, the Authors examine Israel\u27s stance on extradition. In Part II, the Article offers an historical timeline of the development of Israel\u27s extradition policies, from common law to reciprocity. In Part III, the Article examines Israel\u27s initial attempts to address the problems inherent in its operating extradition policy. This section also includes an analysis of the reform movement\u27s effect on specific cases. In Part IV, the Article examines the most recent reform of Israel\u27s extradition policy

Chromatic Signatures in the Microlensing of GRB Afterglows

We calculate the radial surface brightness profile of the image of a Gamma-Ray-Burst (GRB) afterglow. The afterglow spectrum consists of several power-law segments separated by breaks. The image profile changes considerably across each of the spectral breaks. It also depends on the density profile of the ambient medium into which the GRB fireball propagates. Gravitational microlensing by an intervening star can resolve the afterglow image. We calculate the predicted magnification history of GRB afterglows as a function of observed frequency and ambient medium properties. We find that intensive monitoring of a microlensed afterglow lightcurve can be used to reconstruct the parameters of the fireball and its environment, and provide constraints on particle acceleration and magnetic field amplification in relativistic blast waves.Comment: Final version, as published in ApJ Letter

Radio Imaging of GRB Jets in Nearby Supernovae

We calculate the time evolution of the flux, apparent size, and image centroid motion of gamma-ray burst (GRB) radio jets, and show that they can be resolved by the VLBA at distances of hundreds of Mpc. We find that GRB 030329 which showed spectroscopic evidence for an associated Type Ic supernova (SN) at a distance of $\approx$ 800 Mpc might just be resolvable by VLBA after several months. The prospects are much better for jets that are oriented sideways in similar SNe with no GRB counterpart; in particular, the motion of the flux centroid in such jets can be detected by VLBA up to $z\sim 1$ even when the jet cannot be resolved. If most GRBs are accompanied by a Type Ib/c SN, then there should be a few SN/GRB jets per year within a distance $\lesssim$ 200 Mpc, and most of them would be oriented sideways with no gamma-ray or X-ray precursor. Detection of these jets can be used to calibrate the fraction of all core collapse SNe that produce relativistic outflows and determine the local GRB rate. Overall, the rate of Type Ib/c SNe that do not produce a GRB at all, but rather make relativistic radio jets with an initial Lorentz factor of a few, may be larger by up to 2 orders of magnitude than the rate of those that produce GRBs.Comment: 4 pages, 3 figures; minor changes to match version published in ApJ